COPD and Asthma

Question 1

Most effective drug for relieving acute bronchospasm and preventing EIB

Answer 1

B2 adrenergic antagonists

Question 2

How are LABAs taken? With what?

Answer 2

Fixed schedule, not PRN. Always with glucocorticoids

Question 3

B2 Adrenergic agonists moa

Answer 3

Activate b2 adrenergic receptors in smooth muscle of lungs, promoting bronchodilation and relieving bronchospasm

Question 4

Methylzanthines moa

Answer 4

Produces bronchodilation by relaxing smooth muscle of bronchi

Question 5

Anticholinergics mechanism of action

Answer 5

Muscarinic antagonist: blocks muscarinic cholinergic receptors in the bronchi, preventing bronchoconstriction

Question 6

Anticholinergics timing

Answer 6

Therapeutic in 30 secs, 50% of max effects in 3 mins, persists for 3 hours

Question 7

Indicated in pts experiencing frequent attacks, for long term control. Preferred for stable COPD

Answer 7

LABA

Question 8

Used PRN in acute attacks, EIB, hospitalized pts with severe attacks

Answer 8

SABAs

Question 9

Maintenance therapy for chronic stable asthma, less effective than b2 agonists but longer duration of action, can decrease frequency of attacks, not for COPD unless nothing else

Answer 9

Methylzanthines

Question 10

Approved for COPD and off label use in asthma, allergen induced asthma, EIB

Answer 10

Anticholinergics

Question 11

Contraindicated in asthma

Answer 11

LABAs

Question 12

LABAs adverse effects

Answer 12

Increase risk of severe asthma and asthma related deaths when used as monotherapy for long term control

Question 13

SABAs adverse effects

Answer 13

Systemic: tachycardia, tremor, angina

Question 14

Methylzanthines adverse effects

Answer 14

Toxicity: normal levels 10-20, mild effects 20-25 nausea, vomiting, diarrhea, insomnia. Severe effects 30+ v fib, convulsions

Question 15

Treatment of Methylzanthines toxicity

Answer 15

Activated charcoal, lidocaine for dysrhythmias, diazepam for convulsions

Question 16

Anticholinergics adverse effects

Answer 16

Irritation of pharynx, dry mouth, increased intraoccular pressure in pts with glaucoma

Question 17

Methylzanthines interactions

Answer 17

Caffeine, tobacco, marijuana smoke

Question 18

Formoterol (oxeze turbohaler)

Answer 18

LABA

Question 19

Salmeterol (serevent)

Answer 19

LABA

Question 20

Albuterol (ventolin)

Answer 20

SABA

Question 21

Theophylline

Answer 21

Methylzanthine

Question 22

Ipratopium (atrovent)

Answer 22

Anticholinergic

Question 23

Tiotropium (spiriva)

Answer 23

Anticholinergic

Question 24

Most effective drug for long term control of airway inflammation

Answer 24

Glucocorticoids

Question 25

2nd line therapy for allergy related asthma, modest benefits for serious drawbacks, unknown long term effects

Answer 25

IgE antagonists

Question 26

Used as second line if glucocorticoids can’t be used, or add on therapy when inhaled glucocorticoids can’t be used

Answer 26

Leukotriene modifiers

Question 27

Glucocorticoids indication

Answer 27

Prophylaxis of chronic asthma, inhaled are first line for inflammatory component of asthma

Question 28

12+ with moderate to severe asthma, allergy related and can’t be controlled with glucocorticoids, asthma caused by specific allergen (allergen skin test required before use to determine allergen reactivity)

Answer 28

IgE antagonist indications

Question 29

Prophylaxis and maintenance therapy of asthma in pts 1+, prevention of EIB in 15+, relief allergic rhinitis, Not for quick relief of symptoms

Answer 29

Leukotriene modifier indications

Question 30

How long for Leukotriene modifiers to develop max effects

Answer 30

24hrs

Question 31

IgE antagonist pharmacokinetics

Answer 31

Administered sub-Q, Slow absorption, peak conc in 7-8 days, approx half life of 26 days

Question 32

Reduces symptoms by suppressing inflammation, reduces bronchial hyperactivity and decreases airway mucous production

Answer 32

Glucocorticoids moa

Question 33

Forms a complex with free IgE and thereby inhibits binding with mast cells, limits ability of allergens to release mediators that promote bronchospasm and airway inflammation

Answer 33

IgE Antagonist MOA

Question 34

Suppress effects of Leukotrienes, decrease bronchoconstriction and inflammatory responses in asthma

Answer 34

Leukotriene modifiers MOA

Question 35

Inhaled Glucocorticoids Adverse effects

Answer 35

Oral Candiasis, dysphonia, slow growth in children and adolescents, promotes bone loss, increase risk of cataracts and glaucoma

Question 36

What education would you provide a patient on the risk of oral candiasis when taking glucocorticoids?

Answer 36

Rinse thoroughly with water or milk after taking, use spacer so more of the meds are absorbed in lungs vs mouth

Question 37

Adverse effects of oral glucocorticoids

Answer 37

Adrenal suppression, Osteoporosis, hyperglycaemia, peptic ulcer disease, growth suppression, decreased ability of adrenal cortex to make glucocorticoids on its own with prolonged therapy, required for high stress situations like surgery or trauma

Question 38

Adverse effects of IgE antagonists

Answer 38

Injection site reactions, viral infections, URTI, sinusitis, headache pharyngitis, small risk of cardiovascular and malignancy problems, life threatening anaphylaxis in 0.1%, urticaria and edema of throat/tongue, most like with first doses

Question 39

How should monitoring occur for adverse affects from IgE antagonists

Answer 39

First dose 2hrs, following doses 30 mins

Question 40

Adverse effects of Leukotriene modifiers

Answer 40

Generally well tolerated, neuropsychiatric effects rare but possible, mood changes and suicidality

Question 41

Budesonide (pulmicort)

Answer 41

Inhaled Glucocorticoid

Question 42

Fluticasone (Flovent)

Answer 42

Inhaled Glucocorticoid

Question 43

Prednisone (Winipred)

Answer 43

Oral Glucocorticoid

Question 44

Omalizumab (xolair)

Answer 44

IgE antagonist

Question 45

Montelukast (Singulair)

Answer 45

Leukotriene modifier

Question 46

Zafirlukast (accolate)

Answer 46

Leukotriene modifier

Question 47

Zileuton (zyflo)

Answer 47

Leukotriene modifier