Ashtma Flashcards
T/F: Asthma is characterized by airway inflammation and airway hyperresponsiveness
True
Diagnosis is dependent on what two factors
Medical history and spirometry
How should FEV1 change in response to a bronchodilator
increase by 12% or greater
What is an exaggerated airway response to repeated stimulation/irritation is known as what
Bronchial hyperresponsiveness
What are the two types of asthma
Eosinophillic and noneosinophillic
What are the goals of therapy for asthma when it relates to reduced impairment
Require infrequent (less than 2 days a week) daytime symptoms and need reliever medications, have less than 2 nighttime awakenings per month from asthma
What is the cornerstone medication class for patients who have asthma
Inhaled corticoid steroids
When do full benefits become apparent with asthma patients who use inhaled corticoid steroids
3 months
What is used when selecting an ICS dose
Patient’s age, patient’s symptoms/impairment, patient’s exacerbation history/risk
Before moving to a different step of therapy what should be asses
adherence to the medication, inhaler technique, enviornmental exposures, confirm the symptoms are due to asthma
How long should patients be stable before stepping down
at least 3 months
What controller should be given if a patient is on step 1 of asthma treatment
no controller
What controller should be given if a patient is on step 2 of asthma treatment
Low dose Inhaled corticoid steroid
What controller should be given if a patient is on step 3 of asthma treatment
Low dose inhaled corticoid steroid with a long acting beta-2 agonist
What controller should be given if a patient is on step 4 of asthma treatment
Medium dose inhaled corticoid steroid with a long acting beta-2 agonist
What controller should be given if a patient is on step 5 of asthma treatment
High dose inhaled corticoid steroid with a long acting beta-2 agonist
What controller should be given if a patient is on step 6 of asthma treatment
High dose inhaled corticoid steroid with a long acting beta-2 agonist plus add-on therapy
When giving patients self-managment education what should always be included
Written Asthma Action Plan
What are triggers that can worse asthma
viral illness, exercise, pollution, stress
What medication classes are triggers for asthma
Aspirin, NSAIDS, and Beta-blockers
What are comorbid conditions that may worsen asthma
allergies, GURD, obesity, sleep apnea
What the two types of ashthma medications
Quick relief medicatons (rescue/reliever) and controller medications (maintenance)
Who should use controller medications
Daytime symptoms or reliever use greater that 2 days a week, nighttime awakening from asthma greater than 2 days per month
What should every patient with ashtma be prescribed
Albuterol
What are side effects of beta 2 agonists
tachycardia, tremor, excitement, nervousness
What is the preferred initial and backbone controller medication for patients that are step 2 and higher
Inhaled corticosteroids
What are the five inhaled corticosteroids used in asthma
Beclomethasone, budesonide, ciclesonide, fluticasone, mometasone
T/F: Fluticasone is the preffered inhaled corticosteriod for pregnant patients
False: Budesonide is preferred in pregnancy
What is a huge side effect ICS, how can this be avoided
thrush (oral candidasis), rinse out the mouth after use
What are the medications that are added to ICS , when
LABA, stage 3
T/F: LABAs can be used alone in treatment for asthma
False: LABAs can never be used alone in asthama
What are the LABAs that are used in asthma
Formoterol, Salmeterol, Vilanterol
Which of the LABAs has the fastest onset, longest duration
formoterol, vilanterol
When would a LAMA be added to therapy for asthma
Step or Step 5
What are the monoclonal antibodies used for asthma
omalizumab, mepolizumab, reslizumab, benralizumab, dupllumab
Which monoclonal antibody is used if there is high IgE levels (30-700 IU/ml)
Omalizumab
How is dosing determined for Omalizumab
patients total baseline IgE level and body weight
How should the eosinophil cell count be before using mepolizumab, resiluzmab or benralizumab
above 300 (above 400 for reslizumab)
What is the only monoclonal antibody that can be administered at home
dupilumab
When are oral corticosteroids given in asthma patients
step 6 as add on therapy
