Advanced pharmacology UPDATED ACTUAL Questions and CORRECT
Answers
1. Intermittent Intermittent, < 2 times/wk, <2 times month @ night, asymptomatic between exac-
Asthma erbations, rescue inhaler < 2d/wk
2. Mild persistent Sx >2x/wk but < once/day; 3-4x/month nocturnal; reduced FEV1 @ 80% predicted;
rescue inhaler 2d/wk but not daily; minor limitation on activity
3. moderate persis- daily symptoms; > 1 weekly nocturnal episode, not nightly; reduced FEV1
tent 60%-80%,reduction in FEV1/FVC ratio; rescue inhaler daily; some limitation of
activity
4. severe persistent Severe persistent
Symptoms throughout the day and nightly
Reduced FEV1 d60 predicted, reduction in FEV1/FVC ratio
Use rescue inhaler several times a day
Very limited physical activity
5. Diagnosis Diagnosis is made by a history of recurrent episodes of coughing, wheezing, chest
tightness, or shortness of breath. This is confirmed by spirometry.
Spirometry will demonstrate obstruction with positive post bronchodilator re-
versibility.
Some patients early on in the disease process will have a normal spirometry, this
is particularly true for patients who only suffer from intermittent symptoms.
Other tests including an exercise challenge test, IgE, Eos, allergy panel, or a
methacholine challenge test can be used to further confirm a diagnosis
6. Desired out- Prevent chronic and troublesome symptoms
comes Infrequent use (2 or fewer days/week) of SABA
Normal or near normal pulmonary function.
Normal activity levels
Prevent exacerbations and need for ED visits/hospitalizations.
Prevent progressive loss of lung function
Provide optimal pharmacotherapy with minimal or no adverse effects
,7. Step 1 in asthma As needed low dose ICS- formoterol vs low dose ICS and SABA together (preferred
controller) Step 1 is considered intermittent
8. Step 2 Asthma Daily low dose ICS or PRN ICS vs Low dose ICS and SABA vs LTRA (leukotriene
receptor antagonists) or low dose ICS taken when SABA taken (controller)
9. Step 3 Asthma Low dose ICS-LABA vs medium dose ICS vs Low-dose ICS+LTRA (considered mod-
erate persistent)
10. Step 4 Asthma Medium dose ICS-LABA vs high-dose ICS, add on tiotripium vs add on LTRA (severe
persistent)
11. Step 5 Asthma High dose ICS-LABA and refer for phenotypic assessment +/- add on therapy OCS
(consider side effects) (Severe persistent)
12. Reliever for asth- Low dose ICS vs SABA
ma
13. Non-pharmaco- Patient education and teaching of self-management skills
logic therapy in Home PEF meter
Asthma Avoidance of known triggers
Supplemental oxygen if acute severe asthma to keep sats >90%
14. Beta2-Adrener- Relax airway smooth muscle by directly stimulating B2-adrenergic receptors
gic Agonists Dilate airways, increase mucous clearance, and stabilize mast cell membranes
Comes in short-acting and long-acting
15. Beta2-Adrener- Tremor, nervousness, tachycardia. Caution in patients with arrhythmias- use Leval-
gic Agonists buterol
Adverse Effects
16. Beta2-Adrener- MAOIs and/or TCAs
gic Agonists
, Contraindica-
tions
17. SABAs (short act- Albuterol (ProAir, Proventil, RespiClick, Ventolin, AccuNeb)
ing beta ago- Levalbuterol (Xopenex)
nists) Usual dose for an MDI is 2 inhalations q 4-6 hrs prn
recommended for exacerbations only--only PRN---and if more than one cannister
a month then poor asthma control
18. LABAs(long act- Not for acute symptom relief, dosed every 12 hours /x indacterol, black box for
ing beta ago- asthma when used alone
nists)
19. LABA types Arformoterol (Brovana)- nebulized soln only
Formoterol (Perforomist, Foradil)
Indacaterol (Arcapta)
Olodaterol (Striverdi Respimat)
Salmeterol (Serevent Diskus)
20. ICS (inhaled corti- Most effective therapy for treatment of asthma; indicated for long term prevention
costeroids) of symptoms & the suppression, control, & reversal of inflammation; reduces airway
inflammation, reduce circulation of eosinophils & mast cells, they reduce symptoms
and improve pulmonary function
1st line for persistent & intermittent asthma
1st line therapy for long term control intermittent and persistent asthma
only therapy shown to reduce the risk of dying from asthma
inhaled do not have systemic side effects
21. ICS AE usually well tolerated, oral candidiasis, hoarseness
22. ICS contraindica- None
tions
Answers
1. Intermittent Intermittent, < 2 times/wk, <2 times month @ night, asymptomatic between exac-
Asthma erbations, rescue inhaler < 2d/wk
2. Mild persistent Sx >2x/wk but < once/day; 3-4x/month nocturnal; reduced FEV1 @ 80% predicted;
rescue inhaler 2d/wk but not daily; minor limitation on activity
3. moderate persis- daily symptoms; > 1 weekly nocturnal episode, not nightly; reduced FEV1
tent 60%-80%,reduction in FEV1/FVC ratio; rescue inhaler daily; some limitation of
activity
4. severe persistent Severe persistent
Symptoms throughout the day and nightly
Reduced FEV1 d60 predicted, reduction in FEV1/FVC ratio
Use rescue inhaler several times a day
Very limited physical activity
5. Diagnosis Diagnosis is made by a history of recurrent episodes of coughing, wheezing, chest
tightness, or shortness of breath. This is confirmed by spirometry.
Spirometry will demonstrate obstruction with positive post bronchodilator re-
versibility.
Some patients early on in the disease process will have a normal spirometry, this
is particularly true for patients who only suffer from intermittent symptoms.
Other tests including an exercise challenge test, IgE, Eos, allergy panel, or a
methacholine challenge test can be used to further confirm a diagnosis
6. Desired out- Prevent chronic and troublesome symptoms
comes Infrequent use (2 or fewer days/week) of SABA
Normal or near normal pulmonary function.
Normal activity levels
Prevent exacerbations and need for ED visits/hospitalizations.
Prevent progressive loss of lung function
Provide optimal pharmacotherapy with minimal or no adverse effects
,7. Step 1 in asthma As needed low dose ICS- formoterol vs low dose ICS and SABA together (preferred
controller) Step 1 is considered intermittent
8. Step 2 Asthma Daily low dose ICS or PRN ICS vs Low dose ICS and SABA vs LTRA (leukotriene
receptor antagonists) or low dose ICS taken when SABA taken (controller)
9. Step 3 Asthma Low dose ICS-LABA vs medium dose ICS vs Low-dose ICS+LTRA (considered mod-
erate persistent)
10. Step 4 Asthma Medium dose ICS-LABA vs high-dose ICS, add on tiotripium vs add on LTRA (severe
persistent)
11. Step 5 Asthma High dose ICS-LABA and refer for phenotypic assessment +/- add on therapy OCS
(consider side effects) (Severe persistent)
12. Reliever for asth- Low dose ICS vs SABA
ma
13. Non-pharmaco- Patient education and teaching of self-management skills
logic therapy in Home PEF meter
Asthma Avoidance of known triggers
Supplemental oxygen if acute severe asthma to keep sats >90%
14. Beta2-Adrener- Relax airway smooth muscle by directly stimulating B2-adrenergic receptors
gic Agonists Dilate airways, increase mucous clearance, and stabilize mast cell membranes
Comes in short-acting and long-acting
15. Beta2-Adrener- Tremor, nervousness, tachycardia. Caution in patients with arrhythmias- use Leval-
gic Agonists buterol
Adverse Effects
16. Beta2-Adrener- MAOIs and/or TCAs
gic Agonists
, Contraindica-
tions
17. SABAs (short act- Albuterol (ProAir, Proventil, RespiClick, Ventolin, AccuNeb)
ing beta ago- Levalbuterol (Xopenex)
nists) Usual dose for an MDI is 2 inhalations q 4-6 hrs prn
recommended for exacerbations only--only PRN---and if more than one cannister
a month then poor asthma control
18. LABAs(long act- Not for acute symptom relief, dosed every 12 hours /x indacterol, black box for
ing beta ago- asthma when used alone
nists)
19. LABA types Arformoterol (Brovana)- nebulized soln only
Formoterol (Perforomist, Foradil)
Indacaterol (Arcapta)
Olodaterol (Striverdi Respimat)
Salmeterol (Serevent Diskus)
20. ICS (inhaled corti- Most effective therapy for treatment of asthma; indicated for long term prevention
costeroids) of symptoms & the suppression, control, & reversal of inflammation; reduces airway
inflammation, reduce circulation of eosinophils & mast cells, they reduce symptoms
and improve pulmonary function
1st line for persistent & intermittent asthma
1st line therapy for long term control intermittent and persistent asthma
only therapy shown to reduce the risk of dying from asthma
inhaled do not have systemic side effects
21. ICS AE usually well tolerated, oral candidiasis, hoarseness
22. ICS contraindica- None
tions
