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xPharm Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

A chronic inflammatory disease of the airways:

A

-Asthma

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2
Q

Flares or exacerbations that require use of rescue medication:

A

-Acute Asthma

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3
Q

Acute asthma that continues to worsen despite rescue therapy:

A

-Status Athmaticus

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4
Q

Child-Onset Asthma (2)

A
  • IgE response to environmental allergens (atopy)

- Biochemical cause is unknown

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5
Q

Adult-Onset (Intrinsic) Asthma (3)

A
  • Not usually IgE-mediated
  • Coexists with other sinus problems
  • Occupational
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6
Q

Risk Factors for Childhood Asthma (3)

A
  • Parental history of asthma
  • Atopic dermatitis
  • 2 of the following: non-viral wheezing, allergic rhinitis, elevated peripheral eosinophil count
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7
Q

Asthma Triggers (8)

[Just Glance IMO]

A
  • Tobacco smoke
  • Air pollution
  • Seasonal and environmental allergies
  • Rhinitis and sinusitis
  • GERD
  • Medications
  • Cold air
  • Exercise
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8
Q

Effects of Inflammation (3)

[Just Glance IMO]

A
  • Airway hyperresponsiveness
  • Airflow limitation (acute bronchoconstriction, edema, chronic mucous plug formation)
  • Airway remodeling
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9
Q

Signs of Acute Asthma (7)

[Just Glance IMO]

A
  • Accessory muscle use
  • Diaphoresis
  • Tachycardia
  • Tachypnea
  • Pulsus paradoxus
  • Hyperinflation
  • Wheezing
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10
Q

Symptoms of Acute Asthma (7)

[Just Glance IMO]

A
  • Shortness of breath
  • Cough
  • Tightness in chest
  • Painful breathing
  • Audible wheeze
  • Disrupted sleep
  • Anxious and nervous
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11
Q

Diagnosis of Asthma (6)

[Just Glance IMO]

A
  • Symptoms of airflow obstruction
  • Partially reversible obstruction
  • Exclusion of other diagnoses
  • Medical history (symptoms, triggers, family/social, hx of asthma, exacerbation profile, etc)
  • Physical exam (thorax expansion, wheezing/prolonged expiration, nasal secretions, mucosal swelling, polyps, atopic dermatitis, eczema)
  • Functional assessment (FVC, FEV1, PEFR)
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12
Q

Measures of Asthma Assessment and Monitoring (5)

[Just Glance IMO]

A
  • Severity: intrinsic intensity of disease process, best measured in pts not receiving long-term control
  • Control: degree manifestations are minimized and goals met
  • Responsiveness: ease control is achieved by therapy
  • Impairment: frequency and intensity of symptoms
  • Risk: likelihood of exacerbations, lung function decline or risk of ADRs of meds
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13
Q

Goals in Treating Asthma (6)

A
  • Prevent chronic and troublesome symptoms (TQ)
  • Maintain normal pulmonary function
  • Maintain normal activity levels
  • Prevent recurrent exacerbations
  • Provide optimal pharmacotherapy
  • Meet patient’s expectations of care
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14
Q

Asthma: Patient Education (6)

[Just Glance IMO]

A
  • Cornerstone of asthma therapy
  • Emphasize importance of therapy
  • Written action plan with long-term controller
  • Inhaler teaching/demonstration
  • PEFR/asthma diary self-monitory
  • Tailor education to patient’s needs
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15
Q

Asthma: Non-Pharmacological Treatment (5)

[Just Glance IMO]

A

Environmental Control

  • Allergen avoidance
  • Beta-blocker avoidance (they bronchoconstrict)
  • Tobacco smoke avoidance
  • Treatment of infections, GERD
  • Exercise limits
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16
Q

Asthma: Monitoring (6)

[Just Glance IMO]

A
  • Signs and symptoms of asthma
  • Pulmonary function testing (every 1-2 years)
  • Quality of life
  • Exacerbation history
  • Pharmacotherapy
  • Patient understanding/satisfaction
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17
Q

Asthma: Written Action Plans (2)

[Just Glance IMO]

A
  • Based on signs/symptoms and PEFR
  • Directions for:
    • Taking controller meds
    • Peak flow meter use
    • Adjusting therapy to symptoms/PEFR
    • Use of rescue meds
    • When to seek help
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18
Q

Goals of Asthma Pharmacotherapy (3)

A
  • Prevent and control asthma symptoms
  • Reduce frequency and severity of exacerbations
  • Reverse airflow obstruction
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19
Q

Asthma: Quick-Relief/Rescue Class Drugs (1)

A

-Short Acting Beta-Agonists (SABA)

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20
Q

Asthma: Long-Term/Controllers Class Drugs (5)

A
  • Inhaled/Oral Corticosteroids (ICS/OCS)
    • First-line
  • Long Acting Beta-Agonists (LABA)
  • Leukotriene Receptor Blockers (LTRB)
  • Mast Cell Stabilizers (MCS)
  • Sustained Release Theophylline (SRT)
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21
Q

When to initiated controller therapy in asthma (4)

A
  • Symptoms/albuterol > 2 times a week
  • Night symptoms >2 times a month
  • Use of >2 albuterol canisters a year
  • Viral wheezing >3 times a year
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22
Q

What is the current recommendation for long-term controllers and why?

A
  • Inhaled Corticosteroids (ICS)
  • Examples: beclometasone, fluticasone
  • Good efficacy, long therapeutic index, long-term safety
23
Q

Which long-term controller should not be used alone without steroids?

A

-Long Acting Beta-Agonists

24
Q

Tapering Controller Therapy (4)

[Just Glance IMO]

A
  • First: oral corticosteroids
  • Second: taper ICS to low doses
  • Wean off one controller, wean to 1 dose a day
  • Stopping therapy: discouraged due to continued lung inflammation
25
Q

Standard Treatment of Acute Asthma (4)

A
  • Beta-2 Agonists: relieve bronchoconstriction
  • Corticosteroids: relieve inflammation and edema
  • Humidified Oxygen: corrects ventilation/perfusion
  • Anticholinergics: not DOC, may add bronchodilation
26
Q

Inhalation Administration in Children (2)

[Just Glance IMO]

A
  • Under 2 years: nebulizer preferred, steroids with mask

- 3-5: Meter dose inhaler (MDI) + spacer + mask

27
Q

Do children outgrow asthma? (3)

[Just Glance IMO]

A
  • Inflammatory markers similar in active and asymptomatic asthmatics
  • Reduced inflammation seen in asymptomatic asthmatics receiving controller therapy
  • Clinical remission does NOT equal resolution of asthma

-So, no

28
Q

A chronic disease of the airways characterized by gradual, progressive loss of lung function:

A
  • COPD (4th leading cause of death in US)

- It is IRREVERSIBLE (TQ)

29
Q

What is the primary cause of COPD?

A
  • Cigarette smoking (accounts for 90% of COPD) [TQ]

- 15-20% all smokers develop COPD

30
Q

Symptoms of COPD (3)

A
  • Chronic cough
  • Sputum production
  • Dyspnea
31
Q

Signs of COPD (7)

A
  • Mucous membrane cyanosis
  • Barrel chest
  • Tachypnea
  • Shallow breathing
  • Pursed lips during breathing
  • Use of accessory muscles
  • Hypoxemia/Hypercapnia
32
Q

Pathogenesis of COPD (3)

[Just Glance IMO]

A
  • Chronic inflammation of airways, parenchyma, vasculature (macrophages, T-cells, Leukotriene B4, IL-8, TNF-a)
  • Proteinase/antiproteinase balance
  • Oxidative stress
33
Q

Prognosis of COPD (3)

[Just Glance IMO]

A
  • Annual decline in FEV1 of 24-30 mL
  • Pulmonary hypertension can lead to right heart failure
  • Worse prognosis: rapidly declining FEV1 (smoker, severe pulmonary dysfunction)
34
Q

Treatment Goals of COPD (8)

[Just Glance IMO]

A
  • Relieve symptoms
  • Improve exercise tolerance
  • Improve overall health status
  • Prevent and treat exacerbations
  • Prevent progression
  • Prevent and treat complications
  • Prevent/minimize ADRs
  • Reduce morbidity and mortality
35
Q

Short Acting Beta-2 Agonists (6)

A
  • Albuterol (TQ), Bitolterol, Pirbuterol
  • Not as B specific: Terbutaline, Metaproterenol
  • Uses: acute relief of bronchoconstriction, exercise-induced asthma, COPD
  • MOA: stimulate adenylate cyclase production leading to bronchial smooth muscle relaxation
  • Drug interactions: MAOIs, other adrenergics
  • ADRs: tachycardia, palpitations, tremor, nervousness, hypokalemia, hyperglycemia
36
Q

Long Acting B-2 Agonists (6)

A
  • Salmeterol, Formoterol
  • Uses: 2nd line therapy for steps 3 and 4, long-term therapy for symptom control, COPD
  • NOT rescue therapy
  • MOA: stimulate adenylate cyclase production leading to bronchial smooth muscle relaxation
  • Drug interactions: MAOIs, other adrenergics
  • ADRs: tachycardia, palpitations, tremor, nervousness, hypokalemia, hyperglycemia
37
Q

Anticholinergics (5)

A
  • Ipratropium, Oxatropium, Tiotropium
  • Uses: acute asthma (only with B-agonists), COPD controller
  • MOA: bronchodilation due to muscarinic inhibition, possible decrease in mucus secretion
  • Drug interactions: additive effects with other anticholinergics
  • ADRs: minimal systemic anticholinergic side effects, not absorbed in blood stream
38
Q

Methylxanthines (6)

A
  • Theophylline, Aminophylline, Caffeine
  • Uses: Step 3 2nd line alternative asthma control, COPD
  • MOA: phosphodiesterase inhibition, block adenosine receptors (causing bronchodilation)
  • Drug interactions: CYP450 substrate, smoking, alcohol, diet (charcol cooked food)
  • ADRs: N/V/D, headache, nervousness, insomnia, tremor, tachycardia, seizure
  • Must check serum levels
39
Q

Inhaled Corticosteroids (3)

A
  • Fluticasone, Budesonice, Beclometasone, Betamethasone
  • Uses: 1st line for chronic symptoms and preventing progression of asthma (TQ), severe COPD
  • MOA: reduce initial manifestations of inflammation by decreasing formation, release, and activity of mediators
40
Q

Intranasal Corticosteroids (2)

A
  • For allergy symptoms

- Not good route for asthma

41
Q

Oral/IV Corticosteroids (5)

A
  • Methylprednisolone (IV), Prednisolone (PO)
  • Uses: short-term burst to control symptoms, long-term therapy in severe persistent asthma, standard therapy for severe acute asthma
  • MOA: reduce initial manifestations of inflammation by decreasing formation, release, and activity of mediators
  • Drug interactions: inhibitors (ketoconazole) and inducers (phenytoin, rifampin) of CYP3A4
  • ADRs: hypertension, infection, decreased growth, osteoporosis, adrenal suppression, hyperglycemia
42
Q

Leukotriene Receptor Blockers (6)

A
  • Montelukast, Zafirlukast
  • Uses: step 3 2nd line alternative for chronic asthma
  • NOT used in COPD (TQ)
  • MOA; inhibits inflammatory action of leukotrienes
  • Drug interactions: Montelukast (phenobarbital, rifampin), Zafirlukast (erythromycin, ASA, warfarin)
  • ADRs: minimal (headache, nausea, myalgia), liver dysfunction (zafirlukast)
43
Q

Mast Cell Stabilizers (4)

A
  • Cromolyn (TQ), Nedocromil
  • Uses: Step 2 alternative for decreasing inflammation, exercise-induced asthma, allergic rhinitis
  • MOA: inhibit release of inflammatory mediators from mast cells
  • ADRs: unpleasant taste
44
Q

Selective Phosphodiesterase Type 4 Inhibitor (5)

A
  • Roflumilast (TQ)
  • Uses: decreases exacerbations and worsening symptoms from COPD
  • NOT intended to treat COPD that involves primary emphysema
  • MOA: treats symptoms related to bronchitis (cough, mucus), does NOT relieve bronchospasm
  • ADRs: weightloss, psychiatric events (suicide), cancer
45
Q

Omalizumab (4)

A
  • Uses: treatment of moderate to severe allergic asthma (TQ) with elevated IgE that are not well controlled with inhaled steroids
  • MOA: anti-IgE monoclonal antibodies
  • Administered SQ every 2-4 weeks in conjunction with controller meds
  • Dose determined by baseline serum IgE and total body weight
46
Q

Bronchodilators

A
  • Beta-2 agonists, anticholinergics, methylxanthines
  • Central to symptom management
  • Inhaled therapy preferred (nebulizers reserved for acute)
  • Long-acting inhalers more effective and convenient, but expensive
  • Combining bronchodilators preferred over high doses of a single agent
47
Q

Combination Therapy

A
  • Combivent: albuterol + ipratropium
    • For bronchodilation (TQ)
  • Advair: salmeterol + fluticasone
48
Q

Signs and Symptoms of Exacerbation (6)

[Just Glance IMO]

A
  • Increased sputum production
  • Purulent sputum
  • Acutely worsening dyspnea
  • Fever
  • Wheezing
  • Decreased breath sounds
49
Q

Home Management for Exacerbation (2)

[Just Glance IMO]

A
  • Bronchodilators: increase dose/frequency, add anticholinergic
  • Glucocorticoids: add prednisolone or nebulized budesonide
50
Q

Hospital Admission for Exacerbation (5)

[Just Glance IMO]

A
  • Sudden dyspnea at rest
  • New signs/symptoms
  • New arrhythmias
  • Unresponsiveness to home management
  • Severe underlying COPD, older age, comorbidities
51
Q

A difference between asthma and COPD, is that only COPD is:
A. An inflammatory disease
B. Characterized by progressively irreversible airway obstruction
C. Treated with oral bronchodilators
D. Associated with allergic rhinitis
E. Expected to be treated and monitored for est of patient’s life

A

B. I think?

52
Q 
The primary cause of COPD in the U.S. is:
A. Industrial chemicals
B. Impaired lung growth
C. Allergies
D. Smoking
E. Air pollution
A

D. Smoking

53
Q 
The drug of choice for treating an acute asthma exacerbation is:
A. Short Acting Beta 2 Agonist
B. Leukotriene Inhibitor
C. Anticholinergic agent
D. Antihistaminic
E. Corticosteroid
A

A. SABA (right?)

54
Q 
The drug of choice for treating an acute COPD exacerbation is: 
A. Antibiotics
B. Immunostimulants
C. Antitussives
D. Sedatives
E. Bronchodilators
A

E. Bronchodilators

xPharm Exam 2 (8 decks)

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