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Pharm II > Asthma > Flashcards

Asthma Flashcards

1
Q

what is the most common chronic dz in children?

A

asthma

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2
Q

is asthma reversible?

A

Yes

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3
Q

risk factors for asthma

A

Allergens
Respiratory infections
tobacco smoke, air pollution, occupation, diet

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4
Q

2 phases of asthma

A

immediate-phase response

late-phase response

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5
Q

what are the most effective drugs in the early phase of an asthmatic attack.

A

Bronchodilators

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6
Q

What occurs in the late-phase response of asthma?

A

bronchospasm, vasodilatation, edema and mucous secretion

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7
Q

what is needed for tx of late-phase response asthma?

A

Anti-inflammatory drug action

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8
Q

what are some environmental triggers of asthma?

A 
Dust mites
pet dancer
cockroaches
pollens
molds
viral URIs
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9
Q

What are some co-morbid conditions with asthma?

A

GERD
allergic rhinitis
sinusitis
depression

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10
Q

what drugs can induce asthma?

A

Cardioselective and non-selective Beta Blockers, Calcium antagonists
Dipyridamole
NSAID’s

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11
Q

Life-threatening acute deterioration of stable asthma

A

Acute asthma/ status asthmaticus

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12
Q

Acute or subacute onset of progressively worsening asthma symptoms

A

Asthma exacerbation

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13
Q

how much time does it take for an acute asthma exacerbation to occur

A

Sudden, less than 6 hours

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14
Q

Physical findings of asthma

A

Hyperexpansion of the thorax
Sounds of wheezing
Increased nasal secretion, mucosal swelling and nasal polyps
Atopic dermatitis/eczema

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15
Q

what do you use to establish reversibility of the airway?

A

spirometry

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16
Q

how often should short-acting inhaled beta-2 agonists be used?

A

<2 days / week

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17
Q

what meds are used for long term controll

A 
Corticosteroid : inhaled and systemic
Long-acting beta 2-agonist
Leukotriene modifiers
Methylxanthines
Cromolyn
Anti-IgE
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18
Q

What is used for quick relief of asthma

A

Short-acting beta 2 agonists (albuterol)
anticholinergics
systemic corticosteroids

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19
Q

Advantages of inhaled therapy

A

deliver drugs directly to the airways
deliver higher drug concentrations locally
minimize systemic side effects.

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20
Q

do you get a lot of systemic absorption with inhaled corticosteroid.

A

No

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21
Q

what makes it easier to use an inhaler?

A

Spacers

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22
Q

Convert a solution of drug into aerosol for inhalation
Used to deliver higher doses of drug to the lungs
more efficient than inhalers

A

Nebulizers

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23
Q

MOA of inhaled corticosteroids

A

Depress the inflammatory response and edema in the respiratory tract
Diminish bronchial hyper-responsiveness

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24
Q

What do inhaled corticosteroids decrease

A

Mucous production

Prostaglandins and leukotrienes

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25
Q

what is the most effective long-term control for persistent asthma

A

corticosteroids

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26
Q

what do you often combine with inhaled corticosteroids?

A

beta 2 agonist or other asthma agents

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27
Q

when do symptoms of asthma respond to ICS?

A

1-2 weeks, max 4-8 weeks

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28
Q

when must inhaled corticosteroids be used?

A

Regularly in order to help

Will not help in an acute setting

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29
Q

Contraindications with ICS?

A

caution in growing children (wash mouth out after)

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30
Q

ADRs of ICS (local)

A

Reflex cough and bronchospasm

thrush

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31
Q

Systemic ADRs of ICS

A

hypothalamic-pituitary-adrenal suppression
impaired growth in children
dermal thinning-dose dependent

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32
Q

in adults what are some concerns with ICS?

A

bone mineral density

ocular effects- cataracts, glaucoma

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33
Q

How can you decrease systemic absorption with ICS?

A

use a holding chamber
rinse and spit
lowest dose possible
used in combo w/ long-acting beta 2-agonists

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34
Q

Name the ICS

A 
fluticasone
Budesonide
Beclomethasone
Flunisolide
Triamcinolone
Mometasone
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35
Q

What are some ICS and LABA combos?

A

Fluticasone/ salmeterol (Advair)

Budesonid/ formoterol (symbicort)

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36
Q

List some long acting beta 2 agonists

A

Salmeterol

Formeterol

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37
Q

are LABAs a substitute for anti-inflammatory therapy? or for acute symptoms

A

No

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38
Q

can you develop tolerance with LABAs?

A

Yes- with chronic administration

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39
Q

what is the black box warning with long acting Beta 2 agonists?

A

Increase the chance of severe asthma episodes and death when those episodes occur

40
Q

what can increase salmeterol plasma levels.

A

Concomitant use of CYP3A4

41
Q

what drugs should be avoided with salmeterol

A

Ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin

42
Q

if a patient is controlled on a low dose ICS, should you start a LABA?

A

No

43
Q

should LABA be used as monotherapy?

A

No

44
Q

which LABA as a quick onset of action

A

Formoterol

45
Q

what are three leukotriene receptor antagonists

A

montelukast (singulair)
zafirlukast
zileuton

46
Q

MOA of leukotriene receptor antagonists

A

Competitively antagonize leukotriene receptors D4 and E4 in the bronchiolar muscle, antagonizing endogenous leukotrienes causing bronchodilation.

47
Q

what leukotriene receptor antagonsits also inhibits 5-lipoxygenase?

A

Zileuton

48
Q

how are luekotriene receptor antagonists administered?

A

Orally

49
Q

Who is ziluton NOT indicated w/?

A

patients with active liver dz

50
Q

who are luekotriene receptor antagonist contraindicated with?

A

pregnancy

elderly

51
Q

ADRs with leukotriene receptor antagonists

A

GI disturbances

HA

52
Q

What are 2 methylxanthines?

A

Theophylliline (oral)

Aminophylline (oral and iv form)

53
Q

MOA of methylxanthines?

A

to increase cAMP levels in the bronchial smooth muscle cells by inhibiting phosphodiesterase, an enzyme which catalyses the hydrolysis of cAMP to AMP.

54
Q

What does increased cAMP lead to?

A

relaxes smooth muscle, causing bronchodilation.

55
Q

Indications for methylxanthines

A

refractory patients

monotherapy and combo with ICS

56
Q

Contrindications of methylxanthines

A

Children <4
cardiac dz
HTN
hepatic impairment

57
Q

Problems with methylxanthinesN

A

narrow therapeutic window

significant interactions

58
Q

Name some mast cell stabilizers

A 
cromolyn sodium (inhaled) 
nedocromil (inhaled)
59
Q

MOA of mast cell stabilizers

A

stabilize mast cells preventing the release of inflammatory mediators

60
Q

Indications for mast cell stabilizers

A

Patients <20 w/ allergic dz; pregnancy

61
Q

which mast cell stabilizer is bitter?

A

Neocromil

62
Q

How long must mast cell stabilizer be used for effects?

A

Several weeks

63
Q

Reserved for moderate-to-severe persistent asthma in patients 12 years of age or older who are not controlled on other therapies (not first line therapy)
SQ injection

A

Omalizumab (Xolair)

64
Q

Black box warning for omalizumab

A

anaphylaxis

65
Q

MOA os systemic corticosteroids

A

Decrease inflammation by suppression of migration of leukocytes and reversal of increased capillary permeability.

66
Q

what route is preferred for systemic corticosteroids?

A

Oral over IV

67
Q

when do you see effects of systemic corticosteroids?

A

after 4-6 hours

68
Q

what are quick relief therapies for asthma?

A

Short acting beta2-adrenoceptor agonists

69
Q

name some bronchodilators

A

Albuterol
Pibuterol
Metaproternol
Levalbuterol

70
Q

MOA of beta 2 adrenoceptor agnoist

A

: β2-adrenoceptors are located on the airway smooth muscles and respond to epinephrine.

71
Q

indications of beta adrenoceptor agonist?

A

relieve bronchospasm during acute exacerbations

pretreatment exercise induced

72
Q

ADRS of beta 2 adrenoceptor agonist

A

fine tremor
tachycardia
hypokalemia w/ high doses

73
Q

____________ are the only inhaled agents indicated for acute asthma attacks therefore also used as rescue inhalers.

A

Short-acting beta agonist such as albuterol

74
Q

list some anticholinergics used for relief of acute bronchospasm (not chosen over albuterol)

A

Ipratropium

Tiotropium

75
Q

what anticholinergic may provide additive effects to B2-agonists, in acute setting

A

Ipratropium

76
Q

Are anticholinergics good for maintenance?

A

No

77
Q

Anticholinergics are an alternative for patients with what type intolerance?

A

B2-agnoist intolerance

78
Q

2 contraindications with anticholinergics

A

Glaucoma

Pregnancy

79
Q

what do systemic corticosteroids do?

A

prevent progression of asthma exacerbation

reduce morbidity of the illness

80
Q

If systemic corticosteroids are used more than how many times in a year should you re-evaluate their asthma treatment.

A

3 courses a year

81
Q

every patient diagnosed w/ asthma should get what?

A

SABA (rescue albuterol inhaler)

82
Q

for mild intermittent asthma what should they be given?

A

No daily meds

quick relief only

83
Q

If patient has mild persistent asthma what meds should they get?

A

Low dose inhaled steroids
PRN SABA
alternative tx- cromolyn or nedocromil, leukotriene modifier or theophylline

84
Q

What meds do you give for moderate persistent asthma

A

Low dose ICS and LABA; PRN SABA

Alternative- med/high dose ICS or low dose ICS + leukotriene modifier or theophylline

85
Q

Meds for severe persistent asthma

A

Medium or high dose ICS and LABA or if needed glucocorticosteroid

86
Q

Is COPD reversible?

A

No

87
Q

what do COPD patients get some relief from (not as well as asthmatics though)

A

Bronchodilators

Anti-inflammatory agents

88
Q

what is a hugely important therapy in COPD patients

A

Oxygen

89
Q

Associated with chronic or recurrent excess mucous secretion into the bronchial tree
Cough that occurs on most days during a period of at least 3 months of the year for at least 2 consecutive years.

A

Chronic bronchitis

90
Q

Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles
Accompanied by destruction of their walls, without obvious fibrosis

A

Emphysema

91
Q

how does oxygen work with COPD

A

It increases alveolar oxygen tension and decreases the work of breathing necessary to maintain arterial oxygen tension.

92
Q

what COPD patients shouldn’t receive oxygen?

A

patient who retain CO2, will depress their respiratory drive

93
Q

what is the gold standard in COPD meds?

A

anticholinergics (can add beta 2 agonist, improves better combined)

94
Q

Who should inhaled steroids be reserved for in COPD

A

Moderate to severe reduction in airflow that failed bronchodilator therapy

95
Q

when are anitbiotics used with COPD?

A

When at least 2 of the following 3 are present
increased dyspnea
increased sputum volume
increased sputum purulence

Pharm II (16 decks)

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