AsthmaCOPD

Question 1

Which drugs can be risk factors for asthma?

Answer 1

Beta Blocker, Ca antagonists, NSAIDS

Question 2

What are the 2 phases of an asthma attack?

Answer 2

Immediate (mainly bronchospasm) Late-phase ( bronchospasm, vasodilation, edema and mucus)

Question 3

What are long term control medications in asthma?

Answer 3

ICS, LABA, leukotriene modifiers, methylxanthines, cromolyn, Anti IgE

Question 4

What are the quick relief medications in asthma?

Answer 4

SABA, anticholinergics, systemic corticosteroids

Question 5

What is a major advantage of inhaled therapy?

Answer 5

Delivery of drugs directly to the airways, deliver higher drug concentrations locally. And minimize systemic side effects

Question 6

What is the MOA for ICS?

Answer 6

Depress the inflammatory response + edema in the reps tract and diminishes bronchial hyper-responsiveness?

Question 7

What is the most effective long-term controlled therapy for persistent asthma?

Answer 7

ICS, have to be used REGULARLY to be effective

Question 8

What are local and systemic ADR of ICS?

Answer 8

Local: thrush, dysphonia, reflex cough. Systemic: hypothalamic- pituitary adrenal suppression, impaired growth in kids, and dermal thinning

Question 9

What are the ICS?

Answer 9

Fluticasone, budesonide, beclomethasone, flunisolide, triamcinolone, mometasone, ciclesonide

Question 10

What are the ICS/ LABA combo drugs?

Answer 10

Fluticasone+ salmeterol ( advair). Flucticason+ vilanterol, Budesonide+ fomoterol, mometasone+ fomoterol

Question 11

Are LABAs a substitute for anti-inflammatory therapy?

Answer 11

no

Question 12

Are LABAs used for monotherapy?

Answer 12

NO

Question 13

What is the LABA black box warning?

Answer 13

May increase the chance of severe asthma episodes and death

Question 14

What are some LABAs?

Answer 14

Salmeterol, formoterol, arformoterol tartrate, and formoterol fumarate

Question 15

What drugs should be avoided d/t interactions that cause prolonged QT, palpitations, and tachycardia?

Answer 15

Ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, intraconazole, netazodone, nelfinavir, saqunavir, and telithromycin

Question 16

What are 3 leukotriene receptor antagonists?

Answer 16

Montelukast ( singular), zarfirlukast, and zileuton

Question 17

What is the MOA of the leukotriene recpetor antagonists?

Answer 17

Competitively antagonize leuk.. receptors D4 and E3 in the bronchiolar muscle, antagonizing endogenous leukotrienes causing bronchodilation

Question 18

Which leuk., receptor antagonists interact with warfin?

Answer 18

Zarfirlukast and zileutin

Question 19

What are the methylxanthines and their MOA?

Answer 19

Theophylline, aminophylline. Increase CAMP in bronchial smooth muscle ñ bronchodilate

Question 20

Can the methylxanthines be used as a monotherapy?

Answer 20

YES

Question 21

Why are the methlyxanthines used infrequently?

Answer 21

They have a narrow therapeutic window and a lot of drug interactions- there are safer alternatives

Question 22

What are the 2 major categories and examples of interactions with methylxanthines?

Answer 22

1)drug-disease: viral illness, CHF, cirrhosis, and smoking. 2) drug-drug: cimetidine, ,macrolides, quinolones, CYP1A2/3A4 substrates

Question 23

What type of drug is indicated for pts

Answer 23

Mast cell stabilizers

Question 24

What is the MOA for mast cell stabilizers?

Answer 24

Stabilize mast cells preventing the release of inflammatory mediators. Must be used regularly for weeks for effect

Question 25

What is the immunodilator and what is its black box warning?

Answer 25

Omalizumab. Anaphylaxis

Question 26

How often is omalizumab administered?

Answer 26

Once every 2-4wks SUB Q

Question 27

What is the MOA for systemic corticosteroids?

Answer 27

Decrease inflammation by suppression of migration of leukocytes and reversal of increased capillary permeability

Question 28

What category is Albuterol

Answer 28

SABA- quick relief bronchdilator

Question 29

What do the beta 2s do?

Answer 29

Increase CAMP- bronchodilation

Question 30

Do Beta 2s treat or control asthma?

Answer 30

No- they only treat symptoms in acute exacerbations

Question 31

A pt needs to have their plan re-evaluated if they have more than how many courses of systemic corticosteroids yearly?

Answer 31

3

Question 32

Increased SABA use to how many times weekly indicated inadequate control and a need to step up treatment?

Answer 32

>2 times weekly

Question 33

What is the approach to initial management of asthma?

Answer 33

Quick relief- SABA, 2-4 puffs PRN, up to 3treatments per 20 min intervals or a single nebulizer tx. Step 1: mild intermittent- symptoms 1day/wk BUT 2 nights a month, preferred tx is low dose ICS, prn SABA Step 3: moderate persistent: symptoms daily, >1 night a week, low dose ICS+ LABA and prn SABA Step 4: severe persistent : continuous symptoms, medium or high dose ICS+LABA and prn SABA and oral steroid if needed

Question 34

What are some risk factors for death by asthma?

Answer 34

2 or more hospitalizations or >3 ED visits in the past year. hospitalized or ED in the past month uses >2 canisters of SABA/month

Question 35

What is the foundation of therapy for COPD?

Answer 35

Anticholinergics + B2 agonist. Combo albuterol and ipratropium

Question 36

What are the antocholinergics and are they indicated for chronic therapy?

Answer 36

Ipratroprium, tiotroprium. NO- relief of ACUTE bronchospasms

Question 37

What is the MOA for the anticholinergics?

Answer 37

Muscarinic antagonist block muscarinic receptors, which respond to the parasympathetic bronchoconstriction tone

Question 38

What are the antichol./ LABA combos?

Answer 38

Indacaterol + glycopyrronium. Tiotropium + olodaterol

Question 39

When are antibiotics indicated for COPD?

Answer 39

When at least 2 of the following symptoms are present: Increased dyspnea Increased sputum volume Increased sputum purulence

Question 40

Which organisms are most common pathogens treated in COPD?

Answer 40

Strep pneumo, H influenzae, and moraxella catarrhalis

Question 41

Which antibiotics are used most often in Mild to moderate COPD and Severe COPD

Answer 41

Mild to mod: doxycycline, sulfamethoxazole/ trimethoprim, amoxicillin clavulante, macrolides, and fluoroquinolones Severe: antipseudomonal PNC, 3rd generation cephs, and fluoroquinolones.