lmbebo
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This questions is saying that flunisolide (a corticosteroid; one that I have never heard about... and I've tried most of them :| ) should be given several mins after taking albuterol.
it was my understanding that corticosteroids should be used as a prophylaxis, at least once per day. And then albuterol should be used as needed. But corticosteroids are only required when the patient requires more control because they are using their albuterol inhalor too much.
I dont understand why kaplan is giving that answer as correct. Its saying that you need to bronchodilate the bronchioles so that they corticosteroids can be spread better.
But that case would only hold true post an attack, but the question is about regular day to day treatment.
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| mjl1717
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I see it as "
1)Albuterol for the bronchspasm
2)The roid for the inflammation and long term affect
The only prophylaxis I know of is Cromyln or a long term Beta 2 agonist.
As far as I know Asthma or Adult Intinsic Alveolitis is treated aggressively
with first the Beta2 then a roid
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| lmbebo
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oh
Ive always thought of the steroid as long term t/x and prophylaxis if needed.
I dont think they use cromyln a lot now.
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| mjl1717
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They may not use cromylyn a lot but usmle could ask:
What stabilizes membranes of mast cells and prevents mediator release
{heparin, histmine, leukotriene C4 and D4,- eosinophilic chemotactic factor
-the generic name for Charcot Leyden crystals.}
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| lmbebo
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i guess thats true, guess I've gotten used to qbank asking stuff that tends to be newer, ie I got a question wrong concerning the treatment of Wilson's disease. I believe I put penicinillase? and they had the right answer as Zinc Acetate.
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| mjl1717
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I) -Just want to add any of these could be used prophylactically:
anticholinergics, leukotriene inh. roids,
II)For Rx of Wilsons I reflexively say Penicillamine, you saying thats incorrect?? Zinc Acetate is an alternative or used in pregnancy as far as I know. Trientine is a third choice.
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| lmbebo
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thats what qbank said. I double checked my answer in FA and it had penicillamine listed.
but the qbank answer said it was approved now by the FDA and has been used worldwide now in the T/x of wilsons.
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| mjl1717
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According to CMDT you still have to chelate first, then Zinc Acetate.
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| lmbebo
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i dunno, Im guessing this all kaplan's fault
with my original question, it wasn't about how to increase delivery of the drug, if it was then the answer would make sense. But then it was asking in what should the boy take the drugs after he left the hospital.
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| mjl1717
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Asthma or COPD is treated more aggressively in the past 5 to 10 years.
There is nothing wrong with saying take 2 or 3 puffs of the albuterol 1st
then the roid as needed maybe 2 or 3 times a day as needed. Stressing that if you find that you dont need the roid as much dont take it.
* The inhaled roid doesnt have a significant affect of "adrenal rebound"
as compared to PO prednisone, in other words its more benign.
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