Drugs

Question 1

What are the names of the 2 long acting beta agonists?

Answer 1

Salmeterol, Formoterol

Question 2

Can long acting beta agonists be used in mono therapy for asthma?

Answer 2

NO - increased risk of asthma death if you do!

Question 2

What’s a common substance that one should avoid/limit when using beta agonists?

Answer 2

caffeine

Question 2

What is considered the long-term control drug of choice in patients with any degree of asthma?

Answer 2

Inhaled corticosteroids

Question 3

What are the names of 3 systemic corticosteroids used in respiratory disorders?

Answer 3

dexamethasone, prednisone, solumedrol

Question 4

If a patient has asthma and COPD, which drug class is indicated?

Answer 4

Anticholinergics. Not for asthma, unless COPD is also present.

Question 5

How does cromolyn work? Based on this, what indications does it have?

Answer 5

Inhibits release of histamine. Can be effective when taken before an exposure or exercise but do not relieve asthmatic symptoms once present.

Question 6

This medication is no longer recommended for asthma due to its narrow therapeutic window?

Answer 6

Theophylline

Question 7

What can happen with a theophylline overdose?

Answer 7

seizures or potentially fatal arrhythmias

Question 9

Which drug class increases liver enzymes, and therefore requires periodic monitoring of LFTs?

Answer 9

Leukotriene antagonists - zafirlukast, montelukast, zileuton

Question 10

What are two non-asthma indications for the use of theophylline?

Answer 10

erectile dysfunction and pulmonary hypertension

Question 12

What patient education is required for taking Zafirlukast?

Answer 12

Food impairs absorption

Question 13

What drug class do Leukotriene antagonists interact with?

Answer 13

CYP450 drugs - i.e. warfarin

Question 14

What is the indication for use of a leukotriene antagonist?

Answer 14

Prophylaxis of asthma, Montelukast can also be used for prevention of exercise-induced bronchospasm

Question 15

What symptoms are associated with an overdose of theophylline?

Answer 15

nausea/vomiting, tremor, anxiety, possible seizure,

Question 16

Besides emergency management, what therapeutic management can be used to treat theophylline overdose?

Answer 16

Propranolol and activated charcoal

Question 17

How does Buproprion, an anti-depressant, help people quit smoking?

Answer 17

By boosting levels of dopamine and NE, it mimics nicotine and reduces cravings

Question 18

How does nicotine gum, patch, etc help people quit smoking?

Answer 18

has about half the peak level of smoking, so it can help people stop and reduce withdrawal symptoms

Question 19

Varenicline (Chantix) is a partial agonist of nicotinic receptors so it produces less euphoric effect, but can help with

Answer 19

withdrawal symptoms

Question 20

It is very important to monitor patients on Chantix for:

Answer 20

suicidal thoughts and mood changes

Question 21

A woman wants to quit smoking but is concerned about gaining weight when she does, what medication could help her?

Answer 21

Naltrexone (Revia)

Question 22

Name some benefits of prescribing dabigatran over warfarin? down sides?

Answer 22

Few interactions, no routine monitoring required. But, it is way expensive and can’t be used if have mechanical heart valves.

Question 23

Drugs used to prevent embolism and stroke in patients with Afib?

Answer 23

Warfarin and dabigatran

Question 24

What medication significantly improves outcome and ability to perform ADLs after a stroke?

Answer 24

Alteplase (Activase) - has to be given within 3 hours

Question 25

What other indications does Alteplase (Activase) have?

Answer 25

It is a thrombolytic so can be used in MI, massive PE, acute arterial occlusion of a limb

Question 26

What drug is indicated after an acute stroke in patients not eligible for thrombolytic therapy and hemorrhage has been excluded?

Answer 26

Aspirin, followed by anticoag drugs

Question 27

How should you instruct a patient to administer a MDI?

Answer 27

slowly and deeply inhale before and during

Question 28

How should you instruct a patient to administer a DPI?

Answer 28

quickly and deeply

Question 29

T/F. Twice-daily dosing of inhaled corticosteroids provides adequate control of asthma in most patients.

Answer 29

true. Once-daily dosing can be sufficient in some patients

Question 30

What time frame can be expected before we notice the maximum response from inhaled corticosteroids?

Answer 30

months

Question 31

What are systemic effects of high-dose inhaled corticosteroid therapy? And how can this be reduced?

Answer 31

adrenal suppression, skin thinning, osteoporosis, easy bruising, cataracts. Use of inhalation chamber coupled with mouth washing after MDI use can decrease local (cough, dysphonia, candidiasis) and systemic side effects.

Question 32

Use of SABA more than how many days a week indicates inadequate control and the need to step up treatment?

Answer 32

>2 days/week

Question 33

Describe the stepwise order of medications for persistent asthma:

Answer 33

Step 1: SABA prn Step 2: low dose ICS Step 3: low dose ICS + LABA (or medium ICS) Step 4: medium ICS + LABA Step 5: high ICS + LABA Step 6: high ICS + LABA + oral corticosteroid

Question 34

At what step should referral to an asthma specialist be warranted?

Answer 34

If step 4 or more higher is needed

Question 35

T/F. Once asthma is controlled for >3 months, patients should stay on current medication regimen.

Answer 35

False. Step down if possible

Question 36

At which steps should subcutaneous allergen immunotherapy for patients with allergic asthma be considered?

Answer 36

Steps 2-4

Question 37

Patients on systemic corticosteroid treatment (oral or parenteral), concurrent treatment with what supplements are needed?

Answer 37

calcium and vitamin D to prevent steroid-induced bone mineral loss (osteoporosis)

Question 38

What syndrome has been diagnosed in a small number of patients who have taken montelukast or zafirlukast?

Answer 38

Churg-Strauss

Question 39

Contraindication to Buproprion?

Answer 39

at risk for seizures, eating disorders

Question 40

What are the names of the inhaled corticosteroids?

Answer 40

-ONE | beclomethasone, fluticasone, triamcinolone, mometasone

Question 41

Which steroid administration route is indicated for acute symptomatic sarcoidosis?

Answer 41

Systemic

Question 42

First line long-term therapy in persistent asthma:

Answer 42

ICS

Question 43

If you’re using your SABA more than 2 days/week for symptom relief, what is the next step?

Answer 43

Indicates inadequate control and time to step up to an inhaled corticosteroid!

Question 44

What are considered “long-term” control med:

Answer 44

1. anti-inflammatory agents (steroids) 2. LABA - salmeterol and formoterol OR bronchodilators - cromolyn, tiotropium, theophylline 3. Leukotriene modifiers

Question 45

What are considered “quick-relief” meds:

Answer 45

1. SABA 2. Ipratroprium bromide 3. steroids (if don’t respond to SABA)

Question 46

Which types of asthma exacerbations do you treat with supplemental oxygen?

Answer 46

Moderate and severe!