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NAPLEX > Asthma > Flashcards

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
Q

What’s the brand name of salmeterol + Fluticasone? LABAs + corticosteroids

A

Advair Diskus/ Advair HFA

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25
Q

What’s the brand name of formoterol + Budesonide? LABA + corticosteroid

A

Symbicort

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26
Q

What’s the dose of Advair Diskus (Salmeterol + Fluticasone)?

A

100, 250, 500mcg Fluticasone + 50mcg salmeterol

> = 4 yrs

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27
Q

What’s the dose of Advair HFA (Salmeterol + Fluticasone)?

A

45, 115, 230 mcg Fluticasone + 21mcg salmeterol

> = 12 yrs

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28
Q

What’s the dose of formoterol + Budesonide (Symbicort)? LABAs

A

80, 160mcg Budesonide + 4.5 mcg formoterol

> = 12yrs

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29
Q

What’s the black box warning of LABAs?

A

Increased risk of asthma related deaths

Don’t use as monotherapy in pts with persistent asthma

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30
Q

Howz LABAs used? (Salmeterol, advair Diskus, advair HFA, Symbicort etc

A

As adjunctive therapy in pts are currently receiving but not adequately controlled on long-term asthma control med eg inhaled corticosteroids

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31
Q

Are LABAs recommended for long-term use in asthma?

A

No!

Once asthma is controlled, assess pt at regular intervals and step down LABAs until d/c, if possible, without loss of asthma

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32
Q

Howz Foradil (Formoterol) LABAs stored? (Controller med)

A

Fridge in the pharmacy

Pt can keep at room temp for 4 months

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33
Q

List drugs under corticosteroids (controller). Are inhaled corticosteroids first line?

A

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

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34
Q

What’s the brand name of beclomethasone? Corticosteroids (controller)

A

QVAR

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35
Q

What’s the brand name of Fluticasone? Corticosteroids (controller)

A

Flovent HFA

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36
Q

SE of inhaled corticosteroids?

A

Dysphonia

Oral candidiasis (thrush)

Cough

High risk of fractures and pneumonia (with high dose, long-term use)

Growth retardation (in kids with high doses)

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37
Q

How to prevent oral candidiasis (thrush) with corticosteroids?

A

Rinse mouth and throat with warm water and spit out

OR

Use a spacer device

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38
Q

What’s the first line for long-term control for all ages and persistent asthma?

A

Inhaled corticosteroids

Budesonide (Pulmicort)
Beclomethasone HFA (QVAR)
Fluticasone HFA

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39
Q

Which of the inhaled corticosteroids has a ‘do not shake before use’?

A

QVAR (beclomethasone)

Alvesco (ciclesonide)

40
Q

How to reduce fracture risk while on corticosteroids? E.g. QVAR, Flovent

A 
Avoid smoking
Exercise
Use lowest effective steroid dose
Recommend Ca and Vit D
Get regular bone density screening
41
Q

Name the 2 types of steroids used in asthma

A

Glucocorticoids - produced by the body as a rxn to stress or given exogenously

Mineralocorticoids (Fludrocortisone) - which regulates Na and H2O balance

42
Q

Clinical Uses of steroids (glucocorticoids)?

A

Primarily to reduce inflammation

43
Q

What’s a steroid taper?

A

A steady reduction in dose for pts using steroids for longer than 14 days.

Not required for inhaled steroid use

44
Q

List the long-term side effect of systemic steroids

A

Cushing syndrome

Hypokalemia

Immunosuppression

Amenorrhea

Acne

Insomnia/nervousness

45
Q

List short-acting oral steroids and dose equivalent

A

Cortisone - 25mg

Hydrocortisone - 20

46
Q

List intermediate-acting oral steroids and dose equivalent

A

Methylprednisolone/Triamcinolone - 4mg

Prednisone/Prednisolone - 5mg

47
Q

List long-acting oral steroids and dose equivalent

A

Betamethasone -0.6mg

Dexamethasone - 0.75mg

48
Q

List mineralcorticoids and dose equivalent

A

Fludrocortisone - no anti-inflammatory effect

49
Q

List oral corticosteroids

A

Cortisone

Hydrocortisone (Solu-CORTEF)

Methylprednisolone (Medrol; Medrol Dosepak; Solu-MEDROL)

Prednisone

Prednisolone (Milipred; Orapred; Prelone)

Triamcinolone (Kenalog)

50
Q

What’s the brand name for hydrocortisone? Oral corticosteroids

A

Solu-CORTEF

51
Q

What’s the brand name for methylprednisolone? Oral corticosteroids

A

Medrol

Medrol Dosepak

Solu-MEDROL

52
Q

What’s the brand name for prednisolone? Oral corticosteroids

A

Milipred

Orapred

Prelone (syrup)

53
Q

What’s the brand name for triamcinolone ?Oral corticosteroids

54
Q

List the oral steroids that are prodrugs

A

Cortisone (prodrug for cortisol)

Prednisone (prodrug for Prednisolone)

55
Q

Which oral steroid is most commonly used in children?

A

Prednisolone

56
Q

When should steroids be given? Why?

A

Between 7-8am

To mimic the body’s diurnal release of cortisol

57
Q

If oral steroids is used for 10-14 days, how should it be stopped?

A

Must taper slowly

58
Q

List relative anti-inflammatory potency of oral steroids

A

Betamethasone/Dexamethasone > Fludrocortisone > methylprednisolone/Triamcinolone > prednisone/Prednisolone > hydrocortisone > cortisone

59
Q

Which has the highest mineralcorticoids potency? Effect? Uses?

A

Fludrocortisone

Causes Na and H2O retention

Used for hyponatremia

60
Q

List agents that are Leukotriene modifying agents

A

Zafirlukast (Accolate)

Montelukast (Singulair)

Zileuton (Zyflo, Zyflo CR)

61
Q

What’s the brand name of montelukast? Leukotriene modifying agents

62
Q

SE of Leukotriene modifying agents

A

Headache

Dizziness

Abdominal pain

Increased LFTs

URTIs

Pharyngitis

Sinusitis

63
Q

What’s the monitoring parameter for Zileuton?

A

LFTs Q month for 1st 3 months

Q 2-3 months for the rest of the 1st year

64
Q

Howz zafirlukast (Accolate) taken?

A

1 hr BEFORE or 2 hrs AFTER meals

65
Q

MOA of Theophylline?

A

Blocks phophodiesterase causing increase cAMP, resulting in bronchodilation

66
Q

Uses of theophylline?

A

As add-on therapy

Not most effective, has high drug interaction and SE limits it’s use

67
Q

What’s the therapeutic range of theophylline? Howz it measured?

A

5-15 mcg/mL

Measure oral level (after 3 days of dosing)

68
Q

SE of theophylline?

A

Nausea

Loose stools

69
Q

How do you calculate the dose if using IV aminophylline?

A

Divide by 0.8

70
Q

List drugs that may increase theophylline levels. By what mechanisms?

A

Due to 1A2 inhibition

Cipro

Fluvoxamine

Propranolol

Zafirlukast

Zileuton

71
Q

List other drugs that may increase theophylline levels. By what mechanisms?

A

Due to 3A4 inhibition

Clarithromycin

Conivaptan

Erythromycin

72
Q

List other factors that may increase theophylline levels.

A

Alcohol

Allopurinol

Antithyroid agents

Disulfiram

Estrogen containing oral contraceptives

Methotrexate

Pentoxifylline

Propafenone

Verapamil

73
Q

List conditions that may increase theophylline levels.

A

Acute pulmonary edema

CHF

Cirrhosis or liver dx

Cor-pulmonale

Fever

Hypothyroidism/ Shock may reduce theophylline clearance

74
Q

List drugs that may reduce theophylline levels

A

Cbz

Foes phenytoin

Phenobarbital

Phenytoin

Primidone

Rifampin

Ritonavir

High protein diet

Hyperthyroidism and cystic fibrosis can increase theophylline level

75
Q

What meds do theophylline reduce their levels?

A

Lithium (by increasing renal excretion of lithium)

Zafirlukast

76
Q

Uses of anticholinergics in asthma?

A

Mainly used with other meds in the emergency dept for bronchodilation in acute attacks

77
Q

List agents under anticholinergics

A

Omalizumab (Xolair)

78
Q

What’s the brand name of omalizumab? Anticholinergics

79
Q

How’s omalizumab (Xolair) anticholinergic used?

A

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
Q

What’s the blackbox warning of omalizumab (Xolair)?

A

Anaphylaxis

81
Q

Howz asthma meds used in exercise induced bronchospasm (EIB)?

A

Pretreat b4 exercise with SABAs, LABAs, or montelukast (Singulair)

82
Q

What’s the drug of choice in EIB?

83
Q

How are SABAs taken in EIB? Duration?

A

Albuterol, Levalbuterol etc drug if choice in EIB

5-15 mins before exercise

Lasts 2-3 hrs

84
Q

How are LABAs taken in EIB? Duration?

A

Formoterol - 15 mins b4 exercise

Salmeterol - 30 mins b4 exercise

85
Q

Should LABAs used as monotherapy in persistent asthma?

86
Q

What’s the preferred SABAs for use during pregnancy?

87
Q

What’s the preferred inhaled corticosteroid in pregnancy?

A

Budesonide

88
Q

Look at pages 698 - 700 in book

A

Make sure you look!

89
Q

What’s the technique to using peak flow meters?

A

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
Q

List the zones of a peak flow meter reading (PEFR)

A

Green zone (80-100% of personal best)

Yellow zone (50-80% of personal best)

Red zone (<50% of personal best)

91
Q

Which zone indicates medical alert and pt needs to seek medical attention?

A

Red zone (< 50%)

92
Q

Is it okay to change the brand of peak flow meter?

A

No. It’s best to use same brand

93
Q

Read page 702 - 707

A

Have you read them?

94
Q

What’s the most likely SE to occur while using Foradil?

A

Palpitations

95
Q

Pt is on 3mg dexamethasone, convert to prednisone?

96
Q

T/F? Advair Diskus treat both airway constriction and inflammation

97
Q

What’s the dose of montelukast for children; 2-4y/o and 5 yrs and above?

A

> = 5 y/o 5mg chewable tablet once daily (in the evening)

2-4 y/o - 4mg chewable tablet once daily (in the evening)

98
Q

Sweetener used in Montelukast chewable tab (& other children chewable)?

A

Phenylalanine

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