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Respiratory Pharmacology Flashcards

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1
Q

Asthma characteristics

A
  1. Increase mucous production
  2. Hyper responsive airways causing broncho-constriction
  3. Marked airway inflammation
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2
Q

What are the key player in Asthma?

A
  1. Mast cells
  2. IgE
  3. Immune cells
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3
Q

Early phase of Asthma

A

Allergen that leads to mast cell deregulation releasing histamine, luekotrienes, interlukeins, and PGE which creates bronco spasms.

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4
Q

Progression of Early phase Asthma to Late phase Asthma

A

infiltration of inflammatory cells: release cytokines, interleukin, and other inflammatory mediators

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5
Q

Late phase Asthma

A
  1. Airway inflammation leading to airflow limitation leading to bronchospasm and increase airway responsiveness
  2. Edema
  3. endothelial injury
  4. Impaired mucocillary function
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6
Q

Symptom Triggers of Asthma

A
  1. Upper Respiratory viral infections
  2. allergens
  3. exercise
  4. stress
  5. Exposure to inhaled irritants
  6. GERD
  7. Aspirin
  8. Exposure to sulfates (wine)
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7
Q

How does Aspirin cause an Asthma attack?

A

Aspirin causes a pseudo reaction to NSAIDS by inhibiting COX 1 and initiating COX 2 and can take up to 20 minutes to 3 hours

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8
Q

If a patient needs to be on aspirin what can we prescribe the patient to prevent an asthma attack

A

Monoleucast (singular)

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9
Q

Diagnostic Criteria for Asthma

A
  1. The presence of symptoms consistent with asthma: wheezing, SOB, cough, chest tightness
  2. The presence of variable airflow limitation
    - measured by spirometry
    - Reversibility of airflow
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10
Q

Factors increasing risk for asthma exacerbation

A
  1. Uncontrolled Asthma symptoms
  2. Use of more than 200 meter dose short acting bronchodilator canisters a month
  3. Inadequate inhaled corticosteroids
  4. Cost
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11
Q

Classification of Asthma: Intermittent

A

Less than 2 days per week, air flow normal

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12
Q

Classification of Asthma: Mild Persistent

A

More than 2 days a week but not daily spirometry is normal

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13
Q

Classification of Asthma: Moderate Persistent

A

Daily symptoms and 60-80 % normal airflow

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14
Q

Classification of Asthma: severe persistent

A

continual symptoms; results of peak flow spirometry is less than 60 % normal

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15
Q

GINA asthma criteria steps

A
  1. Assess
  2. Adjust
  3. Review
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16
Q

GINA step 1: Preferred controller

A
  1. As need low dose ICS- Formoterol
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17
Q

GINA step 2: Preferred Controller

A
  1. Daily low dose inhaled corticosteroid

2. or as needed ICS- Formoterol

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18
Q

GINA step 3: Preferred Controller

A
  1. Lose dose ICS and LABA
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19
Q

GINA step 4: Preferred Controller

A
  1. Medium dose ICS and LABA
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20
Q

GINA step 5: Preferred Controller

A
  1. High dose ICS and LABA

2. Refer to phenotypic assessment

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21
Q

GINA Preferred Step Reliever for Stage 1 and 2

A

As needed low dose ICS formoterol

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22
Q

Stage 1

A

Symptoms less than twice a month

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23
Q

Stage 2

A

Symptoms twice a month or more but not daily

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24
Q

Stage 3

A

Symptoms most days or walking with asthma once a week or more

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25
Stage 4
Symptoms most days or walking with asthma once a week or more, and low lung function
26
Preferred Reliever Stages 3-5
As needed low dose ICS-formoterol for patients prescribed maintenance and reliever therapy
27
Asthma Assessment
1. Confirmation of diagnosis 2. Symptoms control and modifiable risk factors 3. Cormobidities 4. Inhaler technique and adherence 5. Patients preference and goals
28
How to use a pressurized meter dose inhaler
1. push to prime 2. press down and inhale (in the patients mouth or close to it) 3. Hold breathe for 10 seconds 4. slowly exhale 5. Rinse mouth afterwards due to increase risk of fungal infections
29
This drug class interferes with gene transcription and activation of inflammatory mediators and stabilizes cellular membrane
Inhaled corticosteroids
30
Example of an inhaled corticosteroids
Budesinode (Pulmoncort)
31
Adverse effects of Budesinode
1. Pharyngeal irritations 2. Dry mouth 3. Oral fungal infections
32
This class of drugs stimulate beta 2 adrenergic receptors relax airway smooth muscle and increase bronchial cillary activity
Beta 2 adrenergic agonists
33
Short acting beta agonists
1. Albuterol (Proventil) | 2. Levabuterol (Xopenex)
34
SABA's are used for..
Acute relief of bronchospasm within four hours
35
Adverse effects of beta 2 adrenergic agonists
1. hypokalemia 2. hyperglycemia 3. CNS stimulation 4. increased skeletal muscle activity
36
Long acting beta 2 agonists
1. formoterol + budsenomide (symbicort)
37
This drug class competitively binds or inhibits proinflammatory leukotriene
Leukotriene modifiers
38
Example of a leukotriene modifier
Montelukast (singuliar)
39
Black box warning for montelukast
neuropsychiatric events- includes suicide in adults and teens nightmares in children
40
What are the biologic agents that treat asthma based on IL phenotype?
1. Mepolizumab (Nucala) 2. Reslizumab (Cingar) 3. Benlarizumab ( fasenra) 4. Dupliumab (Dupixent)
41
Before starting a biologic treatment on a patient the provider must check..
a serum IgE level
42
What monoclonal antibody is used for asthma prophylaxis
Omalizumab (Xolair)
43
How does omalizumab (Xolair) work?
Attaches to the receptor on IgE and prevents the IgE mediated release of inflammatory mediators
44
omalizumab (Xolair) BLACK BOX warning
Anaphylaxis; monitor patient for several hours after administration
45
Who can take omalizumab (Xolair)
reserved only for patients with persistent asthma not controlled by corticosteroids or other agents
46
Signs and Symptoms of COPD
1. ongoing cough 2. SOB 3. Wheezing 4. Chest tightness
47
This disease cause abnormal enlargement of air spaces distal to the terminal broncholies and leads to destruction of aveolar walls with air trapping and expiratory flow impairment
COPD
48
Main cause of COPD
smoking
49
Diagnostic Criteria for COPD
1. Chronic cough with or without sputum production 2. Persistent progressive dyspnea that worsens with exercise 3. May or may not have chest tightness 4. May or may not having wheezing, cyanosis, barrel shaped chest, low diaphragms and for pulmonale
50
What is required for the diagnosis of COPD
Spirometry and less than 70% is the diagnosis
51
Diagnostic Criteria for COPD spirometry
Preformed without a bronchodilator and then with a bronchodilator to evaluate the difference between in air flow limitation
52
Community acquired pneumonia treatment for outpatient without comorbiditie's
1. Doxycycline 2. Amoxicillin 3. Marcolides
53
Community acquired pneumonia treatment for outpatient with comorbiditie's
1. Bactrim + doxycycline | 2. fluorquinolines
54
Community acquired pneumonia is usually caused by what organism
Strep. pneumonia
55
Inpatient treatment for MRSA
1. Vancomycin | 2. Linezolid
56
Inpatient treatment for PSA
1. cefepime 2. Ceftazidine 3. Aztreonam 4. Meropenem 5. Imipinem
57
Most common cause of bronchitis
viral infections
58
Mom common cause of bacterial bronchitis
Bordetella pertusis
59
Acute bronchitis
less than 3 weeks
60
Supportive care for patients with bronchitis
1. Hydration 2. Tea 3. Honey 4. cough suppressant 5. Throat lozenges
61
Indications for antibiotic use in patients with bronchitis
1. Prolonged symptoms > 3 weeks 2. postive cultures 3. High Fevers 4. Purulent sputum 5. Respiratory symptoms for longer than 4-6 days 6. People over 65 years old 7. Patients with chronic diseases
62
How do you treat B. Pertussis
Marcolide
63
How do you treat M.pneumoniae
Macrolide or doxycycline
64
Community acquired pneumonia
Acute infection of the lower respiratory tract that is usually associated with symptoms of acute infection and acute infiltrates detected by chest x-ray or chest ultrasound
65
COVID 19 and asthma using spirometry
1. Avoid spirometry in patients with confirmed or suspected covid because it can disseminate viral particles and expose the infection to staff and other patients

Advanced Pharmacology (5 decks)

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