Chapter 79: Drugs for Asthma and COPD

Question 1

what is asthma

Answer 1

chronic inflammatory disorder of the airway

Question 2

asthma signs and symptoms

Answer 2

• sense of breathlessness
• tightening of the chest
• wheezing
• dyspnea
• cough

Question 3

asthma cause

Answer 3

immune-mediated airway inflammation

Question 4

risks for asthma

Answer 4

• family history, air pollution, tobacco smoke, respiratory viral infections in the early years, allergic sensitizations,
• allergic rhinitis

Question 5

very mild asthma is well controlled on

Answer 5

PRN SABA

Question 6

mild asthma is well controlled on

Answer 6

low dose ICSS or LTRA or PRN budesonide/formoterol

Question 7

symptoms of asthma result from

Answer 7

a combination of inflammation and bronchoconstriction

Question 8

what are mild triggers for asthma

Answer 8

cold air, exercise, tobacco smoke

Question 9

what is COPD

Answer 9

chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation

Question 10

COPD signs and symptoms

Answer 10

• chronic cough
• excessive sputum production
• wheezing
• dyspnea
• poor excersize tolerance

Question 11

COPD cause

Answer 11

noxious particles or gases (tobacco, marijuanna, occupational chemical exposure, ect.)

Question 12

symptoms of COPD result from

Answer 12

chronic bronchitis and emphysema –> caused by cigarette smoke

Question 13

chronic bronchitis

Answer 13

chronic cough and excessive sputum production

Question 14

chronic bronchitis results from

Answer 14

hypertrophy of mucus secreting glands in the epithelium and larger airways

Question 15

emphysema

Answer 15

• enlargement of the air space within the bronchioles and alveoli
• deterioration of the walls of these airspaces

Question 16

what are the 2 pharmacologic classes used for treatment of COPD

Answer 16

• anti-inflammatory agents
• bronchodialators

Question 17

anti-inflammatory agents consist of

Answer 17

• glucocorticoids
• mast cell stabilizers
• leukotriene modifiers
• phosphodiesterase-4 inhibitors
• IgE antagonists
• Cromolyn

Question 18

bronchodialators consists of

Answer 18

• beta2 agonists
• methylanthines
• aanticholinergics

Question 19

advantages of inhalation drug therapy

Answer 19

• therapeutic effects are enhanced
• systemic effects minimized
• releif of acute attacks is rapid

Question 20

types of inhalers

Answer 20

• Metered-dose inhalers (MDIs)
• Respimat style
• Dry powder inhalers (DPIs)
• nebulizers
• ellipta style

Question 21

what is considered the most effective anti-asthma drugs

Answer 21

glucocorticoids

Question 22

glucocorticoids mechanism of action

Answer 22

• decrease synthesis and release of inflammatory mediators (leukotrienes, histamine, prostaglandin)
• reduce infiltration and activity of inflammatory cells (eosinophils, leukocytes)
• decrease edema of the airway mucosa cause by beta2 agonists

Question 23

glucocorticoids is usually administered by

Answer 23

inhalation
- IV and oral routes too

Question 24

glucocorticoids use

Answer 24

prophylaxis of chronic asthma

Question 25

glucocorticoids dosing

Answer 25

fixed schedule

Question 26

inhaled use of glucocorticoids

Answer 26

• first line therapy for management of asthma
• more effective and safer

Question 27

oral use of glucocorticoids

Answer 27

• for patients with moderate to severe persistant asthma
• potential for toxicity
• treatment should be used as brief as possible

Question 28

adverse effects of inhaled from of glucocorticoids

Answer 28

• adrenal suppression, oropharyngeal canidiasis, dysphonia, can slow growth in children, promotion of bone loss, increased risk of cataracts, increased risk of glaucoma

Question 29

adverse effects of oral forms of glucocorticoids

Answer 29

• adrenal suppression, osteoporosis, hyperglycaemia, peptic ulcer disease

Question 30

Leukotriene modifiers mechanism of action

Answer 30

supress/block effects of leukotrienes

Question 31

leukotrienes

Answer 31

promote smooth muscle constriction, blood vessel permeability, and inflammatory response through direct action and recruitment of eosionophila

Question 32

leukotriene modifiers use

Answer 32

prevention and treatment of chronic asthma symptoms (alone or in combination)

Question 33

leukotriene modifiers adverse effects

Answer 33

Gi upset, headache, liver damage, neuropsychiatric effects (depression, sucidal thinking, and sucidal behaviour)

Question 34

Leukotriene modiferes avaliable agents

Answer 34

• montelukast [Singulair]
• Zafirlukast [Accolate]

Question 35

Cromolyn mechanism of action

Answer 35

works on mast cells to suppress inflamamtion by preventing the release of histamine and other inflammatory mediators

Question 36

cromolyn is used for

Answer 36

prophylaxis of mild to moderate asthma

Question 37

cromolyn adverse effects

Answer 37

cough

Question 38

cromolyn administration

Answer 38

inhaler and eye drops

Question 39

Omalizumab [Xolair] [Anti-IgE Antibody] mechanism of action

Answer 39

forms complexes with free IgE therefore reducing the amount of IgE avaliable to bind on mast cells

Question 40

Omalizumab [Xolair] [Anti-IgE Antibody] therapeutic uses

Answer 40

• patients age 6 or older with moderate to severe asthma that is allergy related and connot be controlled with glucocorticoid

Question 41

Omalizumab [Xolair] [Anti-IgE Antibody] administration

Answer 41

subcut, every 2-4 weeks

Question 42

Omalizumab [Xolair] [Anti-IgE Antibody] adverse effects

Answer 42

• injection site reactions, viral infection, upper resp infection, sinusitis, headache, pharyngitis, cardiovascular events, malignancy, life threatening anaphylaxis