51 - Asthma in Adults

Question 1

What does control mean?

Answer 1

<3 attacks/ week

<3 reliever doses/week

Question 2

non-pharms

Answer 2

• identify and avoid precipitating factors

- smoking cessation

Question 3

Bronchodilators:

Examples of SABAs

Answer 3

• salbutamol

- terbutaline

Question 4

Bronchodilators:

What are SABAs used for?

Answer 4

acute exacerbations and for prevention of exercise-induced asthma

used PRN

Question 5

Bronchodilators:

If they use their SABA more than 2 times/week, initiate treatment with ?

Answer 5

anti-inflammatory agent

Question 6

Bronchodilators:

Give examples of LABAs

Answer 6

• salmeterol (slow onset of action)

- formoterol (fast onset of action)

Question 7

Bronchodilators:

What are LABAs for?

Answer 7

for regular BID treatment of asthma

Question 8

Bronchodilators:

Who should LABAs be given to?

Answer 8

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

Question 9

Bronchodilators:

In adults, consider adding LABA when low-dose ____ fail to provide adequate control of asthma

Answer 9

ICS

Question 10

Bronchodilators:

LABAs also help to prevent _____-induced bronchospasm

Answer 10

exercise

Question 11

Bronchodilators:

Why should adults not have monotherapy with LABA in asthma?

Answer 11

has been associated with increased risk of death in asthmatics

Question 12

Bronchodilators:

Why are oral beta agonists not used?

Answer 12

offer less bronchodilation, more systemic s/e and slower onset of action than inhaled preparations

Question 13

Anticholinergics:

______ is a short-acting anticholinergic used as add-on therapy to beta agonists for management of acute asthma

Answer 13

ipratropium

Question 14

Anticholinergics:

When are anticholinergics useful?

Answer 14

if patients get tremor or tachycardia from beta agonists

Question 15

Anticholinergics:

Bronchodilator effects last longer than ____ _____

Answer 15

beta agonists

Question 16

Anticholinergics:

____ is a long acting once daily bronchodilator to improve lung function and decrease exacerbations

Answer 16

tiotropium

Question 17

Methylxanthine:

Why is oral theophylline uncommonly used?

Answer 17

bc of systemic toxicity and only mild bronchodilator activity

Question 18

Methylxanthine:

Need to monitor what with theophylline?

Answer 18

blood levels

Question 19

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

Answer 19

ciclesonide

Question 20

When are systemic corticosteroids used?

Answer 20

for acute exacerbations (x 7-14 days)

Question 21

s/e of systemic corticosteroids?

Answer 21

fluid retention, glucose intolerance, increased BP, increased appetite, mood alterations, weight gain

Question 22

Place in therapy for montelukast?

Answer 22

• 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

Question 23

What is an IgE-neutralizing antibody for mod-severe asthma uncontrolled by ICS and add-on Tx (and positive to allergen test)?

Answer 23

Omalizumab

Question 24

What is an IL-5 inhibitor for eosinophilic asthma?

Answer 24

Mepolizumab, Resilizumab, Benralizumab

Question 25

How often is Mepolizumab administered?

Answer 25

SC injection every month

Question 26

How often is Resilizumab administered?

Answer 26

IV q4 weeks

Question 27

How often is Benralizumab administered

Answer 27

every 8 weeks

Question 28

Step up therapy at ____ weeks

Answer 28

6-12

Question 29

Can step down at ___ month intervals

Answer 29

3

Question 30

Describe step down therapy

Answer 30

can include reducing ICS by 25-50% reducing another agent or removing a bronchodilator

Question 31

For pregnancy:

Everything is safe except ______ as it worsens GERD and nausea

Answer 31

theophylline

Question 32

For breastfeeding, what can they use?

Answer 32

everything