Asthma/COPD

Question 1

SABA
Albuterol
Levalbuterol

Answer 1

SABAs

Question 2

Salmeterol
Formoterol
Budesonide/Formoterol
Mometasone/Formoterol
Fluticasone/Salmeterol
Fluticasone/Vilanterol (Breo Ellipta)

Answer 2

LABAs

Question 3

Tiotropium (Spiriva)

Answer 3

LAAC aka LAAM aka LAMA

Question 4

DOC for long-term control of pts with any degree of persistent asthma

Answer 4

ICS (inhaled corticosteroids)

Question 5

Sx tx of bronchospasm providing quick relief of acute bronchoconstriction; rapid onset 5-30 mins; 4-6 hour relief; monotherapy for patients with intermittent or exercise-induced asthma

Answer 5

SABA, albuterol and levalbuterol

Question 6

Less tachycardic effects than albuterol

Answer 6

levalbuterol

Question 7

A/E: Tachycardia, hyperglycemia, hypokalema, hypomagnesemia, B2-mediated skeletal muscle tremors

Answer 7

SABAs

Question 8

Bronchodilation for ~12 hrs; slow onset of action
Monotherapy C/I for asthma patients
Used in conjunction with an ICS
Combination drugs now exist with an ICS (symbicort, advair, dulera, Breo Ellipta).

Answer 8

LABAs

Question 9

Beclomethasone, Budesonide, Ciclesonide, Fluticasone, Mometasone; DOC for long-term control for pts with any degree of PERSISTENT asthma. Inhibits arachidonic acid which mediates normal inflammatory responses. Metabolism in the liver. Low bioavailability.

Answer 9

ICS

Question 10

No direct on the airway smooth muscle

Answer 10

ICS

Question 11

Directly targets underlying airway inflammation through daily use

Answer 11

ICS

Question 12

IV methylprednisolone or oral prednisone needed to reduce airway inflammation during _____ exacerbations.

Answer 12

severe

Question 13

Systemic administration of corticosteroids should be reserved for patients who are not controlled on ____.

Answer 13

ICS

Question 14

A/E: Deposition on the oral and laryngeal mucosa can cause candidiasis and hoarseness. “Swish and Spit” required.

Answer 14

ICS

Question 15

Useful for patients who are poorly controlled by conventional therapy or experience A/E secondary to corticosteroids. Not monotherapy.

Leukotriene modifiers
Cromolyn 
Chrolinergic Antagonists
Theophylline
Omalizumab

Answer 15

Alternative Asthma Treatment

Question 16

Products of the 5-lipoxygenase pathway

Answer 16

Leukotrienes

Question 17

5-lipoxygenase inhibitor

Answer 17

Zileuton

Question 18

Not used for immediate bronchodilation
Alternate for prevention of exercise-induced asthma
Prevents formation of LTB4 and the cysteinyl leukotrienes. Asthma prophylaxis.

Answer 18

Zileuton

Question 19

Cysteinyl-leukotriene-1 receptor selective antagonist

Answer 19

Zafirlukast/Montelukast

Question 20

A/E: Elevation of hepatic enzymes, HA, dyspepsia

Answer 20

Leukotriene Modifiers

Question 21

Prophylactic anti-infammatory
Mast cell stabilizer
Alternative for mild-persistent asthma
NOT USEFUL IN AN ACUTE ATTACK
A/E: Cough, irritation, unpleasant taste
NO BRONCHODILATOR ACTIVITY

Answer 21

Cromolyn

Question 22

Ipratropium
Not recommended for routine tx of acute bronchospasm
Onset slower than inhaled SABAs
Useful for patients who cannot tolerate SABA or with concomitant COPD
Joined with SABA = beneficial for ER acute exacerbations
A/E: cough, dry mouth, nausea, nervousness

Answer 22

SAAC

Question 23

Tiotropium
First for use in maintenance of treatment of persistent asthma
Approved for COPD
No guidelines for severe asthma, but considered an “add-on” option; not first line

Answer 23

LAAC

Question 24

Bronchodilator relieving airflow obstruction in chronic asthma; some anti-inflammatory action
Narrow therapeutic window
A/E: seizures, arrhythmias with overdose; adversely interacts with many drugs

Answer 24

Theophylline

Question 25

Cimetidine, macrolides and quinolones decrease it Cigarettes, phenobarbital and phenytoin increase it B-blockers diminish its bronchodilatory effects It causes decreased effects of benzodiazepines

Answer 25

Theophylline

Question 26

Xolair Recombinant DNA-derived monoclonal Ab IgE selective Indicated for moderate-severe persistant asthma in pts poorly controlled on conventional therapy A/E: injection site rxn, viral infections, URI, sinusitis, HA, pharyngitis, anaphylaxis

Answer 26

Omalizumab

Question 27

Indacterol Olodaterol Salmeterol

Answer 27

LABAs for COPD

Question 28

Aclidinium Glycopyrrolate Tiotropium Umeclidinium

Answer 28

LAACs for COPD

Question 29

LABA + LAAC (LAMA) combo *LABAs are superior to LAMAs in preventing exacerbations Formoterol/glycopyrrolate Indacaterol/Glycopyrrolate Olodaterol/Tiotropium Vilanterol/Umeclidinium

Answer 29

First line for moderate COPD

Question 30

LABA + ICS combo Formoterol/Budesonide Salmeterol/Fluticasone Vilanterol/Fluticasone

Answer 30

For severe to very severe COPD (with frequent exacerbations)

Question 31

LABA + LAAC (LAMA) + ICS | Fluticasone furoate/Umeclidinium/Vilanterol

Answer 31

For severe or very severe COPD (with continued exacerbations despite use of LABA + LAMA, or in pts who also have asthma)

Question 32

____ has been associated with an increased risk of pneumonia in COPD pts

Answer 32

ICS

Question 33

``` Oral phosphodiesterase-4 inhibitor Reduces exacerbations in severe bronchitis Not a bronchodilator Not used acutely Limited due to A/E: N/V/D/HA ```

Answer 33

Roflumilast

Question 34

LABAs have primarily replaced this drug in therapy.

Answer 34

Theophylline

Question 35

For allergic rhinitis, these are preferred.

Answer 35

antihistamines and/or intranasal corticosteroids

Question 36

Most frequently used in tx of sneezing associated with allergic rhinitis caused by histamine release; more effective for prevention than after dx have begun; differ in ability to causes sedation; Benadryl (first gen, sedation), Claritin, Zyrtec, Allegra (2nd gen)

Answer 36

Antihistamines

Question 37

Intranasal Beclomethasone, budesonide, fluticasone, ciclesonide, mometasone, triamcinolone Nasal spray for allergic rhinitis Improves sneezing, itching, rhinorrhea and nasal congestion A/E: nosebleed, sore throat, candidiasis (rare)

Answer 37

Corticosteroids

Question 38

Nasal decongestants that can reduce airway resistance I-Phenylephrine (short acting) Oxymetazoline (longer acting) Rapid onset of action with few systemic effects Combined frequently with antihistamines Can cause rebound nasal congestion if used more than 3 days.

Answer 38

Alpha-adrenergic agonists

Question 39

Useful when administered before contact with an allergen. Dosed at least 1-2 weeks prior to exposure. Available OTC.

Answer 39

Intranasal Cromolyn

Question 40

Treat rhinorrhea associated with allergic rhinitis/common cold; but not for sneezing or nasal congestion

Answer 40

Intranasal Ipratropium

Question 41

Cough suppressant that decreases the sensitivity of CNS cough centers to peripheral stimuli; decreases mucosal secretion; lower doses for therapeutic effects than when used for analgesia; S/E include constipation, dysphoria and fatigue

Answer 41

Codeine

Question 42

Cough suppressant derived from morphine that suppresses the response from the cough center. Antitussive doses can trigger addiction. Safer than codeine, but with equal effectiveness.

Answer 42

Dextromethorphan (DM)

Question 43

Expectorant (robitussin/mucinex) used often with codeine or DM. Hydrate well to thin mucous.

Answer 43

Guaifenesin

Question 44

Cough suppressant that suppresses the cough reflex peripherally. Anesthetizes receptors located in the respiratory passages, lungs and pleura. Can cause dizziness, numbness of tongue/mouth/throat, and drowsiness.

Answer 44

Benzonatate