Asthma and Asthma Pharm

Question 1

Things we always have to ask about in the history to diagnose asthma?

Answer 1

Coughing! Always have to ask about a night time cough. Wheezing too but not always present

Question 2

How would we set up successful management of asthma?

4

Answer 2

1. Routine monitoring of lung function
2. Patient education
3. Environmental factors (avoid triggers)
4. Pharm (taper down or taper up step wise approaches)

Question 3

What is asthma?

Answer 3

A chronic inflammatory disorder of the airways.

Question 4

Kids with what kind of symptoms often test positive for asthma?
3

Answer 4

children with atopy/eczema risk factors for asthma. obesity- sleep apnea also would cause asthma exacerbations by increasing chronic inflammation

Question 5

Definition of asthma?

3

Answer 5

A complex disorder characterized by variable and recurring symptoms,

1. airflow obstruction,
2. bronchial hyperresponsiveness and an
3. underlying inflammation.

Question 6

What are the three things that cause airflow limitations?

Answer 6

Bronchoconstriction

Airway hyperresponsiviness

Airway edema

Question 7

Describe the following:
Bronchoconstriction

Airway hyperresponsiviness

Airway edema

Answer 7

—Bronchial smooth muscle contraction in response to exposure to a variety of stimuli

—Exaggerated bronchoconstrictor response to stimuli

—Edema, mucus hypersecretion, formation of thickened mucus plugs

Question 8

Asthma is characterized by episodic, reversible _____ resulting from an exaggerated ______ ______ to various stimuli.

Answer 8

bronchospasm

bronchoconstrictor response

Question 9

Symptoms patterns for asthma can vary. Describe how they can present?
4

Answer 9

1. Perennial versus seasonal
2. Continual versus episodic
3. Duration, severity and frequency
4. Diurnal variations (nocturnal and early morning)

Question 10

Inflammatory response involves multiple players

The trigger or stimulus may be exposure to intrinsic or extrinsic host factors such as?

Answer 10

Eosinophils

Lymphocytes

MAST Cells

Question 11

Describe the following in how they affect asthma pts:

Eosinophils?

Lymphocytes?

MAST Cells?

Answer 11

– release granular protein that damages bronchial epithelium and promotes airway hyper-responsiveness. (allergic and parasites)

– produce Cytokenes, Leukotriene B-4 and C-4, prostaglandin and histamine. (viral)

– initiate arousal condition in IgE receptors

Question 12

What are leukotrienes?

How do they work in exacerbating asthmatics?
5

Answer 12

Potent Inflammatory Mediators

1. Increased vascular permeability /edema
2. Increased mucus production
3. Decreased mucociliary transport
4. Inflammatory cell recruitment i.e. eosinophils—release inflammatory mediators i.e. cationic proteins
5. LTD4: profound bronchoconstriction, about 1000 x more potent than histamine

Question 13

Describe the early phase of an asthma exacerbation?

2

Answer 13

1. IgE is secreted by plasma cells, binds to receptors on mast cells and basophils
2. Mast cells release mediators that contract airway smooth muscle directly

Question 14

Describe the late phase of an asthma exacerbation?

3

Answer 14

1. Recruitment of inflammatory and immune cells, including the eosinophil, basophil, neutrophil, and helper, memory T-cells to sites of allergen exposure.
2. Dendritic cells are also recruited and play an important role.
3. The late phase reaction is more complex than just causing smooth muscle contraction.

Question 15

What is the difference between instrinsic and extrinsic asthma?

Etiology?
Onset?
Genetic?

Answer 15

Intrinsic:
1. Considered non-immune
Serum IgE levels are normal
2. Usually develops in later life
3. Usually no personal or family hx

Extrinsic:

1. Type-1 Hypersensitivy reaction
   - Associated with other allergic manifestations
2. Onset is usually the first two decades of life
3. Family history

Question 16

Stimuli that have little or no effect in normal subjects can trigger bronchospasm in intrinsic asthmatics. What are examples of these?
8

Answer 16

1. ASA
2. Pulmonary infections (especially viral)
3. Cold
4. Psychological stress
5. Exercise
6. Inhaled irritants
7. GERD
8. Post nasal drip

Question 17

What is samters triad?

Answer 17

aspirin, allergy/ rhinitis, nasal polyps

Question 18

What is usually elevated in extrinsic asthma pts?

2

Answer 18

Serum IgE and eosinophil count are usually elevated

Question 19

Occupational asthma and

Allergic bronchopulmonary aspergillosis are categorized as what kind of asthma?

Answer 19

extrinsic

Question 20

What is exercise induced asthma?

Can be found in asthmatics, patients with the following types:
3

Treatment?
2

Answer 20

Exercise or vigorous physical activity triggers acute bronchospasms in persons with heightened airway reactivity.

Can be found in asthmatics, patients with

1. atopy,
2. allergic rhinitis, or even
3. healthy persons
4. Beta-Agonist 10-15 minutes before activity
5. Avoid activity in cold air if possible

Question 21

Classic triad of symptoms

in asthmatics?

Answer 21

1. Persistent wheeze, end expiratory wheeze
2. Chronic episodic dyspnea
3. Chronic cough

Question 22

Associated Symtpoms in asthmatics?

7

Answer 22

1. Tachypnea, tachycardia, and systolic hypertension
2. Audible harsh respirations, prolonged expiration, wheezing
3. Sputum production (yellow sputum is probably underlying asthma)
4. Chest pain or tightness
5. Hemoptysis (pretty rare)
6. Diminished breath sounds during acute exacerbations
7. Pulses paradoxus (pulse rate changes with inspiration and expiration)- asthma, tamponade, pericarditis, sleep apnea. systolic blood pressure change and pulse change

Question 23

What should we ask about the timing of these symtpoms?

Answer 23

Symptoms may be worse or only present at night

Question 24

What should be in our diff for asthma?

12

Answer 24

1. COPD (usually in older pts)
2. Anaphylaxis
3. Foreign body ingestion
4. Congestive heart failure
5. Pulmonary embolism
6. Panic disorder, hyperventilation syndrome
7. Pneumonia, bronchitis
8. Alpha1-Antiprypsin Deficiency (leads to COPD)
9. GERD
10. Sarcoidosis (thickening of the lungs)
11. Vocal Cord Dysfunction
12. Cough secondary to drugs (ACE inhibitors)- lisinopril

Question 25

With hemoptysis, should consider: | 4

Answer 25

1. Allergic bronchopulmonary aspergillosis 2. Bronchiectasis (cystic fibrosis) 3. Lung carcinoma 4. TB

Question 26

Indicators for considering a Dx of Asthma: | 4

Answer 26

``` 1. Wheezing Any history of: 2. Cough (worse particularly at night) 3. Recurrent wheeze 4. Recurrent difficulty in breathing, recurrent chest tightness ```

Question 27

Indicators for considering a Dx of Asthma: Symptoms occur or worsen in the presence of? 7

Answer 27

1. Exercise 2. Viral infection 3. Inhalant allergens and irritants 4. Changes in weather 5. Strong emotional expression (crying, laughing) 6. Stress 7. Menstrual cycles

Question 28

What is needed to establish an asthma diagnosis?

Answer 28

spirometry

Question 29

PFT results for asthma pts will show? FEV1? FEV1/FVC? Inflation will be? What FEV1 change shows reversibility?

Answer 29

Obstructive disease that is reversible Decreased FEV1 less than 80% predicted FEV1/FVC less than 65% Hyperinflation Establish reversibility FEV1 increase of > or = 12% and at least 200ml after using a short acting B2 agonist.

Question 30

Provocation testing with Methacholine or histamine will show us what? 3

Answer 30

1. Detects bronchial hyperactivity 2. Supports the dx of asthma 3. Sometimes done when asthma is suspected but PFT’s are near normal.

Question 31

Diagnostics tests that we would do in addition to PFTs? | 4

Answer 31

Chest xray GE reflux assessment Skin tests Blood tests

Question 32

Why would we want to do a chest X-ray? 5 What would a skin test demonstate to support our diagnosis? What will the blood tests show that will help support our diagnosis? 2

Answer 32

May not show much, but will help rule in 1. pneumonia, 2. CHF, 3. pneumothorax, 4. airway lesions or 5. FBO Demonstrate atopy Eosinophils and IgE elevations (these support the dx, absence does not exclude asthma)

Question 33

Global Strategy for Asthma and Prevention: 7

Answer 33

1. Achieve and maintain control of symptoms 2. Prevent asthma exacerbations 3. Maintain pulmonary function as close to normal levels as possible. 4. Maintain normal activity levels, including exercise. 5. Avoid adverse effect from asthma medications 6. Prevent the development of irreversible airflow limitation 7. Prevent asthma mortality

Question 34

The aspects of the patient's asthma that should be assessed at each visit include the following: 7 Follow up visits should be as frequent as how many mmonths depending on the severity?

Answer 34

1. signs and symptoms 2. pulmonary function 3. quality of life 4. exacerbations 5. adherence with treatment and 6. side effects 7. patient satisfaction with care. at a frequency of every one to six months

Question 35

Asthma Assessment should address 3

Answer 35

1. daytime symptoms and/or nighttime symptoms 2. use of short acting inhaled beta agonists to relieve symptoms 3. difficulty in performing normal activities and exercise.

Question 36

What are some good asthma questions to ask? | 5

Answer 36

1. Has your asthma awakened you at night or in the early morning? 2. Have you needed your quick-acting relief medication more than usual? 3. Have you needed any unscheduled care for your asthma, including calling in, an office visit, or going to the emergency room? 4. Have you been able to participate in school/work and recreational activities as desired? 5. If you are measuring your peak flow, has it been lower than your personal best?

Question 37

Describe an asthma action plan? | 3

Answer 37

The patient's 1. normal peak flow (PEF) value is used to construct a personalized "asthma action plan” which provides specific directions for 2. daily management and for 3. adjusting medications in response to increasing symptoms or decreasing PEFR.

Question 38

What does peak flow monitor?

Answer 38

1. Monitor airway obstruction Alter long-term therapy for optimal control of symptoms Keep diary Have clear plan in place for using peak flow info to intervene early in exacerbations

Question 39

4 Classifications of Asthma for Stepwise Management Approach | what are they?

Answer 39

Step 1: Intermittent Step 2: Mild persistent Step 3: Moderate persistent Step 4: Severe persistent

Question 40

What classifies a pt as having intermittant asthma: 1. Day time asthma symtpoms? 2. Nocturnal awakenings? 3. Use of short acting B-agonists? 4. Interference with normal activities? 5. FEV1 measurements b/w exacerbations? 6. FEV1/FVC ratio between exacerbations? 7. Use of oral glucocorticoids? How would we treat this pt and what would we prescribe them?

Answer 40

1. Daytime asthma symptoms occurring two or fewer days per week 2. Two or fewer nocturnal awakenings per month 3. Use of short-acting beta agonists to relieve symptoms fewer than two times a week 4. No interference with normal activities between exacerbations 5. FEV1 measurements between exacerbations that are consistently within the normal range (80% of predicted normal) 6. FEV1/FVC ratio between exacerbations that is normal (based on age-adjusted values) 7. One or no exacerbations requiring oral glucocorticoids per year Short acting beta-2- for rescue – PRN - albuterol (using > 2 times/wk may indicate need to start long-term-control therapy.)

Question 41

What classifies a pt as having mild persistent asthma: 1. Day time asthma symtpoms? 2. Nocturnal awakenings? 3. Use of short acting B-agonists? 4. Interference with normal activities? 5. FEV1 measurements b/w exacerbations? 6. FEV1/FVC ratio between exacerbations? 7. Use of oral glucocorticoids? How would we treat this pt and what would we prescribe them? 4

Answer 41

1. Symptoms more than twice weekly (although less than daily) 2. Three to four nocturnal awakenings per month due to asthma 3. Use of short-acting beta agonists to relieve symptoms more than two times a week (but not daily) 4. Minor interference with normal activities 5. FEV1 measurements within normal range (80% of predicted normal) 6. FEV1/FVC ratio is normal (based on age-adjusted values) 7. Two or more exacerbations requiring oral glucocorticoids per year (virus or seasonal allergies) 1. Short acting beta-2 for rescue – PRN – albuterol (using > 2 times/wk may indicate need to start long-term-control therapy.) 2. Low dose inhaled steroids or 3. cromolyn or nedocromil, 4. Leukotriene inhibitors

Question 42

What classifies a pt as having moderate persistent asthma: 1. Day time asthma symtpoms? 2. Nocturnal awakenings? 3. Use of short acting B-agonists? 4. Interference with normal activities? 5. FEV1 measurements b/w exacerbations? 6. FEV1/FVC ratio between exacerbations? 7. Use of oral glucocorticoids? How would we treat this pt and what would we prescribe them? 5

Answer 42

1. Daily symptoms of asthma 2. Nocturnal awakenings more than once per week 3. Daily need for short-acting beta agonists for symptom relief 4. Some limitation in normal activity 5. FEV1 between 60 and 80 percent of predicted 6. FEV1/FVC is 95 to 99 percent of normal (based on age-adjusted values) 7. Two or more exacerbations requiring oral glucocorticoids per year. 1. Short acting beta-2 for rescue – PRN – albuterol (using > 2 times/wk may indicate need to start long-term-control therapy.) 2. Either an inhaled steroid (medium dose) OR 3. inhaled steroid (low-medium dose) AND 4. either long acting inhaled B2 agonist or 5. sustained release theophylline. If needed, give inhaled steroids in a medium to high dose CONSIDER REFERRAL TO SPECIALIST

Question 43

What classifies a pt as having severe persistent asthma: 1. Day time asthma symtpoms? 2. Nocturnal awakenings? 3. Use of short acting B-agonists? 4. Interference with normal activities? 5. FEV1 measurements b/w exacerbations? 6. FEV1/FVC ratio between exacerbations? 7. Use of oral glucocorticoids? How would we treat this pt and what would we prescribe them? 5

Answer 43

1. Symptoms of asthma throughout the day 2. Nocturnal awakenings nightly 3. Need for short-acting beta agonists for symptom relief several times per day 4. Extreme limitation in normal activity 5. FEV1 less than 60% of predicted 6. FEV1/FVC less than 95% of normal (based on age-adjusted values) 7. Two or more exacerbations requiring oral glucocorticoids per year 1. Short acting beta-2 for rescue – PRN - albuterol (using > 2 times/wk may indicate need to start long-term-control therapy.) 2. High dose inhaled steroid AND either a 3. long acting B2 agonist or 4. sustained release theophylline or 5. long acting oral B2 agonist AND 6. oral steroids. Make repeated attempts to reduce systemic steroids and maintain control with high dose inhaled steroid REFERRAL TO SPECIALIST

Question 44

When would we consider refferal to a specialist and when would we always referr to a specialist?

Answer 44

moderate persistant severe persistant

Question 45

Controlling Asthma Severity Identify and control contributing factors: 6

Answer 45

1. Inhaled allergens 2. Tobacco smoke 3. Rhinitis/sinusitis 4. GERD 5. Occupational exposures 6. Viral respiratory infections

Question 46

Periodic Assessment & Monitoring of Asthma Severity Patient self-monitoring: 2 Clinician monitoring: 4

Answer 46

Patient self-monitoring: 1. Peak flow measurements 2. Self-awareness of symptoms Clinician: 1. Frequent visits to achieve clinical control 2. Assess achievement of therapy goals 3. Prevention of chronic symptoms/episodes 4. Maintain normal activity levels

Question 47

What is status asthmaticus? Describe the onset? What do most pts have a history of that experience this? (symtpom, timeline, med use)

Answer 47

Severe Bronchospasm that is unresponsive to routine therapy. Can be sudden and rapidly fatal Most patients have a 1. history of progressive dyspnea, 2. over hours to days, with 3. increasing bronchodilator use.

Question 48

Status Asthmaticus presentation? | 5

Answer 48

1. Difficulty talking 2. Using accessory muscles of inspiration 3. Orthopnea 4. Diaphoresis 5. Mental status changes

Question 49

Status Asthmaticus treatment?

Answer 49

1. Oxygen 2. Oximetry 3. ABG’s 4. Peak flows with treatments

Question 50

Peak flows with treatments consists of what kind? | 3

Answer 50

1. Inhaled B2 agonists 2. Inhaled anticholinergics 3. Oral or IV corticosteroids

Question 51

In Status Asthmaticus, if the previously mentioned treatments do not work what should we do? If they have a good response what should we do? 4

Answer 51

If inadequate response 1. Hospital admission ``` If good response – discharge with: 1. Inhaled B2 agonist 2. Inhaled anticholinergic 3. Oral corticosteriods x 5 days (steroid burst) 4. Follow-up within 5 days ```

Question 52

What are our quick relief medications and how do they work?

Answer 52

Inhibit smooth muscle contraction Short-acting beta-2 agonists

Question 53

What are our long term control (preventer, controller, or maintenance medications) and how do they work? 6

Answer 53

Prevent and/or reverse inflammation (most effective approach) 1. Anticholinergics 2. Corticosteroids 3. Mast cell-stabilizing agents 4. Leukotriene modifiers 5. Methylxanthines Inhibit smooth muscle contraction 6. Long-acting beta-2 agonists

Question 54

What is an MDI and how does it work? What do we have to use with it?

Answer 54

Metered dose inhaler Releases specific amount of aerosolized particles Use a spacer

Question 55

What is a nebulizer and how does it work? Who is this ideal for?

Answer 55

Liquid medicine used in machine Provides “nebulized” particles with moist continuous airflow Ideal for pediatric patients or those unable to use MDI

Question 56

What are our inhaled powder options and how are they administered?

Answer 56

Rotacaps, Disc-haler, etc. Mechanical crushing of tablet or capsule releases powder for inhalation

Question 57

What are our Sympathomimetics Bronchodilators and what is their MOA? 5

Answer 57

“Beta-2 agonists” 1. Produce airway dilation 2. Stimulation of beta-adrenergic receptors 3. Activation of G proteins with resultant formation of cyclic AMP 4. Decrease release of mediators 5. Improve mucociliary transport

Question 58

What are the two kinds of beta 2 agonists and what does each work to do? 2 and 1

Answer 58

Short-acting 1. acute attack (rescue treatment) 2. prevention of exercise-induced bronchospasm Long-acting 1. prevention and maintenance therapy

Question 59

What are the types of Short acting B2 agonists? 3 Describe their onset? What are the other kinds of SA Beta 2 agonists? 3

Answer 59

Albuterol, Proventil, Ventolin Quick onset, lasts 4 to 6 hrs ``` 1. Terbutaline (Brethine) also used to prevent uterine contractions 2. Bitolterol (Tornalate) 3. Pirbuterol (Maxair) All similar to albuterol ```

Question 60

Dosing for SA Beta 2s? What would show us lack of adequate asthma control?

Answer 60

Usual dosing for beta-agonists MDI: 2-4 puffs q4-6h and prn Increasing use more than 1 canister (200 puffs) per month signals lack of adequate asthma control.

Question 61

Adverse effects of beta-2 agonists 6

Answer 61

Rare when given by inhalation 1. tachycardia 2. tremor 3. hypokalemia 4. headache 5. hyperglycemia 6. increased lactic acid

Question 62

What are our Long acting beta-2 agonists? 2 How are they administered?

Answer 62

Salmeterol (Serevent) inhaled | Formoterol (Foradil) inhaled

Question 63

Long acting beta-2 agonists onset?

Answer 63

Slower onset (30 min), long-lasting (9 to 12 h)

Question 64

Newer long acting Beta-2 agonists? | 2

Answer 64

``` 1. Levalbuterol (Xopenex) Long acting 0.63-1.25 mg q 6-8 h by nebulization may have more beta-2 selectivity than albuterol 2. Fenoterol (Berotec) Available in Canada, soon in U.S. similar to albuterol or terbutaline ```

Question 65

WHat are the Anticholinergics Antimuscarinic Agents Bronchodilators?

Answer 65

``` Ipratropium bromide (Atrovent) Tiotropium (Spiriva) ```

Question 66

What is Anticholinergics Antimuscarinic Agents Bronchodilators main use? Describe their onset? How long does it act?

Answer 66

may enhance the bronchodilation achieved by beta-agonists. main use is in combination with beta-agonist slow to act (60-90 min) Long (spiriva lasts up to 24 hours)

Question 67

What are the Methylxanthines Bronchodilators? What is the plasma concentration of this drug? (need to know)

Answer 67

Theophylline therapeutic plasma concentrations 10-15 mcg/mL (narrow window, hard to achieve and maintain)

Question 68

Thepphylline Clearance (and dosage requirement) is decreased in what kind of pts? 6 Clearance (and dosage requirement) is increased in what kind of pts? 2

Answer 68

1. neonates 2. elderly 3. acute and chronic hepatic dysfunction 4. cardiac decompensation, cor pulmonale 5. febrile illnesses 6. concurrent use of macrolide antibiotics, quinolones, allopurinol, cimetidine, propranolol 1. children 2. concurrent use of cigarettes, marijuana, phenobarbital, phenytoin

Question 69

What is Theophylline Bronchodilators used for in asthma pts? Side effects?

Answer 69

Maintenance therapy long-acting theophylline compounds (Slo-Bid, Theo-24, etc.) usually given once or twice per day or once daily Most common side effects - -insomnia, nervousness, N/V, anorexia, headache, and tachycardia - -plasma levels >30 g/mL: risk of seizures and cardiac arrhythmias

Question 70

What should we start Theophylline dosing at?

Answer 70

Start with 16mg/kg/day or 400mg/day in divided doses Single-dose administration in evening reduces nocturnal symptoms

Question 71

Corticosteroids MOA? Why do we use them in acute illness? WHy do we use them in chronic illness?

Answer 71

Reduce airway inflammation Use with Acute illness 1. severe airway obstruction is not resolving or is worsening Use with Chronic disease 2. failure of a previously optimal regimen with frequent recurrences of symptoms of increasing severity

Question 72

Corticosteroids Anti-inflammatory: Inhaled sterids reduce what? If symptoms are not eliminated by standard dose, increase how much? What is another main benefit of inhaled cortiocosteriods?

Answer 72

Reduce airways reactivity If symptoms are not eliminated by standard dose, increase two fold or more Greatly facilitate withdrawal of oral steroids

Question 73

Side effects of inhaled Corticosteroids? 2 What about at larger doses? 5 When do they start to work?

Answer 73

1. Thrush (Oral fungal infection) 2. Dysphonia 1. adrenal suppression, 2. cataract formation, 3. decreased growth in children, 4. interference with bone metabolism, and 5. purpura 2-4 weeks to produce beneficial effect --May/need to start short course of oral glucocorticoids simultaneously with inhaled drug

Question 74

Corticosteroids: Name the Products (in order of potency)? 6

Answer 74

1. Fluticasone (Flovent) 2. Budesonide (Pulmicort) 3. Beclomethasone (Vanceril, 4. Beclovent, QVAR) 5. Triamcinolone (Azmacort) 6. Flunisolide (Aerobid, Aerobid-M)

Question 75

What medications would we use with PO steriods? 2 What do we need to do to make sure to prevent recurrent obstruction? How should we do this?

Answer 75

1. Methylprednisolone 40 to 60 mg IV q6h 2. Prednisone 60 mg po q6h can be substituted rapid tapering of glucocorticoids reducing dose by 1/2 every 3-5 days following an acute episode

Question 76

Chronic treatment with oral agents. What should we not use?

Answer 76

Long-acting preparations (dexamethasone) should not be used | prolonged suppression of the pituitary-adrenal axis

Question 77

Advair Diskus is a combination of what? Combivent MDI?

Answer 77

fluticasone + salmeterol Ipratropium + albuterol

Question 78

What are the mast cell stabilizers (2) and how do they work? What do they not do? What kind of disease are they most effective for and how long does it take them to work? Dosing? 2

Answer 78

Cromolyn (Intal), Nedocromil (Tilade) 1. inhibit degranulation of mast cells 2. prevent release of chemical mediators of anaphylaxis do not influence airway tone most effective for seasonal disease 4-6 weeks before beneficial effects 1. Dose: 2 puffs qid 2. prophylactically15-20 min pre contact with precipitant

Question 79

What are the Leukotriene inhibitors/Anti-inflammatory? What is there MOA?

Answer 79

``` Montelukast (Singulair) 5mg qd (chewable tablet) Zafirlukast (Accolate) 20-40mg qd Zileuton (Leutrol, Zyflo) 600mg qid ``` MOA: suppress action of cysteinyl leukotriene (proinflammatory mediators involved in asthma pathogenesis)

Question 80

Leukotriene inhibitors/Anti-inflammatory improve what? 3 What is it effective in combination with? Safe in what ages of children? 2

Answer 80

1. improvement in FEV1, 2. asthma exacerbations 3. improvement in frequency of prn beta-agonist use safe in children ages 6-14 adverse side effects minimal effective in combination with corticosteroid or beta-agonist

Question 81

Leukotriene inhibitors Anti-inflammatory 1. Alternative to what? 2. Add on therapy when? 3. Help reduce higher doses of what? 4. What can we not use this for? 5. Side effects? 2

Answer 81

1. alternative to inhaled corticosteroid 2. add-on therapy when response to inhaled corticosteroids is suboptimal 3. help reduce higher doses of inhaled corticosteroids 4. NOT for reversal of acute attack (onset 1 hr) 5. Side effects: LFT abnormalities, headache

Question 82

What is Omalizumab? MOA? What does it not do? What will the plasma IgE look like?

Answer 82

Anti-IgE Monoclonal Antibodies Inhibits the binding of IgE to mast cells Does not promote mast cell degranulation to already bound IgE Lowers plasma IgE to undetectable levels

Question 83

What is the main treatment for an Allergic Asthmatic?

Answer 83

Elimination of the causative agent(s)

Question 84

What are some of these agents that could cause allergic asthma? 4

Answer 84

1. Aspirin even in small quantities 2. Other NSAIDs - -indomethacin, fenoprofen, naproxen, ibuprofen 3. Tartrazine (coloring agent) 4. Sulfiting agents (preservatives) - --K metabisulfite, K and Na bisulfite, Na sulfite, sulfur dioxide

Question 85

Preventative measures for all asthmatics???? | 2

Answer 85

Yearly influenza vaccination | Pneumococcal vaccine