Week 6 Asthma

Question 1

List the common triggers

Answer 1

Allergies
Irritants (tabaco, pollution)
Exercise
Medication (NSAIDs, B blocker)
Infection (cold, sinusitis)
Exposure (cold, dry air)
Acid reflux

Question 2

Describe the process of airway remodeling

Answer 2

Long time change to asthmatic pt airway
→cause structural change

Basement membrane thickens
Goblet cells thicken

Question 3

Symptoms of a patient with asthma

Answer 3

Wheezing
Cough
Chest tightness
Shortness of breath
Dyspnea/Shortness of breath

Question 4

Role of spirometry and what measure?

Answer 4

Diagnostic process (require!!)
Measure force and volume

Question 5

Role of peak flow meter and what measure?

Answer 5

Measures force
Used daily at home to possible predict

Question 6

Describe the four classes of asthma

Answer 6

Question 7

What is the Metered Dose Inhaler?

Answer 7

Drug in solution or suspension in a pressurized canister
Must shake if suspension

Question 8

Metered Dose Inhaler
a) Advantages
b) Disadvantages

Answer 8

a) Small and convenient
b) Technique-dependent efficacy

Question 9

What is the Spacer Device?

Answer 9

Used only with MDIs
Allows evaporation of propellant prior to inhalation
enhanced lung delivery

Question 10

Spacer Device
Advantages

Answer 10

Decreased oropharyngeal deposition
Enhanced lung delivery
Eliminates need for good lung-hand coordination

Question 11

What is the Dry Powder Inhaler (DPI)?

Answer 11

Breath actuated micronized powder

Question 12

Dry Powder Inhaler
a) Advantages
b) Disadvantages

Answer 12

a) Requires minimal hand-lung coordination

b) Require higher inspiratory flows than MDIs
Powder may irritate throat and cause cough

Question 13

What is the Nebulizer?

Answer 13

Use pressure or vibration to aerosolize liquid medication

Question 14

Nebulizer
a) Advantages
b) Disadvantages

Answer 14

a) Requires no special technique
Can be used in patients unable to take
　deep or forceful breaths

b) Requires electricity (plug-in or battery)
Longer duration of treatment
　(10-15 minutes)

Question 15

How to use Metered Dose Inhaler?

Answer 15

Take off the cap and shake it!
Breath out
Breathe in SLOWLY!! then actuate inhaler
Hold the breath as long as comfortable
breath out slowly

Wait 1-2 min to do more

Question 16

Inhaled Corticosteroids
Medications name 6

Answer 16

Mometasone (Asmanex®)
Beclomethasone (QVAR®)
Budesonide (Pulmicort®)
Triamcinolone
Flunisolide (Aerobid®)
Fluticasone (Flovent®)
Triamcinolone (Azmacort®)

Mom,Bec, Bud tri (try)

Question 17

Inhaled Corticosteroids
Characteristics

Answer 17

Anti-inflammatory
Reduce responsiveness to asthma triggers

First-line treatment for control
All ages

Question 18

Inhaled Corticosteroids
Adverse effects

Answer 18

Cough
Oral thrush (topical fungal infections)
Hoarseness
Possible systemic effects

Question 19

Inhaled Corticosteroids
Reducing Adverse effects

Answer 19

Administer with aerochamber spacer device
Rinse mouth thoroughly following inhalation
Always use the lowest effective dose

Question 20

Long-Acting β2 Agonists/LABA
Medication name

Answer 20

Salmeterol
Formoterol
Vilanterol (only in combination products)

Question 21

Long-Acting β2 Agonists/LABA
Characteristics

Answer 21

ONLY used in addition to inhaled ICS in patients with asthma
Black Box Warning
Can be used alone in COPD

Question 22

Long-Acting β2 Agonists/LABA
What is the black box waring?

Answer 22

Pt is more likely to die for asthma attack if used alone to prevention

Question 23

Leukotriene Receptor Antagonists
Medication name

Answer 23

Montelukast
Zafirlukast

Question 24

Leukotriene Receptor Antagonists
Characteristics

Answer 24

Block leukotriene receptors and prevent bronchoconstriction
Not a bronchodilator – NOT for rescue
Mainly adjunctive therapy

Question 25

Leukotriene Receptor Antagonists Advantages

Answer 25

Oral administration Well tolerated in children and adults Useful in patients with poor inhaler technique Use with ICS or LABA

Question 26

Mast Cell Stabilizers Characteristics

Answer 26

Prevents mast cell degranulation during asthma attacks NOT a bronchodilator

Question 27

Mast Cell Stabilizers Advantages

Answer 27

Very well tolerated unpleasant taste

Question 28

Mast Cell Stabilizers indication

Answer 28

Pt with allergen mediated and exercise induced bronchoconstriction

Question 29

Methylxanthines Medication

Answer 29

Theophylline (PO) Aminophylline (IV)

Question 30

Methylxanthines Characteristics

Answer 30

Smooth muscle relaxation 3rd line

Question 31

Leukotriene Receptor Antagonists Disadvantages

Answer 31

Lacks anti-inflammatory properties Many ADRs/Serious ADRs Need to monitor serum drug concentrations Therapeutic range = 10-20 mcg/ml

Question 32

Methylxanthines ADRs

Answer 32

Common ADRs Insomnia GI upset (including vomiting) Tachycardia Headaches Serious ADRs Seizures Cardiac arrhythmias

Question 33

Short-Acting β2 Agonists/SABA Medication name

Answer 33

Albuterol Levalbuterol

Question 34

Short-Acting β2 Agonists/SABA Indications

Answer 34

Quick relief of acute symptoms Preventative treatment prior to exposure to trigger Being replaced by formoterol + inhaled corticosteroid LABA+ICS

Question 35

Short-Acting β2 Agonists/SABA Mechanism

Answer 35

Stimulates β2 receptors in the lung　 Smooth muscle relaxation → bronchodilation

Question 36

Short-Acting β2 Agonists/SABA ADR

Answer 36

Tremor Tachycardia d/t stimulating B1 receptors in heart

Question 37

Short-Acting Muscarinic Antagonists(SAMA) Medication name(SAMA)

Answer 37

Ipratropium Oxitropium

Question 38

Short-Acting Muscarinic Antagonists(SAMA) indication

Answer 38

Relief of acute bronchospasm Reverses acetylcholine-induced bronchospasm

Question 39

Short-Acting Muscarinic Antagonists(SAMA) ADRs

Answer 39

Dry mouth headache dizziness Anticholinergic effects

Question 40

Short-Acting Muscarinic Antagonists(SAMA) Place in therapy

Answer 40

Used as an additive drug with SABA Never used alone for rescue No effect on exercise-induced asthma Do not use open mouth inhaler technique

Question 41

Systemic Corticosteroids Medication name

Answer 41

Methylprednisolone – IV Prednisolone – Syrup Prednisone – Oral tablet

Question 42

Systemic Corticosteroids indication

Answer 42

Pt with severe exacerbation or a longer duration of exacerbation Reverses inflammation and speeds up recovery by preventing profession of exacerbation 悪化

Question 43

Systemic Corticosteroids ADR

Answer 43

Adrenal suppression Osteoporosis Hypertension Hyperglycemia Weight gain, fluid retention Cataracts and glaucoma Slow wound healing