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Therapeutics I - Spring 2017 > Asthma > Flashcards

Asthma Flashcards

1
Q

Normal Value for FEV1

A

> 80%

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2
Q

Normal Value for FVC

A

Adults can empty 80% of air in 6 seconds

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3
Q

Normal Value for FEV1/FVC

A

Within 5% of predicted value (based on age, height, sex, gender)

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4
Q

Which spirometry test can be done at the patients home?

A

Peak Flow/ PEFR = Peak expiratory flow rate

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5
Q

Which Spirometry value determines if the disease is obstructive of restrictive

A

FEV1/FVC

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6
Q

what are obstructive diseases vs restrictive diseases of the lung

A

obstruct: asthma/COPD
restrict: pulmonary fibrosis

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7
Q

If the FEV1/FVC is low what kind of lung disease is it - obstructive or restrictive

A

obstructive

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8
Q

If the FEV1/FVC is normal what kind of lung disease is it - obstructive or restrictive

A

restrictive

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9
Q

If the FEV1/FVC is high what kind of lung disease is it - obstructive or restrictive

A

restrictive

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10
Q

Asthma or COPD - has DRY cough

A

asthma

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11
Q

Asthma or COPD - signs of atopy

A

asthma (atopy is basically allergies…)

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12
Q

Possible Asthma triggers

A
  • Exercise
  • Stress
  • pets
  • Emotions
  • Pollution
  • Insects/fecal matter
  • Dust
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13
Q

How to Classify Asthma

A

Intermittent or Persistant

within Persistant - mild, moderate, severe

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14
Q

COPD - what 3 main factors cause the airflow limitation

A
  • chronic bronchitis
  • emphysema
  • inflammation
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15
Q

Describe Emphysema

A

Abnormal enlargement of the airspaces in alveoli - leads to destruction of alveolar walls
- the structural changes/destruction of alveoli lead to REDUCED ELASTICITY

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16
Q

Definition of Chronic Bronchitis (number wise…)

A

Cough and Sputum production for at least 3 MONTHS in each of 2 CONSECUTIVE YEARS

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17
Q

Chronic bronchitis causes structural changes which will __________ the airways due to FIBROSIS

A

narrow

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18
Q

Inflammation in COPD - comes from irritants -

causes 2 things that will lead to making of fibroblasts

A 
Oxidative stress (more oxidants)
Protease - antiprotease imbalance (more proteases than antiproteases
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19
Q

Asthma or COPD - reversible

A

asthma

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20
Q

Asthma or COPD - irreversible

A

COPD

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21
Q

Hallmark symptoms of COPD

A

Chronic cough; dyspnea; SPUTUM PRODUCTION

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22
Q

Typically patient of COPD

A

> 40 years of age w/ common symptoms of COPD;
Hx of exposure to risk factors (smoke)
Family hx of COPD

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23
Q

COPD Signs

A 
BARREL CHEST!
Increase Resp. Rate
Use of accessory muscles to breath
Decreased breath sounds
Prolonger Expiration
Lips pursing on expiration
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24
Q

Particles that can cause COPD

A

CIGARETTE SMOOOOKE
Occupational dust/fumes
Indoor pollution

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25
Q

Spirometry is REQUIRED to diagnose _______

A

COPD

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26
Q

A post-bronchodilator FEV1/FVC has to be _______ to be diagnosed as COPD

A

< 0.7

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27
Q

Assessment Categories for COPD

A
  • Spirometry
  • Symptoms
  • Exacerbation Risk
  • Comorbidities
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28
Q

What do Inhaled beta agonists do

A

cause bronchodilation by relaxing bronchial smooth muscle

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29
Q

What are the SABAs (short acting beta 2 agonists)

A

Albuterol and Levalbuterol

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30
Q

What is the onset of action for SABAs

A

3 - 5 minutes

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31
Q

SABAs are best for _______ asthma symptoms

A

acute

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32
Q

Brand for Levalbuterol

A

Xopenex

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33
Q

Xopenex is what kind of asthma drug

A

SABA - short acting beta2 agonist (levoalbuterol)

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34
Q

What are the Long acting Beta 2 agonists (LABAs)

A 
Salmeterol
Formoterol
Arformoterol
Indacterol
Olodaterol
(there are combo products with inhaled corticosteroids and LAMAs)
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35
Q

What is the onset of action for LABAs (and peak effect time)

A

15 - 30 minutes - up to 3 hours for peak effect!!

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36
Q

Side effects of Beta 2 agonists for asthma

A

Hyped up pts = tachycardia, skeletal muscle tremors, palpitations
HYPOKALEMIA
HYPERGLYCEMIA

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37
Q

What is the Boxed Warning for LABAs

A

LABA canNOT be used as monotherpay for asthma patients!! Increased risk for asthma induced death

LABA monotherapy is OK for COPD patients tho

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38
Q

Brand: ?
Generic: Salmeterol

A

Serevent Diskus

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39
Q

Brand: ?
Generic: Formoterol

A

Foradil Aerolizer

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40
Q

Brand: ?
Generic: Arfomoterol

A

Brovana Nebulizer

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41
Q

Brand: ?
Generic: Indacterol

A

Arcapta Neohaler

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42
Q

Brand: ?
Generic: Olodaterol

A

Striverdi Respimat

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43
Q

Brand: Serevent Diskus
Generic: ?

A

Salmeterol

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44
Q

Brand: Foradil Aerolizer
Generic: ?

A

Formoterol

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45
Q

Brand: Brovana Neublizer
Generic: ?

A

Arformoterol

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46
Q

Brand: Arcapta Neohaler
Generic: ?

A

Indacterol

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47
Q

Brand: Striverdi Respimat
Generic: ?

A

Olodaterol

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48
Q

What are the SAMAs (short acting Antimuscarinics)

A

Ipratropium; Ipratropium + Albuterol

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49
Q

What are the LAMAs (long acting Antimuscarinics)

A 
Tiotropium
Umeclidinium 
Aclidinium
Glycopyrrolate
(there are combo products with LABAs)
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50
Q

Brand: ?
Generic: Tiotropium

A

Spiriva

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51
Q

Brand: ?
Generic: Umeclidinium

A

Incruse Elipita

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52
Q

Brand: ?
Generic: Aclidinium

A

Tudorza Pressair

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53
Q

Brand: ?
Generic: Glycopyrrolate

A

Seebri Nebulizer

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54
Q

Brand: Spiriva
Generic: ?

A

Tiotropium

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55
Q

Brand: Incruse Elipta
Generic: ?

A

Umeclidinium

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56
Q

Brand: Tudorza Pressair
Generic: ?

A

Aclidinium

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57
Q

Brand: Seebri Neohaler
Generic: ?

A

Glyccopyrrolate

remmeber this one bc seebri - like sebring and glyccopyrolate normally for GI -and mom has a sebring and GI issues…

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58
Q

Brand: ?
Generic: Ipratropium

A

Atrovent

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59
Q

Brand: ?
Generic: Ipratropium and Albuterol

A

Combivent

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60
Q

Brand: Atrovent
Generic: ?

A

Ipratropium

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61
Q

Brand: Combivent
Generic: ?

A

Ipratropium and Albuterol

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62
Q

If a COPD patient is Group A - how do you treat it?

A

bronchodilator —> try another class

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63
Q

If a COPD patient is Group B - how do you treat it?

A

Long acting bronchodilator –> LABA + LAMA

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64
Q

If a COPD patient is Group C - how do you treat it?

A

LAMA –> LABA + LAMA

can go to LAMA + ICS but try to hold off on ICS as much as possible in COPD pts

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65
Q

If a COPD patient is Group D - how do you treat it?

A

LABA + LAMA –> LABA + LAMA + ICS

Maybe Dalrisep or Macrolide Abx

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66
Q

An asthma patient that is intermittent will fall into Step ___ for asthma treatment

A

1

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67
Q

An asthma patient that is persistent - mild will fall into Step ___ for asthma treatment

A

2

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68
Q

An asthma patient that is persistent - moderate will fall into Step ___ for asthma treatment

A

3 or 4

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69
Q

An asthma patient that is persistent - severe will fall into Step ___ for asthma treatment

A

5 or 6

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70
Q

Asthma Treatment Guidelines:

Step 1

A

No control agent; Use SABA prn

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71
Q

Asthma Treatment Guidelines:

Step 2

A

Low ICS as control agent; SABA prn

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72
Q

Asthma Treatment Guidelines:

Step 3

A

Low ICS/LABA; SABA prn

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73
Q

Asthma Treatment Guidelines:

Step 4

A

Med or high ICS/LABA; SABA prn

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74
Q

Asthma Treatment Guidelines:

Step 5

A

Med or high ICS/LABA; SABA prn and maybe add on:

  • tiotropium
  • Anti-IgE
  • Anti-IL5
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75
Q

Alternate Controller Options for Asthma:

When would a leukotriene modifier be utilized?

A

Steps 2 - 4

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76
Q

Alternate Controller Options for Asthma:

When would low dose oral corticosteroid be utilized?

A

Step 5

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77
Q

3 main treatment strategies for Asthma

A

Bronchodilation; anti-inflammation; Inhibit mast cell degranulation

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78
Q

Treatment strategies for Asthma:

What drugs are used for bronchodilation

A
  • Beta2 agonists
  • Anticholinergics
  • Methylxanthines
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79
Q

Treatment strategies for Asthma:

What drugs are used for anti-inflammation

A

Glucocorticoids

Antileukotriene Agents

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80
Q

Treatment strategies for Asthma:

What drugs are used to inhibit mast cell degranulation

A

Cromolyn- like drugs

Xolair (Omalizumab)

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81
Q

what does LTRA stand for

A

leukotriene receptor antagonist

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82
Q

what does A1R stand for

A

adenosine receptor

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83
Q

what does CysLT stand for

A

cysteine leukotrienes

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84
Q

what does CystLT-1R stand for

A

cysteine leukotriene receptor

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85
Q

what does MAO stand for

A

monoamine oxidase

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86
Q

what does COMT stand for

A

catechol-O-methyltransferase

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87
Q

Sympathomimetic Amines aka

A

B2 adrenergic receptor agonists

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88
Q

Primary activity of sympathomimetic amines

A

relax bronchial smooth muscle

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89
Q

Secondary activities of sympathomimetic amines

A

inhibit release of mediators from mast cells, inhibit microvascular leakage, increase microcilliary transport of mucus

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90
Q

what pathway do B2 agonists stimulate/what is the pathway

A

they stimulate the GaS pathway - which increases the amount of cAMP –> more PKA –> PKA will phosphorylate MLCK to make it inactive –> causes relaxation

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91
Q

SABAs are resistant to (COMT/MAO/BOTH)

A

COMT

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92
Q

LABAs are resistant to (COMT/MAO/BOTH)

A

BOTH

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93
Q

Patients should not be using albuterol more than ____ times per week unless its for exercise induced asthma

A

2

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94
Q

inhalational drugs allow for more _____ action and fewer _______ effects

A

local; systemic

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95
Q

Adverse effects of Selective B2 adrenergic agonists

A
  • tachycardia/palpitations

- skeletal muscle tremors

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96
Q

Glucocorticoid MOA:

alter __________ of proteins involved in the ______ process

A

gene expression; inflammatory

97
Q

Glucocorticoid MOA:

what 3 type of cells will be found in the bronchial epithelium and submucosa and will be decreased via glucocorticoids

A

eosinophils, macrophages, mast cells

98
Q

Glucocorticoid MOA:

will inhibit synthesis of what ________ and ________

A

prostaglandins; Leukotrienes

99
Q

Glucocorticoids should not be used for patients under ____ years old

A

12

100
Q

How does theophylline work to cause bronchodilation?

A

antagonizes the adenosine receptor and inhibits PDE4

101
Q

What happens when the adenosine receptor is BLOCKED/antagonized by theophylline

A

the Gq pathway is NOT stimulated and not IP3/No Ca is released –> Myosin LC kinase does not work to activate myosin LC –> NO CONTRACTION

102
Q

what happens when PDE4 is inhibited by theophylline

A

if PDE4 doesn’t work - cAMP is not made into AMP = more cAMP = more PKA = it will INHIBIT myosin LC kinase = no activated mysoin LC = no contraction = relaxation

103
Q

why is theophylline not used as often anymore?

A

it has a narrow therapeutic range

104
Q

the half-life of theophylline is _______ in patients with _________

A

increased; CHF

105
Q

_________ will delay the absorption of theophylline

A

Mg and Al antacids

106
Q

Theophylline may aggravate pre-existing __________

A

seizure disorders

107
Q

What agents increase theophylline levels by competition

A
  • cimetidine
  • allopurinol
  • erythromycin
  • fluroquinolones
  • propranolol
  • leukotriene inhibitors (Zileutin)
108
Q

primary use for theophylline

A

prevent asthma attacks

109
Q

usual therapeutic range for theophylline

A

10 - 15 ug/mL

110
Q

when do you start to see adverse effects of theophylline

A

20 ug/mL

111
Q

Mechanism of Mast Cell degranulation process/what is needed

A 
1- IgE Ab bind to FcR
2- binding of antigen to IgE Ab
3 - clustering of FcR receptors
4 - influx of Ca2+ via CRAC (Calcium released activated channels)
5 -  ATP
112
Q

Ways to Inhibit Mast Cell Degranulation

A

Cromolyn and Xolair

113
Q

Cromolyn is very _____ (stable/unstable) but extremely _______ (soluble/insoluble)

A

stable; insoluble

114
Q

Is cromolyn used to treat an attack or used as preventative?

A

preventative — can’t

re-granulate a mast cell…..

115
Q

What is Xolair and how does it work

A

it is an anti-human IgE ab

Xolair will bind to IgE abs so that IgE cannot bind to the FcR1 receptors on mast cells

116
Q

Xolair is indicated for who?

A

patients over 12 y.o with moderate - severe persistent asthma and has been unresponsive to inhaled steroids

117
Q

xolair causes a 96% _______ in free _____ levels

A

reduction; IgE

118
Q

Brand for Zileuton

A

Zyflo

119
Q

what does Zileuton do

A

it is a selective inhibitor of 5-lipoxygenase –> inhibits synthesis of leukotrienes (LTB4, LTC4, LTD4)

120
Q

Zileuton - for acute attack or nah?

A

nah

121
Q

Zileuton is indicated for what?

A

the prophylaxis and treatment of chronic asthma

122
Q

Zileuton will _______ the blood levels of theophylline

A

double

123
Q

What are some Leukotriene inhibitors

A

Zieluton
Montelukast
Zafirlukast

124
Q

Accolate is brand for?

A

Zafirlukast

125
Q

how do zafirlukast/montelukast work?

A

the selectively and competitively inhibit CysLT1 receptor

126
Q

zafirlukast/montelukast are known to inhibit the ____ phase of _________

A

late; bronchoconstriction

127
Q

If zafirlukast/montelukast black the CysLt1R - what happens cellularly/in a pathway?

A

IF CysLt1R is inhibited - there is no Gq pathyway stimulated –> no IP3/Ca –> no muscle contraction

128
Q

CysLT1R antagonists (aka zafirlukast/montelukast) are metabolized by the ______

A

liver

129
Q

Food _______ the bioavailability zafirlukast/montelukast

A

reduces

130
Q

zafirlukast/montelukast - (should/should not) be abruptly substituted for inhaled/oral corticoisteroids

A

should NOT

131
Q

Drugs that are used to treat COPD

A
  • inhaled antimuscarinic agents
  • LABA
  • SABA
    (rare: a1 antitrypsin replacement)
132
Q

Ipratropium and Tiotropium are antimuscarinics used for ______ - their structures are both _____________ which ______ systemic absorption

A

COPD; quaternary ammonium compound; decreases

133
Q

___________ (Ipratropium or Tiotropium) has higher affinity and is more selective for the M1/M3 receptors

A

tiotropium

134
Q

how do antimuscarinics works? (pathway etc…)

A

they BLOCK Ach from working @ M1/M3 receptors - prevents Gq pathway –> no IP3/No Ca –> No contraction

135
Q

Iptratropium is given ______ time(s) per day

Tiotropium is given _____ time(s) per day

A

3 - 4; 1

136
Q

used for COPD, Asthma, or Both?

Formoterol

A

both (but remember cannot use JUST a LABA in asthma!!!)

137
Q

used for COPD, Asthma, or Both?

Salmerterol

A

both (but remember cannot use JUST a LABA in asthma!!!)

138
Q

used for COPD, Asthma, or Both?

Indacaterol

A

COPD only

139
Q

Remodeling in COPD - what kind of things occur

A
  • fibrosis of small airways
  • hyperinflation of lungs
  • Alveolar enlargement/wall destruction (emphysema)
  • mucus hypersecretion
140
Q

what is the drug Ivacaftor?

A

it is a CFTR regulator - will potentiate Cl current through CFTR in response to cAMP

141
Q

Adverse Events for ICS

A

oral thrush, cough, dysphonia (hoarse voice)

142
Q

which ICS product has a built in spacer

A

Aerospan

143
Q

Counseling tip for ICS

A

rinse and SPIT after use

144
Q

Clinical pearl about pulmicort respules

A

should use Jet nebulizer and should not be mixed with other nebulizer solutions

145
Q

want to titrate to the ________ effective dose because at ______ doses there is an increase for systemic side effects

A

lowest; high

146
Q

Boxed warnings for LABA agents

A

1) monotherapy of LABA with asthma patients can increase risk of asthma related death
2) increasing hospitalization in pediatric and adolescent patients

147
Q

adverse effects for LABA agents

A

tachycardia; headache; tremor; irritability

148
Q

LABA agents: _______ seen with intentional overdoses

A

prolonged QT

149
Q

LABA (may or may not) be useful for exercise induced bronchospasm

A

may

150
Q

Taken once or twice a day?

brovana

A

twice

151
Q

Taken once or twice a day?

foradil

A

twice

152
Q

Taken once or twice a day?

arcapta neohaler

A

once

153
Q

Taken once or twice a day?

striverdi respimat

A

once

154
Q

Taken once or twice a day?

Serevent

A

twice

155
Q

Taken once or twice a day?

Turdoze

A

twice

156
Q

Taken once or twice a day?

Spiriva

A

handihaler - once

respimat - once

157
Q

Taken once or twice a day?

Incruse ellipta

A

once

158
Q

Taken once or twice a day?

QVAR

A

twice

159
Q

Taken once or twice a day?

Budesonide DPI/Flexhaler

A

twice

160
Q

Taken once or twice a day?

Alvesco

A

once

161
Q

Taken once or twice a day?

Aerospan

A

twice

162
Q

Taken once or twice a day?

Flovent

A

twice

163
Q

Taken once or twice a day?

Armon Air

A

twice

164
Q

Taken once or twice a day?

Arnuity Ellipta

A

twice

165
Q

Taken once or twice a day?

Asmanex

A

twice for adults

166
Q

Taken once or twice a day?

Budesonide nebulizer

A

once (divided dose maybe…)

167
Q

Adverse effects of LAMA

A

dry mouth dizziness, blurred vision, upper RTIs; paradoxical bronchospasms

168
Q

_______ (a antimuscarinic) has been approved for use in asthma as an add-on option in steps ___ or ____ (IF has Hx of exacerbations despite ICS and LABA use)

A

tiotropium; 4;5

169
Q

Taken once or twice a day?

Advair

A

twice

170
Q

Taken once or twice a day?

airduo

A

twice

171
Q

Taken once or twice a day?

symbicort

A

twice

172
Q

Taken once or twice a day?

dulera

A

twice

173
Q

Taken once or twice a day?

Breo Ellipta

A

once

174
Q

Taken once or twice a day?

Stiolto Respimat

A

once

175
Q

Taken once or twice a day?

Anoro Ellipta

A

once

176
Q

Taken once or twice a day?

Utibron Neohaler

A

twice

177
Q

Taken once or twice a day?

Bevespi Aerosphere

A

twice

178
Q

Adverse effects of SABAs

A

tachycardia; hypokalemia; skeletal tremors; irritability

179
Q

May mix albuterol nebulizer solution with what other things?

A

cromolyn solution;

budesonide inhalant suspension; ipratropium solution

180
Q

Levoalbuterol and albuterol comparison

A

levoalbuterol at 1/2 mg dose of albuterol will provide comparable efficacy and safety

181
Q

Adverse effects of SAMAs

A

Dry mouth; urinary retention; infection; sinusitis; bronchitis

182
Q

which is first line therapy for severe exacerbations?

albuterol or ipratropium

A

albuterol

183
Q

Adverse effects of systemic corticosteroids

A

short term use: Hyperglycemia; increased appetite; fluid retention; demargination of WBCS; psychiatric disturbances;

184
Q

Drug interactions with oral corticosteroids

A

warfarin INR increases; efficacy of vaccines decreases

185
Q

can oral corticosteroids and ICS be used together?

A

yes if ICS was being used before hospital exacerbation

186
Q

contraindications of oral corticosteroids

A

systemic fungal infections; administration of live vaccine

187
Q

why are “bursts” of oral corticosteroids used

A

to establish control when initiating therapy or during period of gradual deterioration

188
Q

when can you do an injection of systemic corticosteroids

A

injection may be used in place of burst if adherence or vomiting is an issue

189
Q

main causes of exacerbations

A

RTIs; Air pollution; unknown;

190
Q

how to treat an exacerbation

A

1) short acting bronchodilators and Systemic Corticosteroids
(albuterol/ipratropium and prednisone 40 mg x 5 days)

2) Abx if CARDINAL SX PRESENT

191
Q

what abx are typically used for treating the cardnial symptoms of an exacerbation

A

macrolides; tetracyclines; amoxicillin/clauvulanate;

192
Q

how long are abx typically used for treating the cardnial symptoms of an exacerbation

A

5 - 7 days

193
Q

Cardinal Symptoms needed in order to give Abx to an exacerbation patient

A

sputum purulence; sputum volume; dyspnea

need all 3 or at least 2 and one of them mst be sputum purulence

194
Q

Pathogenesis of Asthma:

Early reaction

A

early - IMMEDIATE bronchoconstriction

antigen binding to IgE Abs will release contents from mast cells/bronchial smooth muscle contraction/vascular leakage

195
Q

Pathogenesis of Asthma:

Delayed Reaction:

A

2 - 8 hours

  • sustained bronchoconstriction
  • activation of TH2 lymphocytes
  • mucus hypersecretion
  • cellular infiltration
196
Q

when TH2 lymphocytes get activated during the delayed reaction of asthma - what is released

A

GM-CSF; IL-4; IL-5; IL-13

197
Q

pathophysiology of asthma:

PAF = platelet activating factor and it causes what?

A

hyper-responsiveness

198
Q

pathophysiology of asthma:

ECP = eosinophil cationic protein - what is it?

A

cytotoxic and a marker of inflammation

199
Q

what is periostin?

A

a matrix protein biomarker

200
Q

how does hypersecretion of mucus in asthma happen?

A

TH2 cells release cytokines –> cytokines causes hyperplasia of goblet cells –> hypersecretion of mucus

201
Q

Hypersecretion of asthma:

what molecule causes the maintenance of hyperplasia?

A

Bcl-2

202
Q

Hypersecretion of asthma:

what molecule causes the development of hyperplasia

A

EGFR; CLCA

203
Q

Genetics and Goblet Cell Hyperplasia

A

IL-4a can have a mutation where Q576 becomes R576 this causes an enhanced response to IL-13;

~50% of African Americans are homozygous for R576 in IL-4a

204
Q

_________ promotes chronic allergic inflammation in response to Th2 cytokines

A

Periostin

205
Q

Airway Remodeling in Asthma:

what happens to the EPITHELIUM?

A

mucous hyperplasia and hypersecretion

206
Q

Airway Remodeling in Asthma:

what happens to the basement membrane?

A

thickening

207
Q

Airway Remodeling in Asthma:

what happens to the smooth muscle

A

hypertrophy

208
Q 
Remodeling in COPD:
\_\_\_\_\_\_\_ of small airways
\_\_\_\_\_\_\_\_ of lungs
Alveolar \_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_ hypersecretion
A

fibrosis; hyperinflation; enlargement; wall destruction; mucus

209
Q

why is a deficiency of alpha-1-antitrypsin bad for COPD pts?

A

NORMALLY alpha-1-antitrypsin INHIBITS neutrophil elastase and limits lung tissues damage

210
Q

What is a cardinal early sign of cystic fibrosis?

A

excessively salty sweat

211
Q

Loss of CFTR function in airway epithelium causes _________

A

thickening of mucus because of dehydrated ASL (airway surface liquid)

212
Q

Lumen of Sweat Duct - how does it normally operate

A

CFTR brings Cl- into the cell and Na+ also comes into the cell via ENaC

213
Q

2 main inflammatory mediators that will stimulate the Gq/IP3/Ca/Contraction pathway

A

LTC4/LTD4 and Histamine

214
Q

Serum Levels of Theophylline and Adverse effects seen there:

20 ug/mL

A

20 ug/mL - nausea/vomiting/nervousness

/abdominal cramping

215
Q

Serum Levels of Theophylline and Adverse effects seen there:

> 25 ug/mL

A

cardiac arrythmias; hypotension; CNS stimulation

216
Q

Serum Levels of Theophylline and Adverse effects seen there:

40 - 100 ug/mL

A

seizures/CV arrest

217
Q

what dosage forms does theophylline come in?

A

ER tablet; ER Capsule; Liquid

218
Q

Adverse effects of Theophylline

A

(THINK OF COFFEE!!) insomnia; GI upset; hyperactivity; hypotension

219
Q

Dose related toxicities of Theophylline (according to Miller)

A

Tachycardia; nausea; vomiting; headache; seizures; arrhytmias

220
Q

Contraindications of theophylline

A
  • peptic ulcers disease
  • Arrhythmias
  • seizure disorders
221
Q

Drug interactions of theophylline:

Theophylline is a major _______ for what CYP enzyme(s)

A

substrate; 3A4; 1A2; 2E1

222
Q

Drug-Interactions of Theophylline:

will increase the concentration of what drugs?

A
  • cimetidine
  • erythromycin
  • clarithromycin
  • ciprofloxacin
  • ticlopidine
223
Q

Miller’s target range for theophylline

A

5 - 15 mcg/mL

224
Q

Drug-Interactions of Theophylline:

will decrease the concentration of what drugs?

A
  • phenobarbitol
  • phenytoin
  • carbamazepine
  • rifampin
  • smoking
225
Q

_____________ is likely the cause for hypotension/tachycardia/nausea seen from theophylline

A

PDE III inhibition

226
Q

For COPD or Asthma?

Daliresp

A

COPD

227
Q

things to monitor with Daliresp

A

Liver function tests; Weight

228
Q

Adverse effects of Xolair

A
  • Headache
  • injection site reactions
  • arthralgias
  • thrombocytopenia
  • pharyngitits
  • sinusitis
  • upper RTIs
229
Q

Xolair: Do not administer more than _______ per injection site

A

150 mg

230
Q

Who is Xolair FDA approved for?

A

moderate - severe asthma patients w/ a positive skin test/reactivity in a perennial aeroallergen and Sx that are inadequately controlled with ICS

231
Q

Adverse events for Nucala

A
  • headache
  • infection site reactions
  • arthralgias
  • Herpes Zoster infection
232
Q

when is Nucala used for an add-on maintenance treatment?

A

when the patient has severe asthma with an EOSINOPHILIC phenotype

233
Q

when is Cinqair used for an add-on maintenance treatment?

A

when the patient has severe asthma with an EOSINOPHILIC phenotype

234
Q

Adverse events of Cinqair

A
  • injection site reactions
  • myalgias
  • increased creatine phosphokinase
235
Q

Which monoclonal Ab has a boxed warning for malignancies?

A

Cinqair

236
Q

Formoterol or Salmeterol?

Which one has a longer duration? and why

A

Salmeterol - it has more lipophilcity

237
Q

Formoterol or Salmeterol?

Which one has the greater receptor affinity?

A

Salmeterol

238
Q

Formoterol or Salmeterol?

Which one has greater water solubility/moderate lipophilicity?

A

formoterol (will have shorter duration of action)

Therapeutics I - Spring 2017 (17 decks)

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