ch. 11 and 12

list 3 components of asthma

A. the acute asthma attack, which resolves spontaneously or with treatment B. hyperresponsiveness of the airways to various stimuli C. persistent inflammation that is now appreciated or becomes worse

Besides its use in asthma, list two other indications for the use of cromolyn.

ACEI-induced cough Anti-sickle cell effects

Trade name: Flunisolide hemihydrate HFA Brand name?

AeroSpan

In infants and children, _____________________ are alternatives to inhaled corticosteroids in step 2 asthma because of their safety profiles.

Cromolyn sodium

What are the 2 most common methods used for the delivery of inhaled corticosteroids?

DPI and HFA-propelled MDIs

True or False: Xolair is a prophylactic agent for uncontrolled moderate to severe persistent asthma.

True

True or false: xolair is a replacement for corticosteroids

True

List 4 symptoms that, in an acute state, the asthmatic pt will exhibit.

Wheezing Breathlessness Chest tightness Cough

List 6 side effects associated with systemic administration of corticosteroids

a. immunosuppression resulting in increased susceptibility to infection b. fluid retention resulting from sodium-sparing effects of glucocorticoids c. increased WBC count w/ an increased neutrophils and decreased in lymphocytes and eosinophils d. hypertention resulting from fluid retention e. dermatologic changes leadign to cushingoid appearance (moon face) f. hyperglycemia from reduced glucose uptake

List 2 formulations in which inhaled corticosteroids are available.

a. oral (SVN, MDI, DPI) b. intranasal

List 2 clinical indications for intranasal aerosolized corticosteroids.

a. seasonal and perennial allergic rhinitis b. nonallergic rhinitis

Name 3 antileukotriene agents that have been approved for use.

a. zileuton (Zyflo) b. Montelukast (Singulair) c. Zarfirlukast (Accolate)

To withdraw an adrenally suppressed pt from oral corticosteroid treatment, the oral agent is tapered off slowly, while __________ corticosteroids are started.

aerosolized

List 3 modes of action of cromolyn sodium

antiasthmatic, antiallergic, and mast cell stabilizer

An agent that blocks the inflammatory response are called?

antileukotriene

Asthma guidelines agree that ______________ are the most effective anti-inflammatory drugs for use in asthma.

corticosteroids

Alternatives to low dose corticosteroids in step 2 asthma include ___________ and __________.

cromolyn-like drugs and antileukotrienes

Accolate inhibits asthma reactions induced by _________, cold air, ________ and aspirin

exercise and allergen

When a pt is using a MDI for inhaled corticosteroids, the pt should use a __________ to enhance deposition in the lungs.

holding chamber

Chemical mediators that cause inflammation are called?

leukotrienes

Singulair metabolism is accomplished primarily by the ________ and excreted by the _______.

liver, bile

Cromolyn is a __________________ as a prohylactic treatment for asthma.

mast cell stabilizer

List 2 side effects of glucocorticoids.

muscle wasting steroid diabetes

The recommended dosage of Zyflo for asthma is?

one 600mg tablet QID

In asthma, to verify peak expiratory flow rate, a __________ should be used.

peak flow meter

Connective tissue cells that contain heparin and histamine are called?

Mast cells

A link appears to exist between RVS and asthma. The use of ______________ blocks these mediators in asthma, as well as in RSV infection.

Montelukast

Trade name: Triamcinolone acetonide Brand name?

Nasacort AQ

Trade name: Mometasone furoate Brand name?

Nasonex

Two drugs that zyflo interacts with are?

Theophylline and warfarin

True or False: Asthma rescue agents may need to be increased with the use of Xolair.

False: Xolair may reduce the need for rescue agents

Instruct the children to take Accolate ___ hours before eating or ___ hours after eating.

1,2

Steroids suppress the inflammatory response by what 3 general pathways?

1. increased (upregulated) transcription of anti inflammatory genes for anti inflammatory proteins 2. suppression of factors that cause gene transcription involved with inflammation 3. increased expression of inhibitors that suppress gene expression for proinflammatory protiens

The dose of Accolate for children 5-11 years of age is to take an oral _____ mg tablet BID; for children 12 years of age and older, an oral ____ mg tablet BID is available.

10,20

Zyflo is approved for childdren ______ years of age and older.

12 and older

It may take ___-____ weeks of cromolyn sodium use before reducing the concomitant therapy of bronchodilator or steroid use.

2-4

List 3 ways to minimize the local side effect of inhaled steroid administration.

A. mouth rinsing after administration B. use of a spacer decrease the amount of drug deposited at the back of the throat C. giving the lowest dose possible

Accolate has been approved for children aged ______ years and older

5

Beclomethasone dipropionate (QVAR) has been reformulated with an HFA propellant; it has a lung deposition measured at ____%-____% of the emitted dose.

50-60

Singulair is the one antileukotirne agent that has been approved for children as young as ___________

6 months old

Give a brief description of each category of the triple response to inflammation?

A. redness: local dilation of blood vessels B. flare: reddish color extending several centimeters from the site, occurring within 15-30seconds C. wheal: local swelling occurring within minutes

List 7 advantages of antileukotriene drug therapy

A. oral administration, possible once a day dosing B. safe, with few side effects C. effective in aspirin sensitivity and often in exercise-induced asthma D. additive effect with ICS E. may reduce steroid dose or prevent and increase in steroid use F. systematic distribution reaches entire lung through the circulation G. formulation approved for pediatric dosing (montelukast)

List 6 disadvantages of antileukotriene drug therapy.

A. anti-inflammatory actions limited to one mediator pathway B. unknown long-term toxicity C. Variable response D. no predictor of pts who will respond E. systemic drug exposure, not limited to lung F. Not effective as a monotherapy

List 2 respiratory care assessments you would perform with long term treatment of an inhaled corticosteroid.

A. assess severity of symptoms; symptoms during exertion; use of rescue bronchodilator; number of exacerbations; missed work/school days; and pulmonary function B. assess for presence of side effects with inhaled steroid therapy; have pt use a reservoir with MDI use and verify correct use.

list the triggers for which antileukotrienes are particularly useful in controlling asthma.

A. exercise-induced asthma B. aspirin-induced asthma C. allergen-induced asthma

List 5 respiratory care assessments you would perform before the treatment of inhaled corticosteroid.

A. instruct pt in correct use of the aerosol delivery system, and then verify B. assess RR and pattern C. assess BS by auscultation before and after treatment D. assess pulse before and after treatment E. assess pts subjective reaction to treatment for any change in breathing effort or pattern

Flunisolide shows a peak plasma level after inhalation between 2-60 minutes, indicating good _______ from the lungs.

Absorption

Chemicals secreted by the adrenal cortex are called

Adrenal cortical hormones

Trade name: Fluticasone propionate/salmeterol Brand name?

Advair HFA, Advair Diskus

Trade name: Ciclesonide Brand name?

Alvesco

Glucocorticoids, often referred to simply as steroids, exert an _________ effect in the body.

Anti-inflammatory

Trade name: Mometasone furate Brand name?

Asmanex HFA, asmanex twisthaler

Name 2 of the most common inflammatory lung diseases

Asthma and chronic bronchitis

What are the different patterns in the inflammatory cells in COPD and those in asthma?

Asthma is predominated by eosinohils and COPD is predominated by neutrophils

Oral inhalation of glucocorticoids is available for the control of _______ and ______. Intranasal administration is for ________

Asthma, COPD, rhinitis

Trade name: Beclomethasone Brand name?

Beconase AQ

What 2 drugs make up Symbicort?

Budesonide and formoterol

Because ciclesonide is a prodrug, it has been shown to decrease the development of _________ ________

Candida albicans

Inflammatory process chemicals, produced and released by the body in response to stimuli are called

Chemical mediators

All the nonsteroidal antiasthma drugs described in this chapter are _________, not relievers, and should never be used during an acute exacerbation of asthma.

Controllers

Trade name: Mometasone furoate/formoterol fumarate HFA Brand name?

Dulera

Substances produced within the body are called

Endogenous

Substances produced outside the body, for administration inside the body, are called

Exogenous

Trade name: Fluticasone Brand name?

Flonase

Trade name: Fluticasone propionate Brand name?

Flovent HFA, Flovent Diskus

What 2 drugs are contained within the DPI Advair?

Fluticasone and salmeterol

A gamma globulin produced by cells in the respiratory tract is

IgE

Evidence indicates that the early asthmatic response is caused by ______ dependent activation of airway mast cells.

IgE

_________________ is a gamma globin that is produced by cells in the resp tract.

IgE (immunoglobulin E)

Flovent is available in what two forms?

MDI and DPI

Briefly describe the mechanism of action of omalizumab (Xolair).

Omalizumab reduces the mediators that can be released in an allergic reaction by blocking the binding of IgE to the IgE receptor on the surface of mast cells and basophils.

Trade name: Ciclesonide Brand name?

Omnaris

What is the indication for Zileuton (Zyflo)?

Prophylaxis and chronic treatment of asthma

This hormone type substance, an inflammatory mediator and part of the arachidonic acid cascade is called

Prostaglandin

Trade name: Budesonide Brand name?

Pulmicort Flexhaler, Pulmicort Respules

What is the benefit of using budesonide in the form of Pulmicort Respules compared with the Pulmicort Flexhaler?

Pulmicort Respules can be mixed with other agents

Trade name: Beclomethasone dipropionate HFA Brand name?

QVAR

Trade name: Budesonide Brand name?

Rhinocort Aqua

At what level of care in asthma, as defined by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 guidelines for the diagnosis and management of asthma-- update on selected topics, are corticosteroids clinically indicated?

Strep 2 or greater

The hyperglycemia resulting from steroids' increasing plasma glucose levels through the breakdown of proteins is called?

Steroid diabetes

Also known as glucocorticoids, _____ produce an inflammatory response in the body.

Steroids

Trade name: Budesonide/formoterol fumarate HFA Brand name?

Symbicort

In severe asthma, both inhaled corticosteroids and ________ corticosteroids can be used together.

Systemic

Trade name: Fluticasone furoate Brand name?

Veramyst

Flunisolide hemihydrate HFA (Aerospan) is marketed with a built in _______

spacer device

In moderate asthma, a combination of ________ and _____________ results in greater lung function.

steroids, antileukotrienes

Singulair is available in _______ and _________ form and can be taken with or without meals.

tablet and granule

Describe a clinical situation in which the use of a controller medication is indicated.

the pt using B2 agonist more than 2 times per week

Besides suppression of the inflammatory response, what is another benefit of steroids?

their ability to restore responsiveness to B-adrenergic stimulation

What is the primary reason for using aerosolized glucocorticoids versus systemic ones?

to minimize HPA suppression

True or false: Cromolyn sodium has no bronchodilating action and should not be used during acute bronchospasm.

true