Drugs for Asthma

Question 1

Asthma

Answer 1

Chronic inflammatory disorder of the airway

Question 2

Signs and symptoms of Asthma

Answer 2

-Sense of breathlessness
-Tightening of the chest
-Wheezing
-Dyspnea
-Cough
-Symptoms are a result of bronchoconstriction and inflammation.

Question 3

Causes of Asthma

Answer 3

-Immune mediated airway inflammation.

Question 4

Inflammatory response

Answer 4

-Allergen binds to immunoglobulin E antibodies on mast cell.
-Mast cells release mediators: histamine, prostaglandins, leukotrienes, interleukins.
-Mediators are responsible for bronchoconstriction and promote infiltration and activation of inflammatory cells.

Question 5

Chronic Obstructive Pulmonary Disease (COPD)

Answer 5

-Chronic, progressive, irreversible disorder.
-Combination of chronic bronchitis and emphysema
-Both processes are caused by exaggerated inflammatory reaction to cigarette smoke.

Question 6

Symptoms of COPD

Answer 6

-Cough
-Dyspnea
-Wheezing
-Sputum production

Question 7

Chronic Bronchitis

Answer 7

-Chronic cough and excessive sputum, hypertrophy of mucus secreting glands of the epithelium of the larger airways.

Question 8

Emphysema

Answer 8

-An enlargement of the air space within the bronchioles and alveoli brought on by deterioration of the walls of these air spaces.

Question 9

2 main pharmacologic classes for asthma

Answer 9

-Anti-inflammatory
-Bronchodilators

Question 10

Advantages to inhalation drug therapy

Answer 10

-Therapeutic effects are enhanced
-Systemic effects are minimized.
-Relief of acute attacks is rapid.
-Gets drugs into the lungs as quick as possible.

Question 11

Three types of inhalation drug administration

Answer 11

-Metered dose inhalers (MDI)- if more than 1 puff is required wait 1 min in between puffs. Rinse mouth out after.
-Dry powder inhaler (DPI)
-Nebulizers

Question 12

Anti-inflammatory drugs: Glucocorticoids

Answer 12

-Budesonide (Pulmicort)- suspension for nebulization.
-Fluticasone (Flovent)- MDI and DPI
-Prednisone (Oral)

Question 13

Glucocorticoids mechanism of action

Answer 13

-Decrease synthesis/production and release of inflammatory mediators.
-Decrease infiltration and activity of inflammatory cells.
-Decrease edema of airway mucosa.

Question 14

Glucocorticoids use

Answer 14

-Prophylaxis of chronic asthma and managing COPD.
-Dosing is on a fixed schedule, not PRN.

Question 15

Inhaled glucocorticoids

Answer 15

-First line therapy for management of inflammatory component of asthma.
-Safer than oral

Question 16

Adverse effects of PO glucocorticoids

Answer 16

-When used acutely, does not cause significant adverse effects.
-Prolonged therapy can cause adrenal suppression, osteoporosis, hyperglycemia, immunosuppression, fluid retention, hypokalemia, peptic ulcer disease

Question 17

Adverse effects of inhaled glucocorticoids

Answer 17

-Oropharyngeal candidiasis- gargle after use.
-Dysphonia hoarseness- gargle, rinse mouth after use.

Question 18

Anti-inflammatory drugs: Leukotriene Modifiers

Answer 18

-Suppress effects of leukotrienes
-In asthma, leukotriene modifiers reduce bronchoconstriction and inflammatory responses such as edema and mucus secretion.

Question 19

Leukotriene Modifier drugs

Answer 19

-Montelukast (Singulair)
-Zileuton (Zyflo)-PO
-Zafirlukast (Accolate)-PO

Question 20

Adverse effects of leukotriene modifiers

Answer 20

-Neuropsychiatric effects, including depression, suicidal thinking, and suicidal behaviors. In children it can cause nightmares.

Question 21

Anti-inflammatory drugs: Mast cell stabilizers

Answer 21

-Cromolyn
-Good for people with exercise induced asthma-taken 15 min before exercise.
-Used for prophylaxis, not for quick relief.

Question 22

Cromolyn therapeutic uses

Answer 22

-Chronic asthma
-Exercise induced bronchospasm
-Allergic rhinitis
-Suppresses bronchial inflammation

Question 23

Cromolyn administration routes

Answer 23

-Inhalation
-Nebulizer
-MDI

Question 24

Cromolyn adverse effects

Answer 24

-Cough
-Bronchospasms

Question 25

Bronchodilators: Beta2-Adrenergic agonists

Answer 25

-Most effective drugs for relief of acute bronchospasm and prevention of exercise induced bronchospasm. -Use in asthma is quick relief and long term control.

Question 26

Beta2-Adronergic Agonist mechanism of action

Answer 26

-Through activation of beta2 receptors in the smooth muscle of the lung, promote bronchodilation, relieving bronchospasm. -Suppress histamine release in lung and increase ciliary motility.

Question 27

Two types of Beta2-Adronergic agonist

Answer 27

-Short acting beta2- agonist (SABA) -Long acting beta2 agonist (LABA)

Question 28

SABA

Answer 28

-Use in asthma -Inhaled taken PRN to stop an ongoing attack -EIB: Taken before exercise to prevent an attack. -Hospitalized patients undergoing a severe acute attack: nebulized SABA.

Question 29

SABA

Answer 29

-Albuterol, proventil -taken PRN, preventive -

Question 30

SABA adverse effects

Answer 30

-Tachycardia -angina -Tremor

Question 31

LABA

Answer 31

-Acilidinium bromide/ Tudorza -Salmetrol/ Serevent diskus

Question 32

LABA

Answer 32

-Long term control, fixed doses, not PRN. -Used for people with COPD.

Question 33

Adverse effects of LABA

Answer 33

-May increase asthma, contraindicated in asthma alone

Question 34

Adverse effects of oral beta2-adronergic agonist

Answer 34

-Angina pectoris -Tachydysrhythmias -Tremor

Question 35

Bronchodilators: Methyxanthines

Answer 35

-Theophylline -Benefits are mainly from bronchodilation. -Narrow therapeutic index: plasma levels 10-20 mcg/mL -Toxicity related to theophylline levels

Question 36

Methyxanthines administration

Answer 36

-Given PO or IV. -IV given for COPD in ICU response.

Question 37

Glucocorticoid/LABA combinations

Answer 37

-Fluticasone/salmeterol (Advair) -Budesonide/formoterol (Symbicort) -Indicated for long-term maintenance in adults and children. -May have black box warning, may effect asthma.

Question 38

Anticholinergic drugs

Answer 38

-Work by blocking muscarinic receptors in the bronchi decreasing bronchoconstriction. -For COPD

Question 39

Anticholinergic drugs

Answer 39

-Ipratropium/Atrovent- derivative of atropine, muscarinic antagonist. -Inhaled to relieve bronchospasms.

Question 40

Adverse effects of anticholinergic drugs

Answer 40

-Dry mouth -Sore pharynx

Question 41

Four classes of chronic asthma

Answer 41

-Intermittent -Mild persistent -Moderate persistent -Severe persistent

Question 42

Treatment goals for chronic asthma

Answer 42

-Reduce impairment -Reducing Risk

Question 43

Drugs for acute severe exacerbation

Answer 43

-Airway is #1. -Requires immediate attention -Goal is to relieve airway obstruction and hypoxemia, normalize lung function as quickly as possible.

Question 44

Initial therapy for acute severe exacerbation

Answer 44

-Oxygen to relieve hypoxemia -Systemic glucocorticoids to reduce airway inflammation. -Nebulized high dose SABA to relieve airflow obstruction.

Question 45

Drugs for exercise induced asthma

Answer 45

-Starts either during or immediately after exercise, peaks in 5-10 min and resolves 20-30 min later.

Question 46

Drugs for exercise induced asthma

Answer 46

-SABA or cromolyn administered prophylactically. -Inhaled SABAs generally preferred over cromolyn -Beta2 agonists should be inhaled immediately before exercise. -Cromolyn should be inhaled 15 min before exercise.