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42 Cards in this Set
- Front
- Back
What are the 7 classes of long term medications used for the treatment of asthma?
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1) Inhaled corticosteroids
2) Systemic corticosteroids 3) Inhaled Cromolyn sodium and Nedocromil 4) Inhaled long-acting beta2 agonists 5) Theophylline 6) Systemic Leukotriene modifiers 7) Omalizumab |
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What are the drugs of choice for asthma treatment long-term?
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Inhaled corticosteroids
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What are three important inhaled corticosteroids?
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1) Budesonide
2) Fluticasone 3) Mometasone furoate |
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What is the mechanism of inhaled corticosteroids?
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They are anti-inflammatory medications that reduce the markers of airway inflammation in the airway
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Who should use inhaled corticosteroids?
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Asthmatics who use beta2 agonists more than twice a week or twice a month during nighttime attacks
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What are the clinical effects of inhaled corticosteroids?
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1) reduction in symptom severity
2) improved peak expiratory flow 3) decreased airway hyperresponsiveness |
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Describe the localized adverse effects of inhaled corticosteroids
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1) Oral Candidiasis
2) Dysphonia (hoarseness) 3) reflex cough and bronchospasm |
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Describe the systemic adverse effects of inhaled corticosteroids
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They are similar to that of oral steroids but significantly less likely to occur
1) impaired growth in children 2) osteoporosis 3) disseminated varicella 4) hypothalamic-pituitary dysfunction |
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Describe the mechanism of action of cromolyn sodium
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It stabilizes mast cells and decreases their degranulation
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Of what is cromolyn sodium used as the major treatment?
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Prophylactic treatment of exercise-induced asthma
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Why are cromolyn sodium and nedocromil no longer used?
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The clinical response is less predictable than inhaled corticosteroids and take 4-6 weeks to reach maximum benefit
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What are the examples of long-acting beta2 agonists? (that we need to know)
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1) salmeterol
2) formoterol 3) salmeterol/fluticasone combo 4) budesonide/formoterol combo |
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Until recently, what was the preferred agent for concomitant use with inhaled corticosteroids?
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Long-acting beta 2 agonists
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Should beta 2 agonists be used as monotherapy in the treatment of asthma?
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No, they are contraindicated as monotherapy
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Salmeterol and formoterol are also used to treat what disease?
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COPD
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Which is better, raising a steroid dose or adding a long-acting beta agonst?
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It is better to add a long-acting beta 2 blocker
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If a patient has an acute exacerbation of asthma, should they us a long acting beta2 agonist?
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No, they have a black box warning against the use in acute exacerbation
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Describe the proposed mechanism of action of theophylline
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It can cause smooth muscle relaxation by inhibition of phosphodiesterase resulting in an increase in cAMP
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Describe the clinical use of theophylline
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It is a mild-to-moderate bronchodilator used as an adjuvant to inhaled corticosteroids for prevention of nocturnal symptoms
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Describe the therapeutic range of theophylline
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It is very narrow
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What are the adverse side effects of theophylline?
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anorexia, nausea and vomiting nervousness, insomnia, tremor, ulcer or reflux aggravation
above 40mcg/ml can cause seizures and arrhythmias blood levels need to be monitored |
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What are the three leukotriene modifiers?
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1) montelukast
2) zafirlukast 3) zileuton |
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What is the mechanism of action of montelukast?
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It is a leukotriene receptor antagonist
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What are the clinical uses of montelukast?
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It is used in mild asthma or allergic rhinitis
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What are the adverse side effects of montelukast?
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Possible neuropsychiatric events
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What is the mechanism of action of zileuton?
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It is a leukotriene synthesis inhibitor that blocks 5-lipoxygenase
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What are the clinical uses of zileuton?
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Exercise induced asthma and aspirin induced asthma
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What are the adverse side-effect associated with zafirlukast?
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1) GI upset
2) Churg-Strauss |
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What are the clinical uses for leukotriene modifiers?
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They can be used as monotherapy for mild asthma (but less effective than inhaled corticosteroids) or as an adjunct to steroids in moderate asthma; they are not used for acute attacks
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What are some drug interactions associated with zafirlukast?
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1) inhibits metabolism of warfarin
2) meals decrease bioavailability |
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What are the adverse reactions of zileuton?
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liver toxicity; should be avoided in pregnancy
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What is the mechanism of action of omalizumab?
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It is an IgG antibody that binds to human IgE and functions to inhibit the binding of IgE to antibody, limiting the release of mediators from the mast cells
Decreases IgE receptor expression |
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Who can be treated with omalizumab?
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Adults or adolescents older than 12 with severe persistent asthma with a positive skin test to an allergen with increased IgE levels and an FEV1 between 40-80% predicted
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What is the black box warning associated with omalizumab?
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anaphylaxis (can be delayed up to a 4 days)
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What are the drugs used for quick relief of asthma ?
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1) inhaled short-acting beta2 agonists
2) inhaled anticholinergics 3) systemic corticosteroids |
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What is most common inhaled short-acting beta2 agonist?
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albuterol and levalbuterol
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What are the clinical indications of short-acting beta 2 blockers?
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1) acute asthma attack
2) exercise-induced bronchospasm 3) regularly scheduled use is NOT RECOMMENDED |
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What are the names of the inhaled anticholinergic?
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tiotropium bromide
ipratropium bromide |
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Describe the mechanism of action of tiotropium
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It is a competitive inhibitor of muscarinic cholinergic receptor inhibitor
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Inhaled anticholinergics are used to treat what illnesses?
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COPD and asthma
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What systemic corticosteroids are used in the treatment of asthma and in what situation would they be used?
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Prednisone and methylprednisone; they are used for asthma exacerbations unresponsive to bronchodilators
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function of Endoplasmic Reticulum (ER)
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stores
separates cell's transport system Rough ER has ribosomes, smooth does not |