Pulm 2- Steroids

Question 1

What is the mechanism of ICS?

Can you double the dose?

Answer 1

Inhibits inflammatory cells (mast cells, eosinophils, basophils), cytokines (histamines, leukotrienes)
No- flat response curve

Question 2

What class is Beclametasone HVA
(QVAR)?

Answer 2

ICS

Question 3

What class is Budesonide DPI
(Pulmicort)?
SE?

Answer 3

ICS
SE: Need more in smokers
Oral Candidiasis
Cough

Question 4

What class is Ciclesonide
(Alvesco)?
SE?

Answer 4

ICS
Dysphonia
Adrenal suppression

Question 5

What class is Fluticasone FHA
(Flovent)?

Answer 5

ICS

Question 6

What class is Flunisolide
(Aerobid)?

Answer 6

ICS

Question 7

What class is Mometasone DPI?

Answer 7

ICS

Question 8

What class is Fluticasone/ Salmeterol
(Advair)?

Answer 8

ICS

LABA

Question 9

What class is Budesonide/Formeterol HFA?

Answer 9

ICS LABA

Question 10

What class is Mometasone/Formeterol?

Answer 10

ICS

LABA

Question 11

What class is Monteleukast
(Singulair)?
Peds?

Answer 11

Leukotriene inhibitor

Peds OK

Question 12

What class is Zafirlukast
(accolate)?
Mechanism?
SE?

Answer 12

Competetively antagonize leukotriene D4

HepatoTox- Monitor LFTs

Question 13

What is the mechanism of Zileuton
(Zyflo)?
SE?

Answer 13

Inhibity 5-liopxygenase (leukotriene)
Hepatotoxic- Monitor LFTs
2C9- Many DDI

Question 14

What is the mechanism of anti-cholinergic bronchodilators?

Answer 14

Inhibit effects of ACh on muscarinic receptors -> bronchodilation

Question 15

What is the mechanism of Ipratropium
(Atrovent)?
SE?
Time to effect?

Answer 15

Anti-cholinergic
Blurred Vision
Dry Mouth
Urinary Retention
DDI- Other Anti-ACh meds
30 min onset, 4 hrs duration

Question 16

What is the mechanism of Tiotropium
(Spiriva)?
SE?
Time to effect?

Answer 16

Anti-cholinergic
Blurred Vision
Dry Mouth
Urinary Retention
DDI- Other Anti-ACh meds
Onset: 30 min, 24hrs duration

Question 17

What is the mechanism of Methylxanthines?

Answer 17

Inhibit phosphodiesterase -> increase cAMP + antagonize adenosine receptors = bronchodilates

Question 18

What are the DDI, SE of theophylline?

What drug class?

Answer 18

Methylxanthine
DDI- SZ meds, rifampin, St Johns Wort, Cipro, Clarothro…. Narrow therapeutic index
HA/N/V
SZ, Arrythmia

Question 19

What is the MOA of immunomodulators?

How given?

Answer 19

Inhibits binging of IgE to receptors on mast cells and basophils -> prevent release of inflammatory markers
SubQ q2-4 weeks

Question 20

What class is Omalixumab
(Xolair)? SE?

Answer 20

Immunomodulator (IgE)

Risk of anaphylaxis, follow for 2 hours for 3 months, then 30 min

Question 21

What is the mechanism of monoclonal anti-bodies?

Answer 21

Monoclonal antibody that targets IL-5

IL-5 -> Stimulates maturaltion/release of eosinophils -> inflammation

Question 22

What class is Mepozimulab (Nucala)?
SA? Indication?

Answer 22

Monoclonal antibody
Anaphylaxis, angioedema, bronchospasm, hypotension, uticaria, ras
Maintenance med for asthma
SQ qmonth
** If Hz of herpes zoster, tax 1st

Question 23

What class is Reslizumab (Cinqair)?
SA? Indication?

Answer 23

Monoclonal antibody
SA: Anaphylaxis, malignancy, CPK elevation -> muscle complications, OP pain
Ind: Maintenance severe asthma >18 c eosinophilic phenotype