Treatment for Asthma and COPD

Question 1

what are the main 2 pharmacologic targets in asthma

Answer 1

tone of bronchial smooth muscle
inflammation of airways

Question 2

Short-acting beta 2 agonists
Short-acting anti-cholinergic agents
Oral corticosteroids

Answer 2

rescue medications for asthma

Question 3

Inhaled corticosteroids
Long-acting Beta 2 agonists
Long-acting muscarinic antagonists
Mast cell inhibitors
Leukotriene inhibitors
Phosphodiesterase inhibitors
Antibodies against IgE

Answer 3

controller medications for asthma

Question 4

MoA of beta2 adrenergic agonists

Answer 4

-K+ out of cell (hyperpolarization; smooth m relaxation)
-increases cAMP and decreases PLC/IP3/Ca2+; smooth muscle relaxation

Question 5

short acting beta2 agonist (SABA) used in mild intermittent asthma and mild COPD

Answer 5

Albuterol

Question 6

long acting beta2 agonists (LABA) used in moderate-severe asthma and >mild COPD

Answer 6

Salmeterol
Formoterol

Question 7

classic non-selective beta agonist

Answer 7

Isoproterenol

Question 8

key drug to use in mild-intermittent asthma

Answer 8

SABA (Albuterol)

Question 9

this drug is added to ICS in patients with poorly controlled mild-persistent asthma

Answer 9

LABA (Salmeterol or Formoterol)

Question 10

SE’s of this type of drug include:
muscle tremor
tachycardia
hypokalemia
restlessness

Answer 10

Beta2 agonists

Question 11

in asthma, ____ should only be used with ICS, never alone

Answer 11

LABA

Question 12

-sones and budesonide are what type of drug

Answer 12

corticosteroids

Question 13

moa of corticosteroids

Answer 13

anti-inflammatory (goes into nucleus and stops inflammatory gene expression)
eosinophil apoptosis

Question 14

____ can cause oral candidiasis (rinse after using this)

Answer 14

inhaled corticosteroids

Question 15

1st line therapy for all patients with persistent asthma

Answer 15

ICS

Question 16

hair loss
bone loss
mood changes
infections

Answer 16

systemic SE’s of corticosteroids

Question 17

prolonged use of ____ causes HPA axis suppression

Answer 17

oral corticosteroids

Question 18

use lowest dose of ____ to control asthma

Answer 18

ICS

Question 19

combination inhalers (LABA + ICS) used for persistent asthma

Answer 19

Advair
Symbicort

Question 20

salmeterol/fluticasone

Answer 20

Advair

Question 21

formoterol/budesonide

Answer 21

Symbicort

Question 22

small changes in airway ______ have important impacts in changing airflow resistance

Answer 22

radius

Question 23

this drug is used to reduce airway constriction and first line in COPD

Answer 23

muscarinic antagonist

Question 24

this drug competitively inhibits Ach pathway of bronchoconstriction

Answer 24

muscarinic antagonist

Question 25

short acting muscarinic antagonist

Answer 25

Ipratropium

Question 26

long acting muscarinic antagonist

Answer 26

Tiotropium

Question 27

this drug is generally well-tolerated

Answer 27

muscarinic antagonist

Question 28

little evidence that ______ are helpful in asthma

Answer 28

anti-histamines

Question 29

used as an add-on to treat bronchoconstriction and inflammation in asthma

Answer 29

anti-leukotrienes

Question 30

LOX inhibitor

Answer 30

Zileuton

Question 31

leukotriene receptor inhibitors

Answer 31

Monteleukast -lukasts zaprinast

Question 32

no benefit in using these in COPD, used as an add-on maybe in asthma

Answer 32

anti-leukotrienes

Question 33

used in both asthma and COPD but not as common PDE inhibitor (allows cAMP to function)

Answer 33

Theophylline

Question 34

has small therapeutic window and toxicity w/ other meds that block CYP function

Answer 34

Theophylline

Question 35

not used often to treat asthma but stabilizes mast cells

Answer 35

Cromolyn

Question 36

-mab against _____ can be used to treat all 3 types of asthma

Answer 36

TSLP

Question 37

Rx mild intermittent asthma

Answer 37

SABA prn

Question 38

Rx mild-persistent asthma

Answer 38

low dose ICS

Question 39

Rx moderate-persistent asthma

Answer 39

medium dose ICS + LABA

Question 40

Rx severe-persistent asthma

Answer 40

high dose ICS + LABA (+ oral corticosteroid) consider: Omalizumab for patients who have allergies

Question 41

_____ causes epithelial cell injury and stimulation of macrophages

Answer 41

cigarette smoking, air pollutants, indoor wood cooking

Question 42

fibrosis increase in proteases that lead to alveolar wall destruction (emphysema) and mucus hypersecretion (chronic bronchitis)

Answer 42

pathogenesis of COPD

Question 43

first line drug for COPD

Answer 43

anti-cholinergic/muscarinic antagonist

Question 44

can use LABA by itself here, but do not use ICS by itself, only as an add on

Answer 44

COPD

Question 45

most important thing to do for COPD

Answer 45

stop smoking

Question 46

Rx mild COPD

Answer 46

SABA (Albuterol)

Question 47

Rx >mild COPD

Answer 47

long acting muscarinic antagonists LABA (ICS if above do not work)