Asthma COPD

Question 1

Two phases of asthmatic response

Answer 1

Early phase: acute bronchoconstriction

Late phase: influx of inflammatory cells, second wave of mediator release

Question 2

Targets of asthma meds:

Answer 2

Bronchiolar SMC
Inflammation
Mediators (histamine, leukotrienes, prostaglandins, IgE, cytokines)

Question 3

Targets of COPD meds:

Answer 3

Pulmonary infection prevention
Hypoxemia (O2)
Bronchiolar SM
Inflammation (contradictory)

Question 4

MDI

Answer 4

drug is suspended in compressed gas propellant

must be coordinated

Question 5

“Spacer”

Answer 5

used to allow sequential action and inhalation

Decrease amount of drug that goes in just oropharynx

Question 6

DPI

Answer 6

Dry powder inhaler
Requires proper use of inhalation
Not good for children, elderly, or those in acute attack

Question 7

Bronchodilators aka

Answer 7

B-2 agonists

Question 8

What are 2 mechanisms of B-2 agonists?

Answer 8

(1) Stimulate B-2 receptor on bronchiole SM, elevate cAMP reduce SM tone = dilation
(2) Anti-inflammatory - inhibit release of histamine

Question 9

What is the first line agent used PRN for acute attacks?

Answer 9

Albuterol

Question 10

What agent is used for prevention of exercise induced asthma?

Answer 10

Albuterol

Question 11

Short acting B-agonist

Answer 11

Albuterol

Question 12

Long-acting B-agonist

Answer 12

Salmeterol

Question 13

Has a long lipophilic tail that anchors to the drug membrane

Answer 13

Salmeterol

Question 14

Which B-2 agent should not be used for acute attacks?

Answer 14

Salmeterol

Question 15

Requires asthma prophylaxis schedule and administration with glucocorticoids?

Answer 15

Salmeterol

Question 16

Long lasting oral B-2 agonist

Answer 16

Albuterol oral

Question 17

Which B-2 agonist can be used in children

Answer 17

Oral albuterol

Question 18

What are adverse effects of B-2 agonists at high doses?

Answer 18

Reflex tachycardia

Palpitation tremor

Question 19

When used alone which B-2 agonists are associated with increase risk of severe asthma attack and asthma related death by exacerbating inflammation?

Answer 19

Salmeterol

Question 20

Which agents must be used in combination and not be used longterm?

Answer 20

B-2 agonists

Question 21

Theophylline mechanism of action

Answer 21

Non-specific inhibitor of phosphodiesterases that degrade cAMP (similar to b-agonist)

Question 22

PDE3 inhibition

Answer 22

Bronchodilation

Question 23

PDE4 inhibition

Answer 23

anti-inflammatory action

Question 24

Which agent antagonizes adenosine receptors on bronchioles?

Answer 24

Theophylline

Question 25

What agent is used if patient is noncompliant or monteleukast is ineffective?

Answer 25

Theophylline

Question 26

Which is an alternative to LABAs?

Answer 26

Theophylline

Question 27

Which agent has large variability in CYP metabolism and can lead to variation in blood levels?

Answer 27

Theophylline

Question 28

Which has high dose effects of nausea, nervousness, anxiety, headache and insomnia?

Answer 28

Theophylline

Question 29

Which at toxic levels creates dysarrthmias?

Answer 29

Theophylline

Question 30

Anticholinergic agent

Answer 30

Ipratropium

Question 31

Which agent is "Atropine like"?

Answer 31

Ipratropium

Question 32

Which agent forms a quaternary amine?

Answer 32

Ipratropium

Question 33

Mechanism of Ipratropium

Answer 33

Blocks muscarinic M3 receptors of bronchoconstriction

Question 34

Which has been approved for symptomatic COPD and better than B-agonists?

Answer 34

Ipratropium

Question 35

Which causes pharyngeal irritation and dry mouth?

Answer 35

Ipratropium

Question 36

Which is often given with B agonists (albuterol)?

Answer 36

Ipratropium

Question 37

Which inhaled corticosteroid is first line for CHRONIC asthma?

Answer 37

Fluticasone

Question 38

Which drug improves lung function and prevents irreversible airway changes?

Answer 38

Fluticasone

Question 39

Which B-agonist and inhaled corticosteroid are combined to treat asthma?

Answer 39

Salmeterol+Fluticasone

Question 40

When is oral/parenteral prednisone used?

Answer 40

During severe asthma attacks and acute exacerbations that are not relieved by B-agonists

Question 41

What is the MOA of Fluticasone

Answer 41

No effect on brochoconstriction Bind to GC receptors and inhibit release and synthesis of inflammatory mediators (anti-inflammatory) decrease airway mucus production increase responsiveness to B-2

Question 42

What is the adverse reaction of inhaled corticosteroids?

Answer 42

Oral thrush | Dysphonia

Question 43

Mechanism of action of Cromolyn

Answer 43

Mast cell stabilizer, preventing the release of histamine (anti-inflammatory) Decreases bronchial hyper-reactivity

Question 44

Use of cromolyn

Answer 44

asthma prophylaxis allergic asthma exercise induced asthma reduce frequency and intensity of attacks

Question 45

Leukotriene modifiers

Answer 45

Monteleukast | Zileuton

Question 46

Monteleukast MOA

Answer 46

Act on leukotriene receptor | Antagonist

Question 47

Which leukotriene acts on leukotriene synthesis (5-lipoxygenase) as an inhibitor?

Answer 47

Zileuton

Question 48

Which asthma agents are used for aspirin sensitive asthma?

Answer 48

Leukotriene modulators (monteleukast and zileuton)

Question 49

Which leukotriene modifier is associated with hepatotoxicity and dyspepsia?

Answer 49

Zileuton (enzyme)

Question 50

Which leukotriene should not be combined with theophylline and warfarin?

Answer 50

Zileuton (enzyme)

Question 51

Which asthma anti-inflammatory acts on IgE?

Answer 51

Omalizumab

Question 52

Omalizumab MOA

Answer 52

Decrease amount of IgE that can bind to mast cells, allergens unable to trigger histamine release from mast cells

Question 53

Use of Omalizumab

Answer 53

Allergy related asthma

Question 54

Which anti-inflammatory is administered subcutaneously?

Answer 54

Omalizumab