Asthma/COPD Flashcards by Kyle Plante

What is the preferred drug of choice for COPD?

Anti-muscarinic agents
Ipratropium
Tiotropium (most common)
Aclidinium
Atropine

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What is the preferred drug of choice for asthma>

Inhaled corticosteroids (ICS)
Budesonide
Fluticasone
Beclomethasone
Ciclesonide

Often combined with beta2 agonist

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Phosphodiesterasse inhibitors (Thophylline, theobromine, roflumilast) are more effective in COPD or ASthma?

COPD

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Anti leukotrienes (Montelukast, pranlukast, zafirlekast, zileuton) are more effective in COPD or Asthma?

Asthma

NOT used in COPD at all

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Are anti-muscarinic agenst used much in asthma?

limited use…used mostly in COPD

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Are beta 2 agonsit used much in COPD?

limited use, mostly used for asthma

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Which if the following are short acting b2 agonist (SABA) and which are LABA
Albuterol
Salmeterol
Formoterol
Terbutaline
Indcaterol

SABA: Albuterol, terbutaline, metoproterenl, pirbutal
(5 min to act, last 4-6h)

LABA: Salmeterol, Formoterol, Indacaterol
(10-15min to act, 6-12 hr duration)

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Which LABA acts longer?

Salmeterol or formoterol?

Salmeterol (partial agonist) last longer than 12h (but delayed onset)

Formoterol (full agonist) <12h (but quicker action)

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Which agents are better to be used for nocternal symptoms? SABA/LABA

LABA b/c they are longer acting and are always used in combo with inhaled steroids

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T/F: using SABA frequently in higher doses can potentially worsen asthma control

True

causes downregulation of receptors and can wrosen asthma control

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T/F: one of the most common side effects of beta2 agonist is muscle tremor and tachycardia/palpatations, prolonged QT?

true

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T/F: long acting beta2 agonist are sometimes used in combo with inhaled corticosteroids?

ALWAYS TRUE….LABA are never used alone, are alsowasy used with ICS

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Ipratropium or tiotroprium….which is long acting and which is short?

Ipratropium is short acting

Tiotropium is long acting (more affinity to M3 receptor)

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Why does tiotroprium have a longer actiion than other antimuscarinic agents?

It is more selective for the M3 receptor

Better M3 selectivity confers less unwatned side effects

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T/F: Dry mouth is a common side effect of antimuscarini agents?

True

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Theophylline and Romflumilast are what class of drug?

PDE inhibitors that fcn as anti inflammatory

Romflumilast is more selective inhbiitor of PDE4

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T/F: ICS increases response to Beta 2 agonist?

True

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In someone who has aspirin induced astham and exercise induced bronchospasm….which class of drug may be useful?

Leukotriene inhibitors
Zileiton (liver toxicity)
Montelukast
Pranlukast
Zafirlukast

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In patients with very sever astham who are poorly controlled on oral corticosteroids, which sub Q injection drug that is anti-IgE may help?

omalizumab

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Which beta (1 or 2) receptor is the preferred target to tx asthma/

B2- agonist relaxes smooth muscle
More selective B2 agonist (albuterol) will cause bronchodiliation without cardiac stimulation

B1- activates heart

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Which one of the following asthma medications poses the greatest risk of side effects?

	(A)	Inhaled beta-2 agonist
	(B)	Oral beta-2 agonist
	(C)	Inhaled corticosteroid
	(D)	Oral corticosteroid
	(E)	Inhaled anticholinergic

Answer: D. Oral corticosteroid
Discussion: Answer: Oral corticosteroid. Treatment with oral corticosteroid drugs pose the greatest risk of side effects compared to other drugs used to treat asthma.

Which one of the following decreases the reflex bronchoconstriction caused by inhaled irritants?

	(A)	Albuterol.
	(B)	Ipratropium
	(C)	Theophylline
	(D)	Prednisone
	(E)	Cromolyn

Answer: B. Ipratropium
Discussion: Answer: Ipratropium is an inhaled, anticholinergic drug which blocks the vagal pathway
mediating the reflex bronchoconstriction caused by inhaled irritants.

Which one of the following medications is used to reverse the acute onset of asthmatic bronchospasm?

	(A)	Cromolyn.
	(B)	Theophylline.
	(C)	Albuterol.
	(D)	Prednisone.
	(E)	Zileuton.

Answer: C. Albuterol
Discussion: Answer: Albuterol. Acute episodes of asthmatic bronchospasm are reversed by inhaled β2 agonists.

Which one of the following medications is used to prevent asthma attacks but does not reverse asthmatic bronochospasm?

	(A)	Cromolyn.
	(B)	Ipratropium.
	(C)	Albuterol.
	(D)	Salmeterol.
	(E)	Terbutaline.

Answer: A. Cromolyn
Discussion: Answer: Cromolyn is the only one which does not directly induce relaxation of bronchial smooth muscle.

Which one of the following antiasthmatic drugs is not given by inhalation? ``` (A) Ipratropium. (B) Cromolyn. (C) Theophylline. (D) Terbutaline. (E) Betamethasone. ```

Answer: C. Theophylline Discussion: Answer: Theophylline is a mild to moderate bronchodilator given orally or by suppositories or by i.v. injection.

Which one of the following antiasthmatic drugs reverses bronchoconstriction by blocking vagal stimulation? ``` (A) Theophylline. (B) Cromolyn. (C) Betamethasone. (D) Prednisone. (E) Ipratropium ```

Answer: E. Ipratropium Discussion: Ipratropium is the only antiasthmatic listed which is an anticholinergic.

``` A drug works by reversing irritnat-induced bronchconstriction. In vagetomized animals, the drug has no bronchodilatory effects...this drug is most similar to which: Albuterol Theophylline Ipratropium Zileuton Flunisolide ```

Ipratropium

``` which if the following prevents mast cell degranulation and mediator release from mast cells...therefore working as an antiinflammatory agent Clclesonide Montelikast Albuterol Cromolyn ```

Cromolyn | Prophylaxis for inhibiting both earlt and late phase reactions iwth minimal side effects

``` Which drug is a prodrug and only activated by airway esterase and is a cornerstone treatment of persistent asthma? Zileutin Ciclesonide Cromolyn Budesonide ```

Ciclesonide beneficial comination with beta-2 agonist; Budesonide worlks by inhibiting acondonic acid

``` male with COPD admitted to hosptial with chest pain...elevated troponin and ST elevation is found...you decided to administer a beta blocker..which is most appropriate?> Propranolol Nadolol Metoprolol Timolol Isoproterenol ```

Metopronol is the only B1 selective which is needed for a patieht with COPD/asthma The following are all non-selective and will have B2 activity:Propranolol Nadolol Timolol

When you have a patient with chronic/persistent bronchiolar astham...which class of drug is most useful as anti-inflammatory agent?

corticosteroids Fluticasone Budesonide beclomethason

``` Which antihypertensive agent would be recommended in a woman with diabetic neuropathy, heart failure and hyperuricemia? Atenolol Enalapril HCTZ Torsemide Verapamil ```

Answer: Enalapril ACE-I are indicated for tx of HTN in diabetic and/or heart failure patients, especially ones with renal issues ``` Atenolol-Beta blocker Enalapril-ACE-I HCTZ-Thaizide diuretic Torsemide- Loop Verapamil-Ca2+ blocker ```

_________ have been shown to slow the progression of renal disease, which is why they are the most preferred anti-HTN medication in diabetic patients

ACE-I

``` Which of the following drugs are indicated for the tx of HTN and BPH but cause orthostatic HTN as a side effect Terazosin Verapamil Atenolol Enalapril ```

Terazosin is an alpha 1 adrenergic agonist that decreases arteriole and venous resistance Side Effects include "first dose" syncope/hypotension and dizziness

A 52-year-old man comes to the physician because of a substantial increase in the size of his breasts over the past two months. He has a longstanding history of hypertension and congestive heart failure. Which of the following best describes the mechanism of action of the drug most likely responsible for the increase in the size of the breasts in this patient? A. Antagonizes collecting tubule aldosterone receptors B. Inhibits distal convoluted tubule sodium and chloride resorption C. Inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride resorption D. Inhibits the conversion of angiotensin I to angiotensin II E. Selectively antagonizes beta-1 adrenergic receptors

A. Antagonizes collecting tubule aldosterone receptors Spironolactone is a K+ sparing diuretic that acts primarily as a competitive inhibitor of aldosterone receptors in the distal segments (distal convoluted tubule and collecting duct)

T/F: The incidence of severoity of digoxin toxicity is grealy increased when hypokalemia is present therefore Loop diuretics are contraindicated

True

``` Which receptor causes an increase in HR and contractility? alpha 1 alpha 2 beta 1 beta 2 ```

B1 Therefore a beta 1 blocke will decrease HR and contractility

``` Which receptor causes an bronchodilation and vasodilation alpha 1 alpha 2 beta 1 beta 2 ```

beta 2 B2 agonist used in asthma non-specific beta blocker contraindicated in COPD/asthma patients (propranolol)

``` Which receptors increases vascular smooth muscle contraction? alpha 1 alpha 2 beta 1 beta 2 ```

alpha 1 alpha 1 antagonist: Terazosin, Doxazosin are used to dilate smooth muscle side effects orthostatic HTN

``` Which is the initial drug of choice in symptomatic patietns with hypertrophic obstructuve cardiomyopathy? Amlodipine digoxin Enalapril Lidocaine Metoprolol ```

Metoprolol Beta blockers-slow HR to improve diastolic filling Amlodipine- dihydropyridiine Ca2+-channel blocker digoxin- antiarrhythmic used primarily fir A-fib and A-flutter Enalapril- ACE-I Lidocaine- Class IB antiarrhythmic -ventricular arrhythmias

``` Which is indicated for chronic HTN in pregnant women? Spironolactone Losartan enalapril methyldopa ```

methyldopa-alpha2 agonist (decreases sympathetic outlfow) Also safe: labetalol (Bblocker)l, nifedipine (CCB), hydralazine (direct vasodilator)

``` which of the fillowing decrease conduction through AV node? Atropine digoxin lidocaine procainamide quinidine ```

digoxin used for afib Atropine- anticholinergic agent Lidocaine- class Ib-ventricular arrhythmias Procainamide and quinidine are both Class I1a

Which leads correspond to the inferior wall?

II, III, AVF | usually right coronary artery

Which leads correspond to the lateral/apex wall?

I, AVL, V5, V6 | usual the circumflex artery

Which leads correspond to the septum ?

V1 & V2 | usually LAD artery

Which leads correspond to the anterior wall?

V1-V4 | usually the LAD artery

Which antihypertensive mediation(s) are first line in patients with DM?

ACE-I/ARB

Which antihypertensive medication(s) are first line agents in patients with heart failure?

1. Diuretics (Furosemide) | 2. ACE-I/ARB

Which anti-HTN are safe in pregnancy

Methyldopa Hydralazine Labetalol Nifedipine

Do nitrates cause more arterial or venous dilation?

venous