Asthma/COPD

Question 1

Two main pharmacologic classes

Answer 1

Anti-inflammatory agents
•Glucocorticoids (inhaled, oral)
–Bronchodilators
•Beta2-adrenergic agonists (long
and short-acting)

Question 2

Inhalation drug therapy advantages

Answer 2

Advantages
– Therapeutic effects are minimized
– Relief of acute attacks is rapid
– Systemic effects are minimized

Question 3

Types of inhaled medications

Answer 3

– Metered-dose inhalers (MDI)
– Respimats
– Dry-powder inhalers (DPIs).
– Nebulizers

Question 4

inhallations should be seperated by

Answer 4

one minute

Question 5

what is recomended to use withan inhaler

Answer 5

spacer

Question 6

what is considered to deliver more drug to the lungs and does not require a spacer. This is activated by the air of the lungs

Answer 6

Dry powder inhaler

Question 7

what type of inhaler uses a spacer

Answer 7

MDI

Question 8

What question should you ask during a follow up

Answer 8

how is the pt using the inhaller. If they are not using it corrctly they won’t get the right amount of medicine

Question 9

Anti-inflamatory are the ___ of asthma therpay and are taken ___ for long term conrol

Answer 9

foundation

daily

Question 10

Principal anti-inflamatory drugs are ____

Answer 10

inhalled glucocorticoids

Question 11

examples of inhalled glucocorticoids

Answer 11

– Beclomethasone dipropionate [QVAR]
– Budesonide [Pulmicort]
– Fluticasone [Flovent]

Question 12

Glucocorticoids - MOA

Answer 12

– Suppress inflammation
– Most effective anti-asthma drug
– Decrease synthesis and release of inflammatory mediators
– Reduce infiltration and activity of inflammatory cells
– Decrease edema of the airway mucosa caused by beta2
agonists
– Reduce bronchial hyperactivity and decrease airway
mucus production
– May increase the # of bronchial beta2 receptors and their
responsiveness to beta2 agonists

Question 13

most effective anti-asthma drug

Answer 13

glucocorticoids

Question 14

glucocorticoids may increase the number of

Answer 14

bronchial beta 2 receptors asnd theary responsiveness to bet2

Question 15

Important pt education for glucocorticoids

Answer 15

preventative medication. Must be taken daily. not used as abortive medication. benificial effects develop slowly

Question 16

Inhaled - first-line therapy for management of inflammatory component of asthma

Answer 16

glucocorticoids

Question 17

inhaled glucocortioid is safeter than

Answer 17

systemic version

Question 18

SE of glucocortioid

Answer 18

• Oropharyngeal candidiasis, dysphonia = most common

adrenal suppression

Question 19

Oral glucocorticoid use

Answer 19

– Management of acute exacerbations
– Short burst, use shortest duration possible
– Use when symptoms cannot be controlled with safer
medications.

Question 20

Oral glucocorticoid ADR

Answer 20

Adverse effects: adrenal suppression, osteoporosis,
hyperglycemia, peptic ulcer disease.
• Growth suppression in the young patient.

Question 21

Oral glucocortoid recomendatiosn to avoid Adverse effects

Answer 21

eat calcium. Weight bearing exercise. Vit d

Question 22

High dose inhalled glucocortoid ADR

Answer 22

catarax and glacoma

Question 23

should use oral glucocortoic less than

Answer 23

10 days. Really the shortest duration possible

Question 24

• Prolonged glucocorticoid use can decrease

Answer 24

the ability
of the adrenal cortex to produce glucocorticoids of its
own

Question 25

High levels of glucocorticoids are required to s

Answer 25

o survive

severe stress

Question 26

Adrenal suppression prevents p

Answer 26

production of

endogenous glucocorticoids

Question 27

Patients must be given increased doses of

Answer 27

oral or IV

glucocorticoids at times of stress

Question 28

failure to increase dose of glucocorticoids during times of stress

Answer 28

can prove fatal

Question 29

addrenal supression is life threatnein gat times of

Answer 29

s of severe physiologic stress

e.g., surgery, trauma, or systemic infection

Question 30

Discontinuation of systemic glucocorticoid

Answer 30

– Most be done slowly
– Recovery of adrenocortical function takes
several months
– Dosages of exogenous sources must be
gradually reduced
– During this patient must be given oral or IV
glucocorticoids at times of severe stress

Question 31

In children there is A dose-dependent reduction in bone

formation with use of

Answer 31

inhaled corticosteroids

Question 32

• Vitamin D and calcium sufficiency should

be ensured with

Answer 32

adequate dietary intake of

vitamin D and calcium

Question 33

Oral Glucocorticoids examples

Answer 33

Prednisone, methylprednisolone,

prednisolone

Question 34

Oral Glucocorticoids adult dose

Answer 34

40 to 60mg/day for 3 to 10 days

Question 35

Oral Glucocorticoids pediatric dose

Answer 35

1 to 2 mg/kg/day for 3 to 10

days

Question 36

Oral Glucocorticoids SE

Answer 36

increased appetite. Increased energy.

Question 37

Oral Glucocorticoids recomendations

Answer 37

take with food. taper dose 60, 40, 20 ect.

Question 38

Leukotriene Modifiers action

Answer 38

suppress effects of leukotrienes

Question 39

leukotriens

Answer 39

Promote smooth muscle
constriction, blood vessel permeability, and
inflammatory responses through direct action
and recruitment of eosinophils and other
inflammatory cells

Question 40

In patients with asthma, leukotriene

modifiers can reduce

Answer 40

bronchoconstriction
and inflammatory responses such as
edema and mucus secretion

Question 41

Leukotriene modifieres are considered

Answer 41

second line agents.

Question 42

Leukotriene modifiers Adverse Neuopsychiatric effects

Answer 42

including

depression, suicidal thinking, and suicidal behavior

Question 43

• Zileuton [Zyflo] action and monitoring

Answer 43

– blocks leukotriene synthesis

– Monitor ALT (one a month for 3 months, then every 2
to 3 months x 1 year, then periodically).

Question 44

Montelukast [Singulair} MOA

Answer 44

Leukotriene Receptor Blocker

Question 45

Montelukast three indications

Answer 45

– 1. Prophylaxis and maintenance therapy
– 2. Prevention of EIB >15 y.o.
– 3. Relief of allergic rhinitis

Question 46

Montelukast Side Effects

Answer 46

Neuropsychiatric effects

Question 47

No serious drug interactions with

Answer 47

Montelukast