Asthma

Question 1

LTD4

Answer 1

Profound bronchoconstrictor released by leukotrienes. 1000x more potent than histamine

Question 2

Intrinsic Asthma

Answer 2

Considered non-immune
Usually no family hx
Occurs later on in life

Question 3

Extrinsic Asthma

Answer 3

Type-1 hypersensitivity rxn
Associated with other allergic manifestations
Serum IgE and Eosinophil count usually elevated

Question 4

Exercise induces asthma (EIA)

Answer 4

An asthma variant
Exercise triggers acute bronchospasm
Beta-agonists 10-15 mins before activity
Avoid activity in cold

Question 5

Asthma triad

Answer 5

Persistent wheeze
Chronic episodic dyspnea
Chronic cough

Question 6

Samters Triad

Answer 6

Asthma
Allergy to ASA
Nasal Polyps
(for aspirin-induced asthma)

Question 7

Beta 2 Agonists

Answer 7

Produce airway dilation
Decrease release of mediators
IMprove mucocililary transport

Question 8

Short acting Beta 2’s

Answer 8

Most widely used
Beta-2 selective
Albuterol, Proventil, Ventolin
Quick onset, lasts 4-6 hrs
2-4 puffs q4-6 hrs

Question 9

Beta 2 agonist SE

Answer 9

Tachycardia
Tremor
Hypokalemia
HA
Hyperglycemia
Increased lactic acid

Question 10

Long-acting Beta-2 agonists

Answer 10

Salmeterol (Serevent)
Formoterol (Foradil)
Levalbuterol (Xopenex)
Not rescue drugs
Slow onset (30 mins), lasts 9-12 hrs

Question 11

Ipratropium Bromide (Atrovent)

Answer 11

Anticholinergic
Main use in combo with beta agonist
Slow acting
minimal side effects

Question 12

Spiriva

Answer 12

Same profile as ipatropium bromide

Longer acting

Question 13

Theophylline

Answer 13

Medium potency bronchodilator

Narrow therapeutic window

Question 14

Theophylline SE

Answer 14

insomnia, nervousness
N/V anorexia
HA
Tachycardia

Question 15

Corticosteroids

Answer 15

Reduce airway inflammation
Use in acute illness
Use in chronic dz

Question 16

Inhaled steroids

Answer 16

reduce airway reactivity
Start inhaled steroids in any pt who is not controlled by bronchodilators
Good alternate to oral glucocorticoids

Question 17

Inhaled steroid SE

Answer 17

Thrush
Dysphonia
Systemic effects in larger doses
takes 2-4 weeks for therapeutic affect

Question 18

Inhaled steroid Types

Answer 18

Fluticasone (flovent)
Budesonide (pulmicort)
others

Question 19

Mast Cell stabalizers

Answer 19

Cromolyn (intal)
Nedocromil (Tilade)
Inhibit degranulation of mast cells
Most effective for seasonal dz
Prophylaxis 15-20 mins prior to exposure

Question 20

Leukotriene Inhibitors

Answer 20

Montelukast (Singulair)
Zafirlukast (Accolate)
Improvement in FEV1
Decrease need for beta agonist use
Safe in kids 6-14
Effective in combo with steroid or beta agonist

Question 21

Anti-IgE Monoclonal Antibodies

Answer 21

Omalizumab (Xolair)
Newer approach to tx of asthma
Inhibits binding of IgE to mast cellsLowers plasma IgE to undetectable levels