NSG 533 - Advanced Pharmacology
Exam 3
Question:
Long-acting Inhaled B2-agonists
Answer:
-Provide 12-24 hours of bronchodilation after single dose -Useful for nocturnal symptoms -Chronic treatment for asthma as ADD-ON therapy for patients not controlled on low-medium dose of ICS -Helps reduce ICS amount necessary for control *-Not to be used a monotherapy (risk for severe attack)* -Salmeterol dosed BID -Available as single agent or as fixed-ratio combo product with ICS -Formoterol and vilanterol only available as combo product with ICS -Combo products may increase adherence
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Question:
Leukotriene Receptor Antagonists
Answer:
-Anti-inflammatory medications that competitively antagonize the effects of leukotriene D4 as montelukast does -Improve FEV, decrease asthma symptoms and SABA use and decrease asthma attacks -Less effective than ICS -Beneficial for asthma patients with allergic rhinitis, aspirin sensitivity, exercise-induced bronchospasm
-SE: sleep disorders, aggressive behavior, suicidal thoughts
Question:
Tiotropium (long acting muscarinic antagonist)
Answer:
-Onset of action 30 minutes, duration 24 hours -For uncontrolled asthma already taking ICS or ICS + LABA combination -Decreases severe exacerbations, improves lung function, steroid sparing
-SE (all muscarinic antagonists): blurred vision, dry mouth, urinary retention
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Question:
Inhaled Corticosteroids
Answer:
-Preferred for therapy for all forms of persistent asthma in all age groups -Decrease airway inflammation, attenuate airway hyperresponsiveness, minimize mucus production and secretion, improve response to B2-agonists -All equally effective in equipotent doses -Flat-dose response curve, doubling dose has little effect. Smokers do need higher doses though
- weeks of therapy needed for significant clinical effects
Question:
ICS side effects
Answer:
Oral candidiasis, cough, dysphoniaRinse mouth with water after, use MDI with VHC, decrease dose to reduce hoarseness
Systemic absorption occurs via pulmonary and oral routes
-SE: adrenal suppression, decreased BMD, skin thinning, cataracts, easy
bruising (all with more likely with higher ICS dose) Risk of pneumonia increases with ICS use
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Question:
ICS drug interactions
Answer:
potent inhibitors of CYP3A4 (ritonavir, itraconazole, ketoconazole) administered with high doses can cause Cushing syndrome and adrenal insufficiency-40% of patients don't respond to therapy may be related to GLCC11 gene variant in some patients
Question:
Leukotriene Receptor Antagonists (LTRAs)
Answer:
-Anti-inflammatory medications that competitively antagonize the effects of leukotriene D4 as montelukast does
-Improve FEV, decrease asthma symptoms and SABA use and decrease asthma attacks -Less effective than ICS
-Beneficial for asthma patients with allergic rhinitis, aspirin sensitivity, exercise-induced bronchospasm
-SE: sleep disorders, aggressive behavior, suicidal thoughts
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