51 - Asthma in Adults Flashcards
What does control mean?
<3 attacks/ week
<3 reliever doses/week
non-pharms
- identify and avoid precipitating factors
- smoking cessation
Bronchodilators:
Examples of SABAs
- salbutamol
- terbutaline
Bronchodilators:
What are SABAs used for?
acute exacerbations and for prevention of exercise-induced asthma
used PRN
Bronchodilators:
If they use their SABA more than 2 times/week, initiate treatment with ?
anti-inflammatory agent
Bronchodilators:
Give examples of LABAs
- salmeterol (slow onset of action)
- formoterol (fast onset of action)
Bronchodilators:
What are LABAs for?
for regular BID treatment of asthma
Bronchodilators:
Who should LABAs be given to?
ONLY for those already taking ICS
*adding LABAs to ICS may permit decreasing the dose of the ICE and also has been clearly shown to reduce the incidence of exacerbations to a great extent in comparison with an increased dose of ICS without a LABA
Bronchodilators:
In adults, consider adding LABA when low-dose ____ fail to provide adequate control of asthma
ICS
Bronchodilators:
LABAs also help to prevent _____-induced bronchospasm
exercise
Bronchodilators:
Why should adults not have monotherapy with LABA in asthma?
has been associated with increased risk of death in asthmatics
Bronchodilators:
Why are oral beta agonists not used?
offer less bronchodilation, more systemic s/e and slower onset of action than inhaled preparations
Anticholinergics:
______ is a short-acting anticholinergic used as add-on therapy to beta agonists for management of acute asthma
ipratropium
Anticholinergics:
When are anticholinergics useful?
if patients get tremor or tachycardia from beta agonists
Anticholinergics:
Bronchodilator effects last longer than ____ _____
beta agonists
Anticholinergics:
____ is a long acting once daily bronchodilator to improve lung function and decrease exacerbations
tiotropium
Methylxanthine:
Why is oral theophylline uncommonly used?
bc of systemic toxicity and only mild bronchodilator activity
Methylxanthine:
Need to monitor what with theophylline?
blood levels
ICS:
____ is a prodrug that is biologically inert until activated by esterases in the lung so may have fewer topical s/e such as thrush
ciclesonide
When are systemic corticosteroids used?
for acute exacerbations (x 7-14 days)
s/e of systemic corticosteroids?
fluid retention, glucose intolerance, increased BP, increased appetite, mood alterations, weight gain
Place in therapy for montelukast?
- not as effective as low-dose ICS so second line monotherapy after ICS for asthma
- they may be considered as add-on to ICS even though ICS/LABA is more effective
What is an IgE-neutralizing antibody for mod-severe asthma uncontrolled by ICS and add-on Tx (and positive to allergen test)?
Omalizumab
What is an IL-5 inhibitor for eosinophilic asthma?
Mepolizumab, Resilizumab, Benralizumab
How often is Mepolizumab administered?
SC injection every month
How often is Resilizumab administered?
IV q4 weeks
How often is Benralizumab administered
every 8 weeks
Step up therapy at ____ weeks
6-12
Can step down at ___ month intervals
3
Describe step down therapy
can include reducing ICS by 25-50% reducing another agent or removing a bronchodilator
For pregnancy:
Everything is safe except ______ as it worsens GERD and nausea
theophylline
For breastfeeding, what can they use?
everything
