PHRM 825: Flipped Lecture

Question 1

What 3 symptoms can lead to asthma diagnosis?

Answer 1

• Chest-tightness
• Dyspnea
• Non-productive cough

Question 2

What signs can lead to an asthma diagnosis?

Answer 2

• Wheezing
• DRY hacking cough
• Signs of atopy
• Decreased FEV1/FVC (reversible with beta2-agonist use)
• Increased eosinophil count and blood IgE

Question 3

What are 6 asthma triggers?

Answer 3

• Emotions
• Pets
• Exercise
• Insects and Fecal Matter
• Dust
• Pollution

Question 4

What are 4 asthma classifications?

Answer 4

• Intermittent
• Persistent mild
• Persistent moderate
• Persistent severe

Question 5

What are 3 characteristics of COPD?

Answer 5

• Chronic bronchitis
• Emphysema
• Inflammation

Question 6

What is emphysema?

Answer 6

Abnormal enlargement of the airspaces that is accompanied by destruction of alveolar walls

Question 7

What is chronic bronchitis?

Answer 7

Presence of cough and sputum production for at least 3 months in each of two consecutive years

Question 8

What structural changes occur during emphysema?

Answer 8

Alveolar destruction and reduced elasticity

Question 9

What structural changes occur during chronic bronchitis?

Answer 9

• Airway narrowing
• Smooth muscle hyperplasia
• Inflammation
• Bronchial wall thickening
• Mucous gland enlargement
• Ciliary abnormalities

Question 10

What do proteases do?

Answer 10

Break down connective tissue in lungs

Question 11

What causes inflammation during COPD?

Answer 11

• Inflammatory response to irritants
• Oxidative stress
• Protease-antiprotease imbalance

Question 12

What are modifiable risk factors of COPD?

Answer 12

Exposure to particles such as:

• Cigarette smoke
• Occupational dust and fumes
• Indoor pollution

Question 13

What are non-modifiable risk factors of COPD?

Answer 13

• Genes
• Age/Gender
• Lung development
• Asthma and airway hyper-reactivity
• Socioeconomic status
• Repiratory infections

Question 14

What are hallmark symptoms of COPD?

Answer 14

• Chronic cough
• Dyspnea
• Sputum production

Question 15

What are signs of COPD?

Answer 15

• Increased RR
• Use of accessory muscles to breathe
• Hyperinflation of chest (barrel chest)
• Decreased breath sounds
• Prolonged expiration
• Lips pursing on espiration

Question 16

What test is required to diagnose COPD and what value confirms COPD?

Answer 16

Spirometry

<0.7

Question 17

Exacerbation definition

Answer 17

Acute event characterized by worsening of the patient’s respiratory symptoms beyond normal day-to-day variation that leads to a change in medication

Question 18

What is the MOA of glucocorticoids?

Answer 18

Prevent and control inflammation

Question 19

Side effects/precautions of glucocorticoinds

Answer 19

• Thrush
• Cough
• Difficulty speaking
• Hoarse throat
• Increased risk of pneumonia (COPD Studies)

Question 20

What is the MOA of inhaled beta 2 agonists

Answer 20

Relaxation of bronchial smooth muscle

Question 21

What is the onset of action for inhaled beta 2 agonists

Answer 21

3-5 minutes

Question 22

What is the onset of action for LABAs?

Answer 22

15 to 30 minutes (up to 3 hours for peak effect)

Question 23

Side effects and precautions of SABAs and LABAs

Answer 23

• Skeletal muscle tremors
• Palpitations
• Tachycardia
• Hypokalemia
• Hyperglycemia

Question 24

What is the MOA of leukotriene receptor antagonists?

Answer 24

Inhibits the cysteinyl leukotriene receptor

Question 25

What is the MOA of 5-lipoxygenase inhibitor?

Answer 25

Inhibits leukotriene formation

Question 26

Side effects of leukotriene modifiers

Answer 26

- Neuropsychiatric events - Churg-Strauss syndrome (rare) - Increase in LFTs - Sinusitis

Question 27

Contraindications of leukotriene modifiers

Answer 27

Hepatic impairment/liver disease

Question 28

What is the MOA of mast cell stabilizers?

Answer 28

Prevents the mast cell release of histamine, leukotriene, and inhibits degranulation after contact with antigens

Question 29

Side effects and precautions of mast cell stabilizers

Answer 29

- Cough - Unpleasant taste in mouth - Cardiac arrhythmias (rare) - Anaphylaxis

Question 30

MOA of methylxanthines

Answer 30

- Bronchodilation - Decrease plasma exudation - Increased mucocilliary clearance - Decreased nutrophil function - Decreased t-cell function - Macrophage function - Increased respiratory muscle strength

Question 31

Side effects of methylxanthines

Answer 31

- Insomnia - GI upset - Tremor - Nervousness - Hyperreactivity in children

Question 32

Precautions of methylxanthines

Answer 32

Caution in patients with CV disease

Question 33

Signs of theophylline toxicity

Answer 33

- N/V - Tachyarrhythmia - HA - Seizures

Question 34

MOA of Anti-IL5

Answer 34

Blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils

Question 35

Side effects of anti-IL5 meds

Answer 35

- Injection site reaction - Arthralgias - Dizziness - Fatigue - CV events - Herpes zoster infection

Question 36

Which anti-IL5 med has a boxed warning for anaphylaxis?

Answer 36

Mepolizumab

Question 37

MOA of phosphodiesterase inhibitors

Answer 37

Prevent phosphodiesterase from converting cAMP to AMP

Question 38

Side effects of phosphodiesterase inhibitors

Answer 38

- Diarrhea - Weight loss - Decreased appetite - Insomnia - Depression

Question 39

Contraindications of phosphodiesterase inhibitors

Answer 39

Moderate to severe liver impairment

Question 40

Which CYP enzymes metabolize theophylline?

Answer 40

1A2 (major) 3A4 (minor) 2E1 (minor)

Question 41

Which CYP enzymes metabolize phosphodiesterase inhibitors?

Answer 41

3A4 (major) | 1A2 (minor)

Question 42

Asthma treatment follow-up after initiating a controller treatment

Answer 42

2-3 month follow-up of response and assess level of control

Question 43

How/when to step down asthma therapy

Answer 43

- Symptoms controlled for 3 months - Low risk for exacerbation - Do not eliminate ICS

Question 44

Which COPD tests should be done at each doctor visit?

Answer 44

- Functional capacity - Symptom assessment (CAT/mMRC) - Smoking status - Pharmacotherapy (current regimen)

Question 45

Which COPD tests should be done annually?

Answer 45

- Lung function - Airflow Limitation - Exacerbations

Question 46

Causes of COPD exacerbations

Answer 46

- RTI | - Air pollution

Question 47

How long should systemic corticosteroids be used in a COPD patient with an exacerbation?

Answer 47

5 days

Question 48

How long should antibiotics be used in a COPD patient with cardinal symptoms present?

Answer 48

5-7 days

Question 49

What are the cardinal symptoms for COPD?

Answer 49

- Sputum purulence - Sputum volume - Dyspnea

Question 50

What are non-pharmacologic therapy options for COPD?

Answer 50

- Oxygen therapy (target 88-92% saturation) - Ventilator support *These are adjunct therapy

Question 51

What is severe acute asthma?

Answer 51

Severe asthma exacerbation unresponsive to bronchodilators

Question 52

Terbutaline MOA

Answer 52

B2 receptor agonist

Question 53

Ketamine MOA

Answer 53

Inhibits reuptake of noradrenaline in presynaptic neurons causing increased circulation of catecholamines resulting in bronchodilation