COPD & Allergy

Question 1

pathophys of COPD

Answer 1

not fully reversible airflow limitation; chronic lung and airway inflammation w mucus hypersecretion and gas exchange abnormalities

Question 2

Treatment strategies for COPD

Answer 2

B2-R agonist
anti-ACh inhalers
bronchodilators
long-acting inhaled bronchodilators
Combined therapy of bronchodilators

Question 3

ADR of inhaled corticosteroids in COPD

Answer 3

increased risk of osteoporosis with extended use

Question 4

roflumilast

Answer 4

oral PDE4 inhibitor

used in pts with severe COPD with bronchitis and history of exacerbation to dec exacerbations

Question 5

ADR roflumilast

Answer 5

nausea, diarrhea, insomnia, weight loss

interaction with CYP 3A4 inhibitors and inducers

Question 6

Meds to use for COPD exacerbations

Answer 6

inhaled bronchodilators (B2-ag or anti-ACh), theophylline, systemic corticosteroids, +/- roflumilast
antibiotics if infection present

Question 7

Tx of COPD

Answer 7

stop smoking, bronchodilators, steroids (?), antibacterials (frequent infection)

Question 8

etiology of allergic rhinitis

Answer 8

Seasonal (SAR) - repetitive predictable symptoms in spring/fall, acute and triggered by allergens
perennial (PAR) - chronic, triggered by non-seasonal allergens
*Can have both

Question 9

Sx of allergic rhinitis

Answer 9

ocular: venous congestion -> “allergic shiners”, pruritus, watery red eyes or SAR conjunctivitis
Nasal: clear rhinorrhea, sneezing, congestion, pruritus, post-nasal drip
systemic: fatigue, irritability, cognitive impairment

Question 10

Drug categories for allergic rhinitis

Answer 10

Anti-histamines/ H1-R antagonist
decongestants
corticosteroids

Question 11

MOA of antihistamines

Answer 11

antagonize capillary permeability, wheal and flare formation, pruritus
anti-ACh properties reduced nasal, salivary, lacrimal gland secretions

Question 12

Brompheniramine

Answer 12

1st gen oral antihistamine

Question 13

chlorpheniramine

Answer 13

1st gen oral antihistamine

Question 14

clemastine

Answer 14

1st gen oral antihistamine

Question 15

diphenhydramine

Answer 15

1st gen oral antihistamine

Question 16

1st vs. 2nd gen oral antihistamines

Answer 16

1st gen penetrates CNS -> sedation/ cognitive impairment; OTC
2nd gen Rx and OTC; peripherally selective = “non-sedating”

Question 17

cetirizine

Answer 17

2nd gen oral antihistamine

Question 18

levocetirizine

Answer 18

2nd gen oral antihistamine

Question 19

fexofenedine

Answer 19

2nd gen oral antihistamine

*really low CNS penetration

Question 20

loratadine

Answer 20

2nd gen oral antihistamine

Question 21

desloratadine

Answer 21

2nd gen oral antihistamine

Question 22

ADR of oral antihistamines

Answer 22

1st gen: anti-ahc effects = dry mouth/nose/eyes, blurred vision, urinary retention, constipation, tachycardia
CNS depression = sedation, impaired performance

Question 23

azelastine

Answer 23

fast-acting intranasal antihistamine, peaks at 3 hours

relieves sneezing, pruritus, rhinorrhea, reduces nasal congestion

Question 24

ADR intranasal antihistamine

Answer 24

bitter taste, sedation, local irritation

Question 25

oral decongestant MOA

Answer 25

A-adrenergic agonist -> vasoconstriction of vessels in mucosa = temporary relief of nasal congestion

Question 26

phenylephrine

Answer 26

direct-acting oral decongestant | also short-acting intranasal decongestant

Question 27

pseudoephedrine

Answer 27

indirect-acting/mixed oral decongestant | slower onset, longer duration, more effective than direct acting phenylephrine

Question 28

ADR of oral decongestants

Answer 28

more likely in young/old: cardiac stimulation -> increased BP and HR, arrhythmia, palpitations; CNS stimulation -> insomnia, anxiety, tremors; if taken with MAOI increases BP further

Question 29

Precautions with oral decongestants

Answer 29

hypersensitivity, idiosyncratic reactions, MAOI use | may exacerbate hyperthyroidism, glaucoma, HTN, BPH

Question 30

naphazoline

Answer 30

intermediate acting intranasal decongestant

Question 31

tetrahydrozoline

Answer 31

intermediate acting intranasal decongestant

Question 32

oxymetazoline

Answer 32

long-acting intranasal decongestant

Question 33

Rhinitis medicamentosa & tx

Answer 33

rebound nasal congestion with more than 3 days use of decongestant Tx: withdraw decongestant 1 nostril at a time, use intranasal corticosteroid, normalizes in 1-2 weeks

Question 34

MOA of intranasal corticosteroid

Answer 34

anti-inflammatory action on cells and mediators involved with inflammation

Question 35

DOC for allergic rhinitis & effects

Answer 35

intranasal corticosteroid (most effective) relieves sneezing, rhinorrhea, pruritus, nasal congestion max benefit in 7 days

Question 36

ADR of intranasal corticosteroid

Answer 36

sneezing, stinging with administration headache epistaxis

Question 37

beclomethasone

Answer 37

intranasal corticosteroid

Question 38

budesonide

Answer 38

intranasal corticosteroid

Question 39

flunisolide

Answer 39

intranasal corticosteroid

Question 40

fluticasone

Answer 40

intranasal corticosteroid

Question 41

mometasone

Answer 41

intranasal corticosteroid

Question 42

triamcinolone

Answer 42

intranasal corticosteroid

Question 43

Use of inhaled corticosteroids in COPD

Answer 43

patients with FEV1 less than 50% expected and exacerbations for 3 years

Question 44

categories of intranasal decongestants

Answer 44

``` short-acting (less than 4 hr) intermediate acting (4-6 hr) long-acting (up to 12 hr) ```