asthma Flashcards
FEV1
how much air can be forcefully exhaled in one second
FVC
after taking a deep breath, the maximum volume of air that is exhaled (how much air is exhaled)
FEV1/FVC
the percentage of total air compacity that can be forcefully exhaled in one second
guidelines
- Global Initiative for Asthma (GINA)
- NHLBI’s expert Pnale Report (EPR)
classification of asthma severity
step 1
daytime symptoms: <2x months
nighttime awakenings: none
classification of asthma severity
step 2
daytime symptoms: >=2x month but <= 4-5 days/week
nighttime awakenings: none
classification of asthma severity
step 3
daytime symptoms: most days
nighttime awakenings: >1x/week
classification of asthma severity
step 4
daytime symptoms: daily
nighttime awakenings: >=1x/week
Low-dose ICS + formoterol (combo ihnaler)
- 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
inhaled short-acting beta2 agonists
- PRN for acute asthma symptoms
- quickly reverses bronchoconstriction
- relievers (rescue drugs)
asthma medication class
systemic steroids
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
inhaled EPI
OTC, can be used intermittently for acute tx of mild asthma only
not included in guidelines
- relievers (rescue drugs)
asthma medication class
inhaled short-acting muscarinic antagonists (SAMAs), also called inhaled anticholinergics
used in combo w/ SABA during exacerbations
- relievers (rescue drugs)
asthma medication class
inhaled corticosteroids (ICS)
1st line for all pt w/ persistent asthma, the most effective anti-inflammatory drugs
- controllers (maintenance drugs)
asthma medication class
inhaled long-acting beta2 agonists (LABAs)
- 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
oral leukotriene receptor antagonists (LTRAs)
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
theophylline (oral or IV)
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
inhaled long-acting muscarinic antagonists (LAMAS), also called inhaled anticholinergics
can be used as add-on tx in pt w/ history of exacerbations despite ICS/LABA tx
- controllers (maintenance drugs)
asthma medication class
injectable monoclonal antibodies (SC or IV)
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
step 1
rescue inhaler
as needed low- low- dose ICS- formoterol
or
SABA + low- lose dose ICS (take together)
step 2
rescue inhaler
as needed low-dose ICS-formoterol
or
rescue inhaler
SABA
+
maintenance inhaler
low- dose ICS
step 3
rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
low-dose ICS-formoterol
or
rescue inhaler
SABA
+
maintenance inhaler
low dose ICS- LABA
step 4
rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
medium-dose ICS-formoterol
or
rescue inhaler
SABA
+
maintenance inhaler
medium- dose ICS- LABA
step 5
rescue inhaler
low-dose ICS-formoterol
+
maintenance inhaler
high-dose ICS-formoterol
or
rescue inhaler
SABA
+
maintenance inhaler
high- dose ICS- LABA
beta-2 agonists
SHOULD ONLY be used w/ ICS
SE: nervousness, tremor, tachycardia, hypoK, hyperglycemia, cough
MDI (HFA products): shake well before use
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
levalbuterol
xopenex
R-isomer of albuterol
- beta-2 agonists SABA
epi
asthmanefrin refill
OTC
- beta-2 agonists SABA
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
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
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
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
fluticasone
+ salmeterol
+ vilanterol
flovent HFA, Flovent Diskus, Arnuity Ellipta
+ Advair diskus, Advair HFA
+ Brio Ellipta
- ICS
Mometasone
+ formoterol
Asmanex
+ Dulera
- ICS
MDI
metered-dose inhalers
DPI
dry powder inhalers
brand name identifiers
MDIs: HFa, Respimat, or no suffix
DPIs: Diskus, Ellipta, Pressair, Handihaler, RespiClick, Flexhaler
dose delivery
MDIs: aerosolized liquid
DPIs: fine powder
propellant
MDIs: some use propellant (HFA)
DPIs: no propellant
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)
spacers
MDIs: can be used
decrease risk of trust w/ ICS
DPIs: can not be used
Shaking prior to use
MDIs: required for all products except: QWAR RediHaler, Alvesco, and Respimat
DPIs: Do not shake
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)
leukotriene modifying agents
leukotriene receptor antagonists reduce airway edema, constriction, and inflammation.
i
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
zafirlukast
accolate
protect from moister and light, dispense in original container
hepatic impairment contra!
increases the level of theophylline
zileuton
zyflo
inhibits leukotriene formation besides the normal antagonism
contra: hepatic impairment
theophylline
blocks phosphodiesterase, causing increase in CAMP and release of EPI from adrenal medulla cells.
tox: vomiting, arrhythmias, seizures, increase HR
metabolite: caffeine
omalizumab
xolair
inhibits gE binding
warning: anaphylaxis after any dose first or after
multi inhalations
wait 60 seconds between doses
use the bronchodilator first (SABA, LABA, SAMA) then ICS
