asthma

Question 1

phosphodiesterase inhibitor

Answer 1

theophylline - oral type of methylxanthimes (tea)
prevents breakdown of cAMP that inc. bronchodilaton
bronchodilator and good prophylatic for night attacks

Question 2

phosphodiesterase inhibitor ADE

Answer 2

CNS and heart problems
insomnia tremor seizures
anorexia arrhythmias
narrow therapeutic range

Question 3

anticholinergics

aka muscranics

Answer 3

aerosol bronchodilator (to dec. systemic effect)
atropine
ipatropium
tiotropium (longer acting)
ADE anticholinergic effects (mad hatter etc)

Question 4

*short acting

beta 2 agonist

Answer 4

albuterol* terbutaline metaproterenol

B2 selective, 1st line

Question 5

SABA ADE

Answer 5

ADE: tremor and bradycardia

Question 6

long acting beta 2 agonist

Answer 6

salmeterol* formaterol indacterol
B2 selective
asthma prophylaxis
potentiates corticosteroids

Question 7

LABA ADE

Answer 7

tremor
tachycardia
cardiac events

Question 8

corticosteroids moa

Answer 8

blocks phosphodiesterase A2 (top of COX LOX b4 split)

Question 9

corticosteroids

Answer 9

oral prednisone - for acute exacerbations or chronically if nothing works
inhaled fluticasone- 1st line prophylaxis
(mometasone, budesonide)
IV prednisolone- prednisione + hydrocortisone for status asthmaticus

Question 10

inhaled corticosteroids ADE

Answer 10

pharyngeal candidiasis
lil steroid toxicity (adrenal supression)
in kids: dec. growth but eventually reach full height

Question 11

leukotriene antagonist

Answer 11

oral montelukast and zafirlukast
for asthma prophylaxis not acute episodes
blocks bronchospasm to antigen, aspirin, exercise
low toxicity not as effective as corticosteroids

Question 12

lipogenase inhibitor

Answer 12

zileuton
inhibits lipogenase so no leukotriene made
for asthma prophylaxis
good for aspirin allergy
elevates liver enzymes

Question 13

anti IgE antibody

Answer 13

cromlyn, nedocromil
insoluble, large doses oral or aerosol so not systemic
dec. release of mediators from mast cells
not a bronchodilator but prevent bronchospasm
good for food allergies*
early bronchoconstriction late inflammation

Question 14

monoclonal/ IgE antibody

Answer 14

binds to IgE on mast cells so mast cells not activated and dont release mediators
expensive, parentally (not orally)

Question 15

mepollizumab

Answer 15

monoclonal antibody to IL5
for eosinophilic asthma
can dec. corticosteroids
inc. risk of herpes zoster so get vaccine 4 wks before

Question 16

GINA diagnosis

Answer 16

Dx with hx of respiratory symptoms
(cough wheezing SOB chest tightness)
and expiratory airflow limitations FEV1/FVC

Question 17

rules of 2s

Answer 17

symptoms SABA = to 2 days a week
night waking = 1 day a month
= exacerbation needing oral glucocorticoids

Question 18

GINA steps

Answer 18

step 1 SABA
step 2 low ICS
step 3 low/med ICS and LABA
step 4 med/high ICS and LABA
step 5 refer for anti IgE, IL5 tiotropium
SLIT sublingual immunotherapy:
if symptoms w/ ICS if FEV1 > 70%
increase steps w/ symptoms
decrease steps w/ 3 months dont stop ICS

Question 19

Inhaler tips

Answer 19

shake 5 secs, breathe out normal
4 cm from mouth (2 fingers)
breathe in deep and slow during inhalation
hold 5 to 10 seconds
wait 15-30 seconds btwn puffs
rinse mouth with ICS inhaler, dont swallow