Asthma

Question 1

What is the pathology of asthma?

Answer 1

Hypersensitivity reaction to an allergen which causes bronchoconstriction, airway hyperresponsiveness, and airway edema

Question 2

What are clinical manifestations of asthma?

Answer 2

Cough, wheezing, SOB, increased respiratory rate, decreased O2 sat, chest tightness

Question 3

What are risk factors of asthma?

Answer 3

Familial history, childhood respiratory infections, early allergen exposure, exposure to chemicals/smoke/pollution, living in urban areas, female gender, young children

Question 4

Triggers of asthma

Answer 4

Pollens (seasonal allergies), dust mites, dust, cold weather, smoke, tobacco smoke, pets, exercise, stress, upper respiratory infection, GERD, aspirin/nsaids, food with tartrazine (yellow dye)

Question 5

What are complications of asthma?

Answer 5

Airway remodeling, respiratory infections

Question 6

What are SABAs? Prototype? What is their MOA? Use? Side effects?

Answer 6

Short acting beta agonists. Albuterol. Stimulate beta cells in smooth muscle to relax and broncho dilate. Used as emergency for acute exacerbations of asthma. Adverse effects include tremors, nervousness, tachycardia

Question 7

What are LABAs? Prototype? What is their MOA? Use? Side effects?

Answer 7

Long acting beta agonists. Formoterol. Stimulate beta cells in smooth muscle to relax -> bronchodilation. Used for long term treatment of asthma. Adverse effects include tremors, nervousness, tachycardia

Question 8

What are inhaled corticosteroids (ICS)? Prototype? What’s their MOA? Use? Side effects?

Answer 8

Beclomethasone. Suppresses inflammatory and immune response, increases beta receptor # and sensitivity. Used as asthma maintenance drug. Adverse effects: pharyngitis, candidiasis

Question 9

Oral corticosteroids for asthma. Prototype? MOA? Use? Side effects?

Answer 9

Prednisone. Reduces inflammation which decreases airway hyperresponsiveness. Given for asthma exacerbations. AE: weight gain, buffalo hump, moon face, hyperglycemia, thin skin, easy bruising

Question 10

What are leukotriene inhibitors (leukotriene receptor antagonist)? Prototype? MOA? Use? Side effects?

Answer 10

Montelukast. Prevents leukotrienes from binding with receptors decreasing inflammation and decreasing bronchoconstriction. Decreases need for quick relief med use. AE: headache, nausea, suicide ideations

Question 11

What are mast cell inhibitors? Prototype? MOA? Use? Side effects?

Answer 11

Cromolyn. Reduces the release of inflammation producing mediators. AE-sedation and coma with overdose, multiple side effects including muscle weakness, joint pain, and wheezing

Question 12

What is the drug of choice for status asthmaticus

Answer 12

Theophylline

Question 13

What is Theophylline? MOA? Use? Side effects?

Answer 13

Bronchodilator that relaxes muscles that constrict airways, dilates airways, sustained release for prevention of nocturnal symptoms. Has narrow therapeutic window. Drug of choice for status asthmaticus. AE: tachycardia, dysrhythmias, hypotension, tremors, restlessness, insomnia, headaches, N/V, diarrhea, and seizures

Question 14

What are monoclonal antibodies? MOA? Side effects?

Answer 14

Omalizumab, mepolizumab. Inhibit inflammatory mediators. AE-arthralgias, lower leg pain

Question 15

What is status asthmaticus? Symptoms? Key sign? RF? Tx?

Answer 15

An extreme form of asthma exacerbation that does not respond well to tx. Characterized by hypoxemia, hypercarbia, and secondary respiratory failure. Key sign is drop in systolic BP by 10 or more. Bronchial asthma increases risk. Tx includes: SABA, systemic steroids, Theophylline, humidified O2, heliox. Keep pt and family calm

Question 16

What are the classifications of asthma?

Answer 16

Mild: < 2 days per week
Moderate: daily
Severe: throughout the day