Treatment of Asthma

Question 1

Short acting B2 agonist

Answer 1

Albuterol, Proventil, Ventolin
most widely used beta-agonist
beta-2 selective
Rescue medication
MDI: 2-4 puffs q4-6h and prn

Question 2

Terbutaline (Brethine)

Answer 2

short acting beta-2 agonists used to prevent uterine contractions

Question 3

Long acting beta-2 agonist

Answer 3

Salmeterol (Serevent) inhaled
Formoterol (Foradil) inhaled
Levalbuterol (Xopenex)
Fenoterol (Berotec)
Oral: sustained-release albuterol
NOT rescue drugs for breakthrough symptoms

Question 4

Anticholinergics Antimuscarinic Agents Bronchodilators

Answer 4

Ipratropium bromide (Atrovent)
Tiotropium (Spiriva)
may enhance the bronchodilation achieved by beta-agonists.
main use is in combination with beta-agonist
slow to act (60-90 min)

Question 5

Methylxanthines Bronchodilators

Answer 5

Theophylline  
Aminophylline (IV Theophylline)
medium-potency bronchodilator
undefined mechanism of action
seizures are a bad SE

Question 6

Corticosteroids Anti-inflammatory

Answer 6

Fluticasone (Flovent)
Budesonide (Pulmicort)- nebulized steroid
Not bronchodilators
Reduce airway inflammation
Use with Acute illness 
Use with Chronic disease (stage IV)

Question 7

PO Steroids

Answer 7

Methylprednisolone 40 to 60 mg IV q6h

Prednisone 60 mg po q6h can be substituted

Question 8

Mast Cell StabilizersAntiinflammatory

Answer 8

Cromolyn (Intal), Nedocromil (Tilade)
do not influence airway tone
inhibit degranulation of mast cells
prevent release of chemical mediators of anaphylaxis

Question 9

Leukotriene inhibitorsAnti-inflammatory

Answer 9

Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Leutrol, Zyflo)
MOA: suppress action of cysteinyl leukotriene (proinflammatory mediators involved in asthma pathogenesis)

Question 10

Anti-IgE Monoclonal Antibodies

Answer 10

Omalizumab
Newer approach to the treatment of asthma
Inhibits the binding of IgE to mast cells
Does not promote mast cell degranulation to already bound IgE

Question 11

Step 1: Intermittent Tx.

Answer 11

Quick relief

PRN short-acting beta-agonist – use > 2x weekly may indicate need to start long term control therapy.

Question 12

Step 2: Mild persistent Tx.

Answer 12

Quick relief - PRN short-acting beta-agonist - use > 2x weekly may indicate need to start long term control therapy.

One daily long-term control medication
inhaled corticosteroid (low dose) or
cromolyn or nedocromil
second-line choices: leukotriene modifier or theophylline

Question 13

Step 3: Moderate Persistent Tx.

Answer 13

Quick relief
PRN short-acting beta-agonist

Long-term control
Inhaled corticosteroid (medium dose) or
Inhaled corticosteroid (low-medium dose) + long acting beta 2 agonist (salmeterol) or sustained release Theophylline or oral beta 2 agonist)
If needed, (medium-high) dose inhaled corticosteroid + long acting Beta 2 agonist, or sustained release theophylline, or long acting oral B2 agonist.

Question 14

Step 4: Severe Persistent Tx.

Answer 14

Quick relief
PRN short-acting beta-agonist

Long-term control
high dose inhaled corticosteroid +
long-acting inhaled B2 agonist or sustained release theophylline or long acting oral B2 agonist + oral corticosteroids