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50 Cards in this Set
- Front
- Back
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What is the MOA of corticosteroids?
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Inhibits or induces the secretion of end-effector proteins by regulating cellular transcription
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What is the MOA of mast cell stabilizers?
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Prevents the influx of calcium into mast cells thus preventing degranulation
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What is the MOA of leukotriene modifiers?
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There are two types of leukotriene modifiers: the receptor antagonists block the leukotriene receptors while the lipoxygenase inhibitors prevent the production of leukotrienes
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True or false: oral corticosteroids can be used in all steps/stages of asthma/COPD for an acute exacerbation
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True - oral corticosteroids can be used for an acute exacerbation in either cases for inpatient or outpatient usage
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What is the MOA of immunomodulators?
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Omalizumab selectively binds to circulating IgE and prevents the IgE from binding to mast cell receptors.
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What is the MOA of mucolytics
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Breaks disulfide bonds in mucus thus making it thinner and easier to expel. May cause blockage of smaller airways because thinning of mucus causes dispersion
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True or false: glucocorticoids can increase the responsiveness of beta-adrenergic receptors and thus increase beta agonist effects.
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True - glucocorticoids can increase beta agonist attraction and increase overall beta agonist activity
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True or false: glucocorticoids are considered safe and effective which is why they are ranked as the gold standard anti-inflammatory
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False - glucocorticoids are ranked as the gold standard anti-inflammatory but they have a serious side effect profile when taken orally or inhaled in high doses.
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True or false: anti-inflammatories are never used as rescue drugs
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True - the main role of an anti-inflammatory is to be used as long term control
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True or false: in the hospital doses of corticosteroids are split to improve patient response
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True - splitting the daily dose into 2 doses improves patient outcome and response to therapy
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In what steps of asthma are oral steroids used as long-term therapy?
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Oral steroids are included as apart of therapy in steps 5 and 6 of asthma
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True or false: a combination of an inhaled corticosteroid with a LABA results in a decrease of exacerbations
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True - the TORCH study showed that in COPD exacerbations, the combination of a ICS and LABA decreased the number of exacerbations
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When are ICS indicated for asthma/COPD
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ICS is indicated at stage 2 and higher for asthma with varying doses but ICS is only recommended for COPD patients with 3+ exacerbations in last 3 years.
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True or false: Mast cell stabilizers are used as preventative therapy in pre-exercise for both asthma and COPD
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False - mast cell stabilizers are not indicated for COPD
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What are the indications for mast cell stabilizer use in asthma?
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Long-term control of step II asthma
Pre-exercise for EIB Pre-exposure to know allergens |
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When is leukotriene modifier therapy indicated?
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For step 2 asthma or combination therapy with ICS in steps 3 and 4 of asthma. Not indicated for COPD.
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When are immunomodulators used in patient therapy?
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Used in patients with an increased IgE level accompanied by steps 5 or 6 asthma
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When are mucolytics recommended in patient therapy?
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Sometimes used for treatment of asthma patients with significant mucus plugging but not EPR3 or GOLD recommended for any use.
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What is the ranking order of anti-inflammatory drugs according to activity?
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Corticosteroids = top of mountain
Antileukotrienes = bottom of mountain Mast cell stabilizers = below sea level |
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True or false: Very high levels of IgE are an indication for the use of Omalizumab because it's effectiveness is proportional to serum IgE level.
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False - too much IgE will prevent omalizumab from being effective in therapy
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What is the recommended adult dose for IV methylprednisolone for an acute asthma exacerbation?
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32-64mg/day until PEF reaches 70% personal best (typically 3-10 days)
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What is the recommended adult dose for IV methylprednisolone for an acute COPD exacerbation?
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24-32mg/day for 7 to 10 days
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What are the recommended doses for a budesonide DPI? (low/med/high) What strengths does it come in?
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Comes in 90 or 180mcg/inhalation
Low = 180-600 Med = 600-1200 High = 1200+ |
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What is a normal adult dose of prednisone short-course 7 day therapy?
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Day 1 = 30mg BID
Day 2 = 20mg BID Day 3 = 15mg BID Day 4 = 10mg BID Day 5 = 5mg BID Day 6 & 7 = 5mg Daily |
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What is a normal adult dose of prednisode short-course 10 day therapy?
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Day 1 & 2 = 20mg BID
Day 3 & 4 = 15mg BID Day 5 & 6 = 10mg BID Day 7 & 8 = 10mg daily Day 9 & 10 = 5mg daily |
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What is the recommended adult dose of montelukast?
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10mg daily in the evening
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What is the recommended adult dose of cromolyn? (MDI/neb)
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MDI: 2 puffs QID
Neb: 20-40mg QID |
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What is the recommended adult dose of omalizumab?
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Subcut every 2 to 4 weeks based on serum IgE AND body weight. Range is 150-375mg with max 150mg per injection.
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True or false: glucocorticoids can cause the breakdown of muscle and severe osteoporosis
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True: glucocorticoids mobilize amino acids by breaking down muscle and can also cause severe osteoporosis which may stunt growth in children
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Common side effects for mast cell stabilizers
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Coughing and wheezing
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Common side effects for leukotriene modifiers
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Montelukast contains phenylalanine
Zileuton (production inhibitor) - hepatotoxicity monitor LFTs. |
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Common side effects for immunomodulators
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Injection site reactions
Increased risk of cancer |
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Common side effects for mucolytics
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Smells and tastes like rotten eggs so can cause nausea and vomiting
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What are some unique CNS effects that can result from the use of corticosteroid therapy?
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CNS stimulation/depression
Nightmares Increased appetite |
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True or false: the route of administration for corticosteroid therapy greatly influences it's side effect profile
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True - the safest route for corticosteroid therapy is inhaled low dose
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True or false: corticosteroid use can be associated with adrenal suppression
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True - however adrenal suppression depends on dose and duration; systemic doses greater than 7.5mg/d for more than 2-3 weeks causes suppression
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True or false:adrenal suppression from high dose corticosteroids can be prevented by administering the therapy via the inhaled method
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False - adrenal suppression has been reported in patients receiving high-dose inhaled corticosteroids
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What is the gold standard inhaled glucocorticoid?
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Fluticasone is the gold standard because it has the majority market share and ease of use
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What is the gold standard IV glucocorticoid?
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Methylprednisolone is the gold standard because it is easy to dose
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What is the gold standard oral glucocorticoid?
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Prednisone is the gold standard because it is easy to titrate and is very cheap
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True or false: glucocorticoid therapy can impair the immune system
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True - macrophages under the influence of steroids slow movement and have impaired phagocytosis
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True or false: budesonide is the only corticosteroid nebulizer formulation indicated for adults
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False - there is no nebulizer formulation for adults; budesonide is used mainly in children 12 months to 8 years
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What are the glucocorticoid equivalencies?
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Cortisone 25mg
Hydrocortisone 20mg Prednisolone 5mg Prednisone 5mg Methylprednisolone 4mg Dexamethasone 0.75mg |
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True or false: when weaning a patient off systemic steroids it is important to switch to alternate day dosing therapy
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True - the goal is to convert the patient to alternate day therapy so that they only receive drug one day and no drug the next
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What important preventative therapy should be taken by patients on medium to high inhaled corticosteroids?
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Add calcium 100-1500mg per day
Add vitamin D 400-800mg per day May need to add bone-sparing therapy like bisphosphonate |
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True or false: patients utilizing corticosteroid therapy are at risk for easily transmissible infectious diseases
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True - the impairing effects on leukocytes can cause flaring of infectious diseases
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True or false: despite it's weakness in having very little effect, cromolyn's strength is it's lack of drug interactions
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True - because cromolyn is not systemically absorbed there are no drug interactions to be concerned about
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What are some important drug interactions of montelukast?
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There are no drug interactions between montelukast that are worth mentioning however, CYP3A4,2C8/2C9 inducers can decrease montelukast serum concentration and effect
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What are some important drug interactions of zileuton?
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Decreases warfarin and theophylline metabolism
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True or false: omalizumab and n-acetylcysteine have no known drug interactions
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True - there are no drug interactions listed for these two medications; maybe due to rare use.
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