asthma and COPD

Question 1

Isoproterenol (Isuprel®)

Answer 1

B- Adrenergic Agonists

Question 2

MOA Albuterol (Ventolin®; Proventil®)

Answer 2

• Selective B2 agonists
• Short Acting
  
  • ​rescue

Question 3

MOA of Ipratropium (Atrovent®)

Answer 3

Muscarinic antagonist : Bronchodilator

Question 4

MOA Theophylline (Theo-Dur®)

Answer 4

• increases cAMP - Phosphodiesterase inhibitor
• blocks adenosine receptor
• effect: relaxes smooth muscle, stimulates CNS and heart

Question 5

Fluticasone (Flovent®)

Answer 5

inhaled corticosteroid

Question 6

Montelukast (Singulair®)

Answer 6

Leukotriene Inhibitors

Question 7

MOA of Salmeterol (Serevent®)? use

Answer 7

• long acting B2 agonist
• prevention and prophylaxis

Question 8

Formoterol/mometasone (Dulera)

Answer 8

long acting bronchodilators

Question 9

MOA of Omalizumab (Xolair)

Answer 9

• monoclonal antibody to IgE
  
  • prevents binding of IgE to cells associated with allergic response

Question 10

list treatment strategies for asthma

Answer 10

• dilate airways
• decrease inflammation
• prevention

Question 11

bronchioles are constricted by and relaxed by receptors

Answer 11

• contstricted: cholinergic innervation
• relaxed: beta- 2 receptors

Question 12

typical symptoms of asthma

Answer 12

• wheeze (not all asthmatics wheeze)
• tightness, burning feeling, SOB
• mucous

Question 13

MOA of Theophylline (Theo-Dur®)

Answer 13

• inhibits PDE which breaks down cAMP
  
  • cAMP needed for bronchodilation

Question 14

what is going on to the airways in COPD

Answer 14

• chronic bronchitis
• cilia immobilized- particles not kept out -> susceptible to infection
• airways narrowed
• increased mucous -> chronic cough

Question 15

what is going on to the airways in emphysema

Answer 15

• walls of alveoli break down
• less surface area available for transfer of gas
• fibrosis, loss of elasticity

Question 16

what are the most widely used treatment for asthma? MOA?

Answer 16

• B2 selective receptor agonists
  
  • increase cAMP -> relax airway smooth muscle and inhibit histamine release

Question 17

B2 selective receptor agonists take how long to have an effect? effects generally last?

Answer 17

• act immediately
• generally last 4-6 hours

Question 18

Salmeterol should always be combined with what

Answer 18

• a steroid
  
  • Salmeterol/fluticasone (Advair)
  • to help reduce tolerance

Question 19

effect of Salmeterol/fluticasone takes

Answer 19

• 20-30 min

Question 20

side effects of short acting B2 agonists

Answer 20

• tachycardia
• nervousness
• dizziness
• tremor

Question 21

route of administration of Ipratropium (Atrovent®)? when is it used

Answer 21

• inhaled
• useful for patients intolerant of B2 agonists
• first line: COPD

Question 22

Ipratropium (Atrovent®) is often combined with

Answer 22

• albuterol -> combivent

Question 23

when is Theophylline (Theo-Dur®) used

Answer 23

• for asthma or COPD not controlled by B agonists or muscarinic antagonists
• generally long acting form used

Question 24

therapeutic index of Theophylline (Theo-Dur®)

Answer 24

• low
  
  • blood level important
  • may differ with generics

Question 25

side effects of Theophylline (Theo-Dur®)

Answer 25

* tachycardia, arrhythmias * seizures

Question 26

List the three anti-inflammatory drug classes

Answer 26

* corticosteroids * leukotriene inhibitors * Cromolyn sodium

Question 27

Effects of inhaled corticosteoids

Answer 27

* decrease inflammation * reduce bronchial reactivity * improve response to B agonists

Question 28

when do inhaled corticosteroids come into tx of asthma

Answer 28

* first line of treatment * combined with SABA, before a LABA is brought on board

Question 29

side effects of inhaled corticosteriods

Answer 29

* oral candidiasis (thrush) * hoarseness

Question 30

when is Omalizumab (Xolair) used

Answer 30

* moderate to severe allergic asthma

Question 31

side effects of Omalizumab (Xolair)

Answer 31

* rash * injection site reaction * small decrease in platelets

Question 32

when are the "Lukast"s like Montelukast used

Answer 32

* usually given as add on if corticosteroids aren't enough * **no effect on attack in progress**

Question 33

MOA of Zileuton (Zyflo®)

Answer 33

Leukotriene Inhibitors

Question 34

unique use of Zileuton (Zyflo®)

Answer 34

may decrease aspirin sensitive asthma

Question 35

List the asthma step therapy

Answer 35

1. **short acting beta agonist: as needed** 2. **inhaled corticosteroid** * or Cromolyn sodium * or leukotriene inhibitor 3. **long acting beta agonist** or bronchodilator 4. add oral steroid when needed

Question 36

MOA of Cromolyn sodium

Answer 36

* inhibits release of histamine from mast cells- not a bronchodilator * used mainly in children * taken 4 x /day for prevention

Question 37

first line drug for COPD

Answer 37

Ipratropium (atrovent): muscarinic antagonist