Question

Case Study #3 A patient with COPD is currently taking albuterol by MDI four times a day. The patient states that her inhaler does not seem to work as well as it used to. She still gets short of breath and it is sometimes hard to wait for the next dose. She is not taking any other medications at this time. Which of the following would you recommend? a. Continue albuterol as ordered b. Give albuterol by nebulizer c. Discontinue albuterol and give Serevent d. Continue albuterol and add tiotropium once a day Define the following terms from Chapter 5 Asthma paradox- Tachyphylaxis - Downregulation Rescue therapy- Maintenance therapy-

Answer 1

#. The correct option is b) give albuterol by nebulizer because her complaint is that the MDI is not working properly as it was earlier and if she doesn't improy after taking albuterol by nebulizer then we can opt for the options.

Definations :-

- Asthma paradox refers to the increasing incidence of asthma morbidity, and especially asthma mortality, despite advances in the understanding of asthma and availability of improved drugs to treat asthma.

- Tachyphylaxis is rapid ↓ drug response - occurs in minutes! (tolerance is more gradual - can take days -> weeks)

- Downregulation refers to prolonged exposure to high hormone concentrations can decrease the # of receptors of that hormone; desensitizes the target cells, so they response less vigoursly to hormonal stimulation, preventing them from overreacting to persistently high hormone levels

ex. progesterone down-regulates estrogen receptors in the uterus, thus antagonizing estrogens actions

- Maintainence therapy is less intense therapy given over a long period of time to maintain remission.

- Rescue therapy

Therapy to establish remission in a patient that has failed first line treatments or to re-establish remission in a patient that has relapsed.