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Spr2015_Week6 > Treatment of Obstructive Disease > Flashcards

Treatment of Obstructive Disease Flashcards

1
Q

Classification of well controlled asthma

1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment

A

1) < 2 days/week
2) < 2x/month
3) > 80% FEV1, peak flow near normal
4) 0-1/uyear
5) SABA prn (<2x weekly)

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2
Q

Classification of not well controlled asthma

1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment

A

1) > 2 days/week
2) 1-3x/week
3) 60-80% FEV1
4) > 2/year
5) Low Dose ICS or

Low Dose ICS + LABA or medium dose ICS

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3
Q

Classification of poorly controlled asthma

1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment

A

1) throughout day
2) > 4x/week
3) < 60% FEV1
4) > 2/year
5) medium dose ICS + LABA or

High dose ICS + LABA

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4
Q

if patient’s asthma is well controlled for at least 3 months

what do you do

A

step down if possible

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5
Q

Goals of asthma therapy

A

1) treat cough, chest tightness, wheezing, dyspnea
2) decr use of rescue SABA
3) decr night awakening
4) prevent exacerbations and muscle hypertrophy

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6
Q

What is good asthma management

A

1) routine monitoring of PFT
2) patient education
3) enviorn triggers
4) meds

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7
Q

What are long term control meds (4)

A

1) inhaled glucocorticoids = long term preferred for persistent asthma
2) long acting inhaled beta2 agonists = preferred supplement for use with inhaled GCs
3) leukotriene modifiers
4) omalizumab (anti-IgE)
5) inhibitors of IL-13 and IL-4 for Th2

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8
Q

Other long term options for asthma (4)

A

1) allergen immunotherapy = decr allergen tolerance effective for allergic rhinitis ad conjunctivitis
2) tiotropium = long acting anticholinergic for COPD NOT asthma
3) theophylline = large adverse effect
4) cromolyn sodium for exercise induced asthma

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9
Q

Quick relievers (rescue therapies) (3)

A

1) short acting beta2 agonists (albuterol) for exercise asthma and immediate
2) anticholinergics = COPD NOT ASTHMA; secondary relief in asthma exacerbations (not tiotropium)
3) systemic glucocorticoids = severe asthma + attacks

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10
Q

Beta adrenergic agonists

1) names of drugs
2) used for?
3) onset
4) administration
5) quick relievers vs. long term

A

1) albuterol, terbutaline, salmeterol, formoterol
2) asthma + COPD
3) oral = tachycardia, injectable, inhale
4) rapid onset
5) quick relief (4-6 hr) = albuterol

long term control = 12 hrs = salmeterol, formoterol

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11
Q

Mechanism of action of beta2 agonists

A

1) stim beta adrenergic receptor
2) relax smooth muscle
3) bronchodilation

inhibit resp secretions

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12
Q

Anticholinergics

1) names
2) uses
3) onset
4) admin form
5) quick relief vs long term controller

A

1) atropine, ipratropium, tiotropium
2) COPD NOT ASTHMA
3) rapid in min
4) inhaled
5) quick relief = 6 hrs = ipratropium

long term = 12 hrs = tiotropium

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13
Q

mechanism of anticholinergics

A

1) inhibit cholinergic receptor (ACh parasympathetic)
2) smooth muscle relax
3) bronchodilation

inhibit resp secretions

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14
Q

Systemic glucocorticoids

1) name
2) used for
3) onset
4) admin route
5) metabolism
6) peak action

A

1) hydrocortisone, prednisone, prednisolone, methylprenisolone
2) asthma exacerbation
3) 30-60 min
4) oral or IV
5) half life = 2-3 hrs
6) approx 8 hrs

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15
Q

mechanism of systemic gluococoritcoids

A

1) phospholipase inhib, inhib cytokine synthesis
2) anti inflamm, vasoconstrictor

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16
Q

Inhaled glucocorticoids

1) preferred when?
2) onset
3) admin route
4) metabolism
5) duration and peak action

A

1) long acting control for asthma and COPD
2) 30-60 min
3) inhaled
4) half life 2-3 hrs except fluticasone (7 hrs)
5) QD or BID; 8 hrs for 1 dose

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17
Q

Mechanism fo inhaled glucocorticoids

A

1) phospholipase inhib
2) inhib cytokine synth
3) anti inflamm and vasoconstrictor

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18
Q

Do you give ICS for children?

A

NO significant effect on growth

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19
Q

Long acting beta agonists

1) names
2) onset
3) admin route
4) duration of action
5) mechanism

A

1) salmeterol, formoterol
2) 15 min
3) inhaled
4) 8-12 hrs
5) beta adrenergic stim

20
Q

BLACK BOX WARNING FOR LABA

A

MUST COMBINE WITH INHALED CORTICOSTEROID TO CONTROL INFLAMMATION

21
Q

Challenges with lung delivery

A

1) airway bifurcation and decr airway caliber
2) entire blood volume thru longs so toxicity
3) changes inv ascular permeability –> incr interstitium –> XS extravascular fluid

22
Q

Topical route

Pros

cons

A

Pros = better than systemic b/c directly deliver bypassing absoprtion, minimal systemic effects, rapid onset

Cons = require device, technique, waste

23
Q

Oral route

Cons

A

Cons = requires absorption from GI tract first, greater side effects

24
Q

parenteral route

Pros

Cons

A

Pros = bypass absoption so 100% available and rapid onset

Cons = greater side effects

25
Q

Advantages of spacers

cons

A

portability and decr time for drug delivery

cons = medication contained in small particles for aerosol to avoid impaction in pharynx and travel to small airways

26
Q

when would you not use aerosol delivery

A

infants and young children = small lungs and airways

deiseased airways = reduced conductance and flows

27
Q

why are spacers necessary

A

particles settle in chamber NOT MOUTH

slow particle velocity, incr pulm deposition

still need shaking and tight seal

28
Q

Disadvantages of nebulizers

A

1) less portable, requires power, expensive and time consuming

29
Q

Advantages and disadvantage of Dry powder inhalers (DPI)

A

pros = easy, quick delivery, no spacer

cons = good coordination so must be >5

30
Q
A
31
Q

Leukotriene modifiers

1) names
2) onset
3) admin route
4) duration
5) metabolism
6) effect

A

1) leukotriene D4 antag = montekulast, zafirlukast; 5-lipooxygenase inhibitor = zileukton
2) 30-60 min
3) oral
4) 12-24 hrs
5) half life of 6 hrs
6) bronchodilator, anti-inflammatory, decr EXERCISE INDUCED ASTHMA

32
Q

Anti-IgE

1) name
2) used in
3) mechanism
4) admin route
5) side effect

A

1) omalizumab = Zolair
2) allergic asthma
3) bind IgE to inhib binding to mast cell
4) IV
5) anaphylaxis

33
Q

Cromolyn/nedocromil

1) admin route
2) half life
3) mechanism
4) effect

A

1) inhaled
2) 20 min
3) inhib mast cell release
4) prevent exercise induced asthma and allergen response

34
Q

Theophylline

1) onset
2) admin route
3) duration
4) metab
5) mechanims
6) effect

A

last add on for severe disease = LOTS OF SIDE EFFECTS

1) 30-60 min
2) oral or IV
3) 12-24 HRS
4) half life 7 hrs
5) inhib PDE
6) brocnhodilator effect and some anti-inflamm

35
Q

Side effects of theophylline

A

1) caffeine like = irritability, GI distress
2) narrow therapeutic range
3) seizures and neuro damage
4) drug interactions

36
Q

Consider step down if subject is wel controlled for ___

A

3 months

37
Q

Mechanisms of airflow limitation in COPD

A

usu both

1) small airways disease from inflamm, luminal plug, incr airway resistance
2) parenchymal destruction = lose alveolar attachment, decr elastic recoil

38
Q

Symptoms of COPD

A

1) dypsnea
2) chronic cough
3) chronic sputum production

39
Q

What is classification of COPD for treatment category

A

B

C

D

A

choose highest risk always

A = low risk, less symptom, GOLD 1-2,<1 exacerbation

B = low risk, more symptom, GOLD 1-2, <1 exacerbation

C = high risk, less symptom, GOLD 3-4, >2 exacerb

D = high risk, more symptom, GOLD 3-4, >2 exacerb

40
Q

For patient A treatment option

A

1) smoking cessation
2) physical activity
3) flu vaccine, pneumococcal vaccine

41
Q

For patient B, C, D treatment option

A

1) smoking cessation
2) pulm rehab
3) physical activity
4) flu vaccine, pneumococcal vaccine

42
Q

Medication for Class A

A

1) SABA prn
2) LAMA or LABA or SABA and SAMA

43
Q

Medication for Class B

A

1) LAMA or LABA
2) LAMA and LABA

44
Q

Medication for Class C

A

1) ICS + LABA or LAMA
2) LAMA and LABA

45
Q

Medication for Class D

A

1) ICS + LABA or LAMA
2) ICS, LABA, PDE-4 inhib

Spr2015_Week6 (9 decks)

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