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53 Cards in this Set
- Front
- Back
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What is PEFR? |
Peak Expiration Flow Rate - maximum flow rate a patient can generate |
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In asthmatics who have been exposed to environmental triggers, what causes the immediate drop in FEV1? (2) |
- Histamines and Leukotrienes causing constriction of airways |
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What does re-exposure to environmental triggers in asthmatics lead to? |
Mucus secretion as stimulated by lymphocytes |
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What is Asthma Step Classification based on? (2) |
Frequency of symptoms and drop in FEV1 |
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Describe each step of Asthma. |
Step 1: <2 week frequency, normal FEV1 Step 2: >2 week freq, not daily, normal FEV1 Step 3: daily Sx, FEV1 60-80% Step 4: continuous Sx,FEV1 <60% |
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What does a spacer do to an inhaler? |
Primes the fumes for controlled inhalation so that simultaneous inhalation with administration is not necessary. |
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What are 3 ways to deliver aerosol drugs for asthma? |
1) Metered-dose inhalers 2) Nebulizers 3) Dry powder inhalers |
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What are the drawbacks of nebulizers? (3) |
needs power and gas pressure, takes 15 mins |
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What are drawbacks of dry-powder inhalers? (3) |
- Dry powder is irritating - Powder can cake - Not good for children and elderly |
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What are the 2 classes of asthma drugs? |
- Relievers - Controllers |
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What are 2 subtypes of relievers? |
- ß2 agonists - M3 antagonists |
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Name an inhaled ß2 agonist? (both names) |
Albuterol / salbutamol |
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Name an oral ß2 agonist? |
salbutamol |
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When is oral salbutamol used? |
For children with URI |
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Name a long-lasting inhaled ß2 agonist.
What is its duration? |
Salmeterol
12hrs |
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Why is Salmeterol long-acting? |
It has a long side-chain that can incorporate into plasma membranes |
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What is a disadvantage of Salmeterol? |
Masks worsening airway inflammation |
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What are adverse effects of ß2 agonists? (3) |
- Heart rhythm effects - Anxiety - Muscle tremors |
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Name 2 Anticholinergic antagonists. |
Ipratropium bromide Triotropium bromide |
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What are the delivery mechanisms and duration of action for each M3 antagonist? |
Ipratropium bromide - inhaler/nebulizer, 6 hrs Triotropium bromide - dry powder, 24 hrs |
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What are the side-effects of M3 antagonists? (4) |
- dry mouth - urinary retention - blurry vision - possible glaucoma in elderly (use mask) |
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Name an inhaled corticosteroid.
Name an oral steroid. |
Inhaled - fluticasone
Oral - prednisone |
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What is the duration of action for steroids? |
6-12 hrs (given prophylactically) |
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What is the mechanism of action of steroids? |
Steroid diffuses into cell, binds to glucocorticosteroid receptor (GR), which causes heat-shock proteins to dissociate, and then GR-steroid complex binds to DNA and down-regulates transcription of inflammatory proteins. |
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What are the side-effects of inhaled corticosteroids? (5) |
- Hoarseness - Thrush (rinse mouth) - Stunts child growth - Osteoporosis - Cataracts |
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What two drugs make up Advair? |
Salmeterol and Fluticasone |
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Name a drug that inhibits mast-cell degranulation. |
Cromolyn sodium |
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Besides inhibiting mast cell degranulation, what else does cromolyn sodium do? (2) |
- Inhibits cough - Inhibits eosinophil migration |
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How is cromolyn sodium administered?
How often? |
inhaler / powder
2-3x daily |
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What are the side-effects of cromolyn sodium? (2) |
- Laryngeal edema - Joint swelling |
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Name 3 biologics used for asthma. |
- Omalizumab - Mepolizumab - Quilizumab |
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On what does omalizumab bind? |
IgE |
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How is omalizumab administered? |
Subcutaneous injection |
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On what does Mepolizumab bind?
For what patients is this drug best? |
IL-5
steroid-resistant patients |
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To what does quilizumab bind?
What is its additional action? |
Neutralizes IgE and blocks its production |
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How is quilizumab administered?
How often? |
inhaled once every 3 months |
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What drug is a leukotriene receptor antagonist? |
Montelukast |
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On what receptor does montelukast bind? |
cys-LT1 receptor |
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What is a disadvantage of montelukast? |
Half of patients do not respond to it. |
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How is montelukast administered?
How often? |
oral, once daily |
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What is an adverse effect of montelukast? |
Abnormal liver function test |
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What is an unusual side-effect of montelukast? |
Suicide risk |
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What are theophylline's 2 mechanisms of action? |
- Activates histone deacetylases (reduces transcription) - PDE inhibitor |
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How is theophylline administered? (2) |
Oral or I.V. |
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What increases theophylline's half-life? (4) |
- CHF - Pulmonary edema - Some antibiotics - OCP |
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What are theophylline's adverse effects? (2) |
- Fatal intoxication (narrow therapeutic window) - Seizures |
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What is a new PDE inhibitor used for asthma? |
Rofumilast |
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What are rofumilasts adverse effects? (2) |
- weight loss - suicide |
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What antibiotic can be used to treat asthma?
How does it work? |
Azithromycin
anti-inflammatory effects |
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What treatment do patients with Step 1 asthma need? |
Only ß2-agonist inhaler |
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What treatment do patients with Step 2 asthma need? |
Low-dose inhaled corticosteroids |
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What treatment do patients with Step 3 asthma need? |
Inhaled corticosteroid with long-acting ß2 agonist |
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At what step of asthma are biologics indicated? |
Step 5 or 6 |
