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Asthma Medication Flashcards

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  1. Which inhaled corticosteroid is a prodrug activated by esterases in the lung, designed to minimize systemic bioavailability?

    Answer: Ciclesonide

    Ciclesonide is an ICS prodrug converted to active des-ciclesonide by airway esterases, reducing oropharyngeal deposition and systemic effects.

  2. A patient develops oropharyngeal candidiasis after starting ICS therapy. What is the FIRST recommended intervention?

    Answer: Use a spacer/valved holding chamber and rinse mouth after each dose

    Using a spacer reduces oropharyngeal drug deposition, and rinsing the mouth after use removes residual ICS to prevent candidiasis.

  3. Benralizumab (Fasenra) reduces eosinophils more rapidly than mepolizumab. What is its mechanism compared to anti-IL-5 agents?

    Answer: It binds IL-5 receptor alpha (IL-5Rα) and induces ADCC of eosinophils

    Benralizumab binds IL-5Rα directly on eosinophils and triggers antibody-dependent cell-mediated cytotoxicity (ADCC), rapidly depleting eosinophils.

  4. Exercise-induced bronchoconstriction (EIB) prophylaxis with a SABA should be administered how long before exercise?

    Answer: 15–30 minutes before exercise

    Albuterol MDI taken 15–30 minutes before exercise provides effective prophylaxis against EIB for approximately 2–3 hours.

  5. Which asthma medication class is CONTRAINDICATED in patients with a known hypersensitivity to aspirin who have asthma and nasal polyps (Samter's triad)?

    Answer: Ketorolac or NSAIDs used as adjunct anti-inflammatory agents

    In Samter's triad (AERD), NSAIDs including ketorolac trigger severe bronchoconstriction by diverting arachidonic acid to leukotriene synthesis.

  6. At GINA Step 5, which is the preferred add-on therapy for severe uncontrolled eosinophilic asthma before considering oral corticosteroids?

    Answer: Add-on biologic therapy targeting type 2 inflammation

    GINA Step 5 recommends add-on biologic therapy (e.g., anti-IL-5, anti-IgE, anti-IL-4/13) over chronic oral corticosteroids due to better safety profiles.

  7. A child uses a DPI for asthma. At what minimum inspiratory flow rate (L/min) are most DPIs optimally effective?

    Answer: 30 L/min

    Most DPIs require a minimum inspiratory flow of approximately 30 L/min to deaggregate the powder for lung deposition, though 60 L/min is optimal.

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