Pulmonary

Question 1

What type of pharmaceutical medications target bronchial smooth muscle?

Answer 1

Beta agonists and anitcholinergics

Question 2

What type of pharmaceutical medications target the inflammation in the lungs?

Answer 2

Inhaled corticosteroids, leukotriene antagonists, and IgE blockers

Question 3

What type of medication reduces viscosity of mucus to aid in coughing up the mucus?

Answer 3

Mucolytics, aka expectorants

Question 4

Most chronic medications are delivered through devices for direct pulmonary delivery. What are the exceptions?

Answer 4

Leukotriene inhibitors

Theophlyne

Question 5

What is helpful about spacers?

Answer 5

More drug gets into the lungs and less gets into the gut (they also enable less emphasis on technique)

Question 6

When should a nebulizer be used and what is the downside?

Answer 6

When the pt can’t handle an inhaler. They use larger particles that are less well absorbed requiring more drug.

Question 7

MOA and duration for a “rescue inhaler”

Answer 7

Beta adrenergic agonists relax bronchial smooth muscle for 3-6 hours. Known as short-acting beta agonists (SABA)

Question 8

What are the two most common SABAs?

Answer 8

Albuterol

Metaproterenol

Question 9

What are the side effects of SABAs and the reason they shouldn’t be used regularly?

Answer 9

Tachycardia
HTN in large doses
Jitters (anxiety)

Question 10

What are the two most commonly used long acting beta agonists?

Answer 10

Salmeterol (1st)

Formoterol

Question 11

Are LABAs controllers or relievers?

Answer 11

FDA warns that is still only a long-acting reliever (half of relieving effects are still present 12 hours after inhalation).

Question 12

MOA of inhaled Ipratropium?

Answer 12

(Anticholinergic) Blocks Ach in the lungs which relaxes bronchial smooth muscle

Question 13

What is the long acting inhaled anticholinergic drug?

Answer 13

Tiotropium

Question 14

What are the four inhaled corticosteroids?

Answer 14

Beclomethasone
Budesonide
Flunisolide
Fluticasone

Question 15

What are the side effects of inhaled corticosteroids?

Answer 15

Thrush (prevent with mouth rinse)
Pneumonia in COPD pts
small effect on bone growth in pediatrics

Question 16

What is important to remember about the differences between inhaled corticosteroids and their dosing?

Answer 16

Dose equivalence is important, but the drugs are all about equally effective.

Question 17

How much of the inhalant gets to the lung on average?

Answer 17

1/3 (with really good technique 1/2)

Question 18

Why don’t we see many Leukotriene Modifiers in use? What is the most likely one to see?

Answer 18

They are not as effective as inhaled steroids

Montelukast (Singulair)

Question 19

Theophylline MOA?

Answer 19

Methylxanthine, mild stimulant, bronchodilator, mild anti inflammatory, diaphragmatic inotrope. Requires monitoring for toxicity especially in a number of factors.

Question 20

What do you need to know about oral or injectable steroids?

Answer 20

It’s a “burst therapy” for exacerbations of asthma or COPD and may be a very last resort in chronic asthma.

Question 21

What is Omalizumab, what is is used for, and what is the warning about it?

Answer 21

Recombinant monoclonal antibody to IgE for “very, very” refractory asthma. Requires 3 statements of medical necessity and may cause hypersensitivity reactions (anaphylaxis).

Question 22

What is the preferred management of intermittent asthma (step 1)?

Answer 22

SABA PRN

Question 23

What is the preferred management of relatively benign persistent asthma (step 2)?

Answer 23

Low-dose ICS

Question 24

Step 3 (out of 6) of persistent asthma management prefers what treatment?

Answer 24

Low-dose ICS + LABA
or
Medium-dose ICS
or
Tiotropium (anticholinergic)

Question 25

What is the primary therapeutic approach to COPD and what class of drugs does that include?

Answer 25

Bronchodilation, with beta-agonists plus anticholinergics