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asthma Flashcards

1
Q

FEV1

A

how much air can be forcefully exhaled in one second

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2
Q

FVC

A

after taking a deep breath, the maximum volume of air that is exhaled (how much air is exhaled)

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3
Q

FEV1/FVC

A

the percentage of total air compacity that can be forcefully exhaled in one second

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4
Q

guidelines

A
  • Global Initiative for Asthma (GINA)
  • NHLBI’s expert Pnale Report (EPR)
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5
Q

classification of asthma severity
step 1

A

daytime symptoms: <2x months
nighttime awakenings: none

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6
Q

classification of asthma severity
step 2

A

daytime symptoms: >=2x month but <= 4-5 days/week
nighttime awakenings: none

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7
Q

classification of asthma severity
step 3

A

daytime symptoms: most days
nighttime awakenings: >1x/week

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8
Q

classification of asthma severity
step 4

A

daytime symptoms: daily
nighttime awakenings: >=1x/week

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9
Q

Low-dose ICS + formoterol (combo ihnaler)

A
  • PRN for acute asthma symptoms
  • formoterol is a long-acting beta2 agonist (LABA) w/ fast onset. this combo reduced the risk of exacerbation compared to SABA alone
  • relievers (rescue drugs)
    asthma medication class
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10
Q

inhaled short-acting beta2 agonists

A
  • PRN for acute asthma symptoms
  • quickly reverses bronchoconstriction
  • relievers (rescue drugs)
    asthma medication class
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11
Q

systemic steroids

A

injection used during exacerbation
oral: used during an exacerbation or for severe asthma that is difficult to control with other combo drugs

  • relievers (rescue drugs)
    asthma medication class
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12
Q

inhaled EPI

A

OTC, can be used intermittently for acute tx of mild asthma only
not included in guidelines

  • relievers (rescue drugs)
    asthma medication class
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13
Q

inhaled short-acting muscarinic antagonists (SAMAs), also called inhaled anticholinergics

A

used in combo w/ SABA during exacerbations

  • relievers (rescue drugs)
    asthma medication class
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14
Q

inhaled corticosteroids (ICS)

A

1st line for all pt w/ persistent asthma, the most effective anti-inflammatory drugs

  • controllers (maintenance drugs)
    asthma medication class
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15
Q

inhaled long-acting beta2 agonists (LABAs)

A
  • used in combo w/ ICS (never to be used alone due to increased ris of adverse outcomes)
  • preferred add-on to ICS
  • controllers (maintenance drugs)
    asthma medication class
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16
Q

oral leukotriene receptor antagonists (LTRAs)

A

alternative to LABA in combo w/ ICS, can be added on ICS/LABA tx
most commonly used in children

  • controllers (maintenance drugs)
    asthma medication class
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17
Q

theophylline (oral or IV)

A

least desirable opt for add-on, due to adverse effects and drug interactions and the need to monitor serum drug concentrations

  • controllers (maintenance drugs)
    asthma medication class
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18
Q

inhaled long-acting muscarinic antagonists (LAMAS), also called inhaled anticholinergics

A

can be used as add-on tx in pt w/ history of exacerbations despite ICS/LABA tx

  • controllers (maintenance drugs)
    asthma medication class
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19
Q

injectable monoclonal antibodies (SC or IV)

A

add-on in pt w/ persistent severe asthma of a specific type:
omalizumab: for severe allergic asthma
mepolizumab, reslizumab, bevacizumab, and dupilumab: for severe eosinophilic asthma

  • controllers (maintenance drugs)
    asthma medication class
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20
Q

step 1

A

rescue inhaler
as needed low- low- dose ICS- formoterol
or
SABA + low- lose dose ICS (take together)

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21
Q

step 2

A

rescue inhaler
as needed low-dose ICS-formoterol

or

rescue inhaler
SABA
+
maintenance inhaler
low- dose ICS

22
Q

step 3

A

rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
low-dose ICS-formoterol

or

rescue inhaler
SABA
+
maintenance inhaler
low dose ICS- LABA

23
Q

step 4

A

rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
medium-dose ICS-formoterol

or

rescue inhaler
SABA
+
maintenance inhaler
medium- dose ICS- LABA

24
Q

step 5

A

rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
high-dose ICS-formoterol

or

rescue inhaler
SABA
+
maintenance inhaler
high- dose ICS- LABA

25
beta-2 agonists
SHOULD ONLY be used w/ ICS SE: nervousness, tremor, tachycardia, hypoK, hyperglycemia, cough MDI (HFA products): shake well before use
26
albuterol
ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA most albuterol inhallers contain 200 inhalations/canister. except Ventolin comes in 200 and 60 inhalation/canister - beta-2 agonists SABA
27
levalbuterol
xopenex R-isomer of albuterol - beta-2 agonists SABA
28
epi
asthmanefrin refill OTC - beta-2 agonists SABA
29
salmeterol
serevent diskus - increased risk of asthma-related death, keep this in mind! with ICS only!!!! - increased risk of asthma-related hospitalization in peds and adolescents pt - not for acute bronchospasm rest is the same as SABA for SE/monitoring - beta-2 agonists LABA
30
inhaled corticosteroids
used as needed in combo with formoterol or a SABA for acute. and as monotherapy or combo w/ laba for maintenance tx. warning: increased risk of fractures, growth retardation (in children), and immunosuppression SE: dysphonia (difficulty speaking), oral candidiasis (trust), cough rinse mouth w/ water and spit out after each use to prevent thrush
31
beclomethasone
QVAR redihaler breath-activated aerosol w/characteristics of a DPI and MDI DO NOT shake or use w/ a spacer DOES NOT need priming or activation! - ICS
32
budesonide + formoterol
pulmicort flexhaler, plumicort respules (nebulizer suspension) + symbicort only ICS w/ nebulizer solution used in children a lot Plumicort respules: only use w/ jet nebulizer connected to air compression, do not use ultrasonic nebulizer - ICS
33
fluticasone + salmeterol + vilanterol
flovent HFA, Flovent Diskus, Arnuity Ellipta + Advair diskus, Advair HFA + Brio Ellipta - ICS
34
Mometasone + formoterol
Asmanex + Dulera - ICS
35
MDI
metered-dose inhalers
36
DPI
dry powder inhalers
37
brand name identifiers
MDIs: HFa, Respimat, or no suffix DPIs: Diskus, Ellipta, Pressair, Handihaler, RespiClick, Flexhaler
38
dose delivery
MDIs: aerosolized liquid DPIs: fine powder
39
propellant
MDIs: some use propellant (HFA) DPIs: no propellant
40
admin
MDIs: slow, deep inhalation while pressing the canister (hand-breath coordination) DPIs: quick, forceful inhalation (breast activated some delivery; no need to press anything)
41
spacers
MDIs: can be used decrease risk of trust w/ ICS DPIs: can not be used
42
Shaking prior to use
MDIs: required for all products except: QWAR RediHaler, Alvesco, and Respimat DPIs: Do not shake
43
Priming
MDIs: before first use and if not use for a certain period of time DPIs: no need except for Flexhaler (prior to first use)
44
leukotriene modifying agents
leukotriene receptor antagonists reduce airway edema, constriction, and inflammation. i
45
montelukast
singulair tablet, chewable tablet, packet - neuropsychiatric evetns - granules: can me admin directly in the mouth, dissolve in 5ml of breast milk or formula or mixed w/ spoonful of applesauce, carrots or rice or ice cream (nothing else), use within 15min of opening
46
zafirlukast
accolate protect from moister and light, dispense in original container hepatic impairment contra! increases the level of theophylline
47
zileuton
zyflo inhibits leukotriene formation besides the normal antagonism contra: hepatic impairment
48
theophylline
blocks phosphodiesterase, causing increase in CAMP and release of EPI from adrenal medulla cells. tox: vomiting, arrhythmias, seizures, increase HR metabolite: caffeine
49
omalizumab
xolair inhibits gE binding warning: anaphylaxis after any dose first or after
50
multi inhalations
wait 60 seconds between doses use the bronchodilator first (SABA, LABA, SAMA) then ICS

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