Drugs for Asthma

Question 1

Asthma

Answer 1

Chronic inflammatory disorder that Limits airflow

Question 2

Allergen causes release of mediators:

Answer 2

histamine, leukotrienes, prostaglandins, interleukins

Question 3

Mediators cause

Answer 3

bronchoconstriction, infiltration of inflammatory cells

Question 4

Adviar is a combination of

Answer 4

(salmeterol) long acting bronchodialator plus (fluticasone) a glucose corticord

Question 5

Metered Dose Inhalers

Answer 5

Use 1-2 puffs, wait 1 minute between puffs; requires lung-hand coordination; Approximately 10% of dose reaches lung; 80% swallowed and other 10% left in device or exhaled; spacers are available to increase amount delivered to lungs. Used 3-4 times per day.

Question 6

Dry-Powder Inhalers (DPIs)-

Answer 6

Breath activated so approximately 20% of dose reaches lung.

Question 7

Nebulizers

Answer 7

Deliver dose slowly (over several minutes) by machine allowing bronchi to gradually dilate and medication to gain deeper access to lungs; Patients who have become unresponsive to a beta2 agonist delivered via an inhaler often respond when the same drug is given by nebulizer.

Question 8

Bronchodilators

Answer 8

Beta 2 adrenergic agonists; Promote bronchodilation; sympathomymetic

Question 9

Levalbuterol (Xopenex)

Answer 9

Bronchodilator; inhaled short acting; effects begin immediately; rescue inhaler, take first then follow up w/ longer acting inhaler, put in breathing treatment

Question 10

Serevent (salmeterol)

Answer 10

Bronchodilator; Delayed effects; Used for prolonged prophylaxis; Do not use to abort an ongoing acute asthamtic attack

Question 11

Serevent (salmeterol) adverse effects

Answer 11

usually minimal with inhaled preparations; tachycardia, angina, tremors

Question 12

Glucocorticoid

Answer 12

fluticasone (Flovent)

Question 13

fluticasone (Flovent)

Answer 13

(glucocorticoid) Blocks synthesis and release of inflammatory mediators (histamine, prostaglandins, interleukins); Decreases hypersensitivity, mucus production; Used for prophylaxis, can be administerd orally or by inhalation

Question 14

Glucocorticoids adverse effects for inhaled medication

Answer 14

oropharyngeal candidiasis- teach patients to gargle with water or saline after each administration

Question 15

Glucocorticoids adverse effects for oral medication

Answer 15

no significant effects when used 10 days or less; prolonged use can cause adrenal suppression, fluid retention, hypertension, moon face, osteoporosis, hyperglycemia, peptic ulcer disease, suppression of growth in young.

Question 16

Cromolyn (Intal) stablizes

Answer 16

membranes of mast cells, blocking release of histamine

Question 17

Cromolyn (Intal) 1st line agent for

Answer 17

for prophylactic therapy of moderate asthma

Question 18

Cromolyn (Intal) prevents

Answer 18

bronchospasm associated with exercise induced asthma

Question 19

Methylxanthines

Answer 19

theophylline, aminophylline

Question 20

Methylxanthines

Answer 20

Relaxes smooth muscle of bronchi; Oral- maintenance, IV- emergencies; Narrow therapeutic range (10-20 mcg/ml)

Question 21

with Methylxanthines caffeine

Answer 21

increases intensity

Question 22

drugs that reduce levels of Methylxanthines

Answer 22

phenobarbital, phenytoin, rifampin

Question 23

drugs that increase levels of Methylxanthines

Answer 23

cimetidine, fluoroquinolone

Question 24

with Methylxanthines you must

Answer 24

individualize dosages

Question 25

with Methylxanthines do not give by

Answer 25

rapid injection-could lead to cardiac arrest

Question 26

most asthma pts are on how many inhalers

Answer 26

3 different types

Question 27

what goes before steroid

Answer 27

bronchodialator then wait 1-2 min

Question 28

oropharyngeal candidiasis

Answer 28

to prevent teach pt to gargle glucocorticoids w/ water or saline after each administration

Question 29

remember Methylxanthines are similar to

Answer 29

caffeine

Question 30

watch Methylxanthines carefully because they can become

Answer 30

toxic; has a Narrow therapeutic range (10-20 mcg/ml)

Question 31

give Methylxanthines

Answer 31

slowy

Question 32

Methylxanthines have what other effect

Answer 32

a diuretic effect

Question 33

Methylxanthines will make what worse

Answer 33

dysrythmias

Question 34

Atropine derivative -

Answer 34

an anticholinergic

Question 35

Atrovent-ipratropium

Answer 35

parasympatholytic so similar to Methylxanthines ; it is a Back-door bronchodilator

Question 36

Atrovent-ipratropium effectiveness

Answer 36

Effective for allergen-induced & exercise-induced asthma; Less effective than beta 2 agonists (albuterol)

Question 37

Leukotriene Modifiers

Answer 37

Anti-inflammatory; Used for maintenance of chronic asthma and allergies

Question 38

Leukotriene Modifiers are given on a

Answer 38

continual basis

Question 39

Leukotriene Modifiers adverse effects

Answer 39

headache and GI upset

Question 40

Montelukast (Singulair)

Answer 40

can be given safely to children