Treatment of obstructive lung disease

Question 1

Goals of asthma therapy

Answer 1

•Reduce the frequency and intensity of asthma symptoms, Prevent exacerbations, Prevent long term consequences of poorly controlled asthma

Question 2

What is well controlled asthma?

Answer 2

Symptoms no more than twice per week, Nighttime symptoms no more than twice per month, SABA should be used less than twice weekly (with the exception of routine use prior to exercise), Peak flow near normal, Oral steroid no more than once per year, Urgent care visit no more than once per year.

Question 3

List long term control meds for asthma

Answer 3

inhaled glucocorticoids, long-acting inhaled beta2 agonists, leukotriene modifiers, Omalizumab (anti-IgE)

Question 4

What is the preferred long term control med for persistent asthma

Answer 4

inhaled glucocorticoids.

Question 5

Allergen immunotherapy

Answer 5

•– potential therapy to modify disease by inducing specific allergen tolerance; tends to be more effective in managing allergic rhinitis and conjunctivitis than asthma

Question 6

Tiotropium

Answer 6

long-acting anticholinergic approved for COPD but not asthma

Question 7

List quick relievers of asthma symptoms

Answer 7

Short acting Beta 2 agonists, anticholinergics, systemic glucocorticoids

Question 8

What is the preferred treatment to symptoms and to prevent exercise-induced asthma

Answer 8

Short acting Beta 2 agonists,

Question 9

anticholinergics and asthma

Answer 9

approved for COPD but not asthma. Used as secondary reliever for significant asthma exacerbations

Question 10

List Beta adrenergic agonists used for asthma and COPD

Answer 10

albuterol, terbutaline, salmeterol, formoterol.

Question 11

pharmacokinetics of B-agonists

Answer 11

rapid onset of action. Albuterol lasts 4-6hrs (quick reliever). Salmeterol and formoterol lasts 12 hrs (long term controller)

Question 12

B-agonists MOA and effect

Answer 12

Stimulation of B-adrenergic receptors cuase bronchodilation via smooth muscle relaxation and inhibits production of respiratory secretions

Question 13

List anticholinergics used for COPD (+/- asthma)

Answer 13

atropine, ipratropium, tiotropium

Question 14

pharmacokinetics of anticholinergics

Answer 14

inhaled- rapid onset. Quick relievers (ipratropium) lasts up to 6 hrs, while long term controllers (titropium) lasts up to 12 hrs

Question 15

Anticholinergics MOA and effect

Answer 15

Inhibits cholinergic receptor. Causes bronchodilation via smooth muscle relaxation and inhibits respiratory secretions

Question 16

List systemic glucocorticoids used to treat acute exacerbations of asthma

Answer 16

hydrocortisone, prednisone, prednisolone, methylprednisolone

Question 17

Systemic glucocorticoids pharmacokinetics

Answer 17

Oral or parenteral. 30-60min onset of action. Peaks of action in 8 hrs. hydrocortisone lasts 12-24 hours.
prednisolone, methylprednisolone last 36-48 hours

Question 18

Systemic glucocorticoids MOA and effect

Answer 18

phospholipase inhibition; inhibition of cytokine synthesis. Anti-inflammatory and vasoconstrictor (reduces edema)

Question 19

Inhaled glucocorticoids pharmacokinetics

Answer 19

Onset in 30-60 minutes. Peak of action is at 8 hrs for single dose, or 4 weeks for continued. Requires 1-2X daily dosing

Question 20

Inhaled glucocorticoids MOA and beneficial effect

Answer 20

phospholipase inhibition; inhibition of cytokine synthesis. Anti-inflammatory and vasoconstrictor (reduces edema)

Question 21

Long acting Beta adrenergic agonists

Answer 21

Salmeterol and formoterol- inhaled with fast onset and 8-12 hr duration

Question 22

Warning with LABA

Answer 22

increase in asthma related deaths- should not be used alone b/c they do not reduce inflammation

Question 23

What is combination therapy

Answer 23

Inhaled products are now available that combine an inhaled corticosteroid plus long acting ß-adrenergic agonist for benefits of both in the same delivery device.

Question 24

What are different aerosol delivery devices

Answer 24

nebulizer, pressurized metered dose inhaler, dry powder inhaler

Question 25

Discuss particle size and aerosols

Answer 25

Large particles (>5 µm in diameter) will deposit in the pharynx and the wall of the larger airways. Small particles (<1 µm in diameter) are too small to be deposited and are retained in the airways and exhaled

Question 26

What is the function of a spacer on an inhaler

Answer 26

Large particles settle in the chamger instead of the mouth, they slow particle velocity which increases pulmonary deposition, reduce the need for timing and coordination.

Question 27

Leukotriene modifiers MOA and effect

Answer 27

leukotriene D4 antagonist (montelukast, zafirlukast) and 5-lipoxygenase inhibition ( zileuton). Bronchodilation, anti-inflammatory, attenuates exercise induced asthma

Question 28

Immunomodulator MOA and effects

Answer 28

Omalizumab (anti-IgE) binds to IgE to reduce likelihood of allergic response by inhibiting binding of IgE to mast cells. Adverse effects include anaphylaxis

Question 29

Cromolyn/nedocromil

Answer 29

Mast cell mediator release inhibition used for exercise induced asthma preventative therapy and can prevent allergen induced pulm response

Question 30

Theophylline

Answer 30

Inhibits phosphodiesterase which has bronchodilation and some anti-inflammatory effects. Has caffeine like effects