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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
Q

What is step 5 treatment for GINA?

A
  • high dose ICS + LABA
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26
Q

How many treatments dose it take to get patient back to normal after an exacerbation?

A

3

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27
Q

Which medications prevent bronchoconstriction?

A
  • Beta 2 agonist
  • theophylline
  • anti-muscarinic
  • mediator antagonists
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28
Q

Which drugs prevent inflammation?

A

-corticosteroids

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29
Q

Which drugs prevent antigen irritant rx?

A
  • immunotherapy

- leukotriene inhibitors

30
Q

What is MOA of Beta 2 agonist?

A
  • binds beta 2 receptors induces G-proteins to stimulate AC enzyme
  • cAMP increases in smooth muscle cells
  • potent bronchodilator
31
Q

Name three beta agonists?

A
  • Albuterol
  • Terbutaline
  • Metaproterenol
  • less than 6 hour duration
32
Q

Name a long duration beta agonist?

A

-Salmeterol. lasts 12-24hrs, formoterol

33
Q

What is the use of albuterol?

A

acute asthma relief

34
Q

What are ADE for albuterol?

A
  • tachycardia

- Tremor

35
Q

What is the use of salmeterol?

A
  • asthma prophylaxis

- not for acute relief

36
Q

What are ADE for salmeterol?

A
  • tremor
  • tachycardia
  • cardiovascular events
37
Q

Name three anti-muscarinic agents?

A
  • Atropine
  • Ipratropium-less systemic effects
  • Tiotropium-longer acting
38
Q

What is MOA of anti-muscarinic agents?

A

blocks muscarinic receptors so that Ach does not bind

-prevents bronchoconstriction

39
Q

What are ADE of ipratropium and tiotropium?

A
  • cough

- dry mouth

40
Q

What are the clinical application of tiotropium and ipratropium?

A
  • COPD
  • asthma
  • useful in peds
41
Q

Name 3 Methylxanthines?

A
  • caffeine
  • theophylline
  • theobromine
42
Q

What is MOA of theophylline?

A
  • blocks PDE which prevents degradation of cAMP inducing bronchodilation
  • blocks adenosine receptors to stop bronchodilation
43
Q

What are the clinical applications of theophylline (2)?

A
  • fatigue

- prophylaxis for nocturnal asthma attacks-nots 1st line

44
Q

What are ADE of theophylline?

A
  • insomnia
  • tremors
  • anorexia
  • seizures
  • arrhythmia
45
Q

T/F Beta blockers are useful in reversing toxicity from theophyllline

A

True

46
Q

What are some effects of theophylline?

A
  • increased contraction of diaphragm
  • diuresis
  • cardiac stimulation
  • increased GI motility
47
Q

Who has the highest clearance rate for theophylline?

A
  • young adults

- smokers

48
Q

T/F Theobromine has increased cardiac effects while caffeine has increased CNS effects

A

True

49
Q

Name 2 systemic/oral corticosteroids?

A
  • prednisone

- prednisolone

50
Q

Name 4 inhaled/ICS?

A
  • Budeosonide
  • Beclomethasone
  • Fluticasone
  • Mometasone
51
Q

When do you use prednisone? When do you use ICS?

A
  • acute asthma exacerbations

- moderate to severe asthma -1st line tx

52
Q

What is MOA of corticosteroids?

A
  • blocks phospholipase A2 and blocks synthesis of arachidonic acid
  • reduces expression of COX 1 enzyme
53
Q

What are clinical applications of ICS? oral steroids?

A

-asthma prophylaxis, tx of late response, anti- inflammatory
-acute refractory asthma
-

54
Q

What are ADE of corticosteroids (7)?

A
  • HPA axis shutdown
  • striae
  • psychiatric issues/depression
  • cataracts
  • mild growth retardation
  • pharyngeal candidiasis (ICS)
  • impaired wound healing
55
Q

What is MOA of leukotrienes?

A

-blocks LTD4 leukotriene receptor

56
Q

Name 2 leukotriene receptor antagonists?

A

Monteleukast

-Zafirlukast

57
Q

What is clinical applications of LRA?

A

-prevents exercise, antigen, and aspirin induced bronchospasms

58
Q

T/F LRA are just as effective in treating acute asthma exacerbations as corticosteroids?

A

False -LRA are not as effective

59
Q

What is MOA of zileuton?

A

-blocks lipoxoygenase enzyme and stops production of leukotrienes which are potent vasoconstrictiors

60
Q

What is clinical application of zileuton?

A

aspirin allergy , prophylaxis of asthma

61
Q

What are ADE of zileuton?

A

elevated liver enzymes

62
Q

What is MOA of cromolyn?

A

-reduces release of inflammatory mediators from mast cells

63
Q

What is ADE of cromolyn (1)?

A

cough

64
Q

When is cromolyn used?

A
  • for people who mow lawns

- rarely used for asthma prophylaxis

65
Q

What is MOA of Omalizumab?

A

-antibody that binds IgE on mast cells and stops antigen sensitization or asthma tiggers

66
Q

What is route of administration for Omalizumab?

A

-parenterally

67
Q

What is clinical application of Omalizumab?

A
  • very sick patients
  • very expensive
  • last resort
68
Q

What is MOA of Mepolizumab or Reslizumab?

A

-IgE to IL-5

69
Q

What is clinical application of Mepolizumab or Reslizumab?

A
  • patients with high eosinophils
  • adult onset asthma
  • high NO
70
Q

What is ADE of mepolizumab?

A

herpes zoster virus

Pharmacology (47 decks)

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