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Questions and Answers
What is the primary reason for QS's asthma symptoms worsening in the context provided?
What mechanism do β2-adrenergic agonists employ to relieve asthma symptoms?
What is the first step noted in managing asthma for patients like QS?
What does a peak flow measurement of 75% indicate about QS's asthma condition?
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Which of the following is a potential environmental trigger that could affect asthma management?
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What might QS need to consider regarding his asthma medication refill habits?
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What happens to bronchial smooth muscle during an asthma attack?
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Why might QS have gone through two albuterol inhalers in two weeks?
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What is the mechanism of action for zileuton in asthma treatment?
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Which of the following drugs carries a boxed warning for serious neuropsychiatric effects?
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What type of asthma treatment are monoclonal antibodies classified as?
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Which medication is primarily used as a mast cell stabilizer?
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What is the first step in the stepwise management of asthma for adults?
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What type of asthma symptoms are characterized as 'refractory'?
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Which drug should be avoided in very young children with asthma?
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What adverse effect is closely associated with zileuton?
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In the emergency department, if a patient does not respond to inhaled SABA and ipratropium, what is the next recommended treatment?
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What is the effect of cromolyn sodium on inflammatory mediators?
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What is the primary role of systemic corticosteroids in asthma management?
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Which monoclonal antibody binds to IgE?
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What is the expected outcome when using a corticosteroid inhaler regularly for asthma?
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Which of the following is NOT a characteristic of biologics used in asthma?
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Which of the following mechanisms primarily causes bronchodilation in response to β2-adrenergic agonists?
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Which class of drug is not typically used as a first-line bronchodilator for asthma?
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What is a significant adverse effect of β-adrenergic stimulation caused by bronchodilators?
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Which of the following adverse effects is associated with theophylline usage?
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What is the primary role of inhaled corticosteroids in asthma management?
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Which adverse effect is most commonly associated with inhaled corticosteroids?
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In the management of acute asthma exacerbations, which medication is typically used as a last resort?
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How do antileukotrienes function in asthma management?
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What is a major concern when using oral corticosteroids for asthma treatment?
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Which of the following statements about long-acting β2-agonists (LABAs) is incorrect?
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What is the main mechanism by which muscarinic antagonists help manage asthma symptoms?
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Which of the following is a potential adverse effect of muscarinic antagonists?
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Why is oral theophylline less favored today in asthma treatment?
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How does magnesium sulfate primarily induce bronchodilation in emergency asthma management?
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What is the primary role of bronchodilators in asthma treatment?
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Which medication class is considered a secondary agent in asthma management?
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What is the mechanism of action of antileukotrienes in asthma treatment?
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In acute asthma management, which of the following is used only in emergencies?
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What is the sequence of treatment progression in a stepwise asthma management approach?
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Which of the following statements about biologics used in asthma is incorrect?
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What should be closely monitored in asthma patients undergoing treatment?
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Which of the following medications primarily serves to inhibit bronchoconstriction?
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Study Notes
Asthma
- A chronic, reversible obstructive lung disease
- Characterized by wheezing and shortness of breath
- Due to bronchial hyper-reactivity and inflammation
- Often seen in patients with allergies
- Severity ranges from mild to life-threatening
Asthma Management
- First Step: Identifying and removing triggers
- Goal: Improve airflow and expiration by bronchodilation or reducing inflammation
- Triggers: Allergens, environmental factors
Bronchodilators
- Used to reverse bronchial smooth muscle constriction, improving airflow
-
β2-Adrenergic Agonists:
- Stimulate β2 receptors in lungs, leading to bronchial dilation
- Types:
- Short-acting (SABAs): Used for acute exacerbations
- Long-acting (LABAs): Daily use for moderate to severe asthma
-
Muscarinic Antagonists:
- Block muscarinic receptors, preventing bronchoconstriction
- Types:
- Short-acting (SAMAs): Used as adjunctive therapy for acute exacerbations
- Long-acting (LAMAs): Used for maintenance therapy
-
Theophylline:
- Phosphodiesterase (PDE) inhibitor and adenosine receptor antagonist, promoting bronchodilation
- Less common due to adverse effects
-
Intravenous Magnesium Sulfate:
- Used in emergencies, causes bronchodilation by inhibiting calcium influx
- Administered as a single intravenous bolus dose
Anti-Inflammatory Drugs
-
Inhaled Corticosteroids (ICS):
- First-line maintenance drug for asthma
- Suppress inflammation in bronchial tubes, reducing swelling
- Types: Beclomethasone, budesonide, fluticasone
-
Oral Corticosteroids:
- Used for severe asthma exacerbations to reduce inflammation
- Examples: Prednisone
-
Intravenous Corticosteroids:
- Used in management of severe asthma exacerbations
Other Drugs
-
Antileukotrienes (Leukotriene Receptor Antagonists [LTRAs]):
- Used for mild to moderate asthma symptoms as secondary drugs
- Inhibit the action of leukotrienes
- Types: montelukast, zafirlukast, zileuton
-
Cromolyn Sodium:
- Inhaled prophylactically before exposure to triggers
- Used for long-term maintenance therapy
- Mechanism not fully understood, likely inhibits mediator release or reduces bronchus sensitivity
-
Biologics:
- Monoclonal antibody drugs used for allergic asthma
- Examples: omalizumab, dupilumab, mepolizumab, reslizumab, benralizumab, tezepelumab
Stepwise Asthma Management
- Step 1: As-needed SABA
- Step 2: ICS added for persistent symptoms
- Step 3: ICS/LABA combination
- Step 4-5: Consider leukotriene inhibitors, cromolyn, theophylline, or biologics
Emergency Department Management
- Step 1: Inhaled SABA and ipratropium
- Step 2: Systemic corticosteroids
- Step 3: IV magnesium
- Step 4: IV epinephrine or terbutaline
- Severe Asthma: Monitor vital signs, provide oxygen, consider BiPAP or intubation
Patient Example: QS
- 19-year-old college student with worsening asthma symptoms
- Using albuterol inhaler frequently
- New prescription: Inhaled corticosteroid for regular use, continue albuterol as needed
Asthma Management
- Asthma is a chronic condition characterized by airway inflammation and hyper-reactivity leading to episodic airway obstruction.
- Bronchodilators and corticosteroids are the primary treatment options for asthma.
- Inhaled β2 agonists (e.g., albuterol) are first-line bronchodilators in adults, acting by stimulating β2 receptors on bronchial smooth muscle.
- Inhaled muscarinic antagonists (e.g., ipratropium) block muscarinic receptors, inhibiting bronchoconstriction.
- Methylxanthines (e.g., theophylline) are phosphodiesterase inhibitors and adenosine receptor antagonists, used as alternative bronchodilators.
- Magnesium relaxes smooth muscle and is used only in acute severe asthma.
- Corticosteroids reduce airway inflammation, thereby reducing swelling and bronchoconstriction.
- Inhaled corticosteroids are often used early in asthma management alongside short-acting β2 agonists.
- Antileukotrienes (e.g., montelukast) block cysteinyl leukotriene receptors and inhibit leukotriene production, reducing airway inflammation.
- Cromolyn is a secondary agent that reduces T-cell secretion of inflammatory mediators.
- Biologics (e.g., omalizumab) are monoclonal antibodies targeting inflammatory mediators like IgE, IL-4, and IL-5, used in severe cases.
- Asthma management is stepwise, progressing with disease severity, drug tolerance, and contraindications.
- Treatment begins with "as-needed" short-acting β2 agonists, followed by inhaled corticosteroids, then long-acting β2 agonists, antimuscarinics, and oral corticosteroids.
- Severe asthma may require intravenous corticosteroids, magnesium, and epinephrine.
- Close monitoring of vital signs, including partial pressure of arterial oxygen (PaO2) and carbon dioxide (PaCO2), is crucial.
- Patients may require continuous oxygen and intubation in severe cases.
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Description
This quiz covers the key concepts of asthma, including its definition, symptoms, and management strategies. It focuses on the use of bronchodilators, their types, and how they function to alleviate asthma symptoms. Test your knowledge on identifying triggers and the overall management of this chronic lung disease.
