Ch 76 Asthma and COPD Flashcards
Asthma is a chronic inflammatory disease characterized by _(3)_.
inflammation of the airways, bronchial hyperreactivity,
and bronchospasm.
Allergy is often the underlying cause.
Asthma is treated with (2).
anti-inflammatory drugs and bronchodilators
Most drugs for asthma are administered by inhalation, a route that (3).
increases therapeutic effects (by delivering drugs directly to their site of action),
reduces systemic effects (by minimizing drug levels in blood),
and facilitates rapid relief of acute attacks.
Four devices are used for inhalation:
metered-dose inhalers (MDIs),
dry-powder inhalers (DPIs),
Respimats, and
nebulizers.
Patients will need instruction on their use.
__ are the most effective anti-inflammatory drugs for asthma management
Glucocorticoids
Glucocorticoids reduce symptoms of asthma by ___.
suppressing inflammation.
As an added bonus, glucocorticoids appear to promote synthesis of bronchial beta2 receptors and increase their responsiveness to beta2 agonists.
Inhaled and systemic glucocorticoids are used for ___.
long-term prophylaxis of asthma—not for aborting an ongoing attack.
Accordingly, they are administered on a fixed schedule—not PRN.
Unless asthma is severe, __ should be administered by inhalation.
glucocorticoids
Inhaled glucocorticoids are generally very safe. Their
principal side effects are (2).
oropharyngeal candidiasis and dysphonia,
which can be minimized by employing a spacer device during administration and by rinsing the mouth and gargling after use.
Inhaled glucocorticoids can slow the __.
growth rate of children, but they do not reduce adult height
Inhaled glucocorticoids may pose a small risk for __.
bone loss.
To minimize loss, dosage should be as low as possible, and patients should perform regular weight-bearing exercise and should ensure adequate intake of calcium and vitamin D.
Prolonged therapy with oral glucocorticoids can cause
serious adverse effects, including (5).
adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.
Because of adrenal suppression, patients taking oral glucocorticoids (and patients who have switched from oral glucocorticoids to inhaled glucocorticoids) must be given ___.
supplemental doses of oral or IV glucocorticoids at times of stress
Cromolyn is an inhaled anti-inflammatory drug used for
___.
prophylaxis of asthma
For long-term prophylaxis, cromolyn is taken daily on
a fixed schedule.
Cromolyn reduces inflammation primarily by ___.
preventing the release of mediators from mast cells
For prophylaxis of exercise-induced bronchospasm, cromolyn is taken __.
15 minutes before anticipated exertion
___ is the safest drug for asthma. Serious adverse
effects are extremely rare.
Cromolyn
Beta2 agonists promote __..
bronchodilation by activating beta2 receptors in bronchial smooth muscle
Inhaled short-acting beta2 agonists (SABAs) are the most effective drugs for relieving (2).
acute bronchospasm and preventing exercise-induced bronchospasm
Three inhaled __ have a long duration of action and are indicated for long-term control.
beta2 agonists - arformoterol, formoterol, and salmeterol
___ rarely cause systemic side effects when
taken at the recommended dosage.
Inhaled SABAs
Excessive dosing with oral beta2 agonists can cause
(2).
tachycardia and angina by activating beta1 receptors on
the heart.
Selectivity is lost at high doses.
Inhaled long-acting beta2 agonists (LABAs) can increase
the risk for ___, primarily when used
alone.
asthma-related death
To reduce risk, LABAs should be used only by patients taking an inhaled glucocorticoid for long-term control, and only if the glucocorticoid has been inadequate by itself. For combined glucocorticoid/LABA therapy, the FDA recommends using a product that contains both drugs in the same inhaler.
Theophylline, a member of the methylxanthine family,
relieves asthma by causing __.
bronchodilation
__ has a narrow therapeutic range and can cause serious adverse effects; it has been largely replaced by safer and more effective medications.
Theophylline
There are four classes of chronic asthma:
intermittent,
mild persistent,
moderate persistent, and
severe persistent.
Diagnosis is based on current impairment and future risk.
For therapeutic purposes, asthma drugs can be classified as _(2)_.
long-term control medications (e.g., inhaled glucocorticoids) and quick-relief medications (e.g., inhaled SABAs).
In the stepwise approach to asthma therapy, treatment
becomes more aggressive as __.
impairment or risk becomes more severe
The goals of stepwise therapy are to (9).
prevent symptoms,
maintain near-normal pulmonary function,
maintain normal activity,
prevent recurrent exacerbations,
minimize the need for SABAs,
minimize drug side effects,
minimize emergency department visits,
prevent progressive loss of lung function,
and meet patient and family expectations about treatment.
The step chosen for initial therapy is based on the ___, whereas moving up or down a step is based on ongoing assessment of asthma control.
pretreatment classification of asthma severity
Intermittent asthma is treated __.
PRN, using an inhaled SABA to abort the few acute episodes that occur.
For persistent asthma (mild, moderate, or severe), the
foundation of therapy is ___.
daily inhalation of a glucocorticoid.
An inhaled LABA is added to the regimen when asthma is more severe. An SABA is inhaled PRN to suppress breakthrough attacks.
For acute severe exacerbations of asthma, patients should receive (3).
oxygen (to reduce hypoxemia), a systemic glucocorticoid (to reduce airway inflammation), and a nebulized SABA plus nebulized ipratropium (to relieve airflow obstruction).
To prevent exercise-induced bronchospasm, patients can
inhale __ just before strenuous activity.
an SABA
Pharmacologic management of stable COPD relies primarily on (3).
bronchodilators, glucocorticoids, and PDE4 inhibitors
___ are preferred for bronchodilation in stable COPD.
Inhaled long-acting formulations of either beta2 agonists
or anticholinergics
___ are preferred for bronchodilation during COPD exacerbations.
Inhaled short-acting beta2 agonists
When given for stable COPD, glucocorticoids should be
given in combination with ___.
a long-acting beta2 agonist.
Glucocorticoid monotherapy is not recommended for longterm therapy.
In patients with severe chronic COPD, the risk for exacerbations may be reduced with __, a PDE4 inhibitor.
roflumilast [Daliresp]
(2) can greatly improve management of COPD exacerbations when they occur.
Systemic glucocorticoids and antibiotics
