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Clinical Pharmacology > Lab 4 - COPD, Asthma > Flashcards

Lab 4 - COPD, Asthma Flashcards

1
Q

Asthma - Diagnosis

A

History: previous measurements; compare values with values expected for the pt (age, gender, ethnicity, height)
Lung function tests:
- Spirometry (reduced FEV1, FEV1/FVC ratio, PEF)
- Bronchodilator reversibility test (increase in FEV1 by more or equal 200 ml/12% 15 min after inhalation of albuterol/salbutamol 400mcg)
- PEF: twice daily
- Flow volume loops (reduced peak flow and max expiration flow)
- Whole body plethysymography (increased airway resistance and total lung capacity and residual V)
Airway hyperresponsiveness:
- exposure to bronchoconstrictors (histamine), calculate provocative conc that reduces FEV1 by 20%
- exercise testing (post-exercise bronchoconstriction)
Hematalogic: total serum IgE, CBC (peripheral eosinophilia)
Imaging:
- CXR usually normal, but may show hyperinflated lungs in severe pts, pnemothorax in acute exacerbations, pneumonia in bronchopulmonary aspergillosis
- CT: bronchiectasis in severe asthma
- Skin prick test: positive in allergic asthma
- Fractional exhaled NO: eosinophilic airway inflammation
- Sputum eosinophilia –> airway inflammation

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2
Q

Asthma - Differential diagnosis

A

Upper airway obstruction by a tumor or laryngeal edema (confirmed with flow volume loops (reduced inspiratory and expiratory flow and bronchoscopy which shows upper airway narrowing)
Endobronchial obstruction with a foreign body (persistent wheezing in a specific area of chest)
LV failure: wheezing of asthma, but presence of basilar crackles
Vocal cord dysfunction
Eosinophilic pneumonia and systemic vasculitis (Churg-Strauss syndrome), polyarteritis nodosa –> wheezing

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3
Q

Salbutamol - dose and route

A

0,1 mg/dose (1-2) doses in aerosol (nebulizer, metered-dose inhaler with a spacer)

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4
Q

Salbutamol - MoA

A

SABA, b2 adrenergic agonist, inhibits mast cell mediator release

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5
Q

Salbutamol - Adverse effects

A

Tremor, peripheral vasodilation, tachycardia, palpitations. hypokalemia (increased uptake by skeletal muscle cells)

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6
Q

Salbutamol - Contraindication

A

Thyrotoxicosis, HTN, CHD

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7
Q

Salbutamol - Interactions

A

Increased risk of hypokalemia with glucocorticoids, diuretics and hypoxia

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8
Q

Salmeterol - dose and route

A

50 mcg/dose (2 doses) in aerosol

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9
Q

Ipratropium - dose and route

A

30 mcg/dose (1-2 doses) 3-4 ganger daglig, in aerosol

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10
Q

Ipratropium - MoA

A

SAMA, muscarine receptor antagonists, prevent cholinergic nerve-induced bronchoconstriction and mucus secretion. Used in acute severe asthma following B2 agonists

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11
Q

Ipratropium - Adverse effects

A

Dry eyes, dry mouth, cycloplegia, constipation, urinary retention

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12
Q

Ipratropium - Contraindication

A

closed angle glaucoma, BPH

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13
Q

Theophylline - Dose and route

A

5-6 mg/kg IV

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14
Q

Theophylline - When used, MoA and adverse effects

A 
Severe asthma if other drugs doesn't work
Both bronchodilator (inh PDE, increase cAMP) and anti-inflammatory effects
Adverse effects: nausea, vomiting, headache, anxiety, dizziness
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15
Q

Fluticasone - dose and route

A

125 mcg, twice daily in aerosol

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16
Q

Fluticasone - MoA

A

ICS, reduces eosinophils in the airway and sputum, and nr of activated T lymphocytes and surface mast cells in airway mucosa.

17
Q

Fluticasone - Adverse effects

A

Oropharyngeal candidiasis, dysphonia, sore/irritated throat, toothache

18
Q

Fluticasone - Contraindications

A

In high doses: Adverse effects of systemic corticosteroids may occur

19
Q

Fluticasone - Interactions

A

CYP3A4 inh (cimetidine, fluconazole, verapamil) –> systemic effects in therapeutic doses

20
Q

Prednisolone - dose and route

A

30 mg/day PO for 5-10 days

21
Q

Prednisolone - Adverse effects

A

Cushing syndrome, osteoporosis, growth retardation, DM, PUD, HTN

22
Q

Prednisolone - Contraindications

A

Psychosis, PUD, heart disease, HTN, DM, osteoporosis

23
Q

Montelukast - dose and route

A

10 mg/d PO

24
Q

Montelukast - MoA

A

Leukotriene inhibitor. Inhibits bronchoconstriction.

25
Q

Montelukast - Adverse effects

A

Hypersensitivity, Churg Strauss syndrome, liver injury

26
Q

Montelukast - Interactions

A

Inh CYP enzymes –> increases levels of phenytoin, warfarin, lovastatin

27
Q

Asthma - Treatment

A

SABA –> ICS –> LABA –> high dose ICS + Leukotriene inh –> OCS

28
Q

Asthma exacerbation - Treatment

A

O2 (achieve saturation >90%) –> SABA and OCS or IV (Methylprenisolone 40 mg IV) –> new b2 agonist + Ipratropium –> Theophylline –> intubation, mechanical ventilation (noninvasive positive pressure ventilation)

29
Q

COPD - Diagnosis

A

Physical exam: cough sputum, exertional dyspnea, Hoovers sign, Hyperinflation (barrel chest), tripod position (to facilitate actions of sternocleidomastoid, scalene, and intercostal muscles), pink puffers vs blue bloaters

Lung function test:

  • Post- bronchodilator spirometry: 0,4 mg salbutamol. Reduced FEV1 and FEV1/FVC –> reduced below 0,7. Increased total lung capacity, FRC and RV
  • Reduced diffusing capacity for carbon monoxide (lung parenchymal destruction)

ABG and oximetry: hypoxemia, PCO2 and pH
Increased hematocrit: chronic hypoxemia

Imaging:

  • CXR: hyperinflation (increased lung V, flattened diaphragm), emphysema (bullae), pulmonary HTN
  • CT: emphysema, coexisting interstitial lung diseases, bronchiectasis, lung cancer

alpha1AT def testing
CBC: asses for erythrocytosis (can occurs secondary to hypoxemia), anemia (worsen dyspnea)
ECG/Echo: exclude CHF, identify cor pulmonale in pst with chronic hypoxia

30
Q

COPD- Treatment

A

Nicotine replacement therapy
A: SABA or SAMA
B: LABA or LAMA –> persistent symptoms: Both
C: LAMA –> Further exacerbations: LABA + LAMA or LABA + ICS
D: LAMA + LABA or LABA + ICS –> further exacerbations: LABA + LABA + ICS –> further exacerbations: Roflumilast
If continued symptoms, try theophylline or oral corticosteroids

31
Q

COPD- nonpharm therapy

A

Influenza vaccine (pneumococcal, Bodetella pertussis)
Pulmonary rehabilitation
Lung volume reduction surgery
Lung transplantation

32
Q

COPD- Differential diagnosis

A

CHF, PE, chronic asthma, pulmonary fibrosis

33
Q

Tiotropium - Dose and route

A

18 mcg 1 dose/day capsule for inhalation (inhalationpowder)

Clinical Pharmacology (14 decks)

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