Ch 76 Asthma and COPD

Question 1

Asthma is a chronic inflammatory disease characterized
by  _(3)_.

Answer 1

inflammation of the airways, bronchial hyperreactivity,
and bronchospasm.

Allergy is often the underlying cause.

Question 2

Asthma is treated with (2).

Answer 2

anti-inflammatory drugs and bronchodilators

Question 3

Most drugs for asthma are administered by inhalation, a route that (3).

Answer 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.

Question 4

Four devices are used for inhalation:

Answer 4

metered-dose inhalers (MDIs),
dry-powder inhalers (DPIs),
Respimats, and
nebulizers.

Patients will need instruction on their use.

Question 5

__ are the most effective anti-inflammatory drugs for asthma management

Answer 5

Glucocorticoids

Question 6

Glucocorticoids reduce symptoms of asthma by ___.

Answer 6

suppressing inflammation.

As an added bonus, glucocorticoids appear to promote synthesis of bronchial beta2 receptors and increase their responsiveness to beta2 agonists.

Question 7

Inhaled and systemic glucocorticoids are used for ___.

Answer 7

long-term prophylaxis of asthma—not for aborting an ongoing attack.

Accordingly, they are administered on a fixed schedule—not PRN.

Question 8

Unless asthma is severe, __ should be administered by inhalation.

Answer 8

glucocorticoids

Question 9

Inhaled glucocorticoids are generally very safe. Their

principal side effects are (2).

Answer 9

oropharyngeal candidiasis and dysphonia,

which can be minimized by employing a spacer device during administration and by rinsing the mouth and gargling after use.

Question 10

Inhaled glucocorticoids can slow the __.

Answer 10

growth rate of children, but they do not reduce adult height

Question 11

Inhaled glucocorticoids may pose a small risk for __.

Answer 11

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.

Question 12

Prolonged therapy with oral glucocorticoids can cause

serious adverse effects, including (5).

Answer 12

adrenal suppression,
osteoporosis, 
hyperglycemia, 
peptic ulcer disease, and
growth suppression.

Question 13

Because of adrenal suppression, patients taking oral glucocorticoids (and patients who have switched from oral glucocorticoids to inhaled glucocorticoids) must be given ___.

Answer 13

supplemental doses of oral or IV glucocorticoids at times of stress

Question 14

Cromolyn is an inhaled anti-inflammatory drug used for

___.

Answer 14

prophylaxis of asthma

For long-term prophylaxis, cromolyn is taken daily on
a fixed schedule.

Question 15

Cromolyn reduces inflammation primarily by ___.

Answer 15

preventing the release of mediators from mast cells

Question 16

For prophylaxis of exercise-induced bronchospasm, cromolyn is taken __.

Answer 16

15 minutes before anticipated exertion

Question 17

___ is the safest drug for asthma. Serious adverse

effects are extremely rare.

Answer 17

Cromolyn

Question 18

Beta2 agonists promote __..

Answer 18

bronchodilation by activating beta2 receptors in bronchial smooth muscle

Question 19

Inhaled short-acting beta2 agonists (SABAs) are the most effective drugs for relieving (2).

Answer 19

acute bronchospasm and preventing exercise-induced bronchospasm

Question 20

Three inhaled __ have a long duration of action and are indicated for long-term control.

Answer 20

beta2 agonists - arformoterol, formoterol, and salmeterol

Question 21

___ rarely cause systemic side effects when

taken at the recommended dosage.

Answer 21

Inhaled SABAs

Question 22

Excessive dosing with oral beta2 agonists can cause

(2).

Answer 22

tachycardia and angina by activating beta1 receptors on
the heart.
Selectivity is lost at high doses.

Question 23

Inhaled long-acting beta2 agonists (LABAs) can increase
the risk for ___, primarily when used
alone.

Answer 23

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.

Question 24

Theophylline, a member of the methylxanthine family,

relieves asthma by causing __.

Answer 24

bronchodilation

Question 25

__ has a narrow therapeutic range and can cause serious adverse effects; it has been largely replaced by safer and more effective medications.

Answer 25

Theophylline

Question 26

There are four classes of chronic asthma:

Answer 26

intermittent,
mild persistent,
moderate persistent, and
severe persistent.

Diagnosis is based on current impairment and future risk.

Question 27

For therapeutic purposes, asthma drugs can be classified
as _(2)_.

Answer 27

long-term control medications (e.g., inhaled glucocorticoids) and quick-relief medications (e.g., inhaled SABAs).

Question 28

In the stepwise approach to asthma therapy, treatment

becomes more aggressive as __.

Answer 28

impairment or risk becomes more severe

Question 29

The goals of stepwise therapy are to (9).

Answer 29

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.

Question 30

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.

Answer 30

pretreatment classification of asthma severity

Question 31

Intermittent asthma is treated __.

Answer 31

PRN, using an inhaled SABA to abort the few acute episodes that occur.

Question 32

For persistent asthma (mild, moderate, or severe), the

foundation of therapy is ___.

Answer 32

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.

Question 33

For acute severe exacerbations of asthma, patients should receive (3).

Answer 33

oxygen (to reduce hypoxemia), a systemic glucocorticoid (to reduce airway inflammation), and a nebulized SABA plus nebulized ipratropium (to relieve airflow obstruction).

Question 34

To prevent exercise-induced bronchospasm, patients can

inhale __ just before strenuous activity.

Answer 34

an SABA

Question 35

Pharmacologic management of stable COPD relies primarily on (3).

Answer 35

bronchodilators, glucocorticoids, and PDE4 inhibitors

Question 36

___ are preferred for bronchodilation in stable COPD.

Answer 36

Inhaled long-acting formulations of either beta2 agonists

or anticholinergics

Question 37

___ are preferred for bronchodilation during COPD exacerbations.

Answer 37

Inhaled short-acting beta2 agonists

Question 38

When given for stable COPD, glucocorticoids should be

given in combination with ___.

Answer 38

a long-acting beta2 agonist.

Glucocorticoid monotherapy is not recommended for longterm therapy.

Question 39

In patients with severe chronic COPD, the risk for exacerbations may be reduced with __, a PDE4 inhibitor.

Answer 39

roflumilast [Daliresp]

Question 40

(2) can greatly improve management of COPD exacerbations when they occur.

Answer 40

Systemic glucocorticoids and antibiotics