Asthma Medications and Biologic Therapies Quiz

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40 Questions

What is the primary guideline for treatment of asthma?

Using long-acting beta-adrenergic agonists for long-term control

What is the basic mechanism of action of antitussive agents?

Cough suppression

Which medication is indicated for immediate relief of asthma symptoms?

Short-acting beta-adrenergic agonists

What are the adverse effects of long-term use of supraphysiologic doses of steroids?

Hyperglycemia and osteoporosis

What is the recommended interval for administering Ipratropium Br 0.5mg?

Every 30 minutes X 3 then q 2-4 hrs prn

What should be monitored in patients with severe respiratory distress unresponsive to medications?

FEV1 or PEF, O2 saturation and pulse

When should patients be evaluated for a change in controller medications?

If patients have asthma symptoms or need a rescue inhaler more than twice a week

What should be assessed before making a change in medication for asthma patients?

Technique and adherence in using inhalers

Which type of medication is the most effective bronchodilator available?

Beta-2 agonists

What is the duration of bronchodilation provided by long-acting LABAs like Formoterol?

4-8 hours

For which symptoms are LABAs preferred?

Nighttime symptoms

What are the adverse effects of beta-2 agonists?

Heart rate, tremor, hypokalemia

Which type of medication is the most effective anti-inflammatory agent for asthma?

Inhaled corticosteroids (ICS)

What are the preferred symptoms for daily maintenance therapy with ICS?

Daytime symptoms

What are the adverse effects of ICS?

Oral candidiasis, dysphonia

When are systemic corticosteroids indicated for asthma exacerbations?

Significant exacerbations

What type of therapy is Omalizumab (Xolair)?

Anti-IgE therapy

For which type of asthma is Omalizumab used?

Severe asthma with poor ICS control

Which biologic therapy is indicated for severe asthma patients with an eosinophilic phenotype and is administered via IV infusion every 4 weeks?

Reslizumab

Which biologic therapy is an interleukin-5 receptor antagonist and is an add-on therapy for severe eosinophilic asthma, administered subcutaneously?

Benralizumab

Which biologic therapy blocks the effects of IL-4 and is used to reduce exacerbations and improve lung function in moderate-to-severe eosinophilic asthma patients, administered subcutaneously every other week?

Dupilumab

Which biologic therapy is indicated to reduce exacerbations in severe asthma patients with blood eosinophil counts of 150/microL or greater, administered subcutaneously?

Mepolizumab

Which biologic therapy is an add-on maintenance medication for moderate to severe asthma in adults and children over 6 years old with poorly controlled symptoms and allergic sensitization?

Omalizumab (Xolair)

Which biologic therapy is an add-on maintenance treatment for severe asthma in adult and pediatric patients over 12 years old, administered subcutaneously every 4 weeks?

Tezepelumab

Which biologic therapy is not recommended for patients with parasitic, especially helminthic, infections?

Mepolizumab

What is the classification and management of asthma severity based on?

Impairment and risk categories

What does the treatment for severe asthma include?

High-dose inhaled glucocorticoid and long-acting beta agonist (LABA) or leukotriene modifier/theophylline

What is the home management of mild to moderate asthma exacerbations involve?

Using SABA beta2 agonists or GC-formoterol for acute symptom relief, with reassessment and appropriate actions based on response

Which of the following is a goal of asthma treatment?

Minimizing medication side-effects

Which aerosol delivery device does not contain propellant?

Soft Mist Inhalers (SMIIs)

What is the primary cause of acute inflammation in asthma?

Viral infection

Which type of inhaler requires shaking and pressing during inhalation?

Metered Dose Inhalers (MDIs)

What is the role of IgE in asthma?

Causing mast cells and lymphocytes to become activated and sensitized

Which type of inhaler requires breath-actuation for drug delivery?

Dry Powder Inhalers (DPIs)

What is the primary cause of chronic inflammation in asthma?

Allergens

Which type of inhaler achieves higher pulmonary deposition than MDIs?

Soft Mist Inhalers (SMIIs)

What is the primary cause of airflow obstruction in asthma?

Bronchoconstriction

Which type of inhaler is used to produce an aerosol from liquid for efficient drug delivery?

Nebulizers

What is the primary role of parasympathetic (vagal) stimulation in the airway?

Providing normal resting airway tone

What is the primary cause of sensitization of mast cells and lymphocytes in asthma?

Allergens

Study Notes

Asthma Medications Overview

  • Medications for asthma include beta-2 agonists, glucocorticosteroids, leukotriene blockers, mast cell stabilizers, methylxanthines, and biologic agents.
  • Beta-2 agonists are the most effective bronchodilators available, with short-acting (SABA) names like Albuterol and Levalbuterol.
  • Long-acting LABAs like Formoterol and Salmeterol provide 4-8 hours and 24-hour duration of bronchodilation, respectively.
  • LABAs are not for acute attacks and are preferred for nighttime symptoms, but have labeling risks and warnings associated with long-acting beta agonists.
  • Other beta agonists include Terbutaline, Isoproterenol, and Epinephrine, each with specific uses and effects.
  • Adverse effects of beta-2 agonists include heart rate, tremor, nervousness, hypokalemia, and tolerance with chronic use.
  • Inhaled corticosteroids (ICS) are the most effective anti-inflammatory agents for asthma, improving responsiveness to beta2 agonists and lung function.
  • ICS are preferred for daily maintenance therapy and have low, medium, and high dose regimens, with adverse effects like oral candidiasis and dysphonia.
  • The prescription of low-dose ICS-formoterol involves specific steps based on severity, with as-needed doses before exercise or allergen exposure.
  • Systemic corticosteroids are indicated for significant asthma exacerbations and have adverse effects like headache, palpitations, and tachycardia.
  • Biologics for asthma include anti-IgE therapy like Omalizumab (Xolair), a monoclonal antibody administered via subcutaneous injection based on IgE levels and weight.
  • Omalizumab is used for moderate to severe asthma with poor ICS control.

Biologic Therapies for Severe Asthma and Management

  • Omalizumab (Xolair) is an add-on maintenance medication for moderate to severe asthma in adults and children over 6 years old with poorly controlled symptoms and allergic sensitization.
  • Common adverse effects of Omalizumab include pain at injection, headache, and upper respiratory infections, with rare cases of anaphylaxis.
  • Mepolizumab, a monoclonal antibody to IL-5, is indicated to reduce exacerbations in severe asthma patients with blood eosinophil counts of 150/microL or greater, administered subcutaneously.
  • Reslizumab, a monoclonal anti-IL-5 antibody, is indicated as an add-on maintenance therapy for severe asthma in patients over 18 years old with an eosinophilic phenotype, given via IV infusion every 4 weeks.
  • Benralizumab, an interleukin-5 receptor antagonist, is an add-on therapy for severe eosinophilic asthma, administered subcutaneously.
  • Dupilumab, which blocks the effects of IL-4, is used to reduce exacerbations and improve lung function in moderate-to-severe eosinophilic asthma patients, administered subcutaneously every other week.
  • Tezepelumab (Tezspire), a monoclonal antibody, is an add-on maintenance treatment for severe asthma in adult and pediatric patients over 12 years old, administered subcutaneously every 4 weeks.
  • Biologics affecting eosinophils are not recommended for patients with parasitic, especially helminthic, infections.
  • The Global Initiative for Asthma classifies and manages asthma severity and control based on impairment and risk categories, determining changes in therapy.
  • The classification and management of asthma severity includes well controlled, not well controlled, and very poorly controlled categories, with corresponding treatment steps.
  • The treatment for severe asthma includes high-dose inhaled glucocorticoid and long-acting beta agonist (LABA) or leukotriene modifier/theophylline, and referral to an asthma specialist.
  • Home management of mild to moderate asthma exacerbations involves using SABA beta2 agonists or GC-formoterol for acute symptom relief, with reassessment and appropriate actions based on response.

Asthma Treatment and Management

  • Atopy refers to the genetic susceptibility to produce IgE directed toward common environmental allergens.
  • IgE causes mast cells and lymphocytes to become activated and sensitized when challenged by allergens, leading to the release of inflammatory mediators.
  • The pathophysiology of asthma involves airflow obstruction with edema, bronchoconstriction, hypersecretion, and inflammation.
  • Acute inflammation in asthma can be provoked by unknown or known factors such as viral infection, allergens, and irritants.
  • Chronic inflammation in asthma involves various cells and clinical consequences like chronic airway hyperreactivity and airway remodeling.
  • Parasympathetic (vagal) stimulation provides normal resting airway tone, while catecholamines such as epinephrine cause bronchodilation via activation of Beta-2 receptors on bronchial smooth muscle.
  • Treatment of asthma involves aerosol delivery devices, including nebulizers, metered dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIIs).
  • Nebulizers, both jet and ultrasonic, are used to produce an aerosol from liquid for efficient drug delivery, with the former requiring flow rates > 6L/Minute for effective delivery.
  • Metered Dose Inhalers (MDIs) are the most used and convenient delivery devices, requiring shaking and pressing during inhalation.
  • Dry Powder Inhalers (DPIs) are breath-actuated devices that deliver micronized drug particles and are used for several asthma medicines.
  • Soft Mist Inhalers (SMIIs) are larger than MDIs, do not contain propellant, and achieve higher pulmonary deposition than MDIs.
  • The goals of asthma treatment include symptom control, maintenance of normal lung function, prevention of flare-ups and asthma deaths, and minimizing medication side-effects, with various terminologies and regimens used in the treatment.

Test your knowledge of asthma medications and biologic therapies with this comprehensive quiz. Explore the various types of medications, their mechanisms of action, dosage regimens, adverse effects, and the use of biologics in severe asthma management. Understand the pathophysiology of asthma, treatment delivery devices, and the goals of asthma treatment and management.

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