Goals for Treating Pulmonary Disorders

Question 1

What is asthma?

Answer 1

Chronic inflammatory disorder in which the bronchi become hyper-reactive from allergens, chemicals, exercise, cold air, aspirin

Question 2

_____ and ____ are used as short tem relievers DURING an asthma attack.

Answer 2

Beta 2 agonists

Anticholinergics

Question 3

List 4 drugs classified as long term controllers to prevent asthma attacks.

Answer 3

1. Steroids
2. Leukotriene Modifiers
3. Theophylline
4. Cromolyn

Question 4

What is the MOA for short acting beta 2 agonists?

Answer 4

Bind to beta 2 agonists: relax of airway smooth muscle resulting in bronchodilation

Question 5

List 5 ADRs associated with the use of short acting beta 2 agonists (SABAs).

Answer 5

1. Tremor
2. Tachycardia
3. Inc BP
4. Hypokalemia
5. Hyperglycemia

Question 6

What is the MOA for long acting beta 2 agonists (LABAs)?

Answer 6

Binds to beta 2 receptors and also activate glucocorticoid receptors and enhance transcription of anti-inflammatory mediators

Question 7

True or False: Long acting beta 2 agonists (LABAs) can be used for acute treatment.

Answer 7

FALSE

Not used for rescue or acute treatment

Question 8

List 2 indications for the use of long acting beta 2 agonists.

Answer 8

1. To reduce frequency of asthmatic episodes and acute respiratory distress in COPD in patients not controlled on SABAs
2. When inhaled steroids are not enough to control symptoms-when dose response curve for steroids has plateaued

Question 9

_____ is an ADR that can occur with steroid based long acting beta 2 agonists.

Answer 9

Candidiasis: yeast infection

Question 10

What is the main drug used to reduce the frequency of asthma attacks? These drugs are often given with _____.

Answer 10

Corticosteroids

Often given with LABAs

Question 11

What are the 2 MOAs of corticosteroids?

Answer 11

1. Dec # mast cells, eosinophils, and submucosal T lymphocytes
2. Dec mRNA expression of interleukins-TNF, IL-2

Question 12

What is the advantage of using leukotriene antagonists over LABAs as long term controllers for asthma?

Answer 12

Have the same effect as corticosteroids but with very few ADRs (maybe headache).

Question 13

Why are we moving away from using aerosol inhalers to treat asthma?

Answer 13

They contain CFC which is damaging to the ozone

Question 14

What can individuals who have trouble coordinating their breath with inhaler use, use to make this process easier?

Answer 14

Spacer

Question 15

What is the best way to treat exercise induced asthma?

Answer 15

Take a beta 2 agonist 15 min before exercise.

Question 16

What 3 things may trigger the onset of exercise induced asthma?

Answer 16

1. Dry cold air
2. Chlorine
3. CO2 emissions from indoor ice rinks

Question 17

What is the primary treatment for acute status asthmaticus?

Answer 17

IV steroids (take 4 to 6 hours to kick in) with beta 2 agonists, oxygen and adequate ventilation

Question 18

What drugs are used to treat COPD short term? What is there MOA?

Answer 18

Short acting anticholinergics

MOA: Competitively inhibit the effect of Ach at muscarinic receptors, so they block contraction of airway smooth muscle, and blocks secretion of mucus

Question 19

Why is the advantage of prescribing patient with COPD an anticholinergic versus a beta agonist?

Answer 19

The anticholinergic provides COPD patients with the added benefit of blocking mucus secretions.

Question 20

List 2 ADRs associated with anticholinergics.

Answer 20

1. Dry mouth

2. Pharyngeal irritation

Question 21

What drug is a long acting muscarinic antagonist used to treat COPD? Advantage? MOA?

Answer 21

Tiotropium (Spriva) (LAMA drug)

Advantage: once a day dosing

MOA: Controller to prevent bronchospasm in COPD

Question 22

What 4 conditions should patients taking anticholinergics be monitored for?

Answer 22

1. Tachycardia
2. Hypertension
3. Dry mouth
4. Urinary retention

Question 23

What 5 conditions should patients taking steroids be monitored for?

Answer 23

1. Oral candidiasis
2. Bruising
3. Osteoporosis
4. Hypertension
5. Hyperglycemia

Question 24

Patients taking beta 2 agonists should be monitored for _____.

Answer 24

ANGINA