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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 19 08 Drugs of Choice Asthma 3 Below
Ok. We’ve covered bronchodilators. Let’s go back to the other important part of treatment.
Again, what other class of drug in conjunction with beta-2 agonists and other bronchodilators is the cornerstone of treatment?
And again, there are 2 benefits that corticosteroids are thought to provide by being used along with bronchodilators.
What are they?
- First, reduction of inflammation and second, restoration of beta receptor activity.
What is the corticosteroid drug of choice for acute asthma, with route of administration?
- Methylprednisolone PO or IV.
Trade name for Methylprednisolone?
There is 1 route of administration for Methylprednisolone/Medrol that is not advisable in the emergency treatment of acute asthma, but can be used later.
What is it?
And why not during the acute episode?
- Even though Methylprednisolone is anti-inflammation, in aerosol form, it will cause airway irritation.
And what are you, the physician, worried about with airway irritation in the acute asthmatic?
If Methylprednisolone/Medrol is given for more than just a day or so, the patient must be tapered off slowly, as with any corticosteroid. What routes of administration are preferred for tapering, assuming the patient is recovering well and IV therapy is no longer needed?
- PO or aerosol.
What is the Methylprednisolone PO package used specifically for tapering off a patient over 7 days?
- The Medrol dose pack.
Again, what 2 classes of drugs together form the foundation of emergency treatment of acute asthma?
- Beta-2 agonists and corticosteroids.
And what 2 other drugs can be helpful in the acute phase?
- Ipratropium bromide/Atrovent, and magnesium sulfate.
And finally, what 2 drugs are helpful in management of asthma but should not be used in the acute phase?
- Theophylline and Salmeterol/Serevent.
The management of chronic asthma may include any of the agents we’ve already discussed, a stepwise approach is usually used.
What single class is usually used for mild asthma?
- Beta-2 agonist bronchodilators.
What is probably the preferred route of administration?
And what are the 2 choices for aerosol administration?
- Metered dose inhalers or solution for use in a nebulizer.
What other 2 forms do the beta-2 agonist bronchodilators often come in when aerosol administration is not necessary?
- Tablets or syrups.
While there are a number of them to choose from, and they’re probably all about equally effective, which one is probably the most popular choice or well known?
And 3 trade names for Albuterol?
- Proventil, Ventolin, Volmax.
Now, in the next step up, when an aerosol beta-2 agonist alone is not enough, what category of drug is added to the treatment program?
- Aerosol anti-inflammatory agents.
And what are the 2 choices? (Note: 1 of these we haven’t talked about yet).
- Aerosol corticosteroids or Cromolyn sodium.
And what is the trade name for Cromolyn sodium in metered inhaler or nebulizer solution?
What class of drug is Cromolyn sodium?
- It is a mast cell stabilizer.
Again, what 2 agents are used together for moderate asthma, where aerosol beta-2 agonists alone are not enough?
- Aerosol beta-2 agonist bronchodilator with either aerosol corticosteroids or aerosol Cromolyn sodium.
Now, in more severe asthma, what are the 2 alternatives for adding a third agent?
- Theophylline PO or Aerosol anticholinergic Ipratropium bromide.
And the trade name again for Ipratropium metered-dose inhaler?
In the particular case of individuals having a chronic productive cough as part of their asthma, which is th drug of choice as a component of the overall treatment program (give both the generic and trade name)?
- Ipratropium bromide/Atrovent.
And when the patient has frequently disrupted sleep due to nocturnal asthma, what is the longer-duration drug of choice for preventing asthma at night?
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