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Pulmonary & Renal > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

what receptors excite & inhibit bronchial smooth muscle?

A

ß agonists -> excite (dilate)

Muscarinic antagonists -> inhibit (dilate)

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2
Q

what drug types inhibit bronchoconstriction?

A

Muscarinic antagonists & theophylline (block adenosine)

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3
Q

what class of drugs reverse bronchoconstriction in asthma?

A

ß2 agonists

relax airway smooth muscle
SABA & LABA

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4
Q

what are SABA?

A

Terbutaline, Metaproterenol, Levabuterol, Pirbuterol, Albuterol

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5
Q

A patient comes in with a complaint of adverse affects from her new SABA prescription for asthma. She notes she broke out in severe itchy rash and forgot to note at the initial meeting that she has an allergy to sulfa drugs. What SABA was she most likely presecribed?

A

subQ Terbutaline

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6
Q

A 6yo is recently diagnosed with intermediate asthma. What would be an appropriate SABA?

A

Levabuterol

patients > 4yo

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7
Q

What is a non-respiratory risk factor when prescribing SABA?

A

Cardiovascular symptoms:
elevated HR & BP

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8
Q

A G1P2 woman comes in with premature contractions at 24w. Her OB prescribes medication to delay these contractions (tocolysis). What SABA should her OB look for in the patients med list before performing tocolysis?

A

Terbutaline

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9
Q

Severe paradoxical bronchospams may occur with administration of what prescripsions

A

Metaproterenol, Albuterol, Levabuterol

“MAL”

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10
Q

In addition to asthma, SABA can be used for what other respiratory conditions?

A

reversible obstructive conditions

COPD, bronchitis, bronchiolitis

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11
Q

What is the most effective controller of asthma?

A

Inhaled Coticosteroids (ICS)

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12
Q

What is the MOA of ICS?

A
  • Decrease pro-inflammatory TFs
  • reduce eosinophils, T cells, Mast cells, & sputum
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13
Q

If a patient comes in on first-line Triamcinolone but has not seen any response in symptoms, what would be the next step in treatment?

A

Add to a LABA

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14
Q

What is one downside to using ICS?

A

Does not cure

only treats symptoms

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15
Q

How long after administering an ICS will patients see improvement?

A

Rapidly

full effect takes several days

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16
Q

A patient was recently taken off of systemic corticosteroids, how long should you wait before administering beclomethasone to a patient with asthma?

A

several months

if too soon can be fatal

wait for HPA axis to recover

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17
Q

What ICS should be used in patients older than 4y?

A

Fluticasone, Mometasone

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18
Q

What ICS should be used in patients older than 5y?

A

Beclomethasone

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19
Q

What ICS should be used in patients older than 6y?

A

Budesonide, Flunisolide

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20
Q

What ICS should be used in patients older than 12y?

A

Ciclesonide

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21
Q

What ICS should be administered for patients who need systemic corticosteroids?

A

Triamcinolone

22
Q

All ICS are contraindcated for what purposes?

A

acute asthma or status asthmaticus,

23
Q

A patient recently started on ICS for asthma and develops pharyngitis with white plaques that easily fall off. What medications was she most likely put on associated with this presentation?

A

Fluticasone or Ciclesonide

associated with oropharyngeal Candida albicans

24
Q

A patient was recently transferred from systemic corticosteroids to a new ICS for asthma. What is the greatest risk in this situation?

A

Adrenal insufficiency & death

fatigue, muscle weakness, decreased appetite, and weight loss

25
Q

A patient is known to have a severe allergy to milk. What ICS medication are contraindicated if needed for asthma?

A

budesonide & mometasone

26
Q

A patient requires oral corticosteroids & ICS for asthma. What would be the most appropriate combination for this patient?

A

Beclomethasone & Prednisone

27
Q

The use of ICS is indicated for what function in asthma treatment?

A

Maintanenance prophylaxis

28
Q

If a patient comes in stating that they have had asthma attacks daily and were woken up about 4 nights a week and it gets in the way of going out and being with friends. These flare ups having been happening more frequently. What is a good course of treatment?

A

SABA & Oral corticosteroids

for moderate - severe asthma FLARE UPS

29
Q

What differentiates the use of prednisone from ICS?

A

immunosuppressant, endocrine conditions, & anti-inflammatory

risk of HPA suppression

30
Q

When puting a patient on prednisone, what are important signs to be looking for?

A

Cushings syndrome & hyperglycemia

fatty neck hump, moon face, striae…

31
Q

What are the best drugs for maintenance of COPD?

A

LABA

(-terol)

32
Q

When administering a LABA for asthma what else is required?

A

ICS

without -> increased fatality risk

33
Q

What LABA should be used for asthma in a 4yo?

A

Salmeterol

otherwise use Fomoterol

34
Q

Salmeterol is beneficial for what asthma?

A

maintenance & exercise induced bronchospasm

35
Q

If you want to target the parasympathetic impulse to prevent smooth muscle constriction in patients with COPD, what class of drugs should be used?

A

anticholinergics

36
Q

A 65yo patient diagnosed with COPD has been sent to you for presecription of a long term, maintenance treatment of bronchospasm. What drugs would be best to use?

A

Tiotropium, Ipratropium & Aclidinium

Block acetylcholine binding nerve terminal

long term maintenance drugs

37
Q

What differentiates ipratropium from other anti-cholinergics for long term COPD?

A

free of systemic effects because of poor absorption

38
Q

You want to put a patient that is responsive to methylcholine test on a new drug that bronchodilates & suppresses airway stimulation. What would be drug of choice?

A

Theophylline

same class as caffeine & theobromineb (chocolate)

39
Q

Your patient that you put on theophylline tells you they are also on omeprazole. What is the problem with this situation?

A

Theophlline exacerbates PUD, seizures, & arrythmias

40
Q

What class of drugs is preferred for managment of asthma?

A

Leukotriene Antagonists

41
Q

What is the target of all leukotriene receptors ending in -lukast?

A

CysLT1 receptor

42
Q

What is the target of Zileuton?

A

5-lipoxygenase

43
Q

You are treating a patient for allergies & also to prevent asthma attacks. You do not want to use an ICS, what would be your best option that targets LTD4 specifically?

A

Monteluksat

inhibits LTD4 on CysLT1-R only

44
Q

Your patient comes in for a visit and tells you they stopped carrying their Pirbuterol inhaler in their gym bag since they started taking their new medicine daily. Why is this a problem?

A

Leukotriene inhibitors are not for acute asthma attacks. SABA still required

45
Q

If you want to target LTD4 & LTE4 on CysLT1 what drug should you use?

A

Zafirluksat

46
Q

What are the contraindications of Zarilukast & Zileuton?

A

Hepatotoxicity

47
Q

A patient tells you they are on a leukotriene inhibitor that starts with a Z but can’t remember which one. What would be a followup question you could ask to narrow down the which medication it is?

A

When did you start taking it?
If <12yo Zafirlukast

Zileuton is for patient older than 12yo.

48
Q

What is the MOA of Zileuton?

A

inhibits 5-lipoxygenase

49
Q

A patient with daily SABA use, 5 wakeful nights, an FEV1/FVC < 0.7 & stated daily-limitations from asthma comes in for a new prescription as their symptoms are unresponsive to ICS & prednisone. What is the mechanism of action of the most likely new drug?

A

anti-IgE -> decrease Fc on mast cell -> dec. mediators -> dec. inflammation & exacerbation

omalizumab is for patients unresponsive ICS, chronic urticaria

50
Q

What is the age difference when prescribing omalizumab for asthma vs chronic idiopathic urticaria?

A

Asthma - older 6yo
Urticaria - older 12yo

51
Q

what anticholinergics may apply to COPD treatment?

A

Ipratropium, Tiotropium, Aclidinium, & atropine (severe)

52
Q

what ß2 agonists would be useful for treatment of COPD?

A

Oldaterol, Indacaterol, Vilanterol, Fometerol, & Salmeterol

Fometerol & Salmeterol are ALSO used in asthma

Pulmonary & Renal (5 decks)

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