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Pulmonology > Asthma and Asthma Pharm > Flashcards

Asthma and Asthma Pharm Flashcards

1
Q

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

A

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

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2
Q

How would we set up successful management of asthma?

4

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

What is asthma?

A

A chronic inflammatory disorder of the airways.

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4
Q

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

A

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

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5
Q

Definition of asthma?

3

A

A complex disorder characterized by variable and recurring symptoms,

  1. airflow obstruction,
  2. bronchial hyperresponsiveness and an
  3. underlying inflammation.
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6
Q

What are the three things that cause airflow limitations?

A

Bronchoconstriction

Airway hyperresponsiviness

Airway edema

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7
Q

Describe the following:
Bronchoconstriction

Airway hyperresponsiviness

Airway edema

A

—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

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8
Q

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

A

bronchospasm

bronchoconstrictor response

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9
Q

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

A
  1. Perennial versus seasonal
  2. Continual versus episodic
  3. Duration, severity and frequency
  4. Diurnal variations (nocturnal and early morning)
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10
Q

Inflammatory response involves multiple players

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

A

Eosinophils

Lymphocytes

MAST Cells

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11
Q

Describe the following in how they affect asthma pts:

Eosinophils?

Lymphocytes?

MAST Cells?

A

– 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

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12
Q

What are leukotrienes?

How do they work in exacerbating asthmatics?
5

A

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
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13
Q

Describe the early phase of an asthma exacerbation?

2

A
  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
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14
Q

Describe the late phase of an asthma exacerbation?

3

A
  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.
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15
Q

What is the difference between instrinsic and extrinsic asthma?

Etiology?
Onset?
Genetic?

A 
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
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16
Q

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

A
  1. ASA
  2. Pulmonary infections (especially viral)
  3. Cold
  4. Psychological stress
  5. Exercise
  6. Inhaled irritants
  7. GERD
  8. Post nasal drip
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17
Q

What is samters triad?

A

aspirin, allergy/ rhinitis, nasal polyps

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18
Q

What is usually elevated in extrinsic asthma pts?

2

A

Serum IgE and eosinophil count are usually elevated

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19
Q

Occupational asthma and

Allergic bronchopulmonary aspergillosis are categorized as what kind of asthma?

A

extrinsic

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20
Q

What is exercise induced asthma?

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

Treatment?
2

A

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
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21
Q

Classic triad of symptoms

in asthmatics?

A
  1. Persistent wheeze, end expiratory wheeze
  2. Chronic episodic dyspnea
  3. Chronic cough
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22
Q

Associated Symtpoms in asthmatics?

7

A
  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
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23
Q

What should we ask about the timing of these symtpoms?

A

Symptoms may be worse or only present at night

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24
Q

What should be in our diff for asthma?

12

A
  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
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25
Q

With hemoptysis, should consider:

4

A
  1. Allergic bronchopulmonary aspergillosis
  2. Bronchiectasis (cystic fibrosis)
  3. Lung carcinoma
  4. TB
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26
Q

Indicators for considering a Dx of Asthma:

4

A 
1. Wheezing
Any history of:
2. Cough (worse particularly at night)
3. Recurrent wheeze
4. Recurrent difficulty in breathing, recurrent chest tightness
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27
Q

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

7

A
  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
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28
Q

What is needed to establish an asthma diagnosis?

A

spirometry

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29
Q

PFT results for asthma pts will show?

FEV1?
FEV1/FVC?
Inflation will be?

What FEV1 change shows reversibility?

A

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.

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30
Q

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

A
  1. Detects bronchial hyperactivity
  2. Supports the dx of asthma
  3. Sometimes done when asthma is suspected but PFT’s are near normal.
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31
Q

Diagnostics tests that we would do in addition to PFTs?

4

A

Chest xray

GE reflux assessment

Skin tests

Blood tests

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32
Q

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

A

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)

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33
Q

Global Strategy for Asthma and Prevention:

7

A
  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
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34
Q

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?

A
  1. signs and symptoms
  2. pulmonary function
  3. quality of life
  4. exacerbations
  5. adherence with treatment and 6. side effects
  6. patient satisfaction with care.

at a frequency of every one to six months

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35
Q

Asthma Assessment should address 3

A
  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.
36
Q

What are some good asthma questions to ask?

5

A
  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?
37
Q

Describe an asthma action plan?

3

A

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.
38
Q

What does peak flow monitor?

A
  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

39
Q

4 Classifications of Asthma for Stepwise Management Approach

what are they?

A

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

40
Q

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?

A
  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.)

41
Q

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

A
  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)
  8. Short acting beta-2 for rescue – PRN – albuterol
    (using > 2 times/wk may indicate need to start long-term-control therapy.)
  9. Low dose inhaled steroids or 3. cromolyn or nedocromil,
  10. Leukotriene inhibitors
42
Q

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

A
  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.
  8. Short acting beta-2 for rescue – PRN – albuterol
    (using > 2 times/wk may indicate need to start long-term-control therapy.)
  9. Either an inhaled steroid (medium dose) OR
  10. inhaled steroid (low-medium dose) AND
  11. either long acting inhaled B2 agonist or
  12. sustained release theophylline.

If needed, give inhaled steroids in a medium to high dose
CONSIDER REFERRAL TO SPECIALIST

43
Q

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

A
  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
  8. Short acting beta-2 for rescue – PRN - albuterol
    (using > 2 times/wk may indicate need to start long-term-control therapy.)
  9. High dose inhaled steroid AND either a
  10. long acting B2 agonist or
  11. sustained release theophylline or
  12. long acting oral B2 agonist AND
  13. oral steroids.

Make repeated attempts to reduce systemic steroids and maintain control with high dose inhaled steroid
REFERRAL TO SPECIALIST

44
Q

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

A

moderate persistant

severe persistant

45
Q

Controlling Asthma Severity
Identify and control contributing factors:

6

A
  1. Inhaled allergens
  2. Tobacco smoke
  3. Rhinitis/sinusitis
  4. GERD
  5. Occupational exposures
  6. Viral respiratory infections
46
Q

Periodic Assessment & Monitoring of Asthma Severity

Patient self-monitoring:
2

Clinician monitoring:
4

A

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
47
Q

What is status asthmaticus?

Describe the onset?

What do most pts have a history of that experience this?
(symtpom, timeline, med use)

A

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
  2. increasing bronchodilator use.
48
Q

Status Asthmaticus presentation?

5

A
  1. Difficulty talking
  2. Using accessory muscles of inspiration
  3. Orthopnea
  4. Diaphoresis
  5. Mental status changes
49
Q

Status Asthmaticus treatment?

A
  1. Oxygen
  2. Oximetry
  3. ABG’s
  4. Peak flows with treatments
50
Q

Peak flows with treatments consists of what kind?

3

A
  1. Inhaled B2 agonists
  2. Inhaled anticholinergics
  3. Oral or IV corticosteroids
51
Q

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

A

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
52
Q

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

A

Inhibit smooth muscle contraction

Short-acting beta-2 agonists

53
Q

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

A

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

54
Q

What is an MDI and how does it work?

What do we have to use with it?

A

Metered dose inhaler

Releases specific amount of aerosolized particles

Use a spacer

55
Q

What is a nebulizer and how does it work?

Who is this ideal for?

A

Liquid medicine used in machine

Provides “nebulized” particles with moist continuous airflow

Ideal for pediatric patients or those unable to use MDI

56
Q

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

A

Rotacaps, Disc-haler, etc.

Mechanical crushing of tablet or capsule releases powder for inhalation

57
Q

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

A

“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
58
Q

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

A

Short-acting

  1. acute attack (rescue treatment)
  2. prevention of exercise-induced bronchospasm

Long-acting
1. prevention and maintenance therapy

59
Q

What are the types of Short acting B2 agonists? 3

Describe their onset?

What are the other kinds of SA Beta 2 agonists?
3

A

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
60
Q

Dosing for SA Beta 2s?

What would show us lack of adequate asthma control?

A

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.

61
Q

Adverse effects of beta-2 agonists

6

A

Rare when given by inhalation

  1. tachycardia
  2. tremor
  3. hypokalemia
  4. headache
  5. hyperglycemia
  6. increased lactic acid
62
Q

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

A

Salmeterol (Serevent) inhaled

Formoterol (Foradil) inhaled

63
Q

Long acting beta-2 agonists onset?

A

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

64
Q

Newer long acting Beta-2 agonists?

2

A 
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
65
Q

WHat are the Anticholinergics
Antimuscarinic Agents
Bronchodilators?

A 
Ipratropium bromide (Atrovent) 
Tiotropium (Spiriva)
66
Q

What is Anticholinergics
Antimuscarinic Agents
Bronchodilators main use?

Describe their onset?

How long does it act?

A

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)

67
Q

What are the Methylxanthines
Bronchodilators?

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

A

Theophylline

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

68
Q

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

A
  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
  7. children
  8. concurrent use of cigarettes, marijuana, phenobarbital, phenytoin
69
Q

What is Theophylline
Bronchodilators used for in asthma pts?

Side effects?

A

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
70
Q

What should we start Theophylline dosing at?

A

Start with 16mg/kg/day or 400mg/day in divided doses

Single-dose administration in evening reduces nocturnal symptoms

71
Q

Corticosteroids MOA?

Why do we use them in acute illness?

WHy do we use them in chronic illness?

A

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

72
Q

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?

A

Reduce airways reactivity

If symptoms are not eliminated by standard dose, increase two fold or more

Greatly facilitate withdrawal of oral steroids

73
Q

Side effects of inhaled Corticosteroids? 2

What about at larger doses? 5

When do they start to work?

A
  1. Thrush (Oral fungal infection)
  2. Dysphonia
  3. adrenal suppression,
  4. cataract formation,
  5. decreased growth in children, 4. interference with bone metabolism, and
  6. purpura

2-4 weeks to produce beneficial effect
–May/need to start short course of oral glucocorticoids simultaneously with inhaled drug

74
Q

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

A
  1. Fluticasone (Flovent)
  2. Budesonide (Pulmicort)
  3. Beclomethasone (Vanceril,
  4. Beclovent, QVAR)
  5. Triamcinolone (Azmacort)
  6. Flunisolide (Aerobid, Aerobid-M)
75
Q

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?

A
  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

76
Q

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

A

Long-acting preparations (dexamethasone) should not be used

prolonged suppression of the pituitary-adrenal axis

77
Q

Advair Diskus is a combination of what?

Combivent MDI?

A

fluticasone + salmeterol

Ipratropium + albuterol

78
Q

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

A

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
79
Q

What are the Leukotriene inhibitors/Anti-inflammatory?

What is there MOA?

A 
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)

80
Q

Leukotriene inhibitors/Anti-inflammatory improve what?
3

What is it effective in combination with?

Safe in what ages of children? 2

A
  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

81
Q

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
A
  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
82
Q

What is Omalizumab?

MOA?

What does it not do?

What will the plasma IgE look like?

A

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

83
Q

What is the main treatment for an Allergic Asthmatic?

A

Elimination of the causative agent(s)

84
Q

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

A
  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
85
Q

Preventative measures for all asthmatics????

2

A

Yearly influenza vaccination

Pneumococcal vaccine

Pulmonology (16 decks)

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