ASTHMA

Question 1

asthma abnormality

Answer 1

insufficient expiration

Question 2

drugs used in asthma symptom relief

Answer 2

symptom relief: beta2 agonists (fast/long-acting), ipratropium, theophylline (less often)

Question 3

drugs used in asthma long term control

Answer 3

corticosteroids; cromolyn, nedocromil; leukotriene modifiers; anti-IgE antibody

Question 4

adjunct drugs used in asthma

Answer 4

antibiotics; mucolytics; oxygen (sedatives ci’d)

Question 5

asthma last resort drugs

Answer 5

general anesthesia; muscle relaxation; controlled respiration; bronchial lavage; ketamine

Question 6

summary of asthma drugs

Answer 6

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Question 7

short-acting beta2 agonists

Answer 7

albuterol, levalbuterol, pirbuterol, terbutaline, metaprotenerol - for acute episodes

Question 8

long-acting beta2 agonists

Answer 8

salmeterol, formoterol - for prophylaxis, long term therapy

Question 9

beta2 agonists adverse effects

Answer 9

selectivity is relative; beta2 - muscle tremor, diabetogenic; beta1 - tachy, arrhythmogenic; loss of responsiveness; high dose continuous use - hypokalemia;

Question 10

beta2 agonists uses

Answer 10

NOT anti-inflammatory; can be for preventative i.e. b4 going to gym

Question 11

beta2 agonists and theophylline moa

Answer 11

can have over-additive effect!

Question 12

theophylline characteristics

Answer 12

methylxanthine, related: caffeine, theobromine

Question 13

theophylline pk

Answer 13

oral, sustained release; iv; many drug interactions; low therapeutic margin

Question 14

theophylline adverse effects

Answer 14

cns - nervousness, tremor; cv - catecholamine release, +inotropy/chronotropy; arrhythmogenic; GI - hyperacidity, nausea

Question 15

theophylline toxicities

Answer 15

convulsions, coma

Question 16

theophylline uses

Answer 16

controversial -> dec in US (seizure risk - last choice); considered safe/useful in Europe esp in emergencies; more used for intermittent claudication

Question 17

theophylline molecular moa

Answer 17

induce histone deacetylase -> dec inflammatory gene expression -> promotes corticoid action (unrelated to phosphodiesterase) -> controller/preventer drug

Question 18

anticholinergics

Answer 18

ipratropium, thiotropium

Question 19

ipratropium characteristics

Answer 19

polar compound; mostly local effect when used as inhalant; ineffective in 30% of asthma pt’s

Question 20

ipratropium adverse effects

Answer 20

rare w/usual doses; dry mouth; NO tremor, tachy, dyskrinia (thickening mucous)

Question 21

ipratropium uses

Answer 21

esp COPD w/vagal components; asthma in kids/old; psychogenic exacerbations of asthma; combo with beta2 agonists

Question 22

thiotropium characteristics

Answer 22

much longer half-life; limited absorption from bronchial mucosa into system; some selectivity for M1, M3 receptors; labeled for COPD (combo tx)

Question 23

corticosteroids inhalants

Answer 23

beclomethasone, budesonide, flunisolide, fluticasone

Question 24

corticosteroids systemic

Answer 24

any e.g. prednisone, dexamethasone

Question 25

corticosteroids adverse effects

Answer 25

depends on dose/asthma severity; inhalant low dose - local ae's, insig systemic ae's; inhalant high dose - local ae's, minor systemic (avoid in kids); oral/systemic - severe systemic ae's; single high dose (emergencies) - no systemic except risk of infection, aggravate DM

Question 26

beclomethasone, budesonide, flunisolide, fluticasone pd

Answer 26

dec asthm symptoms; dec hyperreactivity; improve bronchial/pulmonary epithelial fxns

Question 27

beclomethasone, budesonide, flunisolide, fluticasone pk

Answer 27

10% inhaled deployed into bronchial tree

Question 28

beclomethasone, budesonide, flunisolide, fluticasone application

Answer 28

use application aids (e.g. spacer); in combo - apply 10 mins after b2 agonist inhaled

Question 29

beclomethasone, budesonide, flunisolide, fluticasone local adverse effects

Answer 29

oral/esophageal candidiasis, hoarseness -> apply b4 meals

Question 30

beclomethasone, budesonide, flunisolide, fluticasone systemic adverse effects

Answer 30

little bioavail -> minor ae's compared to systemic corticosteroids

Question 31

cromolyn, nedocromil characteristics

Answer 31

mast cell stabilizers

Question 32

cromolyn, nedocromil pk

Answer 32

topical aerosol (for other indications - nasal spray, eye drops, oral)

Question 33

cromolyn, nedocromil pd

Answer 33

inhibit early/late response by stabilizing mast cells, eosinophils -> dec hyperreactivity

Question 34

cromolyn, nedocromil uses

Answer 34

preventative tx of antigen/exercise-induced asthma; INEFFECTIVE in acute exacerbation

Question 35

cromolyn, nedocromil adverse effects

Answer 35

cough, airway irritation; RARE: drug allergies, gastroenteritis

Question 36

leukotriene modifiers pd

Answer 36

effective in antigen/exercise-induced asthma, esp aspirin-asthma

Question 37

leukotriene modifiers adverse effects

Answer 37

inc LFT, headache, dyspepsia

Question 38

leukotriene modifiers

Answer 38

zileuton, montelukast, zafirlukast

Question 39

zileuton moa

Answer 39

5-lipoxygenase antagonist; rarely used

Question 40

montelukast, zafirlukast moa

Answer 40

LTD4 anatagonist, also blocks LTE4

Question 41

leukotriene modifiers characteristics

Answer 41

less effective than inhaled corticosteroids, but used to dec cort. dose; definite position in asthma therapy not established

Question 42

mucolytics pd

Answer 42

facilitate expectoration by dec viscosity of bronchial mucus

Question 43

mucolytics

Answer 43

water (most important); acetylcysteine

Question 44

acetylcysteine pd

Answer 44

disrupts S-S bonds in mucoproteins

Question 45

mucolytics application

Answer 45

nebulizer, oral, iv, endotracheal lavage; tastes, smells like rotten eggs -> oral is best

Question 46

mucolytics adverse effects

Answer 46

mechanical airway irritation, GI disturbances; allergic rxns; use w/CAUTION in severe acute asthma, gastric ulcer pt's

Question 47

asthma absolute contraindications

Answer 47

ALL beta-blockers; cholinergic drugs; centrally-acting anticholinergic drugs; codeine, dextrometorphane; aspirin, other nsaids

Question 48

asthma relative contraindications

Answer 48

diuretics; ace-inhibitors; cns depressants; sedatives

Question 49

treatment of mild intermittent asthma

Answer 49

reliever - inhaled short-acting beta2 agonist as needed - less than 1x/day; controller - none or cromolyn b4 allergen exposure

Question 50

treatment of mild persistent asthma

Answer 50

reliever - inhaled short-acting beta2 agonist as needed, but less than 4x/day; controller - inhaled low dose corticosteroid or cromolyn, nedocromil

Question 51

treatment of moderate persistent asthma

Answer 51

reliever - inhaled long-acting beta2 agonist; controller - inhaled corticosteroid

Question 52

treatment of severe persistent asthma

Answer 52

reliever - (plus oral theophylline); controller - oral corticosteroid

Question 53

asthma prevention of acute exacerbation

Answer 53

short oral prednisolone 'rescue' at anytime

Question 54

emergency treatment of asthma

Answer 54

1. oxygen, monitor

Question 55

NO-NO'S in asthma emergency treatment

Answer 55

nedocromil, cromolyn; uncritical sedation