Asthma

Question 1

Pathologic increase in the bronchoconstrictor response to antigens and irritants
Caused by bronchial inflammation

Answer 1

Bronchial hyperreactivity

Question 2

Phosphodiesterase (PDE)

Answer 2

Enzymes that degrades cAMP (active) to AMP (inactive)

Question 3

Tacyhphylaxis

Answer 3

Rapid loss of responsiveness to a stimulus (e.g. drug)

Question 4

Asthma Diagnosis

Answer 4

1. Airflow obstruction
2. Reversibility of airflow obstruction
3. Prolonged expiration and diffuse wheezes
4. LIMITATION OF AIRFLOW on PFTs or bronchoprovocation challenge

Question 5

What is drug therapy aimed to target?

Answer 5

1. Narrow airway
2. Tightened muscles
3. Inflammation

Question 6

What are the asthma treatment goals?

Answer 6

1. Prevent bronchoconstriction-early phase, rescue
2. Reduce inflammation- Late/Chronic phase, controller
3. Prevent irritant reaction (IgE)- Late/Chronic phase

Question 7

What drugs target early response phase (bronchoconstriction)?

Answer 7

1. Beta agonists
2. Theophylline
3. Muscarinic antagonists
4. Leukotriene antagonist

Question 8

What drugs target late response phase (inflammation)?

Answer 8

1. Steroids
2. Cromolyn
3. Leukotriene antagonists

Question 9

What is the ultimate goal in drug therapy?

Answer 9

Relax bronchial tone

Question 10

Beta Agonists MOA

Answer 10

Stimulate adenylyl cyclase (AC)
Increases cAMP in smooth muscle cells
Bronchodilator response

Question 11

When would you use Albuterol (Short acting beta agonist )?

Answer 11

Acute asthma–>Rescue

Question 12

When would you use Salmeterol (long acting beta agonist)?

Answer 12

Asthma proyphlaxis

COPD

Question 13

Albuterol SEs

Answer 13

Tremor

Tachycardia

Question 14

Salmeterol SEs

Answer 14

Tremor
Tachycardia
CV events

Question 15

Lists antimuscarinic agents

Answer 15

Ipatropium

Tiotropium

Question 16

antimuscarinic agents MOA

Answer 16

Competitively block muscarinic receptors

Prevent bronchoconstriction mediated by vagal discharge

Question 17

When would you use antimuscarinic agents?

Answer 17

Asthma

COPD

Question 18

antimuscarinic agents SEs

Answer 18

Dry mouth

Cough

Question 19

What is unique about antimuscarinic agents?

Answer 19

REVERSE bronchoconstriction in some asthma pt’s (esp. children)
AND in COPD pt’s

Question 20

Where can you find Methylxantines?

Answer 20

Plants:

1. Caffeine
2. Tea (Theophylline)
3. Cocoa (Theobromine)

Question 21

Methylxantines MOA

Answer 21

1. Inhibits phosphodiesterase (PDE)
   - increases cAMP–>Bronchodilation
2. Adenosine receptor antagonist

Question 22

Who would we consider using Methylxantines in?

Answer 22

Prophylactic for nocturnal asthma attacks

Question 23

Methylxantines effects

Answer 23

1. Bronchodilation
2. Cardiac stimulation
3. CNS effect
4. Increased muscle strength

Question 24

Methylxantines SEs

Answer 24

1. Insomnia
2. Seizures
3. Tremor
4. Arrhythmias
5. Anorexia

Question 25

What drug can reverse Theophylline (Methylxantine) CV toxicity?

Answer 25

Beta blockers

Question 26

What does Theophylline clearance depend on?

Answer 26

Age

Question 27

Who is Theophylline clearance increased in?

Answer 27

1. Young adolescents | 2. Smokers

Question 28

What is first line therapy for moderate-to-severe asthma?

Answer 28

ICS: - Beclomethasone - Fluticasone - Mometasone - Budesonide

Question 29

ICS MOA

Answer 29

1. Inhibition of phospholipase A2 2. Inhibit expression of COX-2 3. Increase B adrenoreceptor responsiveness 4. Prevent full expression of inflammation and allergy

Question 30

ICS SEs

Answer 30

1. Pharyngeal candidiasis 2. Minimal systemic steroid toxicity 3. Mild growth retardation

Question 31

Who would we consider using oral Prednisone in?

Answer 31

Severe refractory chronic asthma | Acute exacerbations

Question 32

What is the number one cause of adrenal insufficiency?

Answer 32

Exogenously administered glucocorticoids (catabolic steroids)

Question 33

What are important medications for status asthmaticus?

Answer 33

IV Prednisolone | IV Hydrocrotisone

Question 34

What is the most potent systemic steroid?

Answer 34

Dexamethosone

Question 35

List a leukotriene receptor blocker

Answer 35

Montelukast (singulair) | LTD4 receptor antagonist

Question 36

What is Montelukast effective in preventing?

Answer 36

Exercise, antigen and ASA induced bronchospasm | Prophylaxis

Question 37

List a Lipoxygenase inhibitor

Answer 37

Zileuton

Question 38

what allergy is Zileuton effective against?

Answer 38

ASA

Question 39

Zileuton MOA

Answer 39

selectively inhibits 5-lipoxygenase | reduces synthesis of leukotrienes

Question 40

Zileuton drug toxicity

Answer 40

elevated liver enzymes

Question 41

What drugs would we use prior to gardening?

Answer 41

Cromolyn and Nedocromil

Question 42

Cromolyn and Nedocromil SEs

Answer 42

Cough

Question 43

Omalizumab MOA

Answer 43

Antibody that binds to the IgE on sensitized mast cells

Question 44

Omalizumab effects

Answer 44

Decreases inflammatory mediator release Decrease allergic inflammation Prevents exacerbation of asthma

Question 45

Mepolizumab MOA

Answer 45

Monoclonal antibody to IL-5

Question 46

Who would we use Mepolizumab in?

Answer 46

Severe eosinophilic asthma

Question 47

What is there an increase in when we treat adults with Mepolizumab?

Answer 47

Herpes Zoster

Question 48

What should we consider adding in adult house dust mites sensitive patients with allergic rhinitis who have exacerbations despite ICS tx provided FEV1 is 70% predicted?

Answer 48

Sublingual immunotherapy (SLIT)