Respiratory

Question 1

asthma treatment algorithm

Answer 1

always assess administration, compliance, and environmental control

assess pt 2-6 weeks after each med adjustment

Question 2

Fluticasone (Flovent)

Answer 2

inhaled corticosteroid

Question 3

COPD 3 MAIN CRITERIA

Answer 3

-symptoms (breathlessness)
-FEV1 / FVC < 0.7
Exacerbation hx

Question 4

anti-muscarinics

Answer 4

Ipratropium bromide (Atrovent) ::: 
potent bronchodilators
minimal systemic absorption
given via inhalation route for ACUTE EPISODES
short-acting (give every 4 - 6 hours)

Enhanced bronchodilation when combined with albuterol ( Combivent) - useful for severe acute asthma attacks

Tiotropium (Spiriva) - long acting, once daily
more commonly used for COPD maintenance

Question 5

ADE of B-2 agonists

Answer 5

transient tachycardia, palpitations, tremor, excitability, headache, hypokalemia …. overall well tolerated

Question 6

Salmeterol / fluticasone (Advair

Answer 6

LABA

Question 7

Leukotriene Pathway Inhibitors

Answer 7

leukotrienes are responsible for bronchoconstriction, bronchial reactivity and mucus secretion

inhibiting leukotriene synthesis (Zileuton (Zyflo))
inhibtiing leukotriene binding (Montelukast (Singulair))

improve control, reduce frequency of exacerbations
MAINTENANCE
given orally (good for kids)
Singulair - most commonly used, well tolerated
Zyflo - associated with liver toxicity

Question 8

Zyflo

Answer 8

leukotriene pathway inhibitor

Question 9

Corticosteroids

Answer 9

broad anti-inflamm properties
inhibit production of cytokines

reduce hyper-reactivity (not a bronchodilator)

give routinely via inhalation as MAINTENANCE THERAPY in moderate to severe asthma

many systemic side effects when give orally (prednisone) - reserved for severe acute episodes and refractory disease

common side effects: hoarseness and THRUSH
rinse mouth after each use

Question 10

Formoterol / budenoside (Symbicort)

Answer 10

LABA

Question 11

COPD treatment

Answer 11

similar pharm approach to asthma
long acting anit-muscarinics aka spiriva are seen more with COPD

IgE NOT used in COPD

antibiotics may be used if infection is present
pneumonia can cause an exacerbation

severe disease may require oxygen supplementation

Question 12

B-2 agonists NOT used in asthma

Answer 12

epinephrine
ephedrine
isoproterenol

non-selective -» cardiac effects

Question 13

Vilanterol / fluticasone (Breo Ellipta)

Answer 13

LABA

Question 14

Bronchodilating agents

Answer 14

Sympathomimetic Agents (B-2 Agonists)
Methylxanthines (Theophylline)
Antimuscarinic Agents

Question 15

Methylxanthines

Answer 15

Theophylline ( and also caffeine etc)
Theophylline is most common
Given orally
Requires therapeutic drug monitoring 
Due to side effects and newer agents, now only used as add-on for refractory disease for maintenance therapy

Question 16

Anti-inflammatory agents

Answer 16

Corticosteroids

Leukotriene Pathway Inhibitors

Question 17

Singulair

Answer 17

leukotriene pathway inhibitor

Question 18

Beclamethasone (QVAR)

Answer 18

inhaled corticosteroid

Question 19

Tiotropium (Spiriva)

Answer 19

anti-muscarinic (long-acting)

Question 20

Levalbuterol (Xopenex)

Answer 20

SABA

Question 21

IgE Monoclonal Antibody

Answer 21

Omalizumab (Xolair)

Question 22

Mometasone (Asmanex)

Answer 22

inhaled corticosteroid

Question 23

Albuterol (Proair, Ventolin)

Answer 23

SABA

Question 24

Ipratropium bromide (Atrovent)

Answer 24

anti-muscarinic (short-acting)

Question 25

Omalizumab (Xolair)

Answer 25

Anti-IgE Monoclonal Antibody antibody that binds and inactivates IgE reserved for severe, frequently exacerbated asthma reduces severity and frequency of exacerbations reduces glucocorticoid steroid requirements used as MAINTENANCE THERAPY

Question 26

Theophylline ADE

Answer 26

normal to high levels of : diuresis, tremors/nervousness, n/v, insomnia very high levels of: seizures, + chronotropic and inotropic

Question 27

LABAs

Answer 27

Salmeterol and Formoterol long duration of action (~12 hours), 2x day combined with corticosteroids (anti-inflamm) Vilanterol longer duration (~24 hours) - once a day dosing combined with corticosteroid *ONLY APPROVED FOR COPD

Question 28

SABAs

Answer 28

maximum bronchodilation achieved 15 mins after inhalation duration of action ~4 hours Levalbuterol more pure? more selective, less tachy and tremors (but not clinically significant) nebulizer option Albuterol also available as PO tablet - but increased side effects

Question 29

Budenoside (Pulmicort)

Answer 29

inhaled corticosteroid

Question 30

B2 agonists

Answer 30

some come oral but inhaled (topical) is preferred to prevent toxicities / systemic absorption SABAs for rescue therapy LABAs for maintenance

Question 31

Black box warning for LABAs

Answer 31

monotherapy of LABAs increases risk of asthma related events including hosptializations, intubations, and death

Question 32

Triamcinolone (Azmacort)

Answer 32

inhaled corticosteroid