Respiratory (Pharm)

Question 1

Allergic rhinitis

Answer 1

-Induced after allergen exposure
-Symptomatic disorder of the nose
-Sneezing, nasal pruritus, airflow obstruction and nasal discharge, +/- conjunctivitis, Bilateral (NOT unilateral symptoms)
-Different classification for severity and duration
-Always check for asthma especially in patients with severe and or persistent rhinitis

Question 2

Allergic rhinitis pathophysiology

Answer 2

-Exposure of allergen, dendritic cells try to clean up
-Antigen presentation and release of mast cells causing allergic reaction, re-exposure releases histamine
-IgE
-Basophil
-Th2 inflammation

Question 3

What is NOT allergic rhinitis?

Answer 3

-Unilateral symptoms
-Nasal obstruction without other symptoms
-Mucopurulent rhinorrhea
-Post nasal drip with thick mucus and no anterior rhinorrhea
-Pain
-Recurrent epistaxis

Question 4

Pharmacological treatment of allergic rhinitis

Answer 4

-Oral antihistamine (1st gen drowsy cross BBB, 2nd generation non drowsy but needs to be taken before exposure due to it not blocking histamine and does not cross BBB)

-Nasal antihistamine (takes few days for effect)

-Intranasal corticosteroids

-Oral decongestants ( work on alpha-adrenergic receptors to cause vasoconstriction, careful for patients with HTN, DM and narrow angle glaucoma, hyperthyroidism, BPH)

-Nasal decongestants (only use 3-7 days to avoid rebound congestion)

-Anti-cholinergic (for runny nose) such as ipratropium

-LTRA (Leukoterine receptor antagonist)

-Normal saline flushes, intraocular

Question 5

Asthma goals of therapy

Answer 5

-Control of symptoms
-Maintain normal activity
-Maintain pulmonary function as close to normal
-Prevent asthma exacerbations
-Avoid S/E of medications
-PEF>90%

Question 6

Assessment of asthma

Answer 6

1. Asthma control, assess over 4 weeks, hospital admissions
2. Treatment issues: check inhaler technique and adherence, side effects, written asthma action plan
3. Comorbidities: think about GERD, obesity, OSA, rhinositusitis

-Assessment: day and night symptoms, physical activity, exacerbations, absence from work or school, need for reliever, FEV or PEF, sputum eosinophils

Question 7

Medications for asthma

Answer 7

-SABA (short acting beta 2 agonist, increase CAMP and causes bronchodilation)

-ICS (shown to decrease exacerbations and increase lung function, may take 8 weeks for full effect)

-ICS/LABA combos (LABA is NEVER used on its own without corticosteroid)

-LTRA (inhibition of leukotriene receptors these are correlated with airway edema and smooth muscle contraction with an inflammatory process)

-LAMA (long acting muscarinic antagonist)
-Oral steroids
-Anti-IgE
-IL-antagonists

Question 8

Long term side effects of ICS (controller) use

Answer 8

-Oral thrush and hoarseness
-Adrenal insufficiency
-Hyperglycemia
-Osteoporosis
-Pneumonia
-Cataracts
-Dermal thinking

Question 9

Side effects of SABA (reliever)

Answer 9

-Tremor
-QT prolongation
-Increase HR
-Increase insulin secretion
-Hypokalemia

Question 10

Side effect of LABA (slower to associate than SABA)

Answer 10

-Tremor
-QT prolongation
-Increase HR
-Increase insulin secretion
-Hypokalemia

Question 11

Side effects of LAMA (controller)

Answer 11

-Dry mouth, cough, constipation, urinary retention,headache

Question 12

COPD

Answer 12

-FEV1/FVC< 0.7
-airflow limitation
-progressive
-abnormal inflammatory response of the lung to noxious particles or gases
-severity of COPD based on FEV
-assess with modified MRC dyspnea scale or CAT tool
-common comorbidities with COPD: DM, CV problems, PVD, anxiety depression, chronic anemia, osteoporosis

Question 13

COPD pharmacological treatment

Answer 13

-A bronchodilator (increase FEV by altering smooth muscle tone, improves lung emptying, reduces hyperinflation)
-LABA+LAMA
-LABA+LAMA
-LABA+LAMA+ICS (if blood eos>300)-improves long function and exacerbations

-oral steroids
-macrolide antibiotics (for anti-inflammatory and antibacterial to reduce chronic airway inflammation and mucus production)