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NAPLEX > Asthma > Flashcards

Asthma Flashcards

1
Q

Intermittent Asthma Severity

A
  • Daytime sxs =< 2d/w
  • SABA rescue inhaler use: =< 2 d/w
  • Recommend Step 1 Therapy initially
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2
Q

Mild Asthma Severity

A
  • Daytime sxs >2 d/w but not daily
  • SABA rescue inhaler use >2 d/w but not daily or >1x/d
  • Recommend Step 2 Therapy initially
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3
Q

Moderate Asthma Severity

A
  • Daytime sxs daily
  • SABA use daily
  • Recommend Step 3 Therapy initially
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4
Q

Severe Asthma Severity

A
  • Daytime sxs throughout the daily
  • SABA use several times per day
  • Recommend Step 4/5 Therapy initially
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5
Q

Asthma Guidelines

A
  • NHLBI’s EPR (Expert Panel Report)

- GINA

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6
Q

Well-Controlled Asthma

A
  • Sxs/use of SABA =< 2 d/w
  • Nighttime awakening =<2x/month
  • No limitations to normal activity
  • Maintain current treatment, if controlled at least 3 months, can consider step down tx
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7
Q

Not Well-Controlled Asthma

A
  • Sxs/use of SABA > 2d/w
  • Nighttime awakening 1-3x/week
  • Some limitations to normal activity
  • Step up 1 level of tx
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8
Q

Very Poorly Controlled Asthma

A
  • Sxs/use of SABA daily
  • Nighttime awakening >4d/week
  • Normal activity extremely limited
  • Step up 1-2 levels of tx, consider systemic steroid course
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9
Q

Step 1 Asthma Tx

A
  • PRN low dose ICS-formoterol

- SABA + Low-dose ICS (taken with SABA)

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10
Q

Step 2 Asthma Tx

A
  • PRN low dose ICS-formoterol

- SABA + Daily low-dose ICS

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11
Q

Step 3 Asthma Tx

A
  • Low-dose formoterol + Low-dose ICS + formoterol

- SABA + Low-dose ICS + LABA

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12
Q

Step 4 Asthma Tx

A
  • Low-dose ICS/formoterol + Medium-dose ICS/formoterol

- SABA + Medium-dose ICS-LABA

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13
Q

Step 4 Asthma Tx

A
  • Low-dose ICS/formoterol + High-dose ICS/formoterol

- SABA + High-dose ICS/LABA

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14
Q

Albuterol

A
  • SABA
  • Proair HFA/Respiclick, Ventolin HFA, Proventil HFA
  • 90 mcg/inh
  • PO forms available but NOT recommended
  • Dose: 1-2 inh Q4-6h PRN
  • Most contain 200 inh/canister, Ventolin HFA has 60 inh/canister option as well
  • Clean by rinsing under water at least once weekly, air dry
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15
Q

SABA Information

A
  • SE: Nervousness, tremor, tachycardia, palpitation, cough, HYPERglycemia, HYPOkalemia
  • Shake HFA products (MDI) well before use
  • EIB: 2 inh 5 minutes prior to exercise
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16
Q

Xopenex HFA

A
  • SABA

- Levalbuterol, R-isomer of albuterol

17
Q

Asthmanefrin Refill

A
  • SABAA
  • Racepinephrine
  • Don’t use since non-selective
  • OTC
18
Q

Primatene Mist

A
  • Epinephrine
  • OTC
  • FDA-approved for mild sxs in intermittent asthma ONLY
  • Generally not a preferred SABA for reliever
19
Q

Serevent Diskus

A

Salmeterol

  • LABA
  • Monotherapy option (NEVER use in asthma, only COPD)
  • Combinations: Advair or AirDuo (Fluticasone) - use in maintenance only
20
Q

LABA Information

A
  • Box warnings: Increased risk of asthma-related deaths (only give if receiving AND uncontrolled on long-term asthma control medications (ICS), increased asthma hospitalization in pediatric/adolescent patients
  • NOT for acute bronchospasm (long onset)
21
Q

QVAR Redihaler

A

Beclomethasone

  • Don’t shake before use
  • No priming/activation needed
22
Q

Flovent HFA/Arnuity Ellipta

A

Fluticasone

23
Q

Symbicort HFA

A
  • Budesonide + Formoterol
  • Never put in water
  • *Preferred 1st line for Asthma, reliever or maintenance (step 2+)**
24
Q

Pulmicort Flexhaler

A
  • Budesonide
  • Use respules in jet nebulizer ONLY
  • Flexhaler is only DPI that needed to be primed
  • Preferred ICS for preggo
25
Q

Advair Diskus

A

-Fluticasone + Salmeterol

ICS + LABA

26
Q

Breo Ellipta

A
  • Fluticasone + Vilanterol
  • ICS + LABA
  • Maintenance only
27
Q

Dulera HFA

A

Mometasone + Formoterol

  • Never put in water
  • *Preferred 1st line for Asthma, reliever or maintenance (step 2+)**
28
Q

ICS Information

A
  • SE: Dysphonia (difficulty speaking), oral candidiasis (thrush), cough
  • Warnings: Increased fracture risk
29
Q

Alvesco

A
  • Ciclesonide

- MDI that DOESN’T need to be shaken before use

30
Q

MDIs

A
  • HFA, Respimat, RediHaler, or no suffix (Alvesco)
  • Aerosolized liquid
  • Some use propellant (HFA)
  • Slow, deep inhalation while pressing canister (coordination)
  • Can use spacer in those with less coordination and/or to decrease thrush risk
  • Must shake prior to use (Exceptions: QVAR Redihaler, Alvesco, and Respimat products)
  • Prime at first use and if not used for a significant period of time (based on med used
  • Ex: Ventolin, Symbicort, Dulera, etc.
31
Q

DPIs

A
  • Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler
  • Fine powder
  • No propellant, spacer, shaking or priming needed
  • Quick, forceful inhalation (no need to press anything)
32
Q

Singulair

A
  • Montelukast
  • Tablet, chewable tablet, granules
  • Approved for allergic rhinitis and EIB as well
  • Dose >14 yo: 10 mg PO QPM
  • Dose 6-14 yo: 5 mg PO QPM
  • Dose 1-5 yo: 4 mg PO QPM
33
Q

Leukotriene Modifying Agent Information

A
  • Box warning: neuropsychiatric events (montelukast)
  • Montelukast granules can be administered directly to mouth or mixed with 5 mL of breast milk/formula OR a spoonful of applesauce, carrots, rice, or ice cream
  • Use granules w/in 15 mins of opening packet
  • Zileuton - Zyflo, QID
  • Zafirlukast (Accolate) must be dispensed in original container (protect from moisture and light) and BID
  • Z drug - liver toxic
34
Q

Theophylline

A
  • Active metabolites include caffeine and 3-methylxanthine
  • Dosing based on IBW (actual if underweight)
  • Therapeutic Range: 5-15 mcg/mL (measure at PEAK) - Michaelis-Menton Kinetics
  • SE: persistent vomiting, arrhythmias, and seizures associated with toxicity
  • ATM
35
Q

Xolair

A
  • Omalizumab
  • Monoclonal antibody that inhibits IgE binding
  • Indicated for moderate to severe allergic asthma in patients 6yo+ with positive skin test
  • Given SQ q2-4w
  • Administer in HC setting with supervision
  • Box Warning: anaphylaxis
36
Q

Reliever Options

A

For sudden sxs relief:

  • ICS + Formoterol: preferred first line
  • SABA (PRN)
  • Systemic steroids: for exacerbations or SEVERE asthma
37
Q

Maintenance Drugs for Asthma

A

Used DAILY to help control sxs:

  • ICS: first line for ALL patients
  • LABA: NEVER alone in asthma
  • LTRA, theophylline, LAMA (Spiriva only in Asthma), monoclonal antibodies: add-ons
38
Q

Interleukin Receptor Antagonists

A
  • Used in severe asthma with eosinophilic phenotype
  • Ex: all have -li- in name - Reslizumab, mepolizumab, etc.
  • Anaphylaxis warning!

NAPLEX (59 decks)

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