Asthma Flashcards
What are the 2 MOAs of B2 agonists?
1) Bronchodilators
2) Inhibition of release of immediate hypersensitivity mediators from mast cells
What is the tolerance of B2 agonists?
Can occur with chronic administration and seems to plateau after about 1 week of regular therapy but response recovers rapidly after only 3 days of nonuse
What has a BLACK BOX WARNING that says it’s not to be used as monotherapy for long term control bc of an increased risk of asthma-related death?
Long-acting (LABA) (like Salmeterol (Serevent) and Formoterol (Foradil, Performist))
What are the preferred concomitant therapy with ICSs in 12+y/o steps 1-5 and 6-11 years of age steps 3-5?
Controller / reliever LABAs
(Salmeterol (Serevent) and Formoterol (Foradil, Performist))
1) Give 3 examples of SABAs
2) Give 2 examples of LABAs
1) Albuterol (Ventolin, ProAir, Proventil) –Rx
Levalbuterol (Xopenex) – Rx
Epinephrine (Primatene Mist) – OTC
2) Salmeterol (Serevent)
Formoterol (Foradil, Performist)
Who is continuous B2 agonist nebulization recommended for?
1) Patients having an unsatisfactory response (achieving less than 50% of normal FEV1 or PEF) following the initial three doses (every 20 minutes) of aerosolized β2-agonists 2) Potentially for patients presenting initially with PEF or FEV1 values of less than 30% of predicted normal
True or false: An elevated heart rate is not an indication to use lower doses or to avoid using inhaled β2-agonists
True
What is the MOA of corticosteroids?
Possible effect on beta receptors:
-May increase the number of receptors
-May improve receptor responsiveness to adrenergic stimulation
List 5 examples of ICSs
1) Beclomethasone
2) Budesonide
-also nebulizer
3) Ciclesonide
4) Flunisolide
5) Mometasone
(all of the above are inhalers)
How do you dose Budesonide?
1) 90 or 180 mcg/ dose DPI, Flexhaler
(15-30% lung delivery)
2) 200 and 500 mcg ampules, 1mg
(5-8%)
What are the DPIs of Budesonide?
1) Low: 180-360/180-540
2) Med: 360-720/540-1080
3) High: >720/ >1080
Systemic Corticosteroids:
1) How long are they dosed for?
2) Give examples
1) Adults 5-7 days, kids 3-5 days (until PEF reaches 70%)
2) Dexamethasone (Decadron), methylprednisolone (Medrol Dosepak), prednisolone (Prelone), prednisone (Deltone) or hydrocortisone
1) List 3 local effects of corticosteroids
2) List 2 long-term systemic effects of corticosteroids
1) Cough, dysphonia, oropharyngeal candidiasis
2) Adrenal axis suppression; immunosuppression
Anticholinergics:
1) What is their MOA?
2) Which one of these can decrease sputum volume long-term?
1) Competitive inhibitors of muscarinic receptors
2) Ipratropium
Give 2 examples of short-acting anticholinergics
1) Ipratropium (Atrovent)
2) DuoNeb (albuterol / ipratropium nebulizer solution)
Give an example of a long-acting anticholinergic used for asthma
Tiotropium (Spirva Respimat; do not use handihaler for asthma)
1) What is the MOA of leukotriene modifiers?
2) What are some side effects?
1) Reduction of production or action of leukotrienes in inflammation and allergy; reduces airway edema and smooth muscle contraction
2) HA, GI upset, psychiatric effects
INCREDIBLY Rare: idiosyncratic syndrome similar to the Churg–Strauss syndrome, HF, vasculitis
Leukotriene Modifiers: Give 3 examples
1) Montelukast (Singulair)
2) Zafirlukast (Accolate)
3) Zileuton (Zyflo)
Give 2 examples of biologics
1) Omalizumab (Xolair)
2) Dupilumab (Dupixent)
1) What does Omalizumab (Xolair) have a black box warning for?
2) What is its dosing based on?
1) Anaphylaxis (even up to 12 mo after)
2) Weight and IgE levels
What is the MOA of Dupilumab/ Dupixent?
Interluekin-4 antagonist
Give examples of Recombinant Interleukin-5 Antagonists
1) Benralizumab
2) Mepolizumab
3) Reslizumab
Give an example of a mast cell stabilizer
Cromolyn
How long do you need to wait between puffs for SABAs?
15-30 seconds
How should pts monitor their PEF?
The green zone is equal to 80% to 100%, the yellow zone is equal to 50% to 79%, and the red zone is less than 50%
What are considered the preferred long-term control therapy for persistent asthma in all patients due to their potency and consistent effectiveness?
ICSs
Differentiate between glucocorticoids and mineralocorticoids
Glucocorticoids – immune system response
Mineralocorticoids – blood pressure response / electrolytes (retain sodium and eliminate potassium)
How is acute severe asthma defined?
FEV1 <40% or SPO2 of <90%
Define Exercise-induced bronchospasm
Drop in FEV1 of 10% or greater from baseline; return of baseline function within ≈ 30 minutes
Experts consider nocturnal symptoms to be a sign of __________________ asthma
inadequately treated persistent
For those patients inadequately controlled on low-dose ICSs, what two actions can you choose from?
An increased dose of the ICS or the combination of ICS and LABA
True or false: ICS use, even with low doses, causes reductions in growth velocity in children
True
Osteoporosis, cataracts, and skin bruising can all be side effects of what?
ICSs
What do you need to know about treating asthma in pregnancy?
1) Low-dose ICSs recommended as preferred treatment for mild persistent asthma with the addition of a LABA if not adequately controlled
2) Avoid stepping down therapy during gestation
-Budesonide and albuterol are preferred drugs
3) Patients who are well-controlled on a particular ICS should remain on current treatment
4) During delivery, fentanyl, rather than morphine, should be used for pain control
-Morphine may induce more histamine release compared to fentanyl
Give some risk factors for death bc of asthma
No current use of ICSs; overuse of short-acting inhaled β2-agonist therapy (more than one canister per month); history of psychiatric disease or psychosocial problems; poor medication adherence; lack of a written asthma action plan
The primary therapy of acute exacerbations of asthma is pharmacologic, which includes what?
1) Short-acting inhaled β2-agonists
2) Depending on the severity: systemic corticosteroids, inhaled ipratropium, intravenous magnesium sulfate, and O2
What therapy, instead of oxygen, reduces resistance to flow and increases ventilation by converting turbulent flow to more efficient laminar flow?
Heliox
What will acute asthma lab values look like on corticosteroids?
1) Leukocytosis: No left shift
2) ↑ glucose and lactic acid
What will acute asthma lab values look like on B2 agonists?
1) Decreases in potassium, magnesium, and phosphate
-Concern for patient with CVD or concomitant diuretics
2) ↑ glucose and lactic acid
