PHRM 825: Flipped Lecture Flashcards
What 3 symptoms can lead to asthma diagnosis?
- Chest-tightness
- Dyspnea
- Non-productive cough
What signs can lead to an asthma diagnosis?
- Wheezing
- DRY hacking cough
- Signs of atopy
- Decreased FEV1/FVC (reversible with beta2-agonist use)
- Increased eosinophil count and blood IgE
What are 6 asthma triggers?
- Emotions
- Pets
- Exercise
- Insects and Fecal Matter
- Dust
- Pollution
What are 4 asthma classifications?
- Intermittent
- Persistent mild
- Persistent moderate
- Persistent severe
What are 3 characteristics of COPD?
- Chronic bronchitis
- Emphysema
- Inflammation
What is emphysema?
Abnormal enlargement of the airspaces that is accompanied by destruction of alveolar walls
What is chronic bronchitis?
Presence of cough and sputum production for at least 3 months in each of two consecutive years
What structural changes occur during emphysema?
Alveolar destruction and reduced elasticity
What structural changes occur during chronic bronchitis?
- Airway narrowing
- Smooth muscle hyperplasia
- Inflammation
- Bronchial wall thickening
- Mucous gland enlargement
- Ciliary abnormalities
What do proteases do?
Break down connective tissue in lungs
What causes inflammation during COPD?
- Inflammatory response to irritants
- Oxidative stress
- Protease-antiprotease imbalance
What are modifiable risk factors of COPD?
Exposure to particles such as:
- Cigarette smoke
- Occupational dust and fumes
- Indoor pollution
What are non-modifiable risk factors of COPD?
- Genes
- Age/Gender
- Lung development
- Asthma and airway hyper-reactivity
- Socioeconomic status
- Repiratory infections
What are hallmark symptoms of COPD?
- Chronic cough
- Dyspnea
- Sputum production
What are signs of COPD?
- Increased RR
- Use of accessory muscles to breathe
- Hyperinflation of chest (barrel chest)
- Decreased breath sounds
- Prolonged expiration
- Lips pursing on espiration
What test is required to diagnose COPD and what value confirms COPD?
Spirometry
<0.7
Exacerbation definition
Acute event characterized by worsening of the patient’s respiratory symptoms beyond normal day-to-day variation that leads to a change in medication
What is the MOA of glucocorticoids?
Prevent and control inflammation
Side effects/precautions of glucocorticoinds
- Thrush
- Cough
- Difficulty speaking
- Hoarse throat
- Increased risk of pneumonia (COPD Studies)
What is the MOA of inhaled beta 2 agonists
Relaxation of bronchial smooth muscle
What is the onset of action for inhaled beta 2 agonists
3-5 minutes
What is the onset of action for LABAs?
15 to 30 minutes (up to 3 hours for peak effect)
Side effects and precautions of SABAs and LABAs
- Skeletal muscle tremors
- Palpitations
- Tachycardia
- Hypokalemia
- Hyperglycemia
What is the MOA of leukotriene receptor antagonists?
Inhibits the cysteinyl leukotriene receptor
What is the MOA of 5-lipoxygenase inhibitor?
Inhibits leukotriene formation
Side effects of leukotriene modifiers
- Neuropsychiatric events
- Churg-Strauss syndrome (rare)
- Increase in LFTs
- Sinusitis
Contraindications of leukotriene modifiers
Hepatic impairment/liver disease
What is the MOA of mast cell stabilizers?
Prevents the mast cell release of histamine, leukotriene, and inhibits degranulation after contact with antigens
Side effects and precautions of mast cell stabilizers
- Cough
- Unpleasant taste in mouth
- Cardiac arrhythmias (rare)
- Anaphylaxis
MOA of methylxanthines
- Bronchodilation
- Decrease plasma exudation
- Increased mucocilliary clearance
- Decreased nutrophil function
- Decreased t-cell function
- Macrophage function
- Increased respiratory muscle strength
Side effects of methylxanthines
- Insomnia
- GI upset
- Tremor
- Nervousness
- Hyperreactivity in children
Precautions of methylxanthines
Caution in patients with CV disease
Signs of theophylline toxicity
- N/V
- Tachyarrhythmia
- HA
- Seizures
MOA of Anti-IL5
Blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils
Side effects of anti-IL5 meds
- Injection site reaction
- Arthralgias
- Dizziness
- Fatigue
- CV events
- Herpes zoster infection
Which anti-IL5 med has a boxed warning for anaphylaxis?
Mepolizumab
MOA of phosphodiesterase inhibitors
Prevent phosphodiesterase from converting cAMP to AMP
Side effects of phosphodiesterase inhibitors
- Diarrhea
- Weight loss
- Decreased appetite
- Insomnia
- Depression
Contraindications of phosphodiesterase inhibitors
Moderate to severe liver impairment
Which CYP enzymes metabolize theophylline?
1A2 (major)
3A4 (minor)
2E1 (minor)
Which CYP enzymes metabolize phosphodiesterase inhibitors?
3A4 (major)
1A2 (minor)
Asthma treatment follow-up after initiating a controller treatment
2-3 month follow-up of response and assess level of control
How/when to step down asthma therapy
- Symptoms controlled for 3 months
- Low risk for exacerbation
- Do not eliminate ICS
Which COPD tests should be done at each doctor visit?
- Functional capacity
- Symptom assessment (CAT/mMRC)
- Smoking status
- Pharmacotherapy (current regimen)
Which COPD tests should be done annually?
- Lung function
- Airflow Limitation
- Exacerbations
Causes of COPD exacerbations
- RTI
- Air pollution
How long should systemic corticosteroids be used in a COPD patient with an exacerbation?
5 days
How long should antibiotics be used in a COPD patient with cardinal symptoms present?
5-7 days
What are the cardinal symptoms for COPD?
- Sputum purulence
- Sputum volume
- Dyspnea
What are non-pharmacologic therapy options for COPD?
- Oxygen therapy (target 88-92% saturation)
- Ventilator support
*These are adjunct therapy
What is severe acute asthma?
Severe asthma exacerbation unresponsive to bronchodilators
Terbutaline MOA
B2 receptor agonist
Ketamine MOA
Inhibits reuptake of noradrenaline in presynaptic neurons causing increased circulation of catecholamines resulting in bronchodilation
