Respiratory: PCOL + Asthma 2 Flashcards

Question

Omalizumab brand

Answer 1

Act on B2 receptor, activating cytoplasmic G proteins which activate adenylyl cyclase to produce cAMP which decreased unbound intracellular calcium, producing smooth muscle relaxation and mast cell membrane stabilization

Answer 2

Decreases histamine release

Answer 3

"-erol are beta agonists" albuterol - onset quick 5-10min Levalbuterol OTC: Epinephrine and Ephedrine

Answer 4

``` Tremor Anxiety Tachycardia Hypokalemia Hypomagnesemia Hyperglycemia ```

Answer 5

Beta blockers (using B1 selective will reduce SE) diuretics Sympathomimetics

Answer 6

Symptoms HR K

Answer 7

Place in therapy | inhalation device technique

Answer 8

competitive inhibition of muscarinic receptors in airways thereby preventing bronchoconstriction mediated by vagal nerve

Answer 9

Ipratropium - slower onset 15-30min compared to albuterol...used as add on

Answer 10

Not really Costs much $$$$ not really worth it

Answer 11

Dry mouth | abnormal taste

Answer 12

Narrow-angle Glaucoma Prostatic hyperplasia Bladder-neck obstruction

Answer 13

Anticholinergic meds

Answer 14

Symptoms | Urinary retention in older men

Answer 15

Place in therapy | inhalation device technique

Answer 16

same as SABA but longer acting

Answer 17

** Salmeterol, olodaterol, formoterol ** Albuterol tab, arfomoterol, indacaterol

Answer 18

< 20 min onset of action | Duration: 12hrs

Answer 19

<5 min onset Duration: 12hrs mixed between albuterol (fast onset) and long duration like Salmeterol

Answer 20

``` Tremor Anxiety Tachycardia Hypokalemia Hypomagnesemia Hyperglycemia Cough w/ indacterol ```

Answer 21

Other meds that prolong QTc

Answer 22

Symptoms | ADR (HR, K+, Mg, Glucose)

Answer 23

Inhalation device training, rationale for use (controller therapy) Not for acute SOB (potential exception with formoterol in the beclomethasone/formoterol combination which may be used as a maintenance and reliever treatment in asthma)

Answer 24

Inhibition of M1-5 receptors, bronchodilator due to M3 activity in lungs

Answer 25

Tiotropium

Answer 26

``` Albuterol Ipratropium Ipratropium/Albuterol Salmeterol Olodaterol Tiotropium Theophylline ```

Answer 27

``` Montelukast Roflumilast Azithromycin Fluticasone Beclomethasone Budesonide Prednisone ```

Answer 28

tiotropium/olodaterol fluticasone/salmeterol budesonide/formoterol fluticasone/umeclidinium/ vilanterol

Answer 29

omalizumab mepolizumab dupilumab trezepelumab

Answer 30

``` Dry mouth Bitter/metalic taste Constipation Urinary Retention Worsened narrow-angle glaucoma ```

Answer 31

Anti-cholinergic medications

Answer 32

symptoms, ADR

Answer 33

role in therapy | inhalation device training

Answer 34

Tiotropium/Olodaterol (Stilt Respimat)

Answer 35

Smooth muscle relaxation/bronchodilation via inhibition of PDE thereby decreasing the degradation of cAMP to AMP; potentially also mild anti-inflammatory activity via PDE4 inhibition; inhibition of adenosine receptors

Answer 36

Theophylline

Answer 37

All are dose related, highest risk of LA Bronchodilator ``` Headache Insomnia Nausea Heartburn Arrhythmias Grand mal convulsions ```

Answer 38

CYP3A3 and CYP1A2 drugs

Answer 39

Theophylline lvls 5-15mcg = adult 5-10 mcg = children Symptoms

Answer 40

place in therapy | side effects + signs/symptoms of toxicities

Answer 41

``` Steroids (OCS/ICS) Mast cell stabilizers Leukotriene Modifiers Macrolide antibiotics Phosphodiesterase 5 inhibiters (PDE4) ```

Answer 42

Modifies gene expression of cells leading to gene activation or suppression Block late reaction to allergen and reduce airway hyperresponsiveness Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation Reverse β2 receptor down-regulation

Answer 43

Prednisone** Prednisolone methylprednisolone "-one" are systemic corticosteroids

Answer 44

Negative feedback onto Hypothalamus and Anterior pituitary long list of side effects

Answer 45

``` Fluoroquinolone (inc tendon rupture) oral antidiabetics (inc Hyperglycemia) CYP3A4 interactions ```

Answer 46

Clinical improvement SE (BP, BG, mental stauts, electrolyte panels) Growth

Answer 47

All the side effects

Answer 48

** Thrush ** Cough Dysphonia Delayed childhood growth Bunch of others

Answer 49

Spacers or valved holding chambers (can reduce thrush) Rinse after inhalation (to reduce thrush) use lowest dose possible

Answer 50

Growth | Disease outcomes

Answer 51

Use a spacer/holding chamber | rinse mouth after inhalation

Answer 52

Protease inhibitors Ketoconazole CYP450-CYP3A4

Answer 53

No need to rinse mouth after PRN ICS/formoterol use in asthma

Answer 54

in the morning or at night

Answer 55

Macrolide antibiotics bind to the 50s ribosomal subunit preventing protein synthesis, also has anti-inflammatory effects

Answer 56

``` Azithromycin = add on in asthma COPD = used for prevention of COPD exacerbations ``` have to balance benefit of risk vs reward of antibiotic resistance

Answer 57

Inhibit phosphodiesterase-4 (PDE-4) causing an increase in cAMP. decreasing inflammatory cell activity, inhibition of fibrosis, relaxation of smooth muscle

Answer 58

Acute bronchospasm Worsen Psychiatric events Weight decrease Don't use with strong CYP- inducers

Answer 59

GI disorders = go away over time infections muscle spasms tremors

Answer 60

Weight FEV1 COPD exacerbations Depression

Answer 61

side effects - weight loss, insomnia, depression | Place in therapy

Answer 62

Extensive CYP3A4 and CYP1A2 metabolism

Answer 63

Omalizumab (Xolair)

Answer 64

Dupilumab (Dupixent)

Answer 65

Mepolizumab (Nucala)

Answer 66

Tezepelumab-ekko (Tezspire)

Answer 67

Binds to IgE, preventing it from binding to the high affinity receptors on basophils and mast cells decreases # of high affinity receptors and mast cell mediated release of inflammatory mediators

Answer 68

IgE levels reduction in exacerbations and symptoms improvements in FEV1 Side effects = anaphylaxis

Answer 69

anaphylaxis = black box parasitic infection Fever/Rash

Answer 70

Humanized IgG1 monoclonal antibody against IL-5 preventing it from binding to its receptor on eosinophils thereby reducing blood, tissue, and sputum eosinophils

Answer 71

improvements in symptoms

Answer 72

Side effects = hypersensitivity

Answer 73

Improvement in symptoms exacerbations FEV1 side effects

Answer 74

Store in fridge SQ injection training, sharps disposal Advise to d/c and seek treatment if hypersensitivity

Answer 75

Reduces TSLP impact in lungs | can use on a variety of different asthma types

Answer 76

injection site reactions conjunctivitis HSV infection

Answer 77

asthma control

Answer 78

role in therapy side effects avoiding live vaccinations

Answer 79

avoid use of live attenuated vaccines may put patients at risk of parasite infection

Answer 80

``` Helminth infection Hypersensitivity back pain pharyngitis Arthralgia (joint stiffness) ```

Answer 81

Asthma Control Test ``` 20-25 = well controlled 16-19 = not well controlled 5-15 = very poorly controlled ```

Answer 82

1. Confirm diagnosis 2. Look for factors contributing symptoms/exacerbations 3. Optimize therapy 4. Review in 3-6 months 5. Asses severe asthma phenotypes 6. Consider other treatments 7. Review response 8. Continue to optimize therapy

Answer 83

``` Adherence Inhaler Technique Comorbid conditions Persistent Allergan exposure Incorrect diagnosis ```

Answer 84

try something different

Answer 85

Day-to-Day = based on symptoms Short Term = 1-2 weeks - when exposed to seasonal allergen or illness Sustained = >2-3 months - when symptoms uncontrolled

Answer 86

if pt has good control for > 3 months reduce ICS by 25-50% close supervision of those with risk factors or exacerbation or persistent airflow limitation

Answer 87

well controlled on step 1/2 treatment

Answer 88

well controlled on step 3/4 treatment

Answer 89

asthma remains uncontrolled despite high dose ICS/LABA or requires high dose ICS/LABA to maintain control

Answer 90

Flu Covid-19 Pneumococcal depends on reference

Answer 91

SCIT and SLIT (Subcu and Sublingual immunotherapy)

Answer 92

adjunct in those 5+ w/ mild/moderate allergic asthma

Answer 93

adults with Allergic Rhinitis and sensitization to house dust mite w/ suboptimally controlled asthma despite low dose ICS only if FEV1 > 70%

Answer 94

procedure which uses heat to remove muscle tissues from the airways not recommended by GINA

Answer 95

``` > 1 Risk Factor of Exacerbations > 1 Severe Exacerbations in the past year Exposure to irritants (Tobacco, food allergies, allergens) FEV1 < 60% predicted Obesity Psychological Conditions Socioeconomic Problems Sputum Eosinophilia ```

Answer 96

``` Avoidance of irritants and triggers Physical Activity Healthy Diet Weight Reduction Education Others ```

Answer 97

``` Allergic Rhinitis Pregnancy GERD Obesity Obstructive Sleep Apnea Depression/Anxiety Food Allergies ```

Answer 98

Daily management | How to recognize and handle worsening asthma

Answer 99

1. Facts about Asthma 2. Medication therapy (SE, Proper technique, Role of med) 3. Self monitoring

Answer 100

Symptom or Peak Flow based

Answer 101

1. Find patients best peak flow | 2. zones are determined by % of best peak flow

Answer 102

If bad perception of symptoms then peak flow might be easier to use.

Answer 103

Acute or sub-acute episodes of progressively worsening SOB, cough, wheezing or chest tightness

Answer 104

``` Inc RR, HR prolonged expiratory phase pronounced accessory muscle use diaphoresis difficulty lying supine, speaking lethargy or reduced exercise tolerance nasal flailing in your children ```

Answer 105

``` Respiratory infections allergens Seasonal changes environment emotions exercise drugs/preservatives poor adherence to therapy occupational stimuli ```

Answer 106

Supplemental O2 ( 93-95% children >12, 94-98% children <11 **Ipratropium = reduce hospitalizations** add steroids

Answer 107

Follow asthma action plan w/ close follow up

Answer 108

Albuterol + Ipratropium Prednisone Magnesium

Answer 109

a genetic predisposition for the development of IgE-mediated response to common aeroallergens

Answer 110

Increased sensitivity of the airways to narrow in response to various stimuli

Answer 111

Exercise-induced bronchospasm which can be pre-treated with certain bronchodilators