Lec 4 COPD II

Question 1

Corticosteroids mechanism of action:

Answer 1

Reduce bronchial reactivity and asthma exacerbations

their most important Action for their effect on airway obstruction is:
inhibition of lymphocytic eosinophillic, mucosal inflammation of asthmatic airways.

Question 2

complete list of mechanism of action of corticosteroids:

Answer 2

1)reduce amount of mast cells and eosinophils
2)increase number of B-adrenergic receptors, improve receptor responsiveness
3)reduce mucus production
4)reduce BHR
5)reduce airway edema

Question 3

cornerstones of Asthma treatment

Answer 3

B agonists and corticosteroids

Question 4

Urgent treatment of asthma:

systemic corticosteroids

Answer 4

oral dose of prednisone WITH an intravenous dose of 1mg/kg methylpredinsolone every 6 hours.

patients improve in 10 weeks

Question 5

The best time to administer corticosteroids is:

Answer 5

early in the morning after ACTH has peaked

but also to prevent nocturnal asthma, administer it in late afternoon

Question 6

When are systemic corticosteroids used?

used for 3-10 days

Answer 6

-they are NOT bronchodialators
-they are used when the patient is poorly responding to SABAs.

-Oral therapy of corticosteroids is as efective as IV route

Question 7

aerosol treatment used for:

Answer 7

used to avoide adverse effecte of systemic corticosteroids

Question 8

beclonathasone,budesonide,flunisolide, fluticasone,mometasone,ciclesonide,triamcinolone all do what:

Answer 8

Corticosteroids that minimize systemic absorption

Question 9

Inhaled corticosteroids Uses:

Answer 9

reduce exacerbations
reduces risk of asthma death

(delayed for response)

Question 10

Adverse effects of inhaled corticosteroids:

Answer 10

-systemic effects at high doses:
-skin thinning
-decreased bone mineral density
-adrenal supression

-oropharyngeal candidiasis
-dysphonia
-growth retardation

Question 10

Nystatin,miconazole,clotrimazole treat:

rinse mouth to prevent this

Answer 10

oral candidiasis

Question 11

Flucoconazole,ketokonazole,itraconazole are methods of:

Answer 11

methods of systemic treatment of Oral candidiasis

Question 12

parents that dont want their child taking corticosteroids often go for:

Answer 12

Cromolyn and nedocromolyn

stabilizers of mast cells

Question 13

Is only effective as prophylaxis

Answer 13

cromolyn and nedocromil

Question 13

This drugs effect inhibits antigen and exercise mediated asthma:

Answer 13

Cromolyn and nedocromil sodiums

Question 14

drugs that block early and late phase responses Thru mast cell inhibition:

Answer 14

Cromolyn and nedocromil sodiums

Question 15

Doses of nedocromil and cromolyn:

Answer 15

4 times daily

cromolyn can be reduced to 3
nedocromil can be reduced to 2

it provides prophylaxis for 1-2 hours

Question 16

cough,weezing,bad taste and headache are side effects of:

Answer 16

Nedocromil

Question 17

Leukotriene receptor antagonist doses:

(zafirlukast and Montelukast)

Answer 17

Zafirlukast- Oral twice daily
Montelukast- Oral once daily

Question 18

BLACK BOXED LEUKOTRIENE IS:

Answer 18

Monteleukast, neuropsychatric events

Question 19

Adverse effects of Leukotriene modifiers:

Answer 19

-Hepatic enzyme increase in ZAFIRLUKAST

-Zileuton can cause hepatotoxicity

Question 19

5-lipoxygenase inhibitor dose :

Answer 19

Zileuton- oral, 4 times daily

**Improve FEV1 **

Question 19

Omalizumab: monoclonal antibody MOA

Answer 19

Prevents IgE from binding to mast cells basophils

Question 20

Uses of Omalizumab:

Answer 20

moderate severe asthma that isnt controlled by corticosteroids

improves asthma related quality of life

Question 21

Dosage of omalizumab:

Answer 21

subcutaneous every 2-4 weeks

dosage based on inital IgE level and patient weight

Question 22

Adverse effects of omalizumab:

Answer 22

Injection site: redness and itching

anaphyalxis

Question 23

Mild asthma attacks are managed with:

Answer 23

B2- receptor agonists (as effective as subcutaneous epinephrine injection

Question 24

Severe attacks of asthma treated with:

Answer 24

-oxygen
-aerosol albuterol
-systemic treatment of prednisone or methylprednisolone

Question 25

used as a reliever treatment:

(track 1)

Answer 25

As needed only low dose ICS-Formeterol

Question 26

reliever treatment for track 2:

Answer 26

as needed ICS-SABA

Question 27

COPD medicaitons:

Answer 27

inhaled bronchodialators
-B2-adrenergic agonists
-anticholinergic agents (muscarinic antagonists)