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Pharmacology Exam 2 > Asthma > Flashcards

Asthma Flashcards

0
Q

What FEV1/FVC value signifies obstruction?

A

< 0.70

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1
Q

Normal FEV1/FVC = ?

A

> 0.70

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2
Q

What are common triggers for asthma?

A

Allergens, humidity, exercise, smoke

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4
Q

What is the preferred route for SABAs?

A

Inhaled

Why? Gets to site quicker and less ADEs

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5
Q

Exercise induced asthma - DOC

A

SABA - Albuterol 2 puffs 15 min before exercise

LABA - Formoterol DPI 1 puff 15 min before exercise

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6
Q

What is the preferred inhaled SABA?

A

Albuterol

Inhaler or neb

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7
Q

Albuterol - indications

A

Reversible bronchospasm (BBW) and EIA

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8
Q

*What are some oral SABAs?

A

Albuterol syrup and tabs
Metoproterenol syrup and tabs
Terbutaline tabs

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9
Q

Beta 2 agonists - side effects

A

Tremor
Palpitations
Reduction in o2 sat (b/c opens unused spaces)

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10
Q

What is considered a “good candidate” for bronchodilators?

A

Increase of 200 mL or 12% in FEV1 compared to baseline

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11
Q

Formoterol - class and dosing

A

LABA

1 puff bid
Onset 5-15 min x 12 hrs

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12
Q

When should LABA be used?

A

Only in combo with an asthma controller med -> never alone!

Use in long term patients that are not adequately controlled with other meds

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13
Q

Who requires a LABA in combination formulation with a corticosteroid?

A

Peds and adolescents

ex. Budesonide + Formoterlol (Symbicort) and Fluticasone +Salmeterol (Advair)

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14
Q

Why do LABAs have a black box warning?

A

Increased risk of asthma related deaths -> Taper off ASAP

Not for acute exacerbations!

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15
Q

*ICS - MOA

A

Inhibits cytokine-induced production of pro inflammatory proteins

Indirect: suppresses inflammation, increased production of beta 2 receptors (improves response), decrease mucous

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15
Q

When should corticosteroids be stepped down?

A

Once controlled, decrease dose by 25% q 2 weeks for 8 weeks

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16
Q

Corticosteroids - side effects

A

Effects in bone growth (slower but catches up)
Adrenal suppression
Osteoporosis
Thrush (inhaler)

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17
Q

What classes can be used in patients that need/want to avoid steroids?

A

Mast cell stabilizers (cromolyn and nedocromil)

Leukotriene modifiers (montelukast)

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18
Q

*Corticosteroids - counseling

A

Inhaler technique
Right order (bronchodilator first)
Daily use (not for exacerbations)
Rinse mouth to prevent thrush

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19
Q

Mast cell stabilizers - ADEs

A

Bad taste, GI

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20
Q

Which drug can be given for mod-severe persistent allergic asthma NOT controlled with inhaled steroids?

A

Omalizumab (xolair)

> 12 yrs
Acts as a receptor to IgE

Given in clinic q 2-4 wks
Expensive!

22
Q

Why isn’t theophylline used much?

A

Narrow therapeutic window (5-15 mcg/mL)

Lots of DDI

23
Q

Treatment for acute asthma exacerbation

A

Albuterol (quick) + ipratropium (long acting)

24
Q

Acute asthma exacerbation - DOC and dosing

A

Albuterol
MID: 4-8 puffs q 20 min x 4 hrs
Neb: 2.5-5 mg q 20 min x 3 2.5-10 mg q 1-4 hrs prn
+
Ipratropium (Never use alone…always w/albuterol)
MDI: 8 inhalations q 20 min prn up to 3 hrs
Neb: 0.5 mg or 500 mcg q 20 min x 3

25
Q

*When are steroids given during acute asthma exacerbation?

A

Early in the attack if incomplete response to inhalers

26
Q

Steroids for acute asthma exacerbation - DOC and dosing

A

Adults - Prednisone 60 mg PO or methylprednisone 80 mg IV

Peds - prednisolone 2 mg/kg PO x 5 days

27
Q

What are the 3 alternative treatments (meds) for acute asthma exacerbation?

A
  1. Mgso4 if not responding and trying to prevent intubation
  2. Racemic epi if not responding to albuterol (SQ or neb)
  3. Antibiotics if evidence of infection
28
Q

*Asthma exacerbation - Treatment steps

A
  1. Albuterol
  2. Oral steroid
  3. O2 (goal sat >95%)
  4. Short acting theophylline if beta 2 agonist not available
  5. If unresponsive to steroid + albuterol -> MgSO4
29
Q

If a pedi RR > 60, what should you do?

A

Admit

30
Q

An asthma attack is considered severe if…

A

Breathless at rest, hunched forward and/or talking in words

Infant - stops feeding, agitated, drowsy, confused, bradycardia or resp >30

31
Q

Budesonide Inhln Powder (pulmacort) - indication

A

ICS for asthma prophylaxis

32
Q

*Montelukast (Singulair) - class

A

Leukotriene receptor antagonist

33
Q

Albuterol - dosing

A

2 puffs q 4-6 hrs prn

Onset 5-8 min x 3-6 hours

34
Q

Which is more effective…oral or inhaled SABA?

A

inhaled

why? oral takes longer (onset 30 minutes) and needs regular dosing (generally TID-QID)

35
Q

What is the only ICS approved for pregnancy?

A

Pulmacort (cat B)

36
Q

Pulmacort - dosing

A

Adults - qd for mild asthma
Peds - bid

Onset 24 hrs, max benefit 1-2 wks

37
Q

Montelukast (Singulair) - dosing

A

Qd in evening

38
Q

*Corticosteroids - MOA

A

Inhibits cytokine-induced production of pro-flammatory proteins

39
Q

*Mast cell stabilizers - MOA

A

no bronchodilation…prevents mast cells from releasing histamine

40
Q

*Omalizumab (Xolair) - class?

A

IgE Antibody Inhibitor

41
Q

*Omalizumab - MOA

A

inhibits the binding of IgE to the high-affinity IgE receptor on the surface of mast cells and basophils

42
Q

*Omalizumab - only FDA approval

A

mod-severe persistent allergic asthma

43
Q

*Formoterol and salmeterol - class?

A

LABA

44
Q

*Albuterol and levalbuterol - class?

A

SABA

45
Q

*Budesonide + Fomoterol (Symbicort) and Fluticasone + Salmeterol - class?

A

LABA + ICS

46
Q

*Budesonide and Beclomethasone - class?

A

ICS

47
Q

*Level of asthma control - “controlled”

A

daytime symptoms < 2 times/week, no limitations, no night symptoms, rescue inhaler < 2 times/week, normal lung function, no exacerbations

48
Q

*Level of asthma control - “partly controlled”

A

any of the following in past week: symptoms > 2 times, any limitations, any night symptoms, rescue inhaler > 2 times, lung function <80% of personal best, any exacerbation this year

49
Q

*Level of asthma control - “uncontrolled”

A

3+ features from partly controlled in last week

50
Q

*Asthma - approaches to treatment based on control

A

controlled - maintain lowest controlling step
partially controlled - consider stepping up
uncontrolled - step up until controlled
exacerbation - treat as exacerbation

Pharmacology Exam 2 (9 decks)

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