Respiratory Week 1 Review

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Description and Tags

All content from week 1 minus the top 200 drugs and inhaler chart

110 Terms

1

BA-pMDI

an aerosol inhaler that is activated by inspiration

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2

pMDI

an aerosol inhaler that uses coordinated administration

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3

DPI

a breath activated inhaler that uses a powder inhalation

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4

SMI

inhaler that creates a slow, fine aerosol (Respimat)

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5

percentage of patients using inhalers with administration errors

50%

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6

MDI administration

shake before administration

slow, prolonged breath timed with actuation

hold breath for 10 seconds

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7

DPI administration

do NOT shake before administration

quick, steady breath

hold for 10 seconds

(rinse mouth for ICS)

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8

SMI BUD

60 days from canister assembly

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9

Asthma

chronic inflammatory disorder of the airways

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10

atopic asthma

allergic asthma

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11

nonatopic asthma

nonallergic asthma

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12

mixed asthma

allergic and nonallergic asthma

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13

types of asthma

exercise-induced

occupational

cough variant

glucocotricosteroid-resistant

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14

typical asthma symptoms

wheezing, SOB, cough, chest tightness

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15

asthma steps

  1. activation of mast cells

  2. infiltration of eosinophils

  3. increased activated helper T 2 cells

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16

asthma risk factors

airway hyperreactivity

allergen exposure

atopy

early menarche

familial history of asthma

male gender

tobacco exposure

obesity

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17

asthma presentation

narrowing of airways

hyperresponsiveness of airways

increased bronchial response to stimuli

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18

th2 cells

responsible for cytokine production that drive eosinophil attack

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19

Asthma allergen triggers

dust mites

pollens

molds

pet dander

cockroach droppings

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20

asthma irritant triggers

cigarette smoke

strong fumes

woodfires/charcoal grills

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21

NSAID induced asthma

asthma caused by inhibition of the COX pathway that pushes arachindonic acid to make leukotrienes (asthma bois) instead of COX

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22

Drugs used for NSAID induced asthma

LT inhibitors, lipooxygenase inhibitor (zileuton)

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23

Bronchodilator classes

Beta-2 agonists, muscarinic antagonists, methylxanthenes

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24

Beta-2 agonist MOA

  1. activate beta-2 receptor -> activate adenyl cyclase and increase cAMP -> smooth muscle relaxation

  2. prevent mediator release from mast cells

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25

SABAs

albuterol*, levabuterol*, metaproterenol, pirbuterol, terbutaline

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26

LABAs

Formoterol, Salmeterol

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27

Ultra LABAs

Olodaterol*, Indacaterol, Vilanterol*

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28

Methylxanthine MOA

non-selective PDE inhibitor

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29

PDE4 inhibitor

Roflumilast

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30

Roflumilast MOA

inhibits breakdown of cAMP by PDE4

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31

SAMA

Ipratropium

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LAMA

tiotropium, aclidinium, umeclidinium

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anticholinergics MOA

competitively bind M3 receptors to block ACh binding

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34

antimuscarinic AEs

anti-SLUD (salivation, lacrimation, urination, defecation)

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35

ICSs

beclomethasone*, budesonide*, fluticasone*, mometasone*ciclesonide

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36

corticosteroid conversions

quick mafs (equivalents will be given on exam)

<p>quick mafs (equivalents will be given on exam)</p>
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37

ICS MOA

inhibit inflammation of the airways and modulate cytokine and chemokine production

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38

LT receptor antagonists

Montelukast, zafirlukast

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39

5-Lipoxygenase inhibitor

Zileuton

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40

anti-IgE agent

omalizumab

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41

IL-5 inhibitors

(MR. B)

mepolizumab

reslizumab

benralizumab

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42

COPD risk factors

cigarette smoking

alpha 1-autitrypsin

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43

Chemical factors for beta2 selectivity

bulky substituent

proper phenyl ring (resorcinol, salicyl alcohol, N-formamide)

<p>bulky substituent</p><p>proper phenyl ring (resorcinol, salicyl alcohol, N-formamide)</p>
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44

Levalbuterol

(R)-isomer of albuterol

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45

factors determining length of action

longer, bulkier, more lipophilic chains will act longer by resisting COMT and MAO metabolism

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46

active enantiomer of olodaterol

R enantiomer

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47

corticosteroid prodrug tells

Ester @ C-17 or 21

Ketone @ C-11

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48

methylxanthine base structure

knowt flashcard image
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49

major enzyme in methylxanthene breakdown

xanthine oxidase

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50

active chemical group of zileuton

N-hydroxyl group

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51

LT receptor antagonists SAR

acidic or negative group

at least three aromatic rings (hydrophobic regions)

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52

threshold for reversibility of airflow limitation

12% increase

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53

Asthma control assessment

Daytime asthma symptoms more than 2x per week

Nighttime waking due to asthma

Reliever used more than 2x per week

Activity limitations from asthma

(0 = well controlled / 1-2 = partially controlled / 3-4 = uncontrolled)

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54

Constant assessment in asthma patients

INHALER TECHNIQUE

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55

Step up criteria

Uncontrolled asthma or risk of exacerbation

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56

asthma step down criteria

consider when well controlled more than 3 months

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PA - Step 1/2 initiation criteria

symptoms <4-5 days per week

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PA/AA - step 3 initiation criteria

symptoms most days OR

Night awakening more than once per week

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59

PA/AA - step 4 initiation criteria

Step 3 + low lung fxn (read absolutely fucked)

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AA - step 1 initiation criteria

Sx < 2x per month

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AA - step 2 initiation criteria

symptoms 2 or more times per month but less than 4-5 times per week

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62

PA - step 1/2 therapy

low dose ICS/formoterol PRN

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PA - Step 3 therapy

low dose ICS/formoterol maintenance and PRN

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PA - Step 4 therapy

Medium dose ICS/formoterol maintentance and low dose ICS/formoterol PRN

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65

PA - Step 5 therapy

Add LAMA to step 4 therapy

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66

AA - step 1 therapy

SABA + ICS prn

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67

AA - step 2 therapy

Low dose ICS maintenance + SABA PRN

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68

AA - step 3 therapy

Low dose ICS/LABA maintenance + SABA PRN

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AA - step 4 therapy

medium/high dose ICS/LABA maintenance + SABA PRN

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70

AA - step 5 therapy

Add LAMA to step 4 therapy (Trelegy only asthma approved triple therapy)

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71

Symbicort low dose

160/4.5 - 1 puff QD or BID

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72

Symbicort medium dose

160/4.5 - 2 puffs BID

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73

Symbicort reliever dose

160/4.5 - 1 puff PRN

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74

Max daily Symbicort dose

12 puffs daily max

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75

Asthma diagnostic criteria

  1. history of respiratory symptoms AND

  2. variable expiratory airflow limitation

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76

measurement device for airflow

Spirometer

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77

Atopic triad

  1. dermatitis

  2. allergic rhinitis

  3. asthma

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78

ICS Counselling Points

Rinse mouth and spit with maintenance doses to reduce risk of oral candidiasis

may cause hoarseness of voice

2 weeks for clinical effects

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79

syndrome occurring with coadministration of strong CYP3A4 inhibitors and high doses of ICS

Cushing syndrome

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80

LABA BBW

Do NOT use without ICS

  • increased asthma related death -- yay!

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81

SAMA/SABA asthma indication

only to be used for acute exacerbations in the hospital setting

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82

Only asthma approved single-agent LAMA

Spiriva (tiotropium)

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83

post-injection monitoring time for Omalizumab

first three months -- 2 hours then 30 minutes every visit after

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84

IL-4 antagonist (dupilumab) AE

injection site pain

transient blood eosinophilia

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85

Possible LTRA uses

asthma patients with…

  1. allergic rhinitis

  2. aspirin sensitivity

  3. exercise-induced asthma

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86

Asthma therapy follow-up

2-6 weeks after initiation of therapy then 3-12 months after controlled

targeting stepdown: every three months

exacerbation: 1 week followup

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87

pharmaceutical aerosol definition

a pressurized dosage form that is released in a fine dispersion

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88

pharmaceutical aerosol ingredients

  1. product concentrate

  2. propellant

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89

Propellant pressure range (room temp [70 F])

10-15 PSI

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90

Propellant requirements

"propellant should not be noticable in the suspension”

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91

Aerosol propellants

hydrocarbons

hydrochlorofluorocarbons

hydrofluorocarbons

compressed gasses

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92

two-phase aerosol system

  1. liquid phase

  2. product concentrate

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93

three-phase aerosol system

  1. water immiscible propellant

  2. Aqueous product concentrate

  3. Vapor phase

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94

Compressed gas system

Product insoluble in gas

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95

main advantage of inhaled vs systemic corticosteroids

increased bioavailability in lungs/lack of systemic adverse effects.

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96

factors for particle distribution

  1. particle size*

  2. velocity of inspiratory flow

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97

ideal particle size

1-5 microns

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98

problem with large particles

fall out of the air quicker / stop upon initial impact (often before the lungs)

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problems with small particles

move too easily → get exhaled as if a gas

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100

percentage of medication reaching the lungs

10-20%

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