Term
| What is the key thing about asthma's cause? What tx category is therefore the primary indication for asthma? |
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Definition
| a chronic *inflammatory* disorder of the airways. glucocorticoids |
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Term
What is the most common PRN for asthma?
How is it administered? |
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Definition
| albuterol. inhaled and nebulized formulations. |
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Term
| How is a MDI more effective? |
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Definition
| metered dose inhaler more effective w/*spacer* |
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Term
| What is the R-isomer of albuterol? How is it administered? |
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Definition
| levalbuterol. s-isomer has no bronchodilator activity. nebulized formula. |
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Term
| What is an example of an oral beta2-adrenergic agonist that has a slower onset, but more systemic side effects? |
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Definition
| oral agents- tertbutaline |
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Term
| How should long acting inhalers be administered for acute attacks? What are 2 examples? How are they administered? |
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Definition
| not for prn use or acute attacks- chronic use. Salmeterol (serevent) and formoterol (foradil). dry powder, bid dosing for pts not controlled on inhaled steroids alone (add-on tx) |
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Term
| What are the preferred agents for long term asthma txs? |
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Definition
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Term
| How should LABA's be used? |
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Definition
| in combination w/corticosteroids but NOT by themselves. controversy regarding the resultant ineffectiveness of shorta acting beta2adrenergic agonists |
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Term
| What are 2 combination products (LABA and steroid)? |
|
Definition
Advair (salmeterol and fluticasone diskus)
New: Symbicort (formoterol and budesonide)
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Term
| What is the important pt about dosing inhaled corticosteroids? |
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Definition
| optimal dose=lowest dose that controls sx |
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Term
| Arrange the following inhaled corticosteroids from greatest to least potency: fluticasone, flunisolide, budesonide, triamcinoone, beclomethasone. |
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Definition
| Potency=1: fluticasone (flovent). potency=0.5: beclomethasone (beconase), budesonide (pulmicort). potency=0.25 flunisolide (aerobid), triamcinolone (azmacort). |
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Term
| Are higher or lower potency corticosteroids more expensive? |
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Definition
| higher potency results in *less doses* per day and *less overall cost* to pt |
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Term
| Which inhalers are not approved by the FDA? |
|
Definition
| anticholinergic agent inhalers |
|
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Term
| What is an example of an anticholinergic agent inhaler? |
|
Definition
|
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Term
| What is combivent MDI? To what class does it belong? |
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Definition
| albuterol + ipratropium, an anticholinergic agent inhaler |
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Term
| To what class do montelukast (singulair) and zafirlukast (accolate) belong? |
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Definition
| leukotriene modifiers: leukotriene recptor antagonists (LTRA)- block some but not all leukotriene receptors |
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Term
| What is the most popular LTRA used? |
|
Definition
|
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Term
| What is the only modifier approved for preventing exercise-induced asthma? what is the dose? |
|
Definition
| montelukast (singulair). single daily dose. |
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Term
| What is a LTRA that has many drug interactions and is a modest inhibitor of CYP 2c9 and 3a4 enzymes? How frequently is it given? |
|
Definition
| given bid, zafirlukast (accolate) |
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Term
| What are new reports of side effects of LTRA's? |
|
Definition
| neuropsychiatric effects (aggitation, aggression, irritability) |
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Term
| What is the drug class of zileuton (zyflo)? |
|
Definition
| leukotriene synthesis inhibitor |
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Term
| What is a leukotriene modifier that is a modest inhibitor of cyp1a2 and 3a4 enzymes? How frequently is it administered? |
|
Definition
| high drug interactions. zileuton (zyflo). cyp 1a2 and 3a4 |
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Term
| What drug for asthma/copd has a narrow therapeutic index that has adverse effects that are dose related (n/v, cardiac arrhythmias, tremor, seizures) |
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Definition
|
|
Term
| What is a recombinant humanized monoclonal IgE antagonist for moderate-severe persistent asthma w/high allergin-specific IgE levels? |
|
Definition
|
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Term
| What is the adr and price of omalizumab (xolair)? |
|
Definition
| very expensive ($500/dose). risk of anapylaxis (only can be given under health care observance- high risk, black box warning) |
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|
Term
| What are the 6 steps for asthma tx? |
|
Definition
| 1. mild intermittent. 2. mild persistent. 3. moderate persistent. 4. severe persistent. 5. severe persistent. 6. severe persistent |
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Term
| Quick relief for mild intermittent asthma involves which steps? |
|
Definition
part of steps 1-4:
Short-acting inhaled β2-agonist PRN
increase use (> 2x/week) may indicate need for long-term control therapy
Treatment intensity depends on exacerbation severity |
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|
Term
| What is daily long-termm control for step 6 asthma? |
|
Definition
| severe persistent: inhaled steroid (high dose) AND LABA AND *oral corticosteroid* AND consider omalizumab for pts who have allergies. *consult w/ashtma specialist* |
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|
Term
| Which is reversible: COPD or asthma? |
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Definition
| COPD not fully reversible; asthma reversible |
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|
Term
| What exposures predisposue pts to copd? |
|
Definition
| *tobacco smoke*, occupational exposure |
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Term
| Of all the opiates, which is most associate w/constipation? |
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Definition
|
|
Term
| What is the active ingredient of mucinex? |
|
Definition
|
|
Term
| What is an adjunctive tx to relieve AR sx (mainly congestion)? |
|
Definition
|
|
Term
| What sx do intranasal antichlinergics tx? |
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Definition
|
|
Term
| What are drug interactions w/systemic decongestants? |
|
Definition
| maois->increase bp, also herbals containing ephedra (ma huang) |
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|
Term
| What relief do decongestants provide from allergic rhinitis? |
|
Definition
| temporary relief of nasal congestion |
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Term
| What relief do intranasal corticosteroids provide from allergic rhinitis? |
|
Definition
| o relieve sneezing, rhinorrhea, pruritis, nasal congestion |
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|
Term
| What relief does intranasal cromolyn provide from allergic rhinitis? |
|
Definition
| o indicated for preventing and tx AR |
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|
Term
| What relief do mast cell stabilizers provide from allergic rhinitis? |
|
Definition
| o indicated for preventing and tx AR |
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|
Term
| What relief do ocular NSAIDs provide for AR? |
|
Definition
| o indicated for relief of ocular itching from allergic conjunctivitis |
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