Asthma/COPD

Question 1

Asthma

Answer 1

Common chronic disorder
Complex
Characterized by
Variable, recurring symptoms
Airway inflammation
Hyper-responsiveness
Airflow obstruction

Treatment is relief inhalers and/or controller medications

Question 2

Asthma treatment

Answer 2

reliever inhalers like beta agonist

controller medications inhaled corticosteroid or corticosteroid with long acting bronchodilator

Question 3

Beta-adrenergic Agonists (beta-agonists)

Answer 3

Relax bronchial smooth muscle resulting in bronchodilation – non-selective versus selective

Question 4

Selectivity for beta-2 receptors

Answer 4

on bronchial smooth muscle without tachycardia – albuterol, levalbuterol, salmeterol, formoterol (less cardiac stimulation)

Question 5

Short (?) or long-acting (?)

Answer 5

rescue

up to 12 hours

Question 6

LABA still have a

Answer 6

black box warning. Should not be used by themselves

Question 7

Brhroncodialator ADR

Answer 7

palpitations, headaches, throat irritation

Question 8

Alternative to bronchodilator

Answer 8

anti-cholinergic like ipatropium bromide

Question 9

Combinations

Answer 9

anti-cholinergic/beta-agonist

Question 10

Combinations ADR

Answer 10

AE: dry mouth, headache, cough, GI distress, headache, and anxiety

Question 11

Methylxanthines

Chemically

Answer 11

related to caffeine

Question 12

Methylxanthines long-term management of

Answer 12

persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.

Question 13

Methylxanthines narrow

Answer 13

safey margin

Question 14

Methylxantinges SE

Answer 14

nausea, vomiting, CNS stimulation (frequenty); dysrhythmias (high doses); nervousness and insomnia.

Question 15

Methylxanthines significant interactmeions

Answer 15

with numerous other drugs

Question 16

methlxanthines can be given

Answer 16

oral or IV

Question 17

methylxanthine example

Answer 17

theophylline

Question 18

methylxanine is used

Answer 18

not as often as before, but in instances where asthma has not been responsive to traditional medications

Question 19

Inhaled Corticosteroids (ICS) Prevention

Answer 19

anti-inflammatory; mucus and edema reduction; sensitize bronchial smooth muscle to beta-agonist stimulation; reduce bronchial hyper-responsiveness to allergens

Question 20

ICS

Answer 20

Qvar or Flovent

Question 21

ICS used as

Answer 21

prevention medicaions

Question 22

ICS are the preferred prevention medication and symtpmos improve in

Answer 22

1 to 2 weeks, up to 4 to 8 weeks maximum therpay

Question 23

If patient has very severe asthma

Answer 23

LABA is added to ICS

Question 24

ICS rarely have

Answer 24

systemic effects – SE – hoarseness, oropharyngeal candidiasis (education – rinse mouth out after use)

Question 25

Long term effects of ICS

Answer 25

Long-term effects – requires careful, long-term follow-up studies

Question 26

Patient ed for ICS

Answer 26

rinse mouth out. avoid thrush

Question 27

Oral Corticosteroids (OC)

Answer 27

prednisone

Question 28

Prednisone

Answer 28

used for uncontrolled symptoms. Should be used for the shortest time possible

Question 29

oral corticosteroid dose and term

Answer 29

1-2mg/kg orally once a day x 5 to 7 days | 40mg orally once a day x 5 to 7 days; could do a taper

Question 30

oral corticosteroid ADR

Answer 30

adrenal gland atrophy, peptic ulcers, and hyperglycemia.

Question 31

oral corticosteroid concern in children

Answer 31

growth retardation

Question 32

Long term use of oral corticosteroids

Answer 32

have the potential to affect bone physiology in adults and childern

Question 33

Oral corticosteroids adults who are at risk for

Answer 33

osteoporosis should receive periodic bone mineral density tests.

Question 34

Oral Corticosteroids taken longer

Answer 34

than 14 days, corticosteroids should be discontinued slowly, by gradually reducing the dose

Question 35

oral corticosteroids are

Answer 35

dose and time dependent; limit to less than 10 days

Question 36

Additional treatment options for asthma

Answer 36

leukotriene modifiers and mast cell stabilizers

Question 37

leukotriene modifiers

Answer 37

Reduce inflammation and ease bronchoconstriction

Question 38

Leukotrienes

Answer 38

second line medications are mediators of the immune response that are involved in allergic and asthmatic reactions

Question 39

leukotriene side effects

Answer 39

headache, cough, nasal congestion, or GI upset

Question 40

Mast Cell Stabilizers

Answer 40

used for prevention | Inhibit release of histamine from mast cells & other chemical mediators of inflammation

Question 41

Mast cell stabilizers example and use

Answer 41

Cromolyn | used 4 to 6 times a day due to short half life

Question 42

cromolyn ADR

Answer 42

stinging or burning of the nasal mucosa, irritation of the throat, and nasal congestion bronchospasm and anaphylaxis (uncommon)

Question 43

Monoclonal Antibodies

Answer 43

Xolair – attach to a specific receptor on a target cell or molecule

Question 44

Evidence-Based Guidelines

Answer 44

Asthma Quick Care Reference Guide | Global Initiative for Asthma (GINA)

Question 45

Asthma Patient Education

Answer 45

``` Side effects Asthma Control Tests Asthma Action Plan Rule of 2’s. Asthma triggers When to follow-up ```

Question 46

Asthma control test

Answer 46

reviews symptoms a patient can have to determine if their asthma is under control