Pharmacologic Therapy Of Asthma

Front 1

impairment?

Back 1

frequency and intensity of symptoms and functional limitations the patient is experiencing currently or has recently experienced

Front 2

risk?

Back 2

likelihood of either asthma exacerbations, progressive decline in lung function (or lung growth in children), or risk of adverse effects from the medication

Front 3

what are initial management decisions for asthma based on?

Back 3

categorization of asthma severity

Front 4

after initial management decisions for treatment of asthma, what are subsequent decisions based on?

Back 4

assessment of asthma control

Front 5

asthma control?

Back 5

degree to which manifestations of asthma are minimized

Front 6

why is it important to separate the two concepts of asthma severity and control?

Back 6

dispels the common misconception that well-controlled asthma is synonymous with mild asthma and that poorly controlled asthma is synonymous with severe asthma

Front 7

responsible for early reaction of asthma?

Back 7

mast cells

Front 8

responsible for late reaction of asthma?

Back 8

leukocytes

Front 9

allergen-induced acute bronchoconstriction results from?

Back 9

IgE-dependent release from mast cells of histamine, tryptase, leukotrienes, and prostaglandins which directly control airway smooth muscle

Front 10

airway hyperresponsiveness?

Back 10

important to the pathogenesis of asthma and level of airway responsiveness usually correlates with the clinical severity of asthma

Front 11

non-antigenic stimuli for asthma?

Back 11

exercise
cold air
environmental pollutants

Front 12

contributors to bronchial asthma?

Back 12

mediator-release pathways
neural/humoral pathways
both

Front 13

neural pathway contributing to asthma?

Back 13

sensory receptors can activate vagal afferents leading to increased output of vagal effects resulting in ACh release and bronchoconstriction

Front 14

goals of asthma pharmacologic therapies?

Back 14

prevent and control symptoms
reduce frequency and severity of exacerbations
reverse airflow obstruction

Front 15

drugs of choice for long-term control of asthma?

Back 15

inhaled corticosteroids

Front 16

inhaled corticosteroids?

Back 16

budesonide
fluticasone
mometasone

Front 17

budesonide?

Back 17

inhaled corticosteroid

Front 18

fluticasone?

Back 18

inhaled corticosteroid

Front 19

mometasone?

Back 19

inhaled corticosteroid

Front 20

inhaled corticosteroids mechanism?

Back 20

block late reaction to allergen
reduce airway hyperresponsiveness

Front 21

clinical effects of inhaled corticosteroids?

Back 21

reduction in severity of symptoms;
improvement in peak expiratory flow and spirometry;
diminished airway hyperresponsiveness;
prevention of exacerbations;
possibly prevention of airway wall remodeling

Front 22

when is maximal improvement in lung function seen with inhaled corticosteroids?

Back 22

may not occur for several weeks

Front 23

local adverse effects to inhaled corticosteroids?

Back 23

thrush
hoarseness

Front 24

potential systemic adverse effects of inhaled corticosteroids?

Back 24

impaired linear growth in children
bone metabolism/osteoporosis
disseminated varicella
dermal thinning, increased ease of bruising
hypothalmic-pituitary-adrenal axis suppression

Front 25

what vaccine should those on corticosteroids receive?

Back 25

varicella vaccine (if not had clinical varicella)

Front 26

systemic corticosteroids?

Back 26

prednisone
others

Front 27

clinical use of systemic corticosteroids for asthma?

Back 27

in severely uncontrolled asthma for long-term prevention (>2 weeks), suppression and control of symptoms and reversal of inflammation

Front 28

mechanism of inhaled cromolyn sodium and nedocromil?

Back 28

inhibition of activation and release of mediators from mast cells, eosinophils, etc (do not degranulate);
inhibit early and late asthmatic response

Front 29

why are inhaled corticosteroids preferable to inhaled cromolyn sodium or nedocromil?

Back 29

must be given prophylactically
administered 4x a day
response is generally less predictable
not as effective at reducing bronchial hyperreactivity

Front 30

clinical uses of inhaled cromolyn and nedocromil?

Back 30

alternative med for mild persistent asthma;
preventative prior to exercise or unavoidable exposure to known allergens;
reduce need for quick relief β agonists

Front 31

adverse effects of cromolyn and nedocromil?

Back 31

virtually no systemic toxicity
transient cough

Front 32

other preparations of cromolyn and nedocromil have uses in what other conditions?

Back 32

vernal conjunctivitis
allergic conjunctivitis
allergic rhinitis

Front 33

contraindicated for monotherapy of persistent asthma?

Back 33

LABAs

Front 34

pharmacologic therapy for controlling moderate asthma?

Back 34

LABA + inhaled corticosteroids is considered more effective than raising the dose of corticosteroids, although this may be necessary as well

Front 35

clinical use of LABAs?

Back 35

concomitant use with inhaled corticosteroids for long term control of moderate to severe asthma, including nocturnal symptoms;
prevent exercise induced bronchospasm;
NOT monotherapy or for acute exacerbations

Front 36

why are LABAs and inhaled corticosteroids available in fixed combinations?

Back 36

more convenient
enhance compliance
eliminate risk of use of LABA as monotherapy

Front 37

revised FDA labeling for LABAs in 2006?

Back 37

associated with possible increased risk of bronchospasm in some people;
although decrease frequency of asthma episodes, may increase chance of severe asthma episodes and death when these episodes do occur

Front 38

main advantage to theophylline?

Back 38

oral asthma drug

Front 39

theophylline mechanism?

Back 39

not definitively established

Front 40

clinical use of theophylline?

Back 40

adjuvant to inhaled corticosteroids for prevention of nocturnal asthma symptoms;
alternative for long-term preventive therapy (issues with cost or adherence)

Front 41

use of low-dose theophylline?

Back 41

revived interest as maintains full anti-inflammatory/immunomodulatory effects without potential for toxicities

Front 42

adverse effects of theophylline?

Back 42

narrow TI necessitating monitoring
>15 microg = anorexia, n/v, nervousness, insomnia, tremor, aggravation of ulcer or reflux, increase in hyperactivity in some children and possible difficulty in urination in elderly males with BPH;
>40 microg = seizures and cardiac arrhythmias possible

Front 43

leukotrienes?

Back 43

potent biochemical mediators;
released from mast cells, eosinophils, basophils;
contract airway smooth muscle;
increase vascular permeability;
increase mucus secretion;
attract and activate inflammatory cells in airways

Front 44

systemic leukotriene modifiers?

Back 44

montelukast
zileuton

Front 45

clinical considerations with leukotriene modifiers?

Back 45

considerable variability in response
less effective as add on therapy than LABAs
not useful for acute asthma attack

Front 46

clinical indications for leukotriene modifiers?

Back 46

alternative monotherapy for mild persistent asthma;
concomitant with inhaled corticosteroids for moderate persistent asthma;
exercise induced asthma (especially in children who may not have access to SABAs when needed)
[indications for responders]

Front 47

leukotriene modifiers effects?

Back 47

improve lung function;
diminish symptoms;
diminish need for short acting β agonists;
reduction in inhaled corticosteroid dosage

Front 48

montelukast mechanism?

Back 48

leukotriene CysLT1 receptor antagonist

Front 49

agonists for leukotriene CysLT1 receptor?

Back 49

LTC4
LTD4
LTE4

Front 50

clinical use of montelukast?

Back 50

asthma
allergic rhinitis

Front 51

adverse effects of montelukast?

Back 51

neuropsychiatric events

Front 52

zafirlukast drug interactions?

Back 52

increased half-life of warfarin
decreased bioavailability with meals

Front 53

zileuton mechanism?

Back 53

inhibits 5-lipoxygenase enzyme to inhibit synthesis of all leukotrienes

Front 54

additional benefit of zileuton over other leukotriene modifiers?

Back 54

capable of attenuating bronchoconstriction from exercise and from aspirin in aspirin-sensitive individuals

Front 55

adverse effects of zileuton?

Back 55

liver toxicity
avoid in pregnancy

Front 56

zileuton drug interactions?

Back 56

metabolized by CYP3A4, 1A2, 2C9
inhibit warfarin, theophylline metabolism

Front 57

omalizumab?

Back 57

monoclonal IgG tha interacts with Fc of IgE to neutralize and prevent its binding to mast cells and basophils

Front 58

administration of leukotriene modifiers?

Back 58

oral

Front 59

administration of omalizumab?

Back 59

subcutaneous

Front 60

effect of omalizumab?

Back 60

limits release of mediators
downregulation of FcI receptors on basophils

Front 61

omalizumab indications?

Back 61

adults and adolescents with severe persistent asthma;
symptoms inadequately controlled with inhaled corticosteroids, LABAs, and leukotriene modifiers

Front 62

how long must patients be treated with omalizumab before efficacy is assessed?

Back 62

at least 12 weeks

Front 63

omalizumab adverse reactions?

Back 63

malignancies
anaphylaxis (contraindication)

Front 64

why are systemic corticosteroids important in treatment of severe exacerbations despite slow onset?

Back 64

prevent progression of exacerbation
speed recovery
prevent early relapses

Front 65

use of quick relief medications?

Back 65

prompt relief of bronchoconstriction, cough, chest tightness, and wheezing

Front 66

mechanism of SABAs?

Back 66

β2 stimulation (functional antagonism)
inhibit function of inflammatory cells

Front 67

therapy of choice for acute symptoms and prevention of exercise induced bronchoconstriction?

Back 67

SABAs

Front 68

frequency of SABAs use?

Back 68

regularly scheduled is not recommended;
use can be used as barometer of disease activity

Front 69

SABAs adverse effects?

Back 69

sympathomimetic effects (tremor, anxiety, heart pounding, tachycardia, small increases in K+ and Mg2+);
possible tolerance

Front 70

SABAs?

Back 70

albuterol
levalbuterol

Front 71

inhaled anticholinergics?

Back 71

tiotropium
ipratropium

Front 72

tiotropium mechanism?

Back 72

competitive inhibitors of M1 and M3 to inhibit bronchoconstriction and secretory effects of ACh

Front 73

clinical uses of ipratropium?

Back 73

bronchospasm in chronic bronchitis, COPD;
bronchospasm due to β-blocker therapy;
allergic rhinorrhea

Front 74

tiotropium clinical uses?

Back 74

COPD
offlabel for refractory severe asthma or those that cannot tolerate β2 agonists

Front 75

side effects of inhaled anticholinergics?

Back 75

drying of mouth
bitter tast
constipation
tachycardia
blurred vision
narrow angle glaucoma

Front 76

clinical use of systemic corticosteroids?

Back 76

severe exacerbations unresponsive to bronchodilators to speed recovery and prevent recurrence of exacerbations;
gain prompt control of disease when initiating long term therapy with inhaled corticosteroids