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Asthma Flashcards

0
Q

S/sx of asthma? U

A

Wheezing

Breathlessness

Chest tightness

Coughing

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1
Q

What’s asthma?

A

Chronic inflammatory disorder of the airways in which many cells, and cellular elements play a role in particular, mast cells, eosinophils, neutrophils, T lymphocytes, macrophages and epithelial cells

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2
Q

List the common triggers of asthma

A

Allergens e.g. Airborne pollens

Drugs e.g aspirin

Environmental e.g. Cold air, fog

Exercise e.g. Cold air

Occupational e.g. Bakers

Respiratory infections e.g. Respiratory syncytial virus (RSV)

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3
Q

List drugs that may trigger asthma

A

Aspirin

NSAIDs

Sulfites

Non-selective beta-blocker

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4
Q

Classify drugs used to treat asthma? U

A

Controllers

OR

Relievers

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5
Q

Define controller asthma meds

A

Drugs taken on a chronic daily basis to keep asthma under control, primarily by reducing inflammation

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6
Q

What’s the primary MOA of controller asthma meds?

A

Primarily by reducing inflammation

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7
Q

Define asthma reliever meds

A

Used as needed to quickly reverse bronchoconstriction

OR

Preventively for exercise-induced bronchospasm (EIB)

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8
Q

What’s the preferred delivery vehicle of asthma meds?

A

Inhaled forms, which deliver drugs directly into the lungs and have reduced toxicity

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9
Q

What’s the most effective and preferred controller asthma med?

A

Inhaled steroids (glucocorticosteroids)

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10
Q

What’s the most effective and preferred reliever asthma med for acute bronchospasm and for prevention of EIB in both adults and children and pregnancy?

A

Rapid-acting beta-agonists (primarily Albuterol)

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11
Q

What does increased use of reliever asthma meds imply? Solution?

A

Indicates worsening asthma control and indicates the need to reassess tx

Primary tx is an increase in inhaled steroid dose

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12
Q

List main classes of asthma rescuers - agents commonly used in asthma exacerbation

A

Short-acting beta2-agonists

Systemic steroids (inj or oral)

Anticholinergic

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13
Q

List main classes of controller asthma meds - agents used in long-term maintenance therapy

A

Inhaled steroids

Long-acting beta2-agonists (taken with steroids)

Leukotriene modifying agents

Theophylline

Omalizumab (Xolair)

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14
Q

MOA of beta2-agonists?

A

Bind to beta2 receptors causing relaxation of bronchial smooth muscle resulting in bronchodilation - inhaled route is the preferred route of admin

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15
Q

List short-acting beta2-agonists (SABAs) - rescue meds

A

Racepinephrine (Asthmanefrin atomizer)

Albuterol (Ventolin HFA, Proventil HFA, ProAir HFA)

Levalbuterol (Xopenex, Xopenex HFA)

Purbuterol (Maxair Autohaler)

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16
Q

What’s the brand name of Albuterol? Rescue asthma med

A

Ventolin HFA, Proventil HFA, ProAir HFA

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17
Q

What’s the brand name of Levalbuterol? Rescue asthma meds

A

Xopenex, Xopenex HFA

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18
Q

Which of the SABAs should not be used in asthma? Why not?

A

Racepinephrine (Asthmanefrin atomizer)

Bcuz it’s not beta2 selective

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19
Q

SE of SABAs?

A

Tremor

Shakiness

Lightheadedness

Cough

Palpitations

Hypokalemia

Tachycardia

Hyperglycemia

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20
Q

How to use MDIs?

A

Shake well before use

Prime prior to first use (3-4 sprays into the airway from face) AND again if not used for > 2weeks

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21
Q

When do you need to increase maintenance therapy?

A

Using SABAs > 2 days/week

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22
Q

What’s the drug of choice for exercise-induced bronchospasm (EIB)?

A

SABAs

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23
Q

List agents under long-acting beta2-agonist (LABAs)

A

Salmeterol (Serevent Diskus)

Salmeterol + Fluticasone (Advair Diskus, Advair HFA) -LABA + corticosteroids

Formoterol (Foradil Aerolizer)

Formoterol + Budesonide (Symbicort) - LABA + corticosteroids

NOTE: SABAs and LABAs end with “terol” e,g albuTEROL

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24
What's the brand name of salmeterol + Fluticasone? LABAs + corticosteroids
Advair Diskus/ Advair HFA
25
What's the brand name of formoterol + Budesonide? LABA + corticosteroid
Symbicort
26
What's the dose of Advair Diskus (Salmeterol + Fluticasone)?
100, 250, 500mcg Fluticasone + 50mcg salmeterol >= 4 yrs
27
What's the dose of Advair HFA (Salmeterol + Fluticasone)?
45, 115, 230 mcg Fluticasone + 21mcg salmeterol >= 12 yrs
28
What's the dose of formoterol + Budesonide (Symbicort)? LABAs
80, 160mcg Budesonide + 4.5 mcg formoterol >= 12yrs
29
What's the black box warning of LABAs?
Increased risk of asthma related deaths Don't use as monotherapy in pts with persistent asthma
30
Howz LABAs used? (Salmeterol, advair Diskus, advair HFA, Symbicort etc
As adjunctive therapy in pts are currently receiving but not adequately controlled on long-term asthma control med eg inhaled corticosteroids
31
Are LABAs recommended for long-term use in asthma?
No! Once asthma is controlled, assess pt at regular intervals and step down LABAs until d/c, if possible, without loss of asthma
32
Howz Foradil (Formoterol) LABAs stored? (Controller med)
Fridge in the pharmacy Pt can keep at room temp for 4 months
33
List drugs under corticosteroids (controller). Are inhaled corticosteroids first line?
Beclomethasone HFA (QVAR) Budesonide (Pulmicort Flexhaler; Respules) Ciclesonide (Alvesco) Flunisolide HFA (Aerospan HFA) Fluticasone (Flovebpnt HFA) Mometasone (asmanex twisthaler) NOTE: corticosteroids end with either "nide/lide" and "sone" Yes. They are first line
34
What's the brand name of beclomethasone? Corticosteroids (controller)
QVAR
35
What's the brand name of Fluticasone? Corticosteroids (controller)
Flovent HFA
36
SE of inhaled corticosteroids?
Dysphonia Oral candidiasis (thrush) Cough High risk of fractures and pneumonia (with high dose, long-term use) Growth retardation (in kids with high doses)
37
How to prevent oral candidiasis (thrush) with corticosteroids?
Rinse mouth and throat with warm water and spit out OR Use a spacer device
38
What's the first line for long-term control for all ages and persistent asthma?
Inhaled corticosteroids Budesonide (Pulmicort) Beclomethasone HFA (QVAR) Fluticasone HFA
39
Which of the inhaled corticosteroids has a 'do not shake before use'?
QVAR (beclomethasone) Alvesco (ciclesonide)
40
How to reduce fracture risk while on corticosteroids? E.g. QVAR, Flovent
``` Avoid smoking Exercise Use lowest effective steroid dose Recommend Ca and Vit D Get regular bone density screening ```
41
Name the 2 types of steroids used in asthma
Glucocorticoids - produced by the body as a rxn to stress or given exogenously Mineralocorticoids (Fludrocortisone) - which regulates Na and H2O balance
42
Clinical Uses of steroids (glucocorticoids)?
Primarily to reduce inflammation
43
What's a steroid taper?
A steady reduction in dose for pts using steroids for longer than 14 days. Not required for inhaled steroid use
44
List the long-term side effect of systemic steroids
Cushing syndrome Hypokalemia Immunosuppression Amenorrhea Acne Insomnia/nervousness
45
List short-acting oral steroids and dose equivalent
Cortisone - 25mg Hydrocortisone - 20
46
List intermediate-acting oral steroids and dose equivalent
Methylprednisolone/Triamcinolone - 4mg Prednisone/Prednisolone - 5mg
47
List long-acting oral steroids and dose equivalent
Betamethasone -0.6mg Dexamethasone - 0.75mg
48
List mineralcorticoids and dose equivalent
Fludrocortisone - no anti-inflammatory effect
49
List oral corticosteroids
Cortisone Hydrocortisone (Solu-CORTEF) Methylprednisolone (Medrol; Medrol Dosepak; Solu-MEDROL) Prednisone Prednisolone (Milipred; Orapred; Prelone) Triamcinolone (Kenalog)
50
What's the brand name for hydrocortisone? Oral corticosteroids
Solu-CORTEF
51
What's the brand name for methylprednisolone? Oral corticosteroids
Medrol Medrol Dosepak Solu-MEDROL
52
What's the brand name for prednisolone? Oral corticosteroids
Milipred Orapred Prelone (syrup)
53
What's the brand name for triamcinolone ?Oral corticosteroids
Kenalog
54
List the oral steroids that are prodrugs
Cortisone (prodrug for cortisol) Prednisone (prodrug for Prednisolone)
55
Which oral steroid is most commonly used in children?
Prednisolone
56
When should steroids be given? Why?
Between 7-8am To mimic the body's diurnal release of cortisol
57
If oral steroids is used for 10-14 days, how should it be stopped?
Must taper slowly
58
List relative anti-inflammatory potency of oral steroids
Betamethasone/Dexamethasone > Fludrocortisone > methylprednisolone/Triamcinolone > prednisone/Prednisolone > hydrocortisone > cortisone
59
Which has the highest mineralcorticoids potency? Effect? Uses?
Fludrocortisone Causes Na and H2O retention Used for hyponatremia
60
List agents that are Leukotriene modifying agents
Zafirlukast (Accolate) Montelukast (Singulair) Zileuton (Zyflo, Zyflo CR)
61
What's the brand name of montelukast? Leukotriene modifying agents
Singulair
62
SE of Leukotriene modifying agents
Headache Dizziness Abdominal pain Increased LFTs URTIs Pharyngitis Sinusitis
63
What's the monitoring parameter for Zileuton?
LFTs Q month for 1st 3 months Q 2-3 months for the rest of the 1st year
64
Howz zafirlukast (Accolate) taken?
1 hr BEFORE or 2 hrs AFTER meals
65
MOA of Theophylline?
Blocks phophodiesterase causing increase cAMP, resulting in bronchodilation
66
Uses of theophylline?
As add-on therapy Not most effective, has high drug interaction and SE limits it's use
67
What's the therapeutic range of theophylline? Howz it measured?
5-15 mcg/mL Measure oral level (after 3 days of dosing)
68
SE of theophylline?
Nausea Loose stools
69
How do you calculate the dose if using IV aminophylline?
Divide by 0.8
70
List drugs that may increase theophylline levels. By what mechanisms?
Due to 1A2 inhibition Cipro Fluvoxamine Propranolol Zafirlukast Zileuton
71
List other drugs that may increase theophylline levels. By what mechanisms?
Due to 3A4 inhibition Clarithromycin Conivaptan Erythromycin
72
List other factors that may increase theophylline levels.
Alcohol Allopurinol Antithyroid agents Disulfiram Estrogen containing oral contraceptives Methotrexate Pentoxifylline Propafenone Verapamil
73
List conditions that may increase theophylline levels.
Acute pulmonary edema CHF Cirrhosis or liver dx Cor-pulmonale Fever Hypothyroidism/ Shock may reduce theophylline clearance
74
List drugs that may reduce theophylline levels
Cbz Foes phenytoin Phenobarbital Phenytoin Primidone Rifampin Ritonavir High protein diet Hyperthyroidism and cystic fibrosis can increase theophylline level
75
What meds do theophylline reduce their levels?
Lithium (by increasing renal excretion of lithium) Zafirlukast
76
Uses of anticholinergics in asthma?
Mainly used with other meds in the emergency dept for bronchodilation in acute attacks
77
List agents under anticholinergics
Omalizumab (Xolair)
78
What's the brand name of omalizumab? Anticholinergics
Xolair
79
How's omalizumab (Xolair) anticholinergic used?
Dose and freq based on pre- tx total IgE serum levels and body weight - given SC Q2 or 4 weeks Drugs should ALWAYS be given in the Doctor's office
80
What's the blackbox warning of omalizumab (Xolair)?
Anaphylaxis
81
Howz asthma meds used in exercise induced bronchospasm (EIB)?
Pretreat b4 exercise with SABAs, LABAs, or montelukast (Singulair)
82
What's the drug of choice in EIB?
SABAs
83
How are SABAs taken in EIB? Duration?
Albuterol, Levalbuterol etc drug if choice in EIB 5-15 mins before exercise Lasts 2-3 hrs
84
How are LABAs taken in EIB? Duration?
Formoterol - 15 mins b4 exercise Salmeterol - 30 mins b4 exercise
85
Should LABAs used as monotherapy in persistent asthma?
No
86
What's the preferred SABAs for use during pregnancy?
Albuterol
87
What's the preferred inhaled corticosteroid in pregnancy?
Budesonide
88
Look at pages 698 - 700 in book
Make sure you look!
89
What's the technique to using peak flow meters?
Use every morning, once u wake up Move indicator to bottom of numbered scale. Stand up straight. Exhale comfortably Inhale as deeply as you can. Place lips firmly around mouthpiece, creating a tight seal Blow out as HARD and as FAST as possible. Write down PEFR Repeat steps 2 more times, allowing enough rest in btw. Record highest value
90
List the zones of a peak flow meter reading (PEFR)
Green zone (80-100% of personal best) Yellow zone (50-80% of personal best) Red zone (<50% of personal best)
91
Which zone indicates medical alert and pt needs to seek medical attention?
Red zone (< 50%)
92
Is it okay to change the brand of peak flow meter?
No. It's best to use same brand
93
Read page 702 - 707
Have you read them?
94
What's the most likely SE to occur while using Foradil?
Palpitations
95
Pt is on 3mg dexamethasone, convert to prednisone?
20mg
96
T/F? Advair Diskus treat both airway constriction and inflammation
True
97
What's the dose of montelukast for children; 2-4y/o and 5 yrs and above?
>= 5 y/o 5mg chewable tablet once daily (in the evening) 2-4 y/o - 4mg chewable tablet once daily (in the evening)
98
Sweetener used in Montelukast chewable tab (& other children chewable)?
Phenylalanine

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