Respiratory Pharmacotherapy & Smoking Cessation – Exam #2 Review (copy)

Flashcards covering asthma and COPD guidelines, pathophysiology, pharmacologic treatments, and smoking-cessation therapies to aid exam preparation.

Which three key guideline sources are most often cited for current asthma management?

2007 NHLBI EPR-3, 2020 Focused Update (EPR-4), and GINA 2022.

Name four common categories of asthma triggers.

Respiratory viral infections, allergens, environmental factors (e.g., cold air, tobacco smoke, pollutants), and exercise/emotions/drugs.

List three major risk factors that increase the likelihood of developing asthma.

Allergen exposure, urbanization/socio-economic status, and decreased exposure to childhood infectious agents (hygiene hypothesis).

What immunoglobulin initiates the early asthmatic response?

IgE.

Which cells are rapidly activated in the early asthmatic response?

Mast cells and eosinophils.

Approximately how long after exposure does the late asthmatic response occur, and what cell type is key?

6–9 hours; activation and recruitment of inflammatory cells, especially T cells.

Give two hallmark structural changes associated with chronic asthma airway remodeling.

Hypertrophy/hyperplasia of bronchial smooth muscle and mucous gland hypertrophy with excess mucus secretion.

What two physiologic features define asthma’s clinical presentation?

Airway obstruction and bronchial hyper-reactivity to diverse stimuli.

Which short-acting β2-agonist (SABA) is racemic?

Albuterol (Ventolin).

Which SABA contains only the R-isomer and is ~50× more potent than racemic albuterol?

Levalbuterol (Xopenex).

Name two long-acting β2-agonists (LABAs) used in asthma.

Salmeterol (Serevent) and Formoterol (Foradil).

Which inhaled corticosteroid–LABA combination is branded as Advair?

Salmeterol + fluticasone.

Provide two systemic glucocorticoids commonly used in severe asthma exacerbations.

Prednisone and methylprednisolone.

Give three examples of inhaled glucocorticoids.

Beclomethasone, budesonide, and fluticasone.

What mast-cell stabilizer can be used prophylactically in asthma?

Cromolyn sodium (Intal).

Identify one leukotriene receptor antagonist and one leukotriene synthesis inhibitor.

Montelukast (antagonist) and zileuton (synthesis inhibitor).

Which monoclonal antibody targets IgE in moderate-to-severe allergic asthma?

Omalizumab (Xolair).

Name two anticholinergic bronchodilators occasionally used in asthma.

Ipratropium (Atrovent) and tiotropium (Spiriva).

Which two overarching phenotypes characterize COPD pathology?

Chronic bronchitis and emphysema.

Define chronic bronchitis clinically.

Productive cough with excessive mucus for ≥3 months in each of two consecutive years.

What structural change defines emphysema?

Permanent enlargement of airspaces distal to terminal bronchioles with destruction of their walls.

List three major exposure-related risk factors for COPD.

Cigarette smoke, occupational dusts/chemicals, and air pollution.

What hereditary deficiency markedly increases COPD risk?

Alpha-1-antitrypsin (AAT) deficiency.

State the fixed post-bronchodilator spirometric criterion for diagnosing COPD.

FEV1/FVC < 0.7.

Give two reversible pathophysiologic contributors to airflow limitation in COPD.

Bronchial smooth-muscle contraction and mucus/inflammatory secretions.

Name two irreversible anatomic changes seen in COPD.

Fibrosis/narrowing of airways and loss of elastic recoil with alveolar destruction.

What two arterial blood-gas complications commonly appear in advanced COPD?

Hypoxemia (PaO2 45-60 mmHg) and hypercapnia (PaCO2 50-60 mmHg).

Define cor pulmonale.

Right-sided heart failure caused by pulmonary hypertension secondary to lung disease.

List four primary goals of COPD pharmacologic and non-pharmacologic therapy.

Reduce symptoms, improve exercise tolerance/health status, prevent progression & exacerbations, and reduce mortality.

Which three cornerstone non-pharmacologic interventions are recommended for every COPD patient?

Smoking cessation, vaccination (flu & pneumococcal), and pulmonary rehabilitation.

Which nicotinic receptor subtype does nicotine primarily activate in the brain’s reward pathway?

α4β2 nicotinic cholinergic receptors in the ventral tegmental area.

Give four common acute pharmacodynamic effects of nicotine.

Arousal, increased heart rate, increased blood pressure, and appetite suppression.

When do nicotine withdrawal symptoms typically peak and subside?

Peak within first week; dissipate over 2–4 weeks (except weight gain).

List the five steps of the 5 A’s approach to smoking cessation counseling.

Ask, Advise, Assess, Assist, Arrange.

What time-to-first-cigarette (TTFC) threshold distinguishes 4 mg vs 2 mg nicotine gum dosing?

≤30 minutes after waking → 4 mg; >30 minutes → 2 mg.

Describe the "chew-and-park" technique for nicotine gum.

Chew slowly until peppery/tingling, park between cheek and gum; repeat when sensation fades for ~30 minutes.

How many cartridges per day are recommended for the nicotine inhaler?

6–12 cartridges/day (maximum 16).

State the standard initial titration schedule for varenicline.

Day 1-3: 0.5 mg daily; Day 4-7: 0.5 mg BID; Day 8-12 weeks: 1 mg BID.

What is varenicline’s mechanism of action?

Partial agonist at α4β2 nicotinic ACh receptors, stimulating dopamine release and reducing cravings/withdrawal.

List two common adverse effects of varenicline.

Nausea and abnormal/vivid dreams (others: headache, insomnia).

Explain bupropion’s proposed mechanism for aiding smoking cessation.

Inhibits dopamine and norepinephrine reuptake in the CNS, reducing withdrawal symptoms and cravings.

Give the usual bupropion SR dosing regimen for smoking cessation.

150 mg once daily ×3 days, then 150 mg twice daily for 7–12 weeks.

Name one absolute contraindication to bupropion use.

History of seizures (others: anorexia or bulimia).

Which metabolic enzyme primarily metabolizes bupropion and may be inhibited by ritonavir?

CYP2B6.

For nicotine patches, what starting dose is recommended for a patient smoking >10 cigarettes/day?

21 mg/day for 4–6 weeks.

When does the nicotine patch reach peak serum concentration?

3–12 hours after application.

Give three common local adverse effects of nicotine patches.

Skin irritation, vivid/abnormal dreams, and headache/dizziness.

How soon should follow-up be arranged after a patient’s quit date in the 5 A’s model?

Within the first week of the quit attempt.

What maximum hourly and daily dose limits apply to nicotine nasal spray?

No more than 5 doses/hour or 40 doses/day.

Describe the proper administration technique for nicotine nasal spray.

Prime 6–8 pumps, tilt head back, spray once in each nostril, breathe through mouth; wait 3 min before blowing nose.

Which COPD guideline collaboration published a comprehensive update in 2024?

NHLBI/WHO 2024 COPD guidelines.

What lung volume changes characterize dynamic hyperinflation during exercise in COPD?

Flattened diaphragm, increased functional residual capacity (FRC), and decreased inspiratory reserve volume (IRV).

Identify two pharmacologic classes that directly target airway inflammation in asthma.

Inhaled corticosteroids and leukotriene modifiers.

Which LABA–ICS combination is marketed as Symbicort?

Formoterol + budesonide.

What laboratory value confirms hypoxemia in COPD complications?

PaO2 between 45 and 60 mmHg.

Name two vaccinations strongly recommended for COPD patients.

Annual influenza vaccine and pneumococcal vaccine.

List three adverse effects frequently associated with nicotine gum.

Mouth irritation, jaw fatigue, and dyspepsia/hiccups.

At what serum concentration time frame do nicotine gum and lozenges peak?

Approximately 30–60 minutes after use.

For nicotine lozenges, what counseling technique improves absorption?

Allow to dissolve slowly, periodically rotating in the mouth; do not chew or swallow whole.

What is the rationale for considering combination NRT (e.g., patch + gum) as first-line therapy?

Provides steady baseline nicotine with patches and rapid craving relief via short-acting NRT, improving quit rates.

Which two pulmonary pressures are elevated in secondary pulmonary hypertension related to COPD?

Pulmonary arterial pressure and right ventricular afterload.

Explain why α1-antitrypsin deficiency predisposes to early-onset emphysema.

Lack of AAT allows unchecked neutrophil elastase activity, destroying alveolar walls and reducing elastic recoil.

What non-pharmacologic intervention can significantly prolong life in hypoxemic COPD patients?

Long-term oxygen therapy (LTOT).

Why are women considered a host risk factor for COPD?

Females may have increased susceptibility to tobacco smoke and smaller airway caliber leading to greater injury.

List two physiologic effects of nicotine that enhance cognitive performance.

Improved attention/learning and memory enhancement.

Which SABA has a single active enantiomer delivering greater β2-selectivity?

Levalbuterol (R-albuterol).