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Naplex 2025 > Asthma > Flashcards

Asthma Flashcards

1
Q

What is Asthma?

A
  • Chronic airway inflammation & bronchoconstriction that causes obstruction (coughing, SOB, chest tightness, wheezing)
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2
Q

What are some of the triggers & comorbid condition of asthma?

A
  • Triggers: Pollution, Cigs, Weather changes, Pets, Dust, Pollen, Drugs (Aspirin. or NSAIDs)
  • Comorbid: Infections, Allergic Rhinitis, GERD, Obesity, OSA, Anxiety, Stress…
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3
Q

What is the way that asthma is diagnosed?

A
  • SPIROMETRY, which looks at;
  • FEV1: exhaled in 1 sec
  • FVC: max volume exhaled after deep breath
  • FEV1/FVC: total air that can be exhaled in 1 sec
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4
Q

What are some of the things to do to help control risk factors for asthma?

A
  • AVOID exposure or perfoming smoking
  • Annual FLU shot (maybe Pneumonia or COVID)
  • Allergen Sensitivity Test if asthma is related to it
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5
Q

What are relivers (rescue) drugs that are used for Asthma and what are some of the drug classes?

A
  • Work within minutes to open airways for the acute symptoms
  • ICS + Fomoterol or SABA (Steroids, SAMA, Epi)
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6
Q

What are controller (maintenance) drugs that are used for Asthma and what are some of the drug classes?

A
  • used daily to help with reducing inflammation & control symptoms
  • ICS (1st line), SAMA, SABA, LTRAs, Monoclonal antibodes
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7
Q

Per the GINA Guidelines what do the individual steps mean for the asthma treatment algorithem?

step 1 - 5

A
  • Step 1: symptoms < 2x / months
  • Step 2: symptoms or SABA for > 2x / months
  • Step 3: symtpoms of most days or waking at night > 1x / week
  • Step 4/5: symptoms daily, waking at night > 1x / week, or exacerbations
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8
Q

What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 1?

“symptoms < 2x / month”

A
  • Low dose ICS + Fomoterol (PRN) [Rescue] OR
  • SABA + Low odse ICS (taken together) [Rescue]

BOTH are rescue

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9
Q

What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 2?

“symptoms or SABA usage . 2x / month”

A
  • Low dose ICS + Fomoterol (PRN) [Rescue] OR
  • SABA or ICS-SABA + Low dose ICS [Rescue + Maintenance]
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10
Q

What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 3?

‘“symptoms mose days or waking at night > 1x / week”

A
  • Low dose ICS-Fomoterol + Low dose ICS-Fomoterol [Rescue + Maintenance] OR
  • SABA or ICS-SABA + Low dose ICS-LABA [Rescue + Maintenance]
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11
Q

What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 4/5?

A
  • Low dose ICS-Fomoterol + Med-High dose ICS-Fomoterol [Rescue + Maintenance] OR
  • SABA or ICS-SABA + Med-High dose ICS-LABA [Resuce + Maintenance]
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12
Q

What is the MOA for the Beta 2 agonists that are used for asthma?

A
  • Bind to the beta 2 receptor which causes relaxation of smooth muscle = bronchodilation
  • SABA or LABA
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13
Q

What are the Short Acting (SABAs) Beta 2 Agonist that are used for Asthma?

A
  • Albuterol (ProAir HFA or RespiClick, Ventilin HFA, Proventil HFA) 90 mcg/inhalation
  • Levalbuterol
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14
Q

What are some of the side effects for the SABAs that are used in asthma?

A
  • Nervousness
  • Tremor
  • Tachycardia
  • Palpitations
  • Cough
  • Hyperglycemia
  • Decrease Potassium
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15
Q

What are some addtional notes for the SABAs that are used for asthma?

A
  • MDIs: need shaken well before use
  • Most albuterol is 200 inhal/canister BUT Ventolin has 200 and 60
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16
Q

What are the Long Acting (LABA) Beta 2 Agonist that are used for Asthma?

A
  • Salmeterol (Serevent Diskus)
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17
Q

What are some boxed warnings for Salmeterol used in asthma?

A
  • Increased risk of asthma related deaths (ONLY in combo with ICS)
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18
Q

What is the MOA for the Inhaled Corticosteroids (ICS) used for asthma?

A
  • Reduce inflamationin airways = reduce asthma symptoms
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19
Q

What are some of the ICSs that are used for asthma?

A
  • Beclomethasone (QVAR)
  • Budesonide (Pulmicort, Arunity Ellipta) + Fomoterol (Symbicort)
  • Fluticasone (Flovent) + Samleterol (Advair); + Vilanerol (Breo Ellipta)
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20
Q

What are some of the warnings for the ICS used in Asthma?

A
  • Increased risk of fractures, Growth Retardation in kids, immunosuppression
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21
Q

What are some of the side effects for the ICS used in asthma

A
  • Difficulty speaking, Thrush, Cough
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22
Q

What are some of the Additional Notes for the ICS used for asthma?

A
  • Rinse out mouth with water to prevent thrush
  • Budesonide is ONLY ICS with Nebs (Repsules)
  • QVAR = DO NOT SHAKE
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23
Q

What ICS is approved for asthma?

A
  • Beclomethasone (QVAR)
  • Budesonide (Pulmicort)
  • Fluticasone (Flovent, Arunity)
24
Q

What ICS is approved for COPD?

Covered in COPD section

A
  • NO single agent
25
What **LABA** is approved for **Asthma**?
- Salmeterol (Serevent Diskus)
26
What **LABA** is approved for **COPD**? ## Footnote Covered in the COPD section
- **Salmeterol (Serevent Diskus)** - Formoterol - Arformoterol - Olodaterol
27
What **LAMA** is approved for **Asthma**?
- Tiotropium (Spiriva)
28
What **LAMA** is approved for **COPD**? ## Footnote Covered in the COPD section
- **Trotropium (Spiriva)** - Aclidinium (Tudorze) - Revefenacin - Umeclidinium (Incurse Ellipta)
29
What **ICS/LABA** is approved for **Asthma**?
- Budenoside/Formoterol (**Symbicort**) - Fluticasone/Salmeterol (**Advair**) - Mometasone/Formoterol (**Dulera**) - Fluticasone/Vilanerol (**Breo**)
30
What **ICS/LABA** is approved for **COPD**?
- Budenoside/Formoterol (**Symbicort**) - Fluticasone/Salmeterol (**Advair**) - Fluticasone/Vilanerol (**Breo**)
31
What **LABA/LAMA** is approved for **asthma**?
- **NONE**
32
What **LABA/LAMA** is approved for **COPD**?
- Aclidinium/Fomoterol (Duaklir) - Clycopyrrolate/Fomoterol (Bevespi) - Tiotropium/Olodaterol (**Stiolto**) - Umeclidinium/Vilanterol (**Anoro**)
33
What **ICS/LABA/LAMA** is approved for **Asthma**?
- Umeclidinium/Valanterol/Fluticasone (**Trelegy**)
34
What **ICE/LABA/LAMA** is approved for **COPD**?
- Umeclidinium/Valanterol/Fluticasone (**Trelegy**) - Glycopyrrolate/Formoterol/Budesonide (**Breztri**)
35
What are some of the **key features** for **MDIs**?
- i.e.; HFAs or Repimats or NO suffix - **SLOW, DEEP** inhalation while pressing - Spacer can be used - Shake before use & prime first dose
36
what are some **key features** for **DPIs**?
- i.e.; Diskus, Ellipta, Pressair, Handihaler, RespiClick, Flexhaler - **Dry Powder** - **QUICK, FORCEFUL** inhalation - NO Spacer; DO NOT shake and NO Priming
37
What is the **MOA** for the **Leukotriene Modifying Agents (LTRAs)** used for **Asthma**
- Mediators for airway inflammation = reduce airway edema, constrictions and inflammation
38
What are the **LTRAs** that are used for **asthma**?
- **Montelukast (Singular)** - Zafirlukast - Zileuton
39
What are some of the **boxed warnings/warnings** for **montelukast** used for **asthma**?
- Neuropsychiatric Events (increase mood changes and suicidal thoughts)
40
What are some of the **side effects** for **montelukast** used in **asthma**?
- Headache, Dizziness, ab pain, Increase LFTs, URTis
41
What are some **additional notes** for **montelukast** used in **asthma**?
- Take in the **Evening** - Monte Granules: Can be taken directly into mouth or with Breast Milk/formula, Applesaue, carrots, rice or ice cream (NOTING ELSE) - 1 - 5 yo = 4 mg & 6 - 14 yo = 5 mg
42
What is the **MOA** for **Theophylline** used for **asthma**?
- Blocks phosphodiesterase = increse in cAMP & Epi = bronchodilation (limited by decreased effectiveness and drug interactions)
43
What are some of the **side effects** for **Theophylline** used for **asthma**?
- N/V, Headache, Insomia, Increase HR, Tremor, Nervousness - **Toxicity**: Presistant vomiting, Arrhythmias, seizures
44
what are some **additional notes** for **Theophylline** used for **asthma**?
- Amino to Theo = **x 0.8** - Theo to Amino = **/ 0.8**
45
What is the **MOA** for the **IgG monoclonal antibodies** used for **asthma**? ## Footnote -
- **Inhibits IgE binding** to the IgE receptor on Mast Cells and Basophils
46
What are the **different monoclonal antibody** class that are used for **Asthma**?
- IgG - Interleukin Receptor Antagonist - Human Thymic Stromal Lymphopoietin Blocker
47
What is the **IgG Monoclonal Antibodies** that is used for **asthma**?
- Omalizumab (Xolair)
48
What is the **Administration and notes** for **xolair**?
- Given **SubQ** IN the healtcare setting - For **severe asthma**, those with positive skin test - Boxed warning: **Anaphylaxis**
49
What are some of the **Interleukin Receptor antagonsts** that are used for **asthma**?
- Mepolizumab (Nucala) **SubQ** - Reslizumab (Cinqair) **IV** - Benralizumab (Fasenra) **SubQ** - **Dupilumab (Dupixent) SubQ**
50
What is the best way to **prevent exercise-induced bronchospasm** within **asthma**?
- SABA or Low dose ICS-Fomoteral **5 - 15 mins** before exercise ## Footnote **Salmeterol** could be used BUT it HAS to be in combo with ICS
51
What is the way to **Keep control** of the **asthma** during **pregnancy**/
- ICS (daily or PRN)
52
What is the **proper timing** and **order** of inhalers if given multiple for **asthma**?
- SABA (bronchodilator 1st) - WAIT 60 secs - LAMA or LAB (other bronchodilator) - WAIT 60 secs - ICS ## Footnote **bronchodilators** help the ICS get deeper into the lungs
53
What is a **spacer** and what is the importance of using one?
- Helps with drug deliverly - Best used for **Kids** or those with **Dexterity issues**
54
What are the **proper steps** to take when using a **MDI**? ## Footnote i.e.; Albuterol, Symbicort, Flovent HFA, Dulera...
- Step 1: **Shake** inhaler for **5 secs** before each spray and **prime** 2 - 4 times (away from faces) - Step 2: Breathe **out fully** through mouth then place the piece in mouth fully closing lips around it - Step 3: Breathe in **SLOW, DEEP** while pressing the top of the cantiser down. **Hold breathe** for **10 secs** then breathe normally (rinse mouth out if ICS)
55
What are the **proper steps** to take when using a **DPI**? ## Footnote i.e.; Advair
- Step 1: Push thumb grip away to prime it (Snaps into spot) - Step 2: hold diskus **flat** with mouthpiece toward you - Step 3: Breath out **away** from diskus - Step 4: place mouth around mouthpiece closing completly. **QUICK, DEEP, FAST** breathe in holding for 10 secs - Step 5: Breath normally, closes the diskus (slide back to you) and rinse month out with water --> spit
56
What are the **proper steps** to take when using a **Flexhaler** ## Footnote i.e.; budesonide flexhaler
- Step 1: Twist off white cover - Step 2: Twist brown base until **click** is heard = dose loaded - Step 3: Turn head away from inhalar and breath out - Step 4: Place mouth arounf mouthpiece tightly and breath **DEEP, FAST** - Step 5: Replace cap and **rinse mouth** with water --> spit

Naplex 2025 (47 decks)

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