Agents for Respiratory Illness

Question 1

Describe the disease process of asthma

Answer 1

• Chronic inflammation of airways
• Contraction of bronchial smooth muscle
• Acute bronchospasm
• Increased secretion of mucus

Question 2

What is the presentation of asthma?

Answer 2

SOB
Cough
Chest tightness
Wheezing (stridor)

Question 3

Respiratory medications used in asthma target which area of the respiratory system?

Answer 3

The conducting zone

Question 4

The conducting zone includes

Answer 4

Sympathetic and Parasympathetic innervation as well as mucus-secreting (goblet) and ciliated cells

Question 5

Sympathetic innervation activates B2 receptors which will cause

Answer 5

bronchial dilation

Question 6

Parasympathetic innervation activates muscarinic receptors which will cause

Answer 6

bronchial constriction

Question 7

What class of drug does Albuterol belong?

Answer 7

Short-acting beta 2-agonist (SABA)

Question 8

Albuterol will cause relaxation of bronchial and tracheal smooth muscle which will cause

Answer 8

-Relieves bronchospasm
- Reduces airway resistance
- Facilitates mucous drainage
- Increases vital capacity

Question 9

What is the indication of albuterol?

Answer 9

Management of acute bronchospasm in asthma and other chronic obstructive airway disease

Question 10

What are the side effects of albuterol?

Answer 10

• Sympathetic effects: tachy, hyperglycemia, hypokalemia
• Tremor
• Paradoxical bronchospasm

Question 11

Metaproteronal (orciprenaline) is in what drug class?

Answer 11

Moderately selective beta 2 agonist

Question 12

What short-acting B2 agonist is inferior to albuterol for management of acute asthma symptoms?

Answer 12

Levalbuterol

Question 13

What are the two categories of Leukotriene Modifiers?

Answer 13

Leukotriene receptor agonists
5-lipoxygenase inhibitors

Question 14

What are the properties of leukotrines?

Answer 14

• Chemoattractant for eosinophils and neutrophils
• Constrict bronchiolar smooth muscle
• Increase endothelial permeability
• Promote mucus secretion

Question 15

What are the indications for leukotrine receptor antagonists (Montolucast and Zafirukast)?

Answer 15

• Asthma
• Allergic rhinitis
• exercise-induced bronchoconstriction (daily med proph.)

Question 16

What are the contraindications of leukotrine receptor antagonists?

Answer 16

• phenylketonuria
• hepatic disease

Question 17

What are the indications for theophylline?

Answer 17

• Used both orally or intravenously in the treatment of asthma, bronchospasm and COPD (rarely); also in infant apnea
• Alternate treatment for asthma, not first-line

Question 18

What is the MOA of theophylline?

Answer 18

Structurally similar to caffeine

Sympathomimetic, increases HR, inotropy, BP
Relaxes smooth muscle
Anti-inflammatory and immunomodulatory effect

Question 19

Why does theophyline have cardiac effects?

Answer 19

Also works as a nonselective adenosine receptor antagonist

Question 20

What are the toxic side effects of theophyline?

Answer 20

Nausea
Diarrhea
Heart arrhythmias
CNS excitation
Seizures

Question 21

What is another methylxanthine that has a similar MOA to theophyline but is not available in the U.S.?

Answer 21

Aminophylline

Question 22

What is the indication for inhaled corticosteriods?

Answer 22

Acute and/or persistent asthma (mild to severe), COPD

Question 23

What are the side effects of inhaled corticosteriods?

Answer 23

Cough (pretreat with inhaled bronchodilator)
Cataracts, thrush, hoarseness
HPA suppression
Growth suppression
Reduction in bone density

Question 24

What are the inhaled corticosteriod drugs?

Answer 24

Budesonide
Beclomethasone
Fluticasone
Mometasone

Question 25

What oral corticosteroids that can be used for asthma?

Answer 25

Methylprednisolone Prednisolone Prednisone

Question 26

Can LABA's be used as a monotherapy in asthma treatment?

Answer 26

NO, need to be used to complement ICS use, action is synergistic

Question 27

Can LABA's be used as a montherapy in COPD?

Answer 27

Yes

Question 28

What is the only meaningful difference in LABA's compared to SABA's?

Answer 28

Duration of action, lasts approximately 12 hours (compared to 4-6 h)

Question 29

Can LABA's be used in an acute attach of asthma or COPD?

Answer 29

No, used in the maintenance of asthma and prevention of attacks, COPD maintenance

Question 30

What drugs are LABA/ICS combination inhalers?

Answer 30

- Salmeterol/Fluticasone (Advair) - Formoterol/Budesonide (Symbicort) - Formoterol/Mometasone (Dulera)

Question 31

What drugs are SABA/anti-cholinergic combination inhalers?

Answer 31

Albuterol/Ipratropium (combivent)

Question 32

What is the management of an mild-to-moderate asthma exacerbation in the primary care setting?

Answer 32

SABA 4-10 puffs every 20min for 1 hour Prednisolone IV if able Controlled O2 (target saturations for adults 93-94% and for children 94-96%)

Question 33

What is the disease process of COPD?

Answer 33

Chronic, irreversible obstruction of the airway (progressive disease) Associated with a decrease in FEV1

Question 34

What are the indications for ipratropium?

Answer 34

COPD management, specifically to block cholinergic (vagal) mediated bronchospasm and mucus production

Question 35

What is the MOA for Ipratropium?

Answer 35

Anti-muscarinic activity on the bronchial smooth muscle that results in decreased contractility of smooth muscle

Question 36

What are the side effects of Ipratropium?

Answer 36

Local and systemic anticholinergic effects Xerostomia Urinary retention *Overall well tolerated