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Pharmacology > ASTHMA > Flashcards

ASTHMA Flashcards

1
Q

Which drugs increase susceptibility to asthma (5)?

A
  • NSAIDS
  • Aspirin
  • Acetaminophen
  • non selective beta blocker
  • sulfites
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2
Q

What is asthma drug therapy aimed at preventing(3)?

A
  1. airway narrowing
  2. bronchospasms
  3. inflammation
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3
Q

What are the phases of an asthma attack?

A
  1. Immediate asthma response: antigen triggers bronchoconstriction due to cytokine release (minutes)
  2. Late phase: interleukin and interferons produce mucous
  3. Chronic phase: remodeling happens
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4
Q

What classifies intermittent asthma at initial visit(6)? Step 1

A
  • < 2 symptoms/week
  • nighttime awakenings <2x/month
  • SABA use <2x/week
  • no interference with daily activities
  • 0-1/ year for exacerbations
  • FEV1/FVC: normal FEV1% predicted >80%
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5
Q

What is treatment for intermittent asthma?

A

SABA as needed

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6
Q

What classifies mild asthma at initial visit? Step 2

A

symptoms >2x/ week but not daily

  • night time awakenings 3-4x/month
  • SABA used more > 2x/week but not daily
  • minor limits to daily activities
  • exacerbations >2x/year
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7
Q

What is the treatment for mild asthma? What is alternative treatment?

A
  • low dose ICS

- cromolyn or monteleukast

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8
Q

What classifies moderate asthma at initial visit ? Step 3

A
  • symptoms daily
  • saba used daily
  • nighttime awakenings >1x/week but not nightly
  • FEV1% predicted: 60-80%
  • FEV1/FVC: 75-80%
  • exacerbations >2x/year but more severe than mild
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9
Q

What is treatment for moderate asthma? what is alternative tx?

A

-medium dose ICS or low dose ICS + LABA

alternative tx: low dose ICS + LTRA or theophylline or zieluton

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10
Q

What classifies severe asthma at initial visit?

A

-symptoms throughout the day
-saba used several times/day
-night time awakenings often 7x/week
-extremely limited daily activities
-FEV1% predicted <60%
FEV1/FVC <70%

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11
Q

What is treatment for severe asthma?

A
  • med dose ICS + LABA

- med dose ICS + LTRA or zieluton or theophylline

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12
Q

What is Step 5 treatment?

A
  • high dose ICS +LABA

- consider omalizumab for allergy patients

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13
Q

What is step 6 treatment?

A

-high dose ICS + LABA + oral systemic steroid

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14
Q

What classifies a well controlled asthma follow up visit?

A
  • no interference with normal activity
  • <2x/week in symptoms
  • SABA used <2/week
  • exacerbations 0-1/year
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15
Q

How do you manage well controlled asthma?

A
  • keep patient on current regimen

- schedule patient 1-6 months

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16
Q

What is considered not well controlled asthma?

A
  • use of SABA more than 2x/week
  • exacerbations >2x/year
  • 1-3x/week for night awakenings
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17
Q

How do you manage not well controlled asthma?

A
  • go up 1 step

- follow up with patient in 2-6 weeks

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18
Q

What classifies poorly/ uncontrolled asthma?

A
  • SABA used through the day
  • night awakenings >4x/week
  • limited activity
  • exacerbation >2x/year
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19
Q

How do you manage uncontrolled asthma?

A
  • short course of oral systemic steroids

- schedule patient for 2 weeks follow up

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20
Q

How are the GINA guidelines different than the asthma quick reference guide?

A

-GINA recommends ICS use from the beginning due to recognizing asthma as inflammation issue

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21
Q

What is Step 1 tx for GINA?

A

-low dose ICS +SABA

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22
Q

What is Step 2 tx for GINA?

A

low dose ICS + SABA

alternative: leukotriene

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23
Q

What is step 3 tx for GINA?

A

low dose ICS + LABA

alternative: medium dose ICS or low dose ICS + LTRA

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24
Q

What is step 4 tx for GINA?

A

medium dose ICS + LABA
or high dose ICS
add on: triotropium (LAMA) or LTRA

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25
What is step 5 treatment for GINA?
- high dose ICS + LABA
26
How many treatments dose it take to get patient back to normal after an exacerbation?
3
27
Which medications prevent bronchoconstriction?
- Beta 2 agonist - theophylline - anti-muscarinic - mediator antagonists
28
Which drugs prevent inflammation?
-corticosteroids
29
Which drugs prevent antigen irritant rx?
- immunotherapy | - leukotriene inhibitors
30
What is MOA of Beta 2 agonist?
- binds beta 2 receptors induces G-proteins to stimulate AC enzyme - cAMP increases in smooth muscle cells - potent bronchodilator
31
Name three beta agonists?
- Albuterol - Terbutaline - Metaproterenol - less than 6 hour duration
32
Name a long duration beta agonist?
-Salmeterol. lasts 12-24hrs, formoterol
33
What is the use of albuterol?
acute asthma relief
34
What are ADE for albuterol?
- tachycardia | - Tremor
35
What is the use of salmeterol?
- asthma prophylaxis | - not for acute relief
36
What are ADE for salmeterol?
- tremor - tachycardia - cardiovascular events
37
Name three anti-muscarinic agents?
- Atropine - Ipratropium-less systemic effects - Tiotropium-longer acting
38
What is MOA of anti-muscarinic agents?
blocks muscarinic receptors so that Ach does not bind | -prevents bronchoconstriction
39
What are ADE of ipratropium and tiotropium?
- cough | - dry mouth
40
What are the clinical application of tiotropium and ipratropium?
- COPD - asthma - useful in peds
41
Name 3 Methylxanthines?
- caffeine - theophylline - theobromine
42
What is MOA of theophylline?
- blocks PDE which prevents degradation of cAMP inducing bronchodilation - blocks adenosine receptors to stop bronchodilation
43
What are the clinical applications of theophylline (2)?
- fatigue | - prophylaxis for nocturnal asthma attacks-nots 1st line
44
What are ADE of theophylline?
- insomnia - tremors - anorexia - seizures - arrhythmia
45
T/F Beta blockers are useful in reversing toxicity from theophyllline
True
46
What are some effects of theophylline?
- increased contraction of diaphragm - diuresis - cardiac stimulation - increased GI motility
47
Who has the highest clearance rate for theophylline?
- young adults | - smokers
48
T/F Theobromine has increased cardiac effects while caffeine has increased CNS effects
True
49
Name 2 systemic/oral corticosteroids?
- prednisone | - prednisolone
50
Name 4 inhaled/ICS?
- Budeosonide - Beclomethasone - Fluticasone - Mometasone
51
When do you use prednisone? When do you use ICS?
- acute asthma exacerbations | - moderate to severe asthma -1st line tx
52
What is MOA of corticosteroids?
- blocks phospholipase A2 and blocks synthesis of arachidonic acid - reduces expression of COX 1 enzyme
53
What are clinical applications of ICS? oral steroids?
-asthma prophylaxis, tx of late response, anti- inflammatory -acute refractory asthma -
54
What are ADE of corticosteroids (7)?
- HPA axis shutdown - striae - psychiatric issues/depression - cataracts - mild growth retardation - pharyngeal candidiasis (ICS) - impaired wound healing
55
What is MOA of leukotrienes?
-blocks LTD4 leukotriene receptor
56
Name 2 leukotriene receptor antagonists?
Monteleukast | -Zafirlukast
57
What is clinical applications of LRA?
-prevents exercise, antigen, and aspirin induced bronchospasms
58
T/F LRA are just as effective in treating acute asthma exacerbations as corticosteroids?
False -LRA are not as effective
59
What is MOA of zileuton?
-blocks lipoxoygenase enzyme and stops production of leukotrienes which are potent vasoconstrictiors
60
What is clinical application of zileuton?
aspirin allergy , prophylaxis of asthma
61
What are ADE of zileuton?
elevated liver enzymes
62
What is MOA of cromolyn?
-reduces release of inflammatory mediators from mast cells
63
What is ADE of cromolyn (1)?
cough
64
When is cromolyn used?
- for people who mow lawns | - rarely used for asthma prophylaxis
65
What is MOA of Omalizumab?
-antibody that binds IgE on mast cells and stops antigen sensitization or asthma tiggers
66
What is route of administration for Omalizumab?
-parenterally
67
What is clinical application of Omalizumab?
- very sick patients - very expensive - last resort
68
What is MOA of Mepolizumab or Reslizumab?
-IgE to IL-5
69
What is clinical application of Mepolizumab or Reslizumab?
- patients with high eosinophils - adult onset asthma - high NO
70
What is ADE of mepolizumab?
herpes zoster virus

Pharmacology (47 decks)

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