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NAPLEX Prep > Asthma > Flashcards

Asthma Flashcards

1
Q

how is asthma dx

A

measure baseline FEV-1
give albuterol
measure FEV-1
if there is >12% increase in FEV-1 - asthma dx

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2
Q

what are the criteria for step 1
what is/are the recommended treatments for this step?

A

asthma sx <2x/week

PRN low dose ICS - formoterol
or
low dose ICS - SABA

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3
Q

what are the criteria for step 2
what is/are the recommended treatments for this step?

A

asthma sx or need for SABA >2x/week

low dose ICS - formoterol for rescue
or
SABA rescue + ICS-LABA maintenance

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4
Q

what dose of ICS is always used in rescue

A

low dose ICS

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5
Q

what are the criteria for step 3
what is/are the recommended treatments for this step?

A

sx most days or waking at night 1+ x/week

low dose ICS-formoterol rescue and maintenance
or
SABA rescue + low dose ICS - LABA maintenance

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6
Q

what are the criteria for step 4
what is/are the recommended treatments for this step?

A

asthma sx daily or waking 1+ night a week or exacerbation upon initial presentation

low dose ICS-formoterol rescue + medium dose ICS - formoterol maintenance
or
SABA rescue + medium dose ICS-LABA maintenance

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7
Q

what are the criteria for step 5
what is/are the recommended treatments for this step?

A

beyond step 4 management, need referral

low dose ICS-formoterol rescue + high dose ICS - formoterol
or
SABA rescue + high dose ICS-LABA

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8
Q

how do we assess asthma control and when to step up therapy?

A

4 questions
daytime sx >2x/week?
nighttime awakenings?
SABA >2x/week?
activity limited 2/2 asthma?
0 yes’ = well controlled
1-2 yes’ = partly controlled, inc by 1 step
3-4 yes’ = uncontrolled, inc by 1-2 steps

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9
Q

what are the three main ICS for asthma

A

budesonide (Pulmicort)
fluticasone (Flovent, Arnuity)
mometasone (Asmanex)

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10
Q

what are the low dose ICS strengths of
budesonide
fluticasone
mometasone

A

budesonide 200-400mcg
fluticasone 100-250mg (MDI and DPI)
mometasone MDI 200-400mcg
DPI 110-220mcg

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11
Q

what are the low doses of ICS usually used for

A

rescue in combination with formoterol

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12
Q

budesonide + formoterol =

A

Symbicort

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13
Q

what are the medium dose ICS strengths of
budesonide
fluticasone
mometasone

A

budesonide >400-800mcg
fluticasone 250-500 (MDI and DPI)
mometasone MDI 200-400mcg
DPI 220-440mcg

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14
Q

what are the high dose ICS strengths of
budesonide
fluticasone
mometasone

A

budesonide >800mcg
fluticasone >500 (MDI and DPI)
mometasone MDI >400mcg
DPI >440mcg

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15
Q

what are the medium/moderate ICS doses usually used for

A

step 4

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16
Q

what are the high ICS doses usually used for

A

step 5

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17
Q

what are the characteristics of an MDI? what inhalers does this include?

A

HFA, Respimat, Symbicort, Dulera
shake before using
can use spacer
aerosolized liquid
HFA = propellant
slow, deep inhalation
need to be primed and re-primed after some time

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18
Q

what are the characteristics of an DPI? what inhalers does this include?

A

Diskus, Ellipta, Handihaler, Respiclick, Flexhaler
do not shake
fine powder
no propellant
need quick, forceful inhalation
no spacer!!
no priming

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19
Q

budesonide =

A

pulmicort

20
Q

fluticasone =

A

Flovent, Arnuity

21
Q

mometasone =

A

Asmanex

22
Q

budesonide + formoterol =

A

Symbicort

23
Q

fluticasone + salmeterol =

A

Advair

24
Q

fluticasone + vilanterol =

A

Breo

25
Q

mometasone + formoterol =

A

Dulera

26
Q

what ICS has a neb soln dosage form? why does this help?

A

budesonide
good for children

27
Q

counseling points for ICS

A

rinse and spit after use
inc risk fx, growth retardation, imm supp
SE: dysphonia, thrush, cough

28
Q

all ICS products are CI as …

A

monotherapy for asthma exacerbation

29
Q

albuterol
brands
dosage forms and dosing
SE

A

Ventolin HFA, Proair Respiclick, Proair HFA, Proventil HFA
MDI/DPI: 1-2 inhalations every 4-6h prn
nebulizer: 1.25-5mg q4-8h prn

SE: tremor, nervousness, palpitaitons, hyperglycemia, hypokalemia

30
Q

Qvar =

A

beclometasone

31
Q

a LABA must always be used with an

A

ICS

32
Q

salmeterol =

A

Serevent

33
Q

Spiriva =

A

tiotropium

34
Q

what ICS/LABA combinations are FDA approved for asthma?

A

fluticasone/salmeterol = Advair, Airduo
fluticasone/vilanterol = Breo
mometasone/formoterol = Dulera
budesonide/formoterol = Symbicort

35
Q

are there any LAMA/LABA/ICS products FDA approved for asthma?

A

yes
Trellegy (umeclidinium/vilanterol/fluticasone)

36
Q

montelukast
MOA
dosing
BBW

A

LTD4 receptor antagonist

1-5 yo = 4mg PO HS
6-14 yo = 6mg PO HS
>14 yo = 10mg PO HS
BBW: neuropsychiatric events

37
Q

theophylline
dosing
DDI

A

5mg/kg IBW LD
then 100-600mg MD

DDI: major 1A2 substrate

38
Q

signs of theophylline toxicity

A

persistent vomiting
arrhythmias
seizures

39
Q

who would not be a good candidate for theophylline

A

patients with epilepsy, arrhythmias, PUD

40
Q

what are the recommended tx for exercise induced asthma? how should the patient use the inhaler(s)?

A

SABA or low-dose ICS-formoterol

take 5-15 min before activity
SABA will last 2-3 hours
ICS-formoterol will last 12 hours

41
Q

what therapies are not recommended for asthma in pregnancy?

A

all are recommended to be continued in pregnancy

42
Q

what order should patients take their inhalers in? do they have to wait between doses

A

SABA, wait 60 sec then
LAMA, LABA, wait 60 sec then
ICS

43
Q

what are the benefits of spacers

A

increase drug delivery to lungs
dec risk of thrush
good for children or those with low hand-breath coordination

44
Q

what readings on a peak flow meter indicate what to do for asthma management?

A

> 80-100% - continue therapies
50-80% - set up asthma action plan, caution
<50% - emergency, go to ED

45
Q

what inhaler needs 2 sprays to be primed and required priming if not used for 7 days

A

Symbicort

46
Q

what inhalers require 4 sprays to prime and should be re-primed if not used for 7 days

A

Flovent
Dulera

47
Q

what inhalers require 4 sprays to prime and should be re-primed if not used for 14 days

A

Flovent
Proair

NAPLEX Prep (57 decks)

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