Therapeutics (Asthma and COPD)

Question 1

What are the adverse effects of Beta-2 agonists?

Answer 1

Tachycardia

Somatic tremor in older patients

Question 2

Is a LABA an effective monotherapy for someone with asthma?

Answer 2

NO!

LABA should be added with inhaled corticosteroids (ICS)

Question 3

Which form of therapy is the only way to improve survival in COPD?

Answer 3

Supplemental Oxygen

Question 4

Which ventilation method is preferred in for acute exacerbations of COPD?

Answer 4

NIV (non-invasive mechanical ventilation)

Question 5

Indicators for respiratory unit admission…

Answer 5

Severe dyspnea that responds adequately to initial emergency therapy
Changes in mental status
Persistent or worsening hypoxemia and/or severe/worsening respiratory acidosis
Need for invasive mechanical ventilation
Hemodynamic instability; need for vasopressors

Question 6

Indications for NIV…

Answer 6

Respiratory acidosis
Severe dyspnea with clinical signs suggestive of respiratory muscle fatigue, increased work of breathing (accessory muscle use, abdominal use, retractions)
Persistent hypoxemia despite supplemental oxygen therapy

Question 7

Duration of therapy for systemic corticosteroids?

Answer 7

5-7 days

Question 8

COPD treatment for A Group?

Answer 8

Bronchodilator and evaluate effect: either continue, stop or try alternative class of bronchodilator

Question 9

COPD treatment for B Group?

Answer 9

A long-acting bronchodilator (LABA or LAMA)

For persistent symptoms: LABA AND LAMA

Question 10

COPD treatment for C group?

Answer 10

Preferred method: LAMA and for further exacerbations LABA and LAMA

Question 11

COPD treatment for D group?

Answer 11

LAMA and LABA
Further exacerbations: LAMA, LABA, and ICS
*Consider macrolides for former smokers
*Consider roflumilast if FEV1 <50%

Question 12

Mechanism of antimuscarinic drugs…

Answer 12

Block the bronchocontrictor effects of acetylcholine on M3 muscarinic receptors expressed in airway smooth muscle

Question 13

The action of Beta2 agonists

Answer 13

Relaxes airway smooth muschle by stimulating beta2 adrenergic receptors, which increases cyclic AMP and produces functional antagonism to bronchoconstriction

Question 14

This is not necessarily a form of treatment. But what should patients with COPD be getting?

Answer 14

VACCINATIONS!!
Annual influenza vaccine
Pneumococcal vaccine

Question 15

What score is the diagnostic cutoff on the CAT assessment?

Answer 15

10

Question 16

What score is the diagnostic cutoff on the mMRC dyspnea scale?

Answer 16

2. I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level

Question 17

Classification of airflow limitation (GOLD method)

Answer 17

Mild: FEV1>80% predicted
Moderate: 50%< FEV1< 80% predicted
Severe: 30%< FEV1< 50% predicted
Very Severe: FEV1< 30% predicted

Question 18

How often should patients with asthma be reviewed?

Answer 18

Patients should preferably be seen 1-3 months after starting treatment and every 3-12 months after that.
Pregnancy women should be reviewed every 4-6 weeks

Question 19

What is the first thing to assess if an asthma patient is not getting better?

Answer 19

Assess their inhaler technique and adherence