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Clin pharm 2 LEC UNO > L2: asthma > Flashcards

L2: asthma Flashcards

1
Q

this is the chronic inflammation in the airways that are caused by allergens/pollutants causing narrowing of airways anf airflow obstruction

A

asthma

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2
Q

inflammation of Nasal mucus membrane, mainly caused by allergens

A

allergic rhinitis

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3
Q

the bronchooles are inflamed, caused by allergens and pollutants

A

asthma

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4
Q

the two pathways in the pathophysiology of asthma

A

allergic and nonallergic eosinophilic airway inflammation

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5
Q

interleukin responsible for the proliferation of mast cells

A

IL-9

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6
Q

IL responsible for the class switchingnif B cells to produce IgE

A

IL 4 and 13

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7
Q

IL that increases govlet cell jyperplasia jn the epithelial cells of the airways causing hypersecretjon of mucus. it also causes the constriction of bronchial smooth muscles

A

IL 13

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8
Q

primary inflammatory regulator

A

histamine

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9
Q

examples of eicosanoids

A

leukotrienes and prostaglandins

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10
Q

cytokines released in non allergic eosinophilic airway inflammation

A

epithelial-derived cytokines

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11
Q

epithelial-derived cytokines activates ___ releasing ___

A

innate lymphoma cells

releasing IL 5 and 13

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12
Q

airway hyperresponsiveness involves:

A

repair
fibrosis
remodelling

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13
Q

structural changes in the airways which makes asthma irreversible

A

remodelling

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14
Q

asthma becomes irreversible when ____ _____ occurs

A

airway hyperresponsiveness

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15
Q
A
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16
Q

t or f: chronic asthma occur with exercise, or spontaneously, or with known allergen

A

t

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17
Q

t or f: in chronic asthma, there js wheezing on auscultation wherein it is typically heard on inspiration

A

f

typically found on expiration causing prolonged expiratory phase

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18
Q

chronic asthma includes signs of __

A

atopy

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19
Q

acute severe asthma is also known as

A

status asthmaticus

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20
Q

inflammation, airway edema, excessive mucus accumulation, and severe bronchispasm result in a profound airway narrowing that is poorly responsive to usual bronchodilator therapy

A

acute severe asthma

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21
Q

expiratory and inspiratory wheezing on auscultation

A

acute severe asthma

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22
Q

in EIB, there is a drop of more than or equal to __% from baseline value

A

10%

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23
Q

refractory period after EIB

A

lasts up to 4 hrs after exercise

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24
Q

nighttime asthma

A

nocturnal asthma

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25
Q

lung fx at midnight ___

A

lowers

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26
Q

histamine and eosinphils levels are ___ at midnight

A

higher

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27
Q

___ happens during this time because endogenous cortisol is low

A

adrenal suppression

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28
Q

cortisol has ___ properties

A

anti inflammatory properties

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29
Q

used to assess how well your lungs work by measuring how much air you jngale, how much tou exhale and how quickly you exhale

A

spirometry

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30
Q

FEV1

A

forced expiratory volume in 1 sec

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31
Q

FVC

A

forced vital capacity

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32
Q

normal ratio of FEV1/FVC

A

> 0.7

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33
Q

a fev1/fvc ratio of less than 0.7 means ?

A

there is airway obstruction

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34
Q

performed when the facility does not have a spirometer, because it is less accurate. the vaues obtained from the PEF depends on the effort and muscular strength of the patient

A

peak expiratory flow

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35
Q

uses to determine improvement in lung function as demonstrated by change in FEV 1 or PEFR

A

reversibility test

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36
Q

bronchodilators used in reversibility test

A

salbutamol or ipratropium

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37
Q

in reversibility test, a difference if more 200mL or 400mL means thag the patient is ____ to bronchodilators

A

responsive

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38
Q

This test is used as a basis for deciding whether a patient can be given bronchodilators

A

reversibility test

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39
Q

this test measures variable airflow limitation reflecting the increased sensitivity of the airways to inhaled stimuli even when spirometric results are normal

A

airway hyper-responsiveness

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40
Q

A. bronchoconstrictors
B. bronchodilators

1.reversibility test
2. airway hyper-responsiveness

A
  1. B
  2. A
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41
Q

this test involves giving bronchoconstrictors tthat acts directly on the bronchioles

A

direct challenge test

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42
Q

this test involves giving bronchoconstrictors that has stimulates the release of inflammatory mediators

A

indirect challange test

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43
Q

drugs used in direct challenge test

A

methacholine and histamine

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44
Q

drugs used in indirect challenge test

A

exercise, mannitol, hyperventilation, AMP

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45
Q

high conc of this means that there is airway inflammation

A

Nitric oxide (Fraction of exhaled nitric oxide FeNO)

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46
Q

used to determine the specific allergen causing the reaction

A

skin-prick testing

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47
Q

asthma can be classified into ?

A

intermittent or persistent

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48
Q

persistent asthma can be further classified as?

A

milk, moderate, or severe

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49
Q

symptoms occur less than or equal to 2 days per week

A

intermittent asthma

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50
Q

lung function is still relatively high (FEV1 >80%)

A

intermittent asthma

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51
Q

are there nocturnal asthma symptoms experienced in intermittent asthma?

A

no.

but there are nighttime awakenings in adults

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52
Q

mild, moderate, severe

symptoms occur more thann 2 days a week but not daily

A

mild

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53
Q

mild, moderate, severe

symptoms occur daily

A

moderate

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54
Q

mild, moderate, severe

symptoms occur throughout the day

55
Q

mild, moderate, severe

nocturnal symptoms 1-2x amonth in children and 3-4x a month in adults

56
Q

mild, moderate, severe

nocturnal symptoms 3-4x a month in children, more than 1x a week but not nightly in adults

57
Q

mild, moderate, severe

nocturnal symptoms is more than 1x a week but not nightly in children and 7x a week for adults

58
Q

mild, moderate, severe

lung functions

  1. FEV1>80%
  2. FEV1=60-80%
  3. FEV1<60%
A
  1. mild
  2. moderate
  3. severe
59
Q

patient is usually reassessed ___ months after initial therapy

60
Q

used as prophylaxis to prevent future exacerbations. taken as a maintenance drug daily to lessen asthma attacks.

A

controller

61
Q

to provide rapid relief of asthma symptoms during attacks

62
Q

the dose or frequency should be ___ if after 1-3 months of therapy, the patient’s symptoms are already controlled

63
Q

preferred controller

A

ICS-formoterol

ICS - beclomethasone/budesonide

64
Q

preferred reliever

A

as needed, low-dose ICS-formoterol

65
Q

the patient uses the same inhaler as reliever and controller

A

maintenance and reliever therapy (MART)

66
Q

GINA track 1
1. steps 1-2
2. step 3
3. step 4
4. step 5

A
  1. as-needed-only low dose ICS-formeterol
  2. low dose maintenance ICS-formoterol
  3. low dose maintenance ICS-formoterol
  4. medium-dose maintenance ICS-formoterol
    5 add LAMA - ICS + formoterol + LAMA
67
Q

alternative controller

A

ICS whenever SABA is taken

ICS - beclomethasonne or budesonide

68
Q

alternative reliever

A

as-needed ICS-SABA, ot as needed SABA

69
Q

GINA track 2
1. step 1
2. step 2
3. step 3
4. step 4
5. step 5

A
  1. take ICS whenever SABA is taken
  2. low dose maintenance ICS
  3. low dose maintenance ICS-LABA
  4. medium or high dose maintenance ICS-LABA
  5. add LAMA
70
Q

intervention for px with EIB

A

give SABA or patient’s reliever meds before doing exercise

71
Q

inhalation technique of DPI vs MDI

A

DPI - fast and swift inhalation

MDI - slow and steady inhalation

72
Q

pharmacologic drugs used for asthma (3)

A
  1. bronchodilators
  2. anti-inflammatory
  3. biologic agents
73
Q

bronchodilator drugs

A

1 b2 agonists
2. anticholinergics
3. methylxanthines

74
Q

anti-inflammatory

A
  1. corticosteroids
  2. leukotriene modifiers
75
Q

stimulating b2-rececptors in bronchial smooth muscles activates __

A

activated adenylyl cyclase stimulating atp then cAMP

76
Q

bronchodilators effects (3)

A

bronchodilation
improve mucociliary clearance
mast cell membrane stabilization

77
Q

more bronchoselective (fast-acting)

A

aerosol route

78
Q

chronic administration of bronchodilators causes ?

A

tolerance (prone to side effects)

79
Q

SE of b2 agonists (4)

A

hypokalemia
inc hr
hyperglycemia
hyperlactermia

80
Q

SABA

A

terbutaline
pirbuterol
albuterol (or salbutamol)
levav\lbuterol
metaproterenol

81
Q

LABA

A

formoterol
salmeterol (slow onset)
bambuterol (PO)

82
Q

Ultra-LABA

A

indacaterol
Vilanterol
Olodaterol

83
Q

first treatment of choice for acute severe asthma and EIB

84
Q

SABA that is not indicated for acute severe asthma exacerbations

85
Q

for patients with unsatisfactory response following initial 3 doses every 20 mins. of aerosolized B2 agonist

PEF or FEV1 of <30% than normal

A

continuous nebulization

86
Q

duration of SABA vs LABA

A

SABA - 2hrs 12 hours
LABA - more than or equal to 12 hrs (2x daily)

87
Q

recommended for chronic therapy only in combination with ICS

88
Q

LABAs provide a bronchodilatory effect but cannot treat the root cause of asthma which is ___ thus ___ should be given

A

inflammation - ICS

89
Q

monotherapy LABA is given when px has _

90
Q

ultraa-LABA duration

A

> 24 hrs (once a day dosing)

91
Q

competitively blocks the muscarinic receptors that prevents the binding of acetylcholine leading to bronchodilation

A

anticholinergiics

92
Q

anticholinergic MOA (2)

A

reduce secretion of mucus
stabilize immune cells, prevent degranulation

93
Q

alternative reliever for BA

A

anticholinergics

94
Q

ROA of anticholinergics

A

inhalation

95
Q

short acting anticholinergic that has a DOA of 4-8 hrs

A

ipratropium bromide

96
Q

long-acting anticholinergic with a DOA of 24 hrs

A

tiotropium bromide

97
Q

adjunctive therapy in acute severe asthma, not completely responsive to B2-agonists alone

A

ipratropium bromide

98
Q

add-on therapy in patients >= 12 yo whose asthma is not well controlled with a medium-to-high dose of ICS and LABA combi

A

tiotropium bromide

99
Q

methylxanthines drugs

A

theophylline (PO, IV) and aminophylline (IV)

100
Q

weak non-selective inhibitory of PDE causing inc in cAMP and cGMP (prevent degradation of cAMP and cGMP causing bronchodilator and anti-inflamm)

A

methylxanthines

101
Q

last resort treatment as bronchodilating agent

A

methylxanthines

102
Q

theophylline requires ___

103
Q

SE of methylxanthines

A

N&V
tachycardia
jitteriness
difficulty sleeping
cardiac tachyarrhythmia
seizure

104
Q

anti-inflammatory proteins

A

annexin-1
secretory leukoprotease inhibitor
IL-10
IkBa

105
Q

pro-inflammatory cytokines

A

IL-1, 4, 5, 6, 8
GM-CSF

106
Q

corticosteroids binds to NFkB and AP-1 which prevents ___

A

action of pro-inflammatory cytokines

107
Q

this is given if acute severe asthma exacerbation does not respond to inhaled b2 agonists

A

systemic corticosteroids

108
Q

duration of therapy of SCS in
adults
children

A

adults: 5-7 days
children: 3-5 days

109
Q

ideal administration of SCS

A

short burst of SCS -> maintain appropriate long-term control with ICS

110
Q

in px requres chronic use of scs….

A

lowest possible dose should be used

alternate day therapy

use short acting corticosteroids

111
Q

long-acting scs

A

dexamethasone

112
Q

short-acting scs

A

prednisone, hydrocortisone, methylprednisolone

113
Q

scs has causes sodium and water retension posing a tisk for_

A

hypertension

114
Q

preferred long-term controller for persistent asthma

A

inhaled corticosteroids

115
Q

inhaled corticostereoids

improvement is seen in ___
max improvement in ___

A

first 1 to 2 weeks

4 to 8 weeks

116
Q

adverse effects of inhaled corticosteroids

A

dysphonia
oropharyngeal candidiasis/thrush

117
Q

5-lipoxygenase inhibitor

118
Q

cysteinyl leuktriene receptor antagonist

A

zafirlukast
montelukast

118
Q

leukotriene modifiers decreases _ _

A

nocturnal awakening and b2 agonist use

119
Q

indication of leukotriene modifiers

A

mild to moderate persistent asthma

119
Q

inidication of montelukast

120
Q

zileuton dosing

A
  • 600 mg QID with meals and at bedtime
  • 2 ER tabs, 600 mg BID, within 1hr after morning or evening meals
121
Q

SE of zileuton

A

elevated hepatic enzymes (1st 3 mos. of therapy)

122
Q

zileuton CI

A

active liver disease
hepatic enzymes 3x higher the upper limit of normal

123
Q

DI of zileuton

A

warfarin

theophylline

124
Q

zafirlukast dosing

A

adult: 20mg BID, 1hr before or 2 hrs after meals

children (5-11 yo) 10 mg BID

125
Q

montelukast dosing

A

adult: 10mg OD in the evening
children (6-14 yo) 5mg OD in the evening

126
Q

SE of monetlukast

A

unmasks the symptioms of churg strauss syndrome (blood vessel inflammation)

127
Q

montelukast DI

128
Q

indicatin of biologic agents

A

moderate to severe asthma

129
Q

t or f: biologic agents are used if asthma is uncontrolled with dual therapy of ICS/LABA or triple therapy ICS/LABA/LAMA

130
Q

inhalational anesthetics

A

halothane
isoflurane
enflurane

131
Q

used when acute sever asthma on mechanical ventilation that is unresponsive to standard medical therapy

A

inhalational anesthetics

132
Q

moa of inhalational anesthtics

A

b2 adrenergic receptor stimulation

direct relaxation on bronchial smooth muscle

attenuate of histamine-induced bronchospasm

alteration of the NO pathway in epithelial cells

Clin pharm 2 LEC UNO (5 decks)

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