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PHRM 825 > PHRM 825: Flipped Lecture > Flashcards

PHRM 825: Flipped Lecture Flashcards

1
Q

What 3 symptoms can lead to asthma diagnosis?

A
  • Chest-tightness
  • Dyspnea
  • Non-productive cough
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2
Q

What signs can lead to an asthma diagnosis?

A
  • Wheezing
  • DRY hacking cough
  • Signs of atopy
  • Decreased FEV1/FVC (reversible with beta2-agonist use)
  • Increased eosinophil count and blood IgE
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3
Q

What are 6 asthma triggers?

A
  • Emotions
  • Pets
  • Exercise
  • Insects and Fecal Matter
  • Dust
  • Pollution
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4
Q

What are 4 asthma classifications?

A
  • Intermittent
  • Persistent mild
  • Persistent moderate
  • Persistent severe
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5
Q

What are 3 characteristics of COPD?

A
  • Chronic bronchitis
  • Emphysema
  • Inflammation
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6
Q

What is emphysema?

A

Abnormal enlargement of the airspaces that is accompanied by destruction of alveolar walls

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7
Q

What is chronic bronchitis?

A

Presence of cough and sputum production for at least 3 months in each of two consecutive years

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8
Q

What structural changes occur during emphysema?

A

Alveolar destruction and reduced elasticity

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9
Q

What structural changes occur during chronic bronchitis?

A
  • Airway narrowing
  • Smooth muscle hyperplasia
  • Inflammation
  • Bronchial wall thickening
  • Mucous gland enlargement
  • Ciliary abnormalities
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10
Q

What do proteases do?

A

Break down connective tissue in lungs

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11
Q

What causes inflammation during COPD?

A
  • Inflammatory response to irritants
  • Oxidative stress
  • Protease-antiprotease imbalance
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12
Q

What are modifiable risk factors of COPD?

A

Exposure to particles such as:

  • Cigarette smoke
  • Occupational dust and fumes
  • Indoor pollution
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13
Q

What are non-modifiable risk factors of COPD?

A
  • Genes
  • Age/Gender
  • Lung development
  • Asthma and airway hyper-reactivity
  • Socioeconomic status
  • Repiratory infections
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14
Q

What are hallmark symptoms of COPD?

A
  • Chronic cough
  • Dyspnea
  • Sputum production
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15
Q

What are signs of COPD?

A
  • Increased RR
  • Use of accessory muscles to breathe
  • Hyperinflation of chest (barrel chest)
  • Decreased breath sounds
  • Prolonged expiration
  • Lips pursing on espiration
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16
Q

What test is required to diagnose COPD and what value confirms COPD?

A

Spirometry

<0.7

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17
Q

Exacerbation definition

A

Acute event characterized by worsening of the patient’s respiratory symptoms beyond normal day-to-day variation that leads to a change in medication

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18
Q

What is the MOA of glucocorticoids?

A

Prevent and control inflammation

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19
Q

Side effects/precautions of glucocorticoinds

A
  • Thrush
  • Cough
  • Difficulty speaking
  • Hoarse throat
  • Increased risk of pneumonia (COPD Studies)
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20
Q

What is the MOA of inhaled beta 2 agonists

A

Relaxation of bronchial smooth muscle

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21
Q

What is the onset of action for inhaled beta 2 agonists

A

3-5 minutes

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22
Q

What is the onset of action for LABAs?

A

15 to 30 minutes (up to 3 hours for peak effect)

23
Q

Side effects and precautions of SABAs and LABAs

A
  • Skeletal muscle tremors
  • Palpitations
  • Tachycardia
  • Hypokalemia
  • Hyperglycemia
24
Q

What is the MOA of leukotriene receptor antagonists?

A

Inhibits the cysteinyl leukotriene receptor

25
Q

What is the MOA of 5-lipoxygenase inhibitor?

A

Inhibits leukotriene formation

26
Q

Side effects of leukotriene modifiers

A
  • Neuropsychiatric events
  • Churg-Strauss syndrome (rare)
  • Increase in LFTs
  • Sinusitis
27
Q

Contraindications of leukotriene modifiers

A

Hepatic impairment/liver disease

28
Q

What is the MOA of mast cell stabilizers?

A

Prevents the mast cell release of histamine, leukotriene, and inhibits degranulation after contact with antigens

29
Q

Side effects and precautions of mast cell stabilizers

A
  • Cough
  • Unpleasant taste in mouth
  • Cardiac arrhythmias (rare)
  • Anaphylaxis
30
Q

MOA of methylxanthines

A
  • Bronchodilation
  • Decrease plasma exudation
  • Increased mucocilliary clearance
  • Decreased nutrophil function
  • Decreased t-cell function
  • Macrophage function
  • Increased respiratory muscle strength
31
Q

Side effects of methylxanthines

A
  • Insomnia
  • GI upset
  • Tremor
  • Nervousness
  • Hyperreactivity in children
32
Q

Precautions of methylxanthines

A

Caution in patients with CV disease

33
Q

Signs of theophylline toxicity

A
  • N/V
  • Tachyarrhythmia
  • HA
  • Seizures
34
Q

MOA of Anti-IL5

A

Blocks binding of IL-5 to the alpha chain of the IL-5 receptor complex, which results in reduced production and survival of eosinophils

35
Q

Side effects of anti-IL5 meds

A
  • Injection site reaction
  • Arthralgias
  • Dizziness
  • Fatigue
  • CV events
  • Herpes zoster infection
36
Q

Which anti-IL5 med has a boxed warning for anaphylaxis?

A

Mepolizumab

37
Q

MOA of phosphodiesterase inhibitors

A

Prevent phosphodiesterase from converting cAMP to AMP

38
Q

Side effects of phosphodiesterase inhibitors

A
  • Diarrhea
  • Weight loss
  • Decreased appetite
  • Insomnia
  • Depression
39
Q

Contraindications of phosphodiesterase inhibitors

A

Moderate to severe liver impairment

40
Q

Which CYP enzymes metabolize theophylline?

A

1A2 (major)
3A4 (minor)
2E1 (minor)

41
Q

Which CYP enzymes metabolize phosphodiesterase inhibitors?

A

3A4 (major)

1A2 (minor)

42
Q

Asthma treatment follow-up after initiating a controller treatment

A

2-3 month follow-up of response and assess level of control

43
Q

How/when to step down asthma therapy

A
  • Symptoms controlled for 3 months
  • Low risk for exacerbation
  • Do not eliminate ICS
44
Q

Which COPD tests should be done at each doctor visit?

A
  • Functional capacity
  • Symptom assessment (CAT/mMRC)
  • Smoking status
  • Pharmacotherapy (current regimen)
45
Q

Which COPD tests should be done annually?

A
  • Lung function
  • Airflow Limitation
  • Exacerbations
46
Q

Causes of COPD exacerbations

A
  • RTI

- Air pollution

47
Q

How long should systemic corticosteroids be used in a COPD patient with an exacerbation?

A

5 days

48
Q

How long should antibiotics be used in a COPD patient with cardinal symptoms present?

A

5-7 days

49
Q

What are the cardinal symptoms for COPD?

A
  • Sputum purulence
  • Sputum volume
  • Dyspnea
50
Q

What are non-pharmacologic therapy options for COPD?

A
  • Oxygen therapy (target 88-92% saturation)
  • Ventilator support

*These are adjunct therapy

51
Q

What is severe acute asthma?

A

Severe asthma exacerbation unresponsive to bronchodilators

52
Q

Terbutaline MOA

A

B2 receptor agonist

53
Q

Ketamine MOA

A

Inhibits reuptake of noradrenaline in presynaptic neurons causing increased circulation of catecholamines resulting in bronchodilation

PHRM 825 (36 decks)

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