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Asthma GINA > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Reversible inflammation

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2
Q

Asthma Pathophysiology

A

Mast cells, eosinophils, epithelial cells, macrophages, active T cells induce inflammation

inflammation is present between flare-ups.

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3
Q

Triggers of Asthma

A

Upper respiratory tract viral infections
Allergens, exercise, stress
Changes in the weather, laughter
Exposure to inhaled irritants (e.g., smoke, vehicle exhaust fumes, strong smells)
Gastroesophageal reflux disease (GERD)
Aspirin (in individuals sensitive to aspirin)
Exposure to sulfites

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4
Q

Diagnostic Criteria

A

Wheeze, shortness of breath, cough, and chest tightness
A hyper-responsiveness to an allergen or situation leads to these symptoms
The presence of variable airflow limitation:
Measured by spirometry
Airflow obstruction reversibility

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5
Q

Asthma Treatment Goals

A

Reduce impairment
Prevent chronic symptoms.
Reduce use of inhaled short-acting beta agonists.
Maintain normal or near-normal pulmonary function.
Maintain normal activity levels.
Meet patient/family expectations of asthma care.
Reduce risk
Prevent recurrent exacerbations and minimize emergency department (ED) visits and hospitalizations.
Prevent loss of lung function.
Provide optimal therapy with minimal adverse drug reactions (ADRs)

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6
Q

Rule of twos for asthma treatment

A

have asthma symptoms/attacks more than twice a week.
wakes up due to asthma symptoms more than twice a month
needs to take prednisone by mouth more than twice a year

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7
Q

Drug Therapy for Asthma

A

Beta 2 agonists
Short Acting Beta Agonist (SABA) for rescue
Long Acting Beta Agonist (LABA) for control
Glucocorticoids (ICS)
Leukotriene modifiers
Methylxanthines
Anticholinergics
Short Acting Methylxanthines
Anticholinergics (SAMA)
Long Acting Methylxanthines
Anticholinergics (LAMA)
Anti-IgE treatment

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8
Q

Short acting Beta2-AdrenergicAgonists drug examples

A

Albuterol (AccuNeb, Proventil HFA, ProAir HFA, Ventolin HFA) and Levalbuterol (Xopenex, Xopenex HFA)

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9
Q

Short acting Beta2-AdrenergicAgonists Side effects

A

SE: tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, hyperglycemia

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10
Q

Short acting Beta2-AdrenergicAgonists mechanism

A

Beta2-adrenergic agonists stimulate beta2-adrenergic receptors, increasing the production of cyclic 3’5’ adenosine monophosphate (cAMP).
Increased cAMP relaxes airway smooth muscle and increases bronchial ciliary activity.

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11
Q

Inhaled Corticosteriod (ics) drug examples

A

Beclomethasone HFA (Qvar)
Budesonide DPI (Pulmicort)
Fluticasone propionate HFA (Flovent HFA)
Mometasone HFA (Asmanex HFA).

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12
Q

Inhaled corticosteroids side effects

A

Adverse effects: oral candidiasis & dysphonia, sodium and water retention, edema, hyperglycemia, ^appetite and weight gain.

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13
Q

Inhaled corticosteroids mechanism

A

Corticosteroids reduce airway inflammation by inhibiting or inducing the production of end-effector proteins.

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14
Q

LONG acting Beta2-Adrenergic Agonists (laba) description

A

Beta2-adrenergic agonists stimulate beta2-adrenergic receptors, increasing the production of cyclic 3’5’ adenosine monophosphate (cAMP).
Increased cAMP relaxes airway smooth muscle and increases bronchial ciliary activity.
Patient

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15
Q

LONG acting Beta2-Adrenergic Agonists Drugs

A

Salmeterol, Formoterol,Aformoterol, Vilanterol

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16
Q

LONG acting Beta2-Adrenergic Agonists side effects

A

SE: tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, hyperglycemia

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17
Q

LONG acting Beta2-Adrenergic Agonists Black Box Warning

A

BBW: LABA’s assoc. with increased risk of asthma related deaths
**Must be used with an ICS-never solo therapy

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18
Q

Leukotriene modifiers

A
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19
Q

C0mbined ICS and LABA

A

Symbicort and Advair are maintenance inhalers that combine an inhaled corticosteroid (ICS) with a long-acting beta agonist (LABA). These inhalers are used daily to help control inflammation in the lungs and keep the airways open.

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20
Q

main differences between Symbicort and Advair

A

Symbicort: budesonide, 6 and up, formoterol
Advair: fluticasone, 4 and up, salmeterol

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21
Q

Mast Cell Stabilizers Asthma

A

Cromolyn:
Solution for nebulization (20 mg/2 Ml)-initial dose is 20 mg QID.
Once asthma symptoms controlled, dose may be tapered to lowest effective dose (e.g., 20 mg three to four times a day).
2-4 weeks to achieve maximum benefit.

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22
Q

Methylxanthines mechanism

A

Methylxanthine bronchodilators (theophylline, aminophylline) relax bronchial smooth muscle, enhance diaphragmatic contractility, and have a slight anti-inflammatory effect

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23
Q

Methylxanthines dose

A

Theophylline & aminophylline - dosed to target plasma drug concentration. Therapeutic theophylline serum drug concentration range -10–20 mg/L.

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24
Q

Methylxanthines delivery methods

A

PO tablets, elixir, solution, IV

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25
Q

Methylxanthines side effects

A

Many drugs interact with Theophylline
Adverse effect: tachycardia, tremor, n/v, GI, seizures if serum conc. > 35mg/L

26
Q

Monoclonal Drugs example

A

Omalizumab (Xolair) is the only recombinant humanized monoclonal drug.

27
Q

Monoclonal drug dosage

A

Omalizumab is indicated for treatment of persons with severe persistent allergic asthma with total serum IgE levels from 30 to 700 IU/mL. The dose is based on the total serum IgE and patient weight.

28
Q

Monoclonal drug dosing considerations

A

Half life 20 days
Assess response to treatment after 16 weeks

29
Q

Monoclonal black box warning

A

BBW: may induce anaphylaxis

30
Q

Injection for
Moderate to Severe Persistent Asthma

A

XOLAIR

31
Q

Xolair precautions

A

Allergic reactions can occur; therefore, first dose is always administered in the provider’s office.

32
Q

Xolair candidates

A

moderate to severe persistent asthma in people 6 years of age and older
nasal polyps in people 18 years of age and older
chronic idiopathic urticaria (CIU, chronic hives without a known cause) in people 12 years of age

33
Q

Xolair administration

A

Patients may inject themselves with prefilled syringe once they’ve been taught proper technique.
1 or more injections administered subq every 2-4 weeks

34
Q

Bad Xolair side effects

A

Cancer
Inflammation of your blood vessels.
Fever, muscle aches, and rash.
Parasitic infections
Heart and circulation problems.

35
Q

Xolair Black Box Warning by FDA

A

WARNING: ANAPHYLAXIS up to 1 year after administration

36
Q

Common side effects of Xolair

A

12 years of age and older with asthma: joint pain in arms and legs, dizziness, feeling tired, itching, skin rash, bone fractures, and ear pain.
6 to less than 12 years of age with asthma: swelling inside nose, throat, or sinuses, headache, fever, throat infection, ear infection, abdominal pain, stomach infection, and nose bleeds.
In adults with nasal polyps: headache, injection site reactions, joint pain, upper abdominal pain, and dizziness.
In people with chronic idiopathic urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.

37
Q

National asthma education and prevention program (NAEPP)
Step 1 Asthma Treatment

A

SABA PRN

38
Q

National asthma education and prevention program (NAEPP)
Step 2 asthma Treatment

A

Low dose ICS
Alternative :
cromolyn, anti leukotriene, methyxanthines, or Nedocromil

39
Q

National asthma education and prevention program (NAEPP)
Step 3

A

Low dose ICS + LABA
Or medium dose ICS
Alternative
Low dose ICS + antileukotriene, methyxanthine, or zileuton

40
Q

Global Initiative for asthma (GINA)
Step 1-2 controller and preferred reliever

A

As needed low dose ICS - formoterol

Reliever: low dose ICS - formoterol

41
Q

Global Initiative for asthma (GINA)
Step 3 controller and preferred reliever

A

Low dose maintenance ICS - formoterol
Reliever: low dose ICS - formoterol

42
Q

Global Initiative for asthma (GINA)
Step 1 controller and alternative reliever

A

Take ICS whenever SABA needed
reliever: SABA

43
Q

Global Initiative for asthma (GINA)
Step 2 controller and alternative reliever

A

Low dose maintenance ICS
reliever: SABA

44
Q

Global Initiative for asthma (GINA)
Step 3 controller and alternative reliever

A

Low dose maintenance ICS + LABA
reliever: SABA

45
Q

Why not treat with SABA alone?

A

Regular use of SABA, even for 1–2 weeks, is associated with increased airway hyperresponsiveness (ahr), reduced bronchodilator effect, increased allergic response, increased eosinophils (e.g. Hancox, 2000; Aldridge, 2000)
Can lead to a vicious cycle encouraging overuse
Over-use of SABA associated with exacerbations and mortality
Starting treatment with SABA trains the patient to
regard it as their primary asthma treatment
The only previous option was daily ICS even when
no symptoms, but adherence is extremely poor
GINA changed its recommendation once evidence for
a safe and effective alternative was available

46
Q

Children 5 and younger GINA

A
47
Q

Children 6-11 GINA

A
48
Q

First-Line Treatment for Asthma

A

A short-acting rescue bronchodilator to be used as needed is required for all persons with asthma.
Inhaled Corticosteroids are the mainstay for patients with asthma
Chronic maintenance therapy with an asthma controller medication is indicated for persistent asthma:
Low-dose ICS are indicated for persons with mild persistent asthma (Step 2).
Medium-dose ICS are indicated for persons with moderate persistent asthma (Steps 3 and 4).
High-dose ICS are indicated for persons with severe persistent asthma (Steps 5 and 6).

49
Q

Managing Exacerbations

A

Treat with oral steroids to regain control.
Use a short burst of prednisone
Adults: 40 to 60 mg/day for 5 to 10 days
Children: 1 to 2 mg/kg daily (maximum 60 mg/day) for 3 to 10 days
Educate on early recognition of sx of decreased lung function and know the action plan for exacerbations

50
Q

Medication Monitoring

A

Once control is achieved, the patient is seen every 1 to 6 months to determine if a step up or step down in therapy is indicated.
The Expert Panel 3 Guidelines recommend the dose of inhaled corticosteroids be reduced about 25% to 50% every 2 to 3 months to lowest possible dose to maintain control.

51
Q

Stepwise approach 0-4
Step 1

A

SABA PRN

52
Q

Stepwise approach 0-4
Step 2

A

Preferred: Low Dose ICS
Alternative: Cromolyn or montelukast

53
Q

Stepwise approach 0-4
Step 3

A

Medium Dose ICS

54
Q

Stepwise approach 0-4
Step 4

A

Medium dose ICS + LABA or montelukast

55
Q

Stepwise approach 0-4
Step 5

A

High dose ICS + LABA or montelukast

56
Q

Stepwise approach 0-4
Step 6

A

High dose ICS + LABA or montelukast
Also oral steroids

57
Q

Stepwise approach 5-11
Step 1

A

SABA PRN

58
Q

Stepwise approach 5-11
Step 2

A

Preferred: Low dose ICS
Alternative: cromolyn, nexocromil, LTRA, or Theophylinw

59
Q

Stepwise approach 5-11
Step 3

A

Low dose ICS + LABA, LTRA, or theophylline

Or

Medium dose ICS

60
Q

Stepwise approach 5-11
Step 4

A

Preferred: Medium Dose ICS + LABA

Alternative: medium dose ICS + LTRA or theophylline

Asthma GINA (1 decks)

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