Asthma/DVT/PE

Question 1

Symptoms of Asthma

Answer 1

Chronic cough, Dyspnea, Wheezes

diminished FEV/FVC ratio, improves with administration of beta-2 agonist (PEFR also increases)

Question 2

Atopic Asthma

Answer 2

Excessive Th2 response
type 1 IgE-mediated hypersensitivity; evidence of allergen sensitization, often in a patient with a history of allergic rhinitis, eczema

Question 3

Non-atopic Asthma

Answer 3

often adult-onset/more severe disease: triggers can be: aspirin/other drugs, exercise, cold air, stress, inhaled irritants

Question 4

Diphenhydramine, chlorpheniramine

Answer 4

1st generation anti-histamines
block H1, muscarinic, cholinergic receptors
not recognized by P-glycoprotein efflux pump –> sedation
side effects from other receptors

Question 5

Fexofenadine, cetirizine, loratidine

Answer 5

2nd generation anti-histamines
block H1 receptor
recognized by P-glycoprotein efflux pump –> no sedation or side effects from other receptors

Question 6

Theophylline

Answer 6

mechanism not fully elucidated
PDE inhibitor –> results in increase in cAMP levels –> results in broncho dilation
Toxic side effects –> don’t use

Question 7

Normal dilation pathway of broncho smooth muscle

Answer 7

Epi binds beta-2 receptors –> GPCR –> adenylyl cyclase –> increased cAMP –> bronchodilation

Question 8

Cromolyn Sodium

Answer 8

anti-inflammatory and mast cell stabilizer

blocks release of histamine and SRS-A

Question 9

Albuterol

Answer 9

SABA –> binds beta-2 receptors causing broncho dilation

Question 10

Salmeterol, formoterol

Answer 10

LABA –> binds beta-2 receptors causing broncho dilation

NEVER use by themselves!!!

Question 11

Zileuton

Answer 11

5-lipoxygenase inhibitor –> inhibits synthesis of LTB4
may decrease the need for beta agonists
require monitoring for hepatic toxicity

Question 12

Monteleukast, Zafirleukast

Answer 12

reversible leukotriene receptor antagonists (LTD4 receptor and Cyst-LTR1)
Safe and once daily administration

Question 13

Phenylephrine

Answer 13

potent, direct acting alpha agonist with no beta activity –> vasoconstriction –> nasal decongestion

Question 14

Pseudoephedrine

Answer 14

Directly stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction; directly stimulates beta-adrenergic receptors causing bronchial relaxation

Question 15

Inhaled corticosteroids

Answer 15

bind steroid response element –> alter transcription –> decreased NF-kB, and other inflammatory cytokines and mediators
Nasal sprays: enhanced uptake in lungs, prolonged tissue binding in the lungs, nearly complete first pass inactivation

Question 16

Omalizumab

Answer 16

• binds to free IgE in circulation → inhibits IgE binding to mast cells & basophils→ decreases mediator release→ decreases free IgE & down-regulates IgE receptors
• Given as injection sub-q, expensive
• Anti-IgE treatment might be recommended if you have allergic asthma and you keep experiencing persistent symptoms despite taking your controller medications.

Question 17

Treatment of different severities of asthma

Answer 17

Step 1 - SABA as needed
Step 2 - Low dose ICS and SABA as needed
Step 3 - Low dose ICS and LABA/medium ICS w/ SABA as needed
Step 4 - Medium dose ICS and LABA
Step 5 - High dose ICS and LABA
Step 6 - High dose ICS, LABA, oral corticosteroid

Question 18

Severity of Asthma symptoms

Answer 18

1. Intermittent: infrequent symptoms (less than twice a week) use albuterol
2. Persistent: more than twice a week - waking up with cough/ not able to breath, Treat these people with daily inhaled corticosteroids. If someone has persistent asthma you will use the least effective dose. When they have an exacerbation you still use the albuterol just like everyone else.
3. Severe: add a long acting, increase the dose, add a leukotriene inhibitor, never use theophylline
4. Super severe: daily oral steroids!!

Question 19

Nonpharmacologic treatment of asthma

Answer 19

Allergen/environment control
Patient Education
Recognition of symptoms and measurements of lung function

Question 20

Inverse Agonist

Answer 20

binds same receptor but induces pharmacological response opposite to that of agonist

Question 21

Competitive Agonist

Answer 21

receptor antagonist that binds receptor but does not activate the receptor

Question 22

Virchow’s Triad

Answer 22

Stasis
Hypercoaguability
Endothelial Damage

Question 23

PE and V/Q mismatch?

Answer 23

V/Q ratio goes to infinity (essentially no perfusion)

Question 24

D-dimer test

Answer 24

Good sensitivity but LOW specificity
Negative test –> NO CLOT
Positive test –> can’t say there is a clot