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1. inhaled

corticosteroids direct

MOA

inhibit (cytokine-induced)

production of inflammatory proteins

2. pharm agents causing ASA, Beta blockers

3. physical triggers cold air, exercise

4. physiologic triggers(4)

stress, GERD, URI, rhinitis

5. factors influencing

dev/exp - host

genetic, gender, obesity

6. inflam cells in asthma mast, eosino/baso/neutrophils,

platelets, TH2

7. mediators histamine

LTE

Kinins, endothelin, prosanoids

8. diagnosis >12% reversibility or increase in

FEV1 of 200c

9. obstructive pattern reduced FEV1/FVC ratio w/ albuterol

10. restrictive pattern reduced FVC (normal ratio) w/

albuterol

11. methacholine

challenge

bronchoprovocative test;

20% or more decrease in FEV1

12. Severe asthmatic

episode - ABG

pH down

paCo2 down

pa02down

HCO3 way down

13. sputum eosinophils, charcot-leyden crystals,

inc IgE

14. chest xray inc AP diam, dark (translucent)

fields, depressed/flat diaphragm

15. Step 1 - 4; symptom

freq

1; 2x per week

3; daily

4; continual

16. Zone mgmnt

green/yellow/red

patient self monitoring system

17. asthma classifications allergic, exercise induced, nocturnal

18.

non drug treatment,avoid triggers & treat

aggravating

allergies, GERD, rhinitis, viral RI

19. drug types for asthma

(6)

beta agonists, corticosteroids, mast

cell stabilizers, LTE modifiers,

theophylline, anti IgE ab's

20. Beta 2 agonists MOA G-protein receptors activates

adenylyl cyclase/cAMP - >

intercellular Ca ->

bronchodiliation & mast cell

stabilization

21. mast cells filled w/ basophil granules

22. short acting beta agonists relax smooth muscle,

inc airflow in 30 sec; DOC for

attacks

23. indicates inadequate

control

> 1 canister/mth SABA

24. dosing positive response is 200 ml increase or 12%

increase in FEV1

25. Beta2 agonists SE tremor

heart palps

hypokal

O2 sat reduction

26. SABAs - ALPMT

(short goats on alp

mountains)

Albuterol

Levalbuterol

Pirbuterol

Metaproterenol

Terbutaline

27. dosing levalbuterol

(Xopenex) - only R

isomer/active

half of racemic albuterol - 0.63

mg, 1.25 mg (3X cost)

28. LABAs - AFAS Albuterol ER

Formoterol

Aformoterol,

Salmeterol,

29. LABA's considerations not monotherapy;

only if cannot be controlled

otherwise

shortest duration & taper off 

30. LABAs - COPD only Formoterol

Aformoterol

31. combo LABA &

corticosteroids (3)

Symbicort, Dulera, Adv air

32. Symbicort Formoterol & Budesonide

33. Advair Salmeterol & Fluticasone

34. Dulera Formoterol & Mometasone

(asthma only)

35. combo LABA & steroid for

asthma only

Dulera

36. inhaled corticosteroids

direct MOA

inhibit cytokine (ind uced

prod of pro-inflamm proteins)

37. inhaled corticosteroids

indirect MOA (4)

alter m-RNA prod

suppress inflam

produce anti-inflam mediator

increase B2 receptors,

decrease mucous

38. mild asthma - once a day

inhaled steroid options

budesonide

ciclesonide

mometasone furoate

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39. corticosteroids

SEs

thrush; hypergly

adrenal suppress

osteoporosis

elev WBC

40. corticosteroids -

dosing therapy

oral or IV "burst" therapy

41. corticosteroids

dosing strategylong term

step down: after controlled

dec 25% every 2 wks (8wks min)

42. methylxanthines

include

caffeine, theophylline, theobromine

43. methylxanthine -

indication

adjuvant to inhaled steroids

alt to LABA to control nocturnal

symptoms

44. methylxanthines

MOA (3)

phosphodiesterase inhib, inc CAMP->

inhibits LTE broncho/vasodilate, cardiac

stim, vasodilate

blockade adenosine receptors

Ca+ released from sarcoplasm

45. theophylline SE's -

7 NITSCHA

N/V

insomnia

tremors

seizures

confusion

HA

arrhyth

46. theophylline -

concern

narrow therapeutic window; monitor

conc

47. theophylline -

interaction

is a Cyp 450 substrate; many interactions

48. theophylline -

CYP450

interaction

causes

inhibitors inhibit liver metabolism;

increase Theo levels

inducers enhance ......cause decreased

Theo

49. theophylline -

avoid CY450

INHIBITORS

(inhibited hide

FACE Very well)

Fluvoxamine

Amiodarone

Cipro

Erythromycin

Verapamil

50. theophylline -

avoid CY450

INDUCERS

(PCPR - induce

halluc)

Phenytoin

Phenobarbital

CBZ

Rifampin

51. theophylline -

disease state

interactions

smoking, hyperthy - dec Theo

CHF, liver disease - inc Theo

52. cromolyn (intal) - class

nedocromil (tilade)

mast cell stabilizer

(no inherent bronchodilation)

53. cromolyn MOA blocks Cl channels

blocks histamine release from

mast cells

54. cromolyn SE bad taste; GI

55. Montelukast (Singulair) -

class

Zafirlukast (Accolate)

LTE receptor antagonists

56. Zileuton (zyflo) - class LTE receptor antagonists

5-lipoxygenase inhibitor -

reduces synthesis

57. Zileuton (zyflo) interaction inhibits metabolism of 

theophylline & warfarin

(increases levels)

58. LTE antagonists - not

indicated for

acute attacks

59. Montelukast vs Zafirlukast Montelukast more favorable;

can be used in kids 2-5 yrs

60. Ipratropium - class antimuscarinic (atropine - like)

61. Ipratroprium - indication quick relief; additive to beta

agonists

62. Omalizumab (xolair) - class IgE antibody inhibitor

63. Omalizumab MOA binds IgE on mast

cells/basophils; prevents

release

64. Omalizumab - indication persistent, mod-severe

allergic asthma not controlled

on oral steroids

65. Omalizumab dosage every 2-4 weeks; half-life 26

days

66. Omalizumab concern very expensive

67. Omalizumab dosage based

on

IgE serum levels -but 1+ yr

post treat

68. Omalizumab SE HA

injection site rxn

URI arthralgia

69. MOA of Omalizumab

(Xolair)?

Inhibits binding of IgE to the

high affinity IgE receptor onsurface of mast cells and

basophils

70. Which type of patient

should use Omalizumab

(Xolair)?

Patient with moderate-severe

persistant allergic asthma not

controlled by inhaled steroids

71. When prescribing Inhibitors

of IgE antibodies, what

should the dosing be based

on?

IgE serum levels and body

weight

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72. T/F: Inhibitors of IgE antibodies are cost

effective for the patient

False: They are about $600 per 1 150mg. vial

73. Intermittent Asthma - Step 1 Tx SABA as PRN

74. Intermittent Asthma - Step 1, w/ mod/sev viral

inf Tx

SABA PRN

short course systemic steroids

75. mild persistent asthma - Step 2 Tx daily long term control

inhaled steroids or (cromolyn or nedocromil)

Zafirlukast or zileuton in adults (12+YOA)

76. mod persistant asthma - Step 3 Tx increased inhaled steroids or

add LABA or

add nedocromil

77. mod persistant asthma - Step 3 not controlled

Tx

increase to high dose inhaled steroids

add LABA (servent or theophylline)

78. severe persistent asthma - Step 4 Tx Add oral systemic steroids

monitor closely

79. LABA black box warning inc risk for asthma-related deaths; only for uncontrolled (w/ inhaled corticostero

or 2+ maintenance meds)

80. Acute asthma exacerbation; FEV1 or PEF < 50% -Tx

O2 90-95% satinhaled SABA or cont albuterol

oral systemic steroids (prednisone)

anti-cholinergics (never alone)

81. which drugs specifically not recommended for

acute asthma

methylxanthine/theophylline

mucolytic

sedation

abx

82. aggressive hydration in acute asthma not reco'd adu lts; maybe infants/children