Asthma and COPD Treatment Goals

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Questions and Answers

What is one of the primary classes of medications used for the management of COPD?

Beta-2 Agonists

Corticosteroids

Anticholinergics (correct)

Antihistamines

Which of the following is a key point for the use of bronchodilators in asthma management?

They provide rapid relief by relaxing airway muscles. (correct)

They should not be combined with other medications.

They act by decreasing inflammation in the lungs.

They should only be used during asthma attacks.

What is the main goal of treatment for stable COPD?

To avoid the use of medications.

To completely cure the disease.

To eliminate allergens from the environment.

To enhance lung function and reduce symptoms. (correct)

Which type of medication is considered a first-line treatment for asthma management?

Corticosteroids Signup and view all the answers

Which scenario is most likely indicating a need for an anticholinergic medication in COPD management?

Patient presents with chronic bronchitis symptoms. Signup and view all the answers

What distinguishes a Beta-2 Agonist's action in asthma treatment?

They target beta-2 receptors to induce bronchodilation. Signup and view all the answers

What is a common misconception about using bronchodilators for asthma?

They can be entirely relied upon to control asthma symptoms. Signup and view all the answers

In asthma management, what role do anti-inflammatory medications play?

They reduce airway swelling and sensitivity. Signup and view all the answers

What is the mechanism of action of leukotriene receptor antagonists like Montelukast in chronic asthma management?

They inhibit the action of leukotrienes at their receptor. Signup and view all the answers

Which of the following statements about the use of inhaled corticosteroids, such as Beclomethasone, is true?

It is important to rinse the mouth after each use. Signup and view all the answers

What is a contraindication for using Montelukast?

Patients with phenylketonuria (PKU). Signup and view all the answers

Which of the following is an important instruction for patients using inhaled corticosteroids?

Always use a bronchodilator after using the corticosteroid. Signup and view all the answers

What is the primary therapeutic use of Budesonide?

For the prophylaxis and long-term control of asthma. Signup and view all the answers

Which type of medication is Fluticasone?

An inhaled corticosteroid. Signup and view all the answers

What is the primary effect of the inhaled corticosteroids on bronchial tissues?

They reduce inflammation in the airways. Signup and view all the answers

Which therapeutic strategy is NOT recommended for acute asthma attacks?

Relying solely on inhaled corticosteroids. Signup and view all the answers

Which of the following statements is correct regarding the use of beta-2 agonists in asthma management?

They work by directly relaxing bronchial smooth muscle. Signup and view all the answers

What is a common side effect of using inhaled corticosteroids?

Oral thrush. Signup and view all the answers

What is the primary indication for the long-term use of LABAs, such as Salmeterol?

Long-term asthma control Signup and view all the answers

Which of the following is a contraindication for the use of LABAs?

Use without an ICS Signup and view all the answers

What is a common side effect associated with anticholinergics?

Dry mouth Signup and view all the answers

Which patient population should be prescribed a combination medication for asthma management?

Pediatric patients Signup and view all the answers

What is a key disadvantage of using Ipratropium in asthma management?

It is not effective for preventing bronchospasms Signup and view all the answers

Which receptor does Tiotropium primarily inhibit to achieve bronchodilation?

M3 receptors Signup and view all the answers

Which of the following symptoms is NOT associated with the use of inhaled corticosteroids (ICS)?

Increased cough Signup and view all the answers

What should be done after achieving control of asthma symptoms with short-term use of LABAs?

Discontinue the treatment Signup and view all the answers

Which medication is contraindicated in patients with hypersensitivity to atropine?

Ipratropium Signup and view all the answers

What is a serious risk associated with giving LABAs in patients with actively deteriorating asthma?

Higher likelihood of bronchospasms Signup and view all the answers

What is the role of leukotriene modifiers in asthma management?

Add-on therapy for severe asthma Signup and view all the answers

Which beta-2 agonist has a shorter duration of action?

Albuterol Signup and view all the answers

Which of the following is an indication for the use of anti-inflammatory inhaled corticosteroids?

Long-term control of persistent asthma Signup and view all the answers

What is an effect of blocking muscarinic cholinergic receptors with anticholinergics?

Decreased bronchoconstriction Signup and view all the answers

What is the primary action of NSAIDs in relation to bronchial smooth muscle?

Enhance cAMP concentrations Signup and view all the answers

What should be done before using a controller medication in asthma management?

Use NSAIDs Signup and view all the answers

Which of the following age groups do NSAIDs apply to regarding their use?

All age groups Signup and view all the answers

What is a key aspect of monitoring when NSAIDs are prescribed?

Observing for signs of immediate hypersensitivity reactions Signup and view all the answers

What is the result of NSAIDs inhibiting the release of mediators from mast cells?

Decreased inflammation in the respiratory tract Signup and view all the answers

What is a significant side effect that is less common with Levalbuterol compared to Albuterol?

Tremors Signup and view all the answers

Which of the following statements about Formoterol is true?

It has a longer half-life than Albuterol. Signup and view all the answers

What should be avoided when using beta-2 agonists like Albuterol?

Use with MAOIs Signup and view all the answers

What effect does Albuterol have on diastolic blood pressure (DBP)?

Decreases DBP Signup and view all the answers

Which of the following is a key characteristic of beta-2 agonists like Albuterol?

They can lead to anxiety and tremors. Signup and view all the answers

Which is a crucial consideration when prescribing Formoterol?

It is effective against allergens. Signup and view all the answers

What is one of the reasons Levalbuterol is significantly more expensive than Albuterol?

It only contains the R-isomer. Signup and view all the answers

What adverse effect is common when using beta-2 agonists like Albuterol?

Palpitations Signup and view all the answers

Which of the following factors is contraindicated for the use of Albuterol?

History of cardiac issues Signup and view all the answers

Which of the following is true regarding the absorption characteristics of beta-2 agonists?

They are absorbed quickly in the bloodstream. Signup and view all the answers

What is a characteristic of first-generation antihistamines?

They primarily act on central H1 receptors. Signup and view all the answers

Which side effect is most commonly associated with first-generation antihistamines?

Dry mouth Signup and view all the answers

How are second-generation antihistamines primarily different from first-generation antihistamines?

They are less sedating and more selective for peripheral H1 receptors. Signup and view all the answers

What is a contraindication for taking cetirizine?

Use in newborns Signup and view all the answers

Which condition is NOT typically treated with antihistamines?

Pyloroduodenal obstruction Signup and view all the answers

What effect do antihistamines have on histamine release?

They can only bind to histamine already released. Signup and view all the answers

Which of the following is an impact of first-generation antihistamines on the CNS?

CNS depression Signup and view all the answers

What condition is a potential side effect from second-generation antihistamines?

Dry mouth Signup and view all the answers

Which of the following statements about first-generation antihistamines is true?

They must be avoided in patients with bladder obstruction. Signup and view all the answers

What additional caution should be considered when prescribing antihistamines?

Contraindicated in patients with MAOI use Signup and view all the answers

What is a common side effect of using inhaled corticosteroids such as Beclomethasone?

Oral thrush Signup and view all the answers

Which statement correctly describes Montelukast's use in asthma?

It is a leukotriene receptor antagonist. Signup and view all the answers

What is a recommended instruction for patients using Budesonide?

Rinse mouth after each use. Signup and view all the answers

What is one important characteristic of Beclomethasone in asthma treatment?

It acts primarily as an anti-inflammatory. Signup and view all the answers

Which method of action is associated with leukotriene inhibitors like Montelukast?

They inhibit leukotriene receptors. Signup and view all the answers

Which of the following is NOT recommended when using Fluticasone?

Taking it during acute asthma exacerbation. Signup and view all the answers

What is a key aspect of the mechanism of action of inhaled corticosteroids in asthma management?

They suppress inflammation in airway tissues. Signup and view all the answers

Which of the following medications is contraindicated in patients with phenylketonuria (PKU)?

Montelukast Signup and view all the answers

Which statement about the inhaled corticosteroid Fluticasone is true?

It has a specific dosage measured in micrograms. Signup and view all the answers

What is an important counseling point for patients prescribed inhaled corticosteroids?

They must use it regularly for effectiveness. Signup and view all the answers

Which of the following medications is indicated for allergic rhinitis?

Decongestants Signup and view all the answers

What is a common side effect of using decongestants?

Rebound congestion Signup and view all the answers

Which class of medication works primarily by activating alpha-1 adrenergic receptors to reduce nasal congestion?

Decongestants Signup and view all the answers

Pseudoephedrine is primarily used for what purpose?

Acting as a nasal decongestant Signup and view all the answers

Which of the following statements accurately describes intranasal steroids?

They decrease nasal congestion by reducing inflammation. Signup and view all the answers

What is the recommended duration for using topical decongestants?

5 to 7 days Signup and view all the answers

Which medication type is contraindicated in patients with hypertension and MAOIs?

Decongestants Signup and view all the answers

Dextromethorphan acts primarily as what type of medication?

Cough suppressant Signup and view all the answers

What is the main therapeutic effect of guaifenesin?

Breaking down mucus to improve expectoration Signup and view all the answers

Which of the following best describes the chronic use of cough preparations?

Is discouraged in chronic cough conditions Signup and view all the answers

Which of the following is NOT a side effect of systemic decongestants?

Constipation Signup and view all the answers

What should be monitored when a patient is taking oral decongestants?

Blood pressure Signup and view all the answers

What statement is true regarding the use of topical decongestants compared to oral forms?

Topical forms are safer than oral forms. Signup and view all the answers

Which of the following medications is NOT classified as an antihistamine?

Phenylephrine Signup and view all the answers

Study Notes

Asthma Treatment Goals

Goal 1: Achieve and maintain control of asthma symptoms.
Goal 2: Prevent asthma exacerbations, which results in hospital visits, emergency department visits, or oral corticosteroid use.
Goal 3: Reduce long-term decline in lung function.

Stable COPD Treatment Goals

Goal 1: Relieve symptoms and improve quality of life
Goal 2: Reduce the frequency and severity of exacerbations

COPD Etiotypes

Cigarette smoking: Most common cause of COPD
Genetic factors: Alpha-1 antitrypsin deficiency
Occupational exposures: Dust and fumes
Air pollution: Smoke and other particulate matter

Clinical Indicators of COPD Diagnosis

History of chronic cough, sputum production, dyspnea
Auscultation findings: Wheezing, rhonchi, diminished breath sounds
History of smoking or other risk factors

Spirometry

Forced expiratory volume in 1 second (FEV1): Reduced to 80% of predicted value in COPD

CT Scan

Emphysema: Shows areas of air trapping, enlarged air spaces
Chronic bronchitis: Shows thickened bronchial walls, mucous plugging

Vaccinations for Stable COPD

Influenza vaccine: Annual flu vaccine recommended
Pneumococcal vaccine: 13-valent PCV (PPSV23) vaccine recommended

Bronchodilators:

Short-acting beta2 agonists (SABAs): Albuterol for rapid relief of bronchospasm;
Long-acting beta2 agonists (LABAs): Salmeterol for long-term control; LABAs are contraindicated without an ICS for long term
Anticholinergics: Ipratropium (SAMA) for short-term relief and Tiotropium (LAMA) long-term control
Combination therapy: Combivent (albuterol/ipratropium) for acute exacerbations; Spiolto (tiotropium/olodaterol) for long-term control

Anti-inflammatory Therapy

Inhaled corticosteroids (ICS): Budesonide, Fluticasone for long-term control
Leukotriene inhibitors: Montelukast for prophylaxis and treatment of chronic asthma

Other Pharmacotherapy

Oral corticosteroids: Prednisone or methylprednisolone for acute exacerbations
Antibiotics: Amoxicillin, doxycycline for bacterial infections

Patient and Family Education

Asthma self-management techniques
COPD inhaler technique
Triggers for asthma and COPD exacerbations
Importance of regular monitoring and medication adherence
Smoke cessation counseling for smokers
Importance of vaccinations

Monitoring Parameters

Lung function testing: FEV1, peak expiratory flow rate (PEFR)
Symptom tracking: Daily asthma symptoms, cough, sputum production
Pulse oximetry readings: Oxygen saturation levels

Allergic Rhinitis

Definition: IgE-mediated inflammatory disease characterized by nasal congestion, rhinorrhea, sneezing, and/or nasal itching when someone inhales an allergen they are sensitive to.
Classification: Seasonal (pollen), perennial (dust mites, pet dander), and occupational (workplace allergens)
Prevalence: Common global health problem
Economic Impact: Increases healthcare costs, lost work productivity
Quality of Life Impact: Impacts quality of life, cognitive function, work productivity, and school performance.

Allergic Rhinitis Treatment:

Pharmacologic therapy: Intranasal corticosteroids, antihistamines, oral corticosteroids, and decongestants.
Immunotherapy: Subcutaneous or sublingual allergen immunotherapy

Patient and Family Education:

Allergen identification and avoidance
Proper use of medications
Importance of regular monitoring
Nasal hygiene practices

Short-Acting Beta-2 Agonists (SABAs)

Albuterol:
- Selective B2 with minor B1 activity
- Used for: Asthma, Asthma-related disorders, COPD, Bronchitis
- Side Effects: Tremors, heart palpitations, increased HR, decrease in DBP, anxiety, insomnia, nausea
- Administration: One minute between puffs; use before, not as, a controller; all age groups; monitor patient and effectiveness.
- Interactions: MAOIs and TCAs can potentiate the effects; thyroid hormones can enhance cardiac effects of both drugs; Do not use with Beta-Blockers; contraindicated in CAD; >4 years of age.
Levalbuterol:
- Similar to albuterol, but only the R-isomer is used, which has fewer adverse effects. It is 3-X the cost of albuterol
- Used for: Asthma, Asthma-related disorders; COPD; Bronchitis
- Side Effects: Tremors, heart palpitations, increased HR, decrease in DBP, anxiety, insomnia, nausea
- Administration: One minute between puffs; use before, not as, a controller; all age groups; monitor patient and effectiveness.
- Interactions: MAOIs and TCAs can potentiate the effects; thyroid hormones can enhance cardiac effects of both drugs; Do not use with Beta-Blockers; contraindicated in CAD; >4 years of age.

Long-Acting Beta-2 Agonists (Labas)

Formoterol:
- 200-fold greater agonist activity at Beta-2 receptors than at Beta-1;
- Used for: Long-acting bronchoprotection effects against allergens.
- Side Effects: anxiety, tachycardia, tremors
- Administration: Use after rescue inhaler; 12 mcg inhalation powder capsule.
- Mechanism of action: The exact MOA by which ICS inhibits bronchoconstriction and produces smooth muscle relaxation is unknown.

Inhaled Corticosteroids (ICS)

Beclomethasone:
- Used for: Asthma, Asthma-related disorders
- Administration: Rinse mouth after each use; use bronchodilator first.
Budesonide:
- Used for: Asthma, Asthma-related disorders
- Administration: Rinse mouth after each use; rapid onset.
Fluticasone (44mcg Low, 110mcg med):
- Used for: Asthma, Asthma-related disorders

Leukotriene Inhibitors

Montelukast:
- Selective leukotriene receptor agonist that inhibits the cysteinyl leukotriene receptor by binding to it.
- Used for: Prophylaxis and treatment of chronic asthma.
- NOT used for primary treatment of acute asthma attacks.
- Side Effects: Tinnitus, lassitude, disturbed coordination, N/V, irritability, blurry vision, tremors, appetite changes, constipation, dry mouth, dysuria
- Administration:
  - Contraindicated in patients with PKU;
  - contraindicated in patients with ulcer disease;
  - contraindicated in patients with symptomatic BPH;
  - contraindicated in patients with bladder neck obstruction;
  - contraindicated in patients with pyloroduodenal obstruction;
  - contraindicated in patients with MAOI use;
  - cannot be used in newborns and premature infants.
  - cannot be taken while breastfeeding
  - Beers criteria medication.

First Generation Antihistamines

Brompheniramine:
- First-generation, non-selectively binds to the central H1 receptors
- Used for: Allergic and vasomotor rhinitis; pruritus; conjunctivitis.
- Side Effects: CNS stimulation, depression, same as Montelukast.

Second Generation Antihistamines

Cetirizine:
- Second-generation, selective for peripheral H1 receptors, less sedating.
- Used for: Seasonal or perennial rhinitis; chronic urticaria; pruritus.
- Side Effects: Less Contraindications and Side Effects than first-generation
  - Cannot take during 3rd trimester of pregnancy- risk for fetal seizures.

Allergic Rhinitis

Second-generation antihistamines like Fexofenadine and Azelastine are effective treatments.
Azelastine is available as an inhaled/intranasal antihistamine.

Decongestants

Activate Alpha 1 adrenergic receptors on nasal blood vessels, reducing nasal congestion.
They do not reduce rhinorrhea, sneezing, or itching.
Should not be used for more than 5 days due to CNS stimulation, cardiovascular effects, and potential for rebound congestion.
Contraindicated in patients taking MAOIs, hypertension, or coronary artery disease.
Topical decongestants are generally safer than oral decongestants.

Phenylephrine

Available in oral and topical formulations.
Used for nasal congestion and eustachian tube congestion.

Pseudoephedrine

Available in oral form.
Acts as a systemic decongestant with mild CNS stimulant effects.

Oxymetazoline

Available in topical form for nasal decongestion.

Cough Preparations (Antitussives)

Avoid using cough preparations for chronic cough caused by smoking, asthma, or emphysema.
Do not use if excessive respiratory secretions are present.
Avoid self-medicating cough for more than 7 days.

Dextromethorphan

D-isomer of the codeine analogue, levorphanol.
Acts centrally in the cough center of the medulla to elevate the coughing threshold.
Caution is necessary in patients with hepatic impairment and when used with MAOIs.
Side effects include drowsiness, dizziness, nausea, and GI upset.

Guaifenesin

Expectorant that increases respiratory tract output by decreasing adhesiveness and surface tension.
Used for cough due to common cold and upper respiratory infections.
Side effect is GI upset.

Intranasal Steroids

Considered first-line treatment for allergic rhinitis.
Add oral antihistamines if intranasal steroids alone are not effective.

Asthma and COPD

Short-acting beta-agonists (SABAs) are used in Stage 1 asthma and COPD.
Use SABAs at least twice a day for the first week, and then transition to a maintenance regimen with inhaled corticosteroids (ICS).
After achieving asthma control, the frequency of SABA use can be reduced as long as it is used before ICS prn.

Drug Targets

On-target side effects occur when the drug interacts with the same receptor as the desired effect.
Off-target side effects result from drug interactions with different receptors than those responsible for the intended actions.

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Description

This quiz covers the treatment goals for asthma and stable COPD, as well as the etiologies and diagnostic indicators for COPD. Learn how to manage symptoms, prevent exacerbations, and understand spirometry results related to lung function. Test your knowledge on these important respiratory health topics.