Respiratory PHARM

Question 1

SABA
Examples

Answer 1

Short acting beta 2 adrenergic agonist

salbuterol
albuterol
terbutaline

Question 2

SABA
Indication

Answer 2

Rescue medication for bronchoconstriction
< 2 x per week = good control

Question 3

SABA
MOA

Answer 3

1. Bronchodilation
   - beta 2 receptors
   - bronchodilation - vascular smooth muscle relaxation
2. Decrease histamine release
   - decrease vascular permeability, edema
   - decrease mucous production
   - decrease vasoconstriction
   - decrease recruitment WBC, inflammation
3. Increase mucocilliary function
   - increase mucous clearance

Question 4

SABA
SE

Answer 4

Tachycardia
Tremors
Dysrhythmias

*not Beta 2 mediated (no beta 2 receptors on heart)

Question 5

Define Poor asthma control

Answer 5

> 2 x SABA use per week

Oral prednisone/hospital visit

smoker

Question 6

ICS
Indication

Answer 6

Inhaled corticosteroid

Mild to severe asthma
Daily controller medication
Usually taken BID

Question 7

ICS
MOA

Answer 7

1 decrease WBC activation and recruitment

2. decrease pro-inflammatory cytokine synthesis and release
   - decrease inflammation
   - decrease bronchoconstriction
   - decrease hypersensitivity
   - decrease remodelling
3. Increase beta 2 receptor syntehsis and sensitivity
   - bronchodilation

Question 8

ICS pharmacokinetics

Answer 8

inhaled safer
decrease systemic effects

maximum effect 6 weeks
1-2 weeks to take effect (long acting, not for rescue)

Question 9

Examples
ICS

Answer 9

budesonide

fluticASONE

beclomethASONE

mometASONE

Question 10

SE
ICS

Answer 10

oral candidiasis
- rinse mouth out with water after each use

dysphonia

*systemic SE are rare

Question 11

LABA
Indication

Answer 11

Long acting beta 2 adrenergic receptor agonist

combination therapy with ICS

ICS/LABA

prescription >12 years old, poor adherence
mild to moderate asthma

Question 12

LABA
MOA

Answer 12

Same as SABA

1. bronchodilation
   - binds beta 2 receptors
   - relaxation bronchial smooth muscle
2. decrease histamine degranulation
   - decrease edema, mucous production
3. increase mucociliary clearance

Question 13

LABA
SE

Answer 13

Monotherapy LABA = asthma death

Dual therapy LABA
- tachycardia, tremor, angina
- oral candidiasis
- dysphonia

Question 14

Examples LABA

Answer 14

fomoterol

afomoterol

salmeterol

indacaterol

olodaterol

Question 15

LTRA
examples

Answer 15

monteleukast
- leukotriene receptor antagonist

Zileuton
- blocks lipooxygenase synthesis of leukotrienes

Zafirleukast
- blocks lipooxygenase syntheiss of luekotrienes

Question 16

LTRA
indication

Answer 16

poor control with
ICS + PRN SABA
or
ICS/LABA + PRN ICS/LABA
adunct
+ LTRA

Question 17

LTRA
MOA

Answer 17

Monteleukast
- block leukotriene receptor

1. bronchodilation - open airway
2. decrease vascular permeabiltiy - decrease edema
3. decrease eosinophil recruitment
   - prevention direct damage mucocillary
   - decrease remodellinga.nd mucous plugs

Zafirleukast/Zileuton
- block lipooxygenase synthesis of leukotrienes from AA
-decrease leukotriene (decrease permeabiilty, decrease bronchoconstriction, decrease eosinophil recruitment)

Question 18

SE

Answer 18

Neuropsychiatric
- suicide
- agitation, insomnia, aggression, depression
> first 10 days

Chu-Strauss Syndrome
- pulmonary vasculitis, weight loss, glu like symptoms
- do not wean glucocorticoids when on this medicaiton

hepatitis
- zileuton
- zafirleukast