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NAPLEx > asthma > Flashcards

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
Q

beta-2 agonists

A

SHOULD ONLY be used w/ ICS
SE: nervousness, tremor, tachycardia, hypoK, hyperglycemia, cough
MDI (HFA products): shake well before use

26
Q

albuterol

A

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
Q

levalbuterol

A

xopenex
R-isomer of albuterol
- beta-2 agonists SABA

28
Q

epi

A

asthmanefrin refill
OTC
- beta-2 agonists SABA

29
Q

salmeterol

A

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
Q

inhaled corticosteroids

A

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
Q

beclomethasone

A

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
Q

budesonide
+ formoterol

A

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
Q

fluticasone
+ salmeterol
+ vilanterol

A

flovent HFA, Flovent Diskus, Arnuity Ellipta
+ Advair diskus, Advair HFA
+ Brio Ellipta
- ICS

34
Q

Mometasone
+ formoterol

A

Asmanex
+ Dulera
- ICS

35
Q

MDI

A

metered-dose inhalers

36
Q

DPI

A

dry powder inhalers

37
Q

brand name identifiers

A

MDIs: HFa, Respimat, or no suffix

DPIs: Diskus, Ellipta, Pressair, Handihaler, RespiClick, Flexhaler

38
Q

dose delivery

A

MDIs: aerosolized liquid

DPIs: fine powder

39
Q

propellant

A

MDIs: some use propellant (HFA)

DPIs: no propellant

40
Q

admin

A

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
Q

spacers

A

MDIs: can be used
decrease risk of trust w/ ICS

DPIs: can not be used

42
Q

Shaking prior to use

A

MDIs: required for all products except: QWAR RediHaler, Alvesco, and Respimat

DPIs: Do not shake

43
Q

Priming

A

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
Q

leukotriene modifying agents

A

leukotriene receptor antagonists reduce airway edema, constriction, and inflammation.
i

45
Q

montelukast

A

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
Q

zafirlukast

A

accolate
protect from moister and light, dispense in original container
hepatic impairment contra!
increases the level of theophylline

47
Q

zileuton

A

zyflo
inhibits leukotriene formation besides the normal antagonism
contra: hepatic impairment

48
Q

theophylline

A

blocks phosphodiesterase, causing increase in CAMP and release of EPI from adrenal medulla cells.
tox: vomiting, arrhythmias, seizures, increase HR
metabolite: caffeine

49
Q

omalizumab

A

xolair
inhibits gE binding
warning: anaphylaxis after any dose first or after

50
Q

multi inhalations

A

wait 60 seconds between doses
use the bronchodilator first (SABA, LABA, SAMA) then ICS

NAPLEx (75 decks)

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