Asthma Flashcards
What FEV1/FVC value signifies obstruction?
< 0.70
Normal FEV1/FVC = ?
> 0.70
What are common triggers for asthma?
Allergens, humidity, exercise, smoke
What is the preferred route for SABAs?
Inhaled
Why? Gets to site quicker and less ADEs
Exercise induced asthma - DOC
SABA - Albuterol 2 puffs 15 min before exercise
LABA - Formoterol DPI 1 puff 15 min before exercise
What is the preferred inhaled SABA?
Albuterol
Inhaler or neb
Albuterol - indications
Reversible bronchospasm (BBW) and EIA
*What are some oral SABAs?
Albuterol syrup and tabs
Metoproterenol syrup and tabs
Terbutaline tabs
Beta 2 agonists - side effects
Tremor
Palpitations
Reduction in o2 sat (b/c opens unused spaces)
What is considered a “good candidate” for bronchodilators?
Increase of 200 mL or 12% in FEV1 compared to baseline
Formoterol - class and dosing
LABA
1 puff bid
Onset 5-15 min x 12 hrs
When should LABA be used?
Only in combo with an asthma controller med -> never alone!
Use in long term patients that are not adequately controlled with other meds
Who requires a LABA in combination formulation with a corticosteroid?
Peds and adolescents
ex. Budesonide + Formoterlol (Symbicort) and Fluticasone +Salmeterol (Advair)
Why do LABAs have a black box warning?
Increased risk of asthma related deaths -> Taper off ASAP
Not for acute exacerbations!
*ICS - MOA
Inhibits cytokine-induced production of pro inflammatory proteins
Indirect: suppresses inflammation, increased production of beta 2 receptors (improves response), decrease mucous
When should corticosteroids be stepped down?
Once controlled, decrease dose by 25% q 2 weeks for 8 weeks
Corticosteroids - side effects
Effects in bone growth (slower but catches up)
Adrenal suppression
Osteoporosis
Thrush (inhaler)
What classes can be used in patients that need/want to avoid steroids?
Mast cell stabilizers (cromolyn and nedocromil)
Leukotriene modifiers (montelukast)
*Corticosteroids - counseling
Inhaler technique
Right order (bronchodilator first)
Daily use (not for exacerbations)
Rinse mouth to prevent thrush
Mast cell stabilizers - ADEs
Bad taste, GI