Pharmacology of Asthma Treatments

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Questions and Answers

What is a potential effect of ICS on growth in children?

It has no effect on growth.

It can lead to accelerated growth rates.

It may slow growth. (correct)

It may enhance growth significantly.

Which medications should not be used as monotherapy in COPD and asthma?

Anticholinergics

Inhaled corticosteroids (correct)

Long-acting beta agonists (correct)

Short-acting beta agonists

Which factor can influence theophylline levels in the body?

Age and gender

Co-administration of certain medications (correct)

Physical activity levels

Dietary sodium intake

What is a risk associated with poorly controlled asthma in children?

Potentially slowed growth Signup and view all the answers

What might poorly controlled asthma lead to in children aside from respiratory issues?

Growth delays Signup and view all the answers

What role do spirometry values play in COPD management?

They help in diagnosis and severity assessment. Signup and view all the answers

What is required for the diagnosis of COPD?

Spirometry testing. Signup and view all the answers

When should spirometry testing be conducted for COPD?

In patients displaying signs and symptoms of COPD. Signup and view all the answers

How do spirometry values influence therapy for COPD?

They do not influence the initiation of therapy. Signup and view all the answers

Which of the following is NOT a consideration for COPD diagnosis?

Blood type of the patient. Signup and view all the answers

What spirometry result is needed to confirm a diagnosis of COPD?

FEV1/FVC less than 0.7 Signup and view all the answers

Which additional test may be performed in asthma diagnosis apart from spirometry?

Eosinophil count Signup and view all the answers

Which statement differentiates COPD from asthma?

Asthma symptoms are often triggered by allergens. Signup and view all the answers

What condition is typically indicated by an FEV1/FVC ratio of less than 0.7?

COPD Signup and view all the answers

Which of the following is not a characteristic of COPD?

Reactive airway disease Signup and view all the answers

Which test is primarily used to assess lung function in both COPD and asthma?

Spirometry Signup and view all the answers

What common symptom do COPD and asthma share?

Wheezing Signup and view all the answers

In the context of asthma, elevated levels of which substance may indicate the condition?

IgE Signup and view all the answers

What effect does caffeine have on theophylline breakdown?

Decreases theophylline breakdown Signup and view all the answers

Which substances are known to lower theophylline levels?

Phenobarbital, phenytoin, and rifampin Signup and view all the answers

What is the effect of cimetidine on theophylline levels?

It elevates theophylline levels Signup and view all the answers

Which of the following statements about phenobarbital is correct?

It increases theophylline clearance Signup and view all the answers

What type of antibiotics can elevate theophylline levels?

Fluoroquinolone antibiotics Signup and view all the answers

How does tobacco interact with theophylline levels?

It decreases theophylline levels Signup and view all the answers

Which of the following combinations is likely to result in lower theophylline levels?

Caffeine and phenobarbital Signup and view all the answers

Identify the interaction that results in elevated theophylline levels.

Cimetidine and fluoroquinolone antibiotics Signup and view all the answers

What is the primary mechanism of action of beclomethasone in asthma management?

Reduces bronchial hyperactivity Signup and view all the answers

What should patients be advised to do after using beclomethasone?

Rinse their mouth and gargle Signup and view all the answers

Which leukotriene modifier is best suited for children over 1 year of age?

Montelukast Signup and view all the answers

What is a common side effect of long-acting muscarinic antagonists like Tiotropium?

Constipation Signup and view all the answers

Which of the following is an indication for Cromolyn?

Prophylaxis of mild to moderate asthma Signup and view all the answers

What is a critical consideration when dosing beclomethasone?

Use a higher initial dose, then a taper Signup and view all the answers

What complication is associated with the use of Montelukast?

Neuropsychiatric events Signup and view all the answers

What is the recommended dosing frequency for Cromolyn when used via nebulizer?

Four times daily Signup and view all the answers

What should patients using short-acting anticholinergics be aware of?

Blurred vision Signup and view all the answers

When are bronchodilators like theophylline typically utilized?

When other medications are too expensive Signup and view all the answers

What is the recommended treatment for Group A patients with 0-1 moderate exacerbation not requiring hospitalization?

LABA + LAMA combination Signup and view all the answers

Which combination therapy is preferred for Group B patients who experience 1 moderate exacerbation leading to hospitalization?

LABA + LAMA Signup and view all the answers

For Group B patients with an eosinophil count over 300, which treatment should be considered?

LABA + LAMA + ICS Signup and view all the answers

What characterizes Group A patients in asthma classification?

Has 0-1 moderate exacerbation not requiring hospitalization Signup and view all the answers

Which exacerbation frequency is associated with Group B patients?

1 moderate exacerbation leading to hospitalization Signup and view all the answers

In the management of asthma, how is Group A primarily treated?

With LABA + LAMA as a combination therapy Signup and view all the answers

In which circumstance is ICS added to treatment in Group B patients?

When their eosinophil count is above 300 Signup and view all the answers

What does a high eosinophil count imply for asthma medication management?

Consideration for ICS in treatment is needed Signup and view all the answers

Study Notes

Glucocorticoid - Beclomethasone (Qvar)

MOA: Reduces bronchial hyperactivity and airway mucus, effective for long-term asthma control.
CI: Candidiasis
Monitoring: Baseline height (children), PFTs (adults), eye exams (adults), bone density (adults).
Patient Education: Rinse mouth and gargle after use to reduce dysphonia and oropharyngeal candidiasis, if using a short-acting beta-agonist (SABA), take 5 minutes before.
Adverse Effects: URI, candidiasis, dysphonia.
Dosage: Initial high dose, tapered to minimize adrenal suppression.

Mast Cell Stabilizer - Cromolyn

MOA: Stabilizes mast cell membranes, preventing histamine release and inflammation.
USE: Suppresses bronchial inflammation, prophylaxis of mild to moderate asthma, seasonal allergies, pre-exposure to allergens, or pre-exercise.
Dosage: Nebulized 4 times daily (20mg).
Patient Education: Take 15 minutes before exercise; proper nebulizer technique; takes weeks to achieve therapeutic effect.
Adverse Effects: None specifically mentioned.

Leukotriene Modifier - Montelukast (Singulair)

USE: For kids over 1 year old.
Adverse Effects: Neuropsychiatric events, headache, URI, mood changes.
Use as adjunct to glucocorticoids for daily inflammation control.

Long-Acting Muscarinic Antagonist (LAMA) - Tiotropium (Spiriva)

MOA: Long-acting bronchodilation.
Duration: 24 hours.
Schedule: Easier to schedule than shorter-acting bronchodilators.
Monitoring: Watch for anticholinergic side effects (constipation, urinary retention, tachycardia, blurred vision).

COPD and Asthma Diagnosis

COPD: Spirometry (FEV1/FVC < 0.7) crucial for diagnosis. History, symptoms, and physical exam also considered.
Asthma: Classic characteristics include breathlessness, chest tightening, wheezing, coughing. Similarities with COPD include airway restriction, inflammation, and excessive sputum. Differentiators include lung function response to treatment, triggers, reversibility of airflow obstruction. Asthma is not preventable like COPD which is largely preventable if smoking is avoided.

Initial Treatment Recommendations

Inhaled glucocorticoids (ICS) preferred first-line for asthma management. Less evidence for routine use in COPD exacerbations.
Short-acting beta-agonists (SABA) (e.g., albuterol) used as needed for asthma (Step 1).
Step 2 is more frequent use of ICS (inhaled corticosteroid).
COPD medication management: Different groups (A, B, etc.) for managing exacerbations (0-1, 2+, needing hospitalization) with varying medication combinations (LABA + LAMA + ICS). LABA preferred over short acting agents.

ICS and Monotherapy

ICS (inhaled corticosteroids) are not recommended as monotherapy in COPD management.
In asthma, LABAs should not be used as monotherapy.
Medications that interact with theophylline (e.g., caffeine, marijuana, certain antibiotics) should be considered.

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Description

This quiz covers the pharmacological aspects of glucocorticoids and mast cell stabilizers used in asthma management. Key topics include mechanisms of action, contraindications, monitoring, patient education, and associated adverse effects. Test your understanding of these important asthma treatments!