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Pharm Kay Exam 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

definition of asthma

A

increase responsiveness of trachea and bronchi to various stimuli causing reversible airway narrowing

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2
Q

4 main asthma triggers

A

control status
H/o exacerbation
enviornmental triggers
seasonal, genetic, immunologic RF

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3
Q

what are the enviornmental triggers of asthma

A 
exercise
smoke
cold-induced
occupational
drug induced--B-blockers, ASA/NSAID
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4
Q

what are the seasonal/genetic/immunologic triggers

A 
URI
recurrent sinus infection
atopic asthma
allergic rhinitis
PND
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5
Q

what is the early phase of asthma attack

A

bronchospasm + mucosal edema after initiating event
followed by wheeze, SOB, cough, edema
within 1-2hrs

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6
Q

what do early phase asthma attacks respond to

A

MDI

nebulized bronchodilators

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7
Q

what is the late phase asthma attack

A

mucosal inflammation & increase mucous production

within 4-6hrs

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8
Q

what do late phase asthma attacks respond to

A

anti-inflammatory (Steroids)

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9
Q

what are asthma related deaths due to?

A 
lack of access
lack of AAP
underuse of steroid
overuse of brochodilator
underestimation of severity
lack of measure of airway obstruction
non-adherence
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10
Q

if you are using a SABA >2 times a week what is indicated

A

anti-inflammatory therapy

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11
Q

what are the most effective anti-inflammatory agents

A

ICS

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12
Q

what can be added to ICS if they aren’t enough

A

LAMA

LABA

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13
Q

what is the final step when all common therapies have been attempted

A

immunologic and avoidance of triggers

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14
Q

why don’t we use epinephrine & isoproterenol?

A

cardiac stimulation via B1–tachy/arrythmias common

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15
Q

why don’t we use albuterol, metaproterenol, terbutaline in pill forms?

A

worse ADR’s w/ skeletal muscle tremor and nervousness

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16
Q

what are the rescue therapies?

A

SABA
SAMA
steroids

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17
Q

what are the maintenance therapies

A 
ICS
LABA
LAMA
leukotriene
mast-cell stab.
Immunotherapy
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18
Q

why do we prefer inhalers?

A

fast onset
small dose
better ADR profile

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19
Q

what are the 4 inhalers?

A

MDI
Soft Mist
Dry Powder
Neb

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20
Q

what is good about soft mist?

A

formulation propelled forward

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21
Q

what do you have to do prior to MDI use?

A

shake

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22
Q

what can be used w/ MDI to help get more drug into lungs?

A

VHS or spacer

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23
Q

who should use dry powder inhalers?

A

ppl w/ technique issues of MDI

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24
Q

example of inhaler wrapped in foil?

A

advair

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25
example of inhaler not in foil?
proair
26
how should you breathe when using MDI, soft mist inhaler?
slow and deep
27
how should you breathe when using an DPI?
quick and deep
28
SABA drugs
albuterol | Levabuterol
29
what forms does albuterol come in?
DPI and HFA
30
what form does levabuterol come in?
dpi
31
MOA of SABA
stimulate adenylyn cyclase--increase cAMP--relax smooth muscel to allow for vasodilation
32
how fast do SABA's work?
5 min w/ peak @30m-60min
33
clinical indications for SABA
relieve broncohspasm | prophylactic for working out
34
how often can you take albuterol ?
2 puffs q4-6hrs
35
dosage of neb albuterol
1.25-5mg in 3mL saline q4-8hrs
36
are nebs more effective?
no
37
when is a pt taking too much albuterol and then what should we do?
2x/wk | anti-inflammatory tx
38
ADR of albuterol
tachycardic palpitations tremor
39
what increases ADR's of albuterol
high doses
40
what is the rescue therapy (antimusc)
nebulized ipratropium + albuterol
41
when does rescue therapy need to be initiated?
FEV1 or PEF <50% or no response to albuterol alone
42
what systemic steroids do we use?
prednisone Methylprednisolone dexamethasone
43
benefits of dexamethasone
longer 1/2 life high potency tolerated more by pts
44
MOA of steroids
inhibit production of inflammatory cytokines and reduce bronchial reactivity
45
clinical indication of steroids
exacerbation | use w/ SABA +/- ipatropium
46
ADRs of steroids
insomnia nervousness increase appetite hyperglycemia
47
what ICS do we use
budesonide | Fluticasone
48
what is the only ICS neb?
budesonide
49
what ICS is a prodrug?
Ciclesonide
50
where is ciclesonide activated?
in the long
51
clinical indications of ICS
presistent asthma
52
what dose ICS should we use?
low!
53
what if low dose ICS + albuterol isn't enough?
increase to medium dose or add LABA
54
what should we do before medium/high dose ICS?
try LABA or leukotriene modifier
55
what is the most potent long-term controller of asthma symptoms?
ICS
56
pt ed for ICS
rinse mouth after use | take 1-2 weeks before effective
57
what are budesonide, fluticasone, and ciclesonide substrates of
CYP3A4
58
what pt population/med is bad to combine with ICS?
HIV meds--COBI
59
HIV patients on ICS can develop what condition
cushings b/c too much steroid d/t inability to metabolize it
60
ADR of budesonide, fluticasone, and ciclesonide
``` dysphonia OP candidiasis skeletal effects--stunts growth increase risk osteoporosis occular issues skin issues ```
61
how can budesonide, fluticasone, and ciclesonide effect the eyes?
increase IOP--glaucoma | increase cataract formation
62
what do budesonide, fluticasone, and ciclesonide do to the skin?
increase risk of bruising/purpura
63
what are the LABAs
salmeterol | Formoterol (NEB)
64
what is the only SOLO laba inhaler?
salmeterol
65
MOA of LABA's
lipid soluble--dissolves in smooth muscle cell membrane to slowly release
66
what type of agonist is formoterol
full agonist
67
what type of agonist is salmeterol
partial
68
what is the BB warning for salmeterol
increase risk of severe asthma attack & death if used solo
69
should you ever use salmeterol alone?
no! medical negligence
70
what is salmeterol a substrate of?
3A4
71
if CYP3A4 inhibitor is present and you use salmeterol, what are the effects?
tachycardia | palpitations
72
what is the LAMA
tiotropium
73
MOA of LAMA
long-acting antimuscarinic
74
what is a SAMA
ipatropium
75
when should we use tiotropium
add on to high dose ICS + LAba
76
minimum age for LAMA
12
77
ADR of lama?
dry mouth | pharyngeal irritation
78
how do leukotrienes exacerbate asthma
chemotaxis of inflammatory cells produce mucous and edema in the airway bronchoconstriction
79
what do leukotrienes result from
5-lipoxygenase on arachidonic acid
80
what is the 5-lipo inhibitor
zileuton
81
do we use zileuton?
no
82
2 drugs that are cysteinyl leukotriene receptor antagonist
Zafirlukast | Montelukast
83
what is the only leukotriene modifer we use
montelukast (tablet)
84
ADR of montelukast
hA | neuropsych effects
85
what patient population is montelukast best for?
those w/ allergies
86
what does montelukast NOT do to help asthma
no effect on smooth muscle tone
87
when should montelukast be taken? exacerbation or prophylatically
prophylactically
88
MOA of theophylline
bronchodilator | blocks PDE
89
what is theophylline a substrate of
1A2
90
what drugs inihibit 1A2
ciprofloxacin amiodarone OCP cimitidine
91
what pt RF decrease ability to clear theophylline
<1yr >60yr concurrent dz drug interactions
92
what theophylline conc causes increase pulm fcn
10mcg/mL
93
what theophylline conc causes anorexia, N/V, abdominal pain, anxiety, HA
>15-20mcg/mL
94
what theophylline conc causes seizures and arrythmias
>40mcg/mL
95
what anti-IgE antibody do we use
Omalizumab (SQ)
96
MOA of omalizumab
IgG binds to free IgE in circulation and blocks its attachment to surface of mast and basophils
97
clinical use of omalizumab
pts >6 w/ mod-severe asthma w/ allergic components
98
serious ADR of omalizumab
anaphylaxis
99
how do we give the 1st 3 injections of omalizumab
monitored!
100
what med should pts w/ eosinophilic phenotype get?
IL-5 antibodies
101
IL-5 antibody drugs
mepolizumab reslizumab benralizumab
102
MOA of mepolizumab and Reslizumab
bind to IL-5 and decrease survival of eosinophils/basophils to decrease airway inflammation
103
MOA of benralizumab
bind to IL-5 causing apoptosis of eosinophils/basophils to decrease airway inflammation
104
IL-4 antagonist
Dupliumab (SQ)
105
MOA of duplimuab
bind to IL-4 receptor to inhibit signaling of cytokines to decrease inflammation drivers
106
what pts should get dupliumab
mod-severe asthma + eosinophilic phenotype
107
what are contract indicated when on dupliumab
live vaccines
108
what ADR has been reported with dupliumab
eosinophila--E-GPA (pneumonia, vasculitis)
109
what NSAID should asthma pts use
celecoxib
110
do we go low & slow dosing for asthma?
NO
111
once we control pts asthma symptoms how long do we stay at that level
3 months
112
how many months should each step down be until we reach a lowest dose?
3 months
113
Risks of asthma in pregnancy
``` preeclampsia preterm birth LBW or IGUGR congeital malformation perinatal death ```
114
drugs in pregnancy for asthma
SABA (C) LABA (C) ICS (B)
115
how frequently should pregnant pts w/ poor asthma control be seen ?
1-2wks

Pharm Kay Exam 2 (3 decks)

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