Chapter 41: Asthma

Question 1

FEV1

Answer 1

How much air can forcefully be exhaled in 1 second

Question 2

FVC

Answer 2

After taking a deep breath, the maximum volume of air that is exhaled

Question 3

FEV1/FVC

Answer 3

The percentage of total air capacity that can be forcefully exhaled in one second

Question 4

Well Controlled

Answer 4

symptoms/use of SABA rescue inhaler <=2 days/week
nighttime awakenings <=2 times/month
no limitation to normal activity

Question 5

Not Well Controlled

Answer 5

symptoms/use of SABA rescue inhaler >2 days/week
nighttime awakenings 1-3 times/week
some limitations to normal activity

Question 6

Very Poorly Controlled

Answer 6

Symptoms/use of SABA rescue inhaler several times daily
Nighttime awakenings >=4 days/week
Normal activity is extremely limited

Question 7

Beta 2 agonists MOA

Answer 7

These bind to beta-2 receptors causing relaxation of bronchial smooth muscle which leads to bronchodilation

Question 8

SABA SE

Answer 8

Nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
decreased K

Question 9

Salmeterol

Answer 9

Serevent Diskus
LABA

Boxed warnings: increased risk of asthma-related death, should only be used in combo with ICS

Not for acute bronchospasm

Question 10

ICS MOA

Answer 10

Inhibit the inflammatory response

Question 11

Qvar Redihaler

Answer 11

Beclomethasone

*Breath activated, do not shake or use with spacer

Question 12

Pulmicort Flexhaler

Answer 12

Budesonide

Question 13

Flovent HFA, Diskus

Answer 13

Fluticasone

Question 14

Arnuity Ellipta

Answer 14

Fluticasone

Question 15

Advair Diskus, HFA

Answer 15

Fluticasone + salmeterol

Question 16

Breo Ellipta

Answer 16

Fluticasone + vilanterol

Question 17

Dulera

Answer 17

Mometasone + formoterol

Question 18

Spiriva Respimat

Answer 18

Tiotropium

LAMA

Question 19

Leukotriene Modifying Agents MOA

Answer 19

LTRAs inhibit leukotriene mediators of airway inflammation. Reduces airway edema, constriction, and inflammation

Question 20

Montelukast MOA and Dosing

Answer 20

Inhibits leukotriene D4

10mg qpm
age 6-14: 5mg qpm
age 1-5: 4mg qpm

Comes in tab, chewable, and packet

Question 21

Montelukast Boxed Warnings

Answer 21

Neuropsychiatric events (suicidal thoughts/behaviors)

Question 22

Montelukast Notes

Answer 22

Granules can be administered directly into the mouth, dissolved in a small amount of breastmilk or formula or mixed with a spoonful of applesauce, carrots, rice, or ice cream.
Use within 15 minutes of opening packet

Question 23

Theophylline MOA

Answer 23

Blocks phosphodiesterase causing an increase in cAMP and release of Epinephrine from adrenal medulla cells. This results in bronchodilation and diuresis, CNS and cardiac stimulation and gastric acid secretion.

Use is limited by decreased effectiveness, DIs and adverse effects

Question 24

Theophylline therapeutic range

Answer 24

5-15mcg/ml

Zero- order kinetics

Question 25

Omalizumab MOA

Answer 25

Xolair

It is a MAB that inhibits IgE binding to the IgE receptor on mast cells and basophils.

Question 26

Omalizumab Indication

Answer 26

For moderate to severe persistent allergic asthma in patients >= 6 years of age with a positive skin test to perennial allergen

Administer in a healthcare setting