Pulm meds and treatments

Question 1

Asthma treatment - general escalation

Answer 1

Mild intermittent - prn SABA

Mild persistent: PRN SABA + low dose ICS

Mod persistent: PRN SABA + mod dose ICS + LABA

Severe persistent: SABA + high dose ICS + LABA + PO steroids

+/- cromolyn for mild persistent
+/- montelukast for all persistent asthmas
+/- theophylline for mod-severe persistent

Question 2

SABAs

Answer 2

Albuterol
levalbuterol

Relax airways with muscle
Rapid onset

Question 3

LABAs

Answer 3

salmeterol
formeterol

Relaxed airway smooth muscle
Gradual onset

Question 4

ICSs

Answer 4

beclomethasone
flunisolide
budesonide
fluticasone

Decrease airway inflammation

Question 5

Leukotriene inhibitors

Answer 5

Inhibit leuoktriene receptor:
montelukast (over 2 yr)
Zafirlukast (over 5 yo)

Inhibit 5-lipoxygenase
Zileutron

adjuncts

Question 6

mast cell stabilizing agents

Answer 6

Cromolyn
nedocromil

Stabilize mast cells - anti-inflammatory prophylaxis

Question 7

Theophylline

Answer 7

Bronchodilator

S/E: neuro- and cardiotoxicity
Hypotension, seizures, tachycardia

Question 8

Anticholinergic agents used in asthma

Answer 8

ipratropium

Block vagal mediated smooth muscle contraction

adjunct

Question 9

Systemic steroids used in severe persistent asthma

Answer 9

methylprednisolone
prednisone

Using refractory cases

4 hr to start working PO or IV

Question 10

Pirfenidone

Answer 10

antifibrotic
Inhibits collagen synthesis
Decreases extracellular matrix, blocks fibroblasts

Used in idiopathic pulmonary fibrosis

Question 11

Nintedanib

Answer 11

Receptor blocker - tyrosine kinase

used in idiopathic pulmonary fibrosis