Asthma Pharm

Question 1

Step Up Therapy

Answer 1

Start treatment at step appropriate to asthma severity at time of evaluation
Goal not achieved- gradually step up therapy until successful

Question 2

Step Down Therapy

Answer 2

Treat exacerbation symptoms with aggressive management

Gradual reduction of long-term-control meds to lowest level possible

Question 3

Types of Long-Term Control

Answer 3

Anticholinergics
Corticosteroids
Mast cell-stabilizing agents
Leukotriene modifiers
Methylxanthines
LABA

Question 4

Administration Techniques

Answer 4

MDI
Nebulizer
Inhaled powder
Systemic administration

Question 5

Beta-2 agonists

Answer 5

Produce airway dilation
Stimulation of beta-adrenergic receptors
Decrease release of mediators

Question 6

Short-acting Beta 2 Agonists

Answer 6

Acute attack

Prevention of exercise-induced bronchospasm

Question 7

Long-acting Beta 2 Agonists

Answer 7

Prevention

Maintenance therapy

Question 8

Examples of Short Acting B2 Agonist

Answer 8

Albuterol
Proventil
Ventolin
Terbutaline (Brethine)
Bitolterol (Tornalate)
Pirbuterol (Maxair)

Question 9

Adverse Effects of Beta-2 Agonists

Answer 9

Tachycardia
Tremor
Hypokalemia
Headache
Hyperglycemia
Increased lactic acid

Question 10

Examples of Long Acting Beta-2 Agonists

Answer 10

Salmeterol (Serevent)
Formoterol (Foradil)
Levalbuterol (Xopenex)
Fenoterol (Berotec)

Question 11

What are LABA’s used for?

Answer 11

Maintenance therapy

Slower onset, long-lasting

Question 12

Anticholinergics Antimuscarinic Agents

Answer 12

Ipratropium bromide (Atrovent)
Tiotropium (Spiriva)

Question 13

What can Ipratropium bromide enhance?

Answer 13

Bronchodilation achieved by beta-agonists

Question 14

Types of Methylxanthines

Answer 14

Theophylline

Aminophylline

Question 15

What is Theophylline for?

Answer 15

Maintenance therapy

Question 16

Theophylline SE

Answer 16

Insomnia
Nervousness
N/V
Anorexia
Headache
Tachycardia
Seizures
Cardiac arrhythmias

Question 17

Theophylline Immediate Release Products

Answer 17

Slo-Phyllin
Theolair
Quibron-T
Elixophillin
Bronkodyl
Theophylline generics

Question 18

Theophylline Sustained Release Products

Answer 18

Slo-bid Gyrocaps
Theo-24
Theobid
Theo-Dur
THeospan-SR
Theophylline SR generics

Question 19

MOA of Corticosteroids

Answer 19

Reduce airway inflammation

Question 20

Inhaled Steroids

Answer 20

Reduce airway reactivity

Question 21

SE of Corticosteroids

Answer 21

Thrush
Dysphonia
Adrenal suppression (LD)
Cataract formation (LD)
Decreased growth in children (LD)
Interference with bone metabolism (LD)
Purpura (LD)

Question 22

Examples of Corticosteroids

Answer 22

Fluticasone (Flovent)
Budesonide (Pulmicort)
Beclomethasone (Vanceril, Beclovent, QVAR)
Triamcinolone (Azmacort)
Flunisolide (Aerobid, Aerobid-M)

Question 23

Budesonide (Pulmicort)

Answer 23

First nebulizer steroid
Greater number symptom free days
Decreased B-agonist need
Reduced hospitalization rates

Question 24

Examples of PO Steroids for Acute Treatment

Answer 24

Methylprednisolone

Prednisone

Question 25

Chronic Treatment with PO Steroids

Answer 25

Alternate-day schedule Minimize SE Interrupts growth Long acting preparations should not be used

Question 26

Newer Steroid Agents

Answer 26

``` Advair Diskus (fluticasone + salmeterol) Combivent MDI (ipratropium + albuterol) ```

Question 27

Examples of Mast Cell Stabilizers

Answer 27

Cromolyn (Intal) | Nedocromil (Tilade)

Question 28

Action of Mast Cell Stabilizers

Answer 28

Don't influence airway tone Inhibit degranulation of mast cells Prevent release of chemical mediators

Question 29

When are mast cell stabilizers most effective?

Answer 29

Seasonal disease

Question 30

Examples of Leukotriene Inhibitors

Answer 30

Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Leutrol, Zyflow)

Question 31

MOA of Leukotriene Inhibitors

Answer 31

Suppress action of sisterly leukotriene

Question 32

Benefits of Leukotriene Inhibitors

Answer 32

``` Improvement in FEV1, asthma exacerbations Improvement in frequency of SABA use Safe in children 6-14 Minimal SE Effective with steroids or LABA ```

Question 33

How can leukotriene inhibitors affect the dose of inhaled corticosteroids?

Answer 33

Reduce higher doses

Question 34

SE of Leukotriene Inhibitors

Answer 34

LFT abnormalities | Headache

Question 35

Example of Anti-IgE Monoclonal Antibodies

Answer 35

Omalizumab

Question 36

MOA of Omalizumab

Answer 36

Inhibits the binding of IgE to mast cells | Doesn't promote mast cell degranulation

Question 37

Intermittent Asthma Treatment

Answer 37

PRN SABA

Question 38

Mild Persistent Asthma Treatment

Answer 38

PRN SABA Low dose ICS or cromolyn or nedocromil 2nd line: leukotriene modifier or theophylline

Question 39

Moderate Persistent Asthma Treatment

Answer 39

PRN SABA | ICS medium dose or low-medum dose ICS + LABA or SR Theophylline or oral beta agonist

Question 40

If needed Moderate Persistent Asthma Treatment

Answer 40

Medium-high ICS + LABA or SR Theophylline or oral LABA

Question 41

Severe Persistent Asthma Treatment

Answer 41

PRN SABA | High dose ICS + LABA or SR Theophylline or oral LABA + Oral corticosteroids

Question 42

Misc. Treatment of the Allergic Asthmatic

Answer 42

Elimination of causative agents | Desensitization or immunotherapy not proven highly effective

Question 43

Environmental Changes for Asthmatic Patient

Answer 43

Change of occupation or relocation of dwelling | Eliminating aerosal sprays

Question 44

Immunizations of the Asthmatic Patient

Answer 44

Influenza vaccination | Pneumococcal vaccine