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Pharmacology > Asthma > Flashcards

Asthma Flashcards

1
Q

What cells are involved in an asthma attach?

A

mast cells, Eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells

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2
Q

Can asthma be reversed

A

yes spontaneously or with treatmentthis is a big difference because you can not reverse COPD

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3
Q

what are Asthma risk factors

A

Innate ImmunityHost factor- geneticsEnvironment Factors

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4
Q

what are some symptoms of asthma

A

WheezingHistory of cough thats worse at night, trouble breathing

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5
Q

When do the symptoms of asthma tend to get worse

A

Exercise Viral infectionInhalant Agents Irritantschanges in weatheremotional responseStressMenstrual cycles

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6
Q

How is Asthma diagnosed

A

episodic symptoms of airflow obstruction or hyperresponsivenessAirflow obstruction is at least partially reversibleFEV1 of >200ml and >or= 12% from baseline measure after SABA

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7
Q

What are the goals of Asthma therapy

A

Reduce impairmentprevent symptomsrequire infrequent use of SABAmaintain norm. pulm functionmaintain norm. activity levelsmeet pt’s and Fams expectations and satisfaction with asthma care

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8
Q

How do you reduce the risk of asthma with therapy

A

prevent exacerbations and minimize ED visitsprevent loss of lung functionprevent reduced growth lung growthprovide optimal pharmacotherapy

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9
Q

what drugs belong to SABA beta 2 agonist?

A

AlbuterolLevabuterolPirbuterol

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10
Q

using a SABA more than 2 days a week indicated what

A

need to begin long term control medications

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11
Q

Ipratropium

A

Anticholinergicnot the preferred agentCan not use in Pts under 12MDI-2puffs every 6 hoursTake longer to workMore Side effects

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12
Q

Albuterol & ipratropium combo dosing forMDI-metered dose inhaledNeulizer

A

MDI- 1inh every 6 hoursNeb: 3ml every 6 hours

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13
Q

Why are low does inhaled corticosteroids preferred treatment for step 2

A

decreased the number and activity of inflammatory cells (better at reducing inflammation from eosinophils& neutrophilsInhibit bronchoconstrictor mech.

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14
Q

What are the side effects of Inhaled steroids

A

cough, dysphonia, oral thrush

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15
Q

what are the effects of high does inhaled steroids

A

Adrenal suppressionOsteoporosisskin thinningeasy bruisingcataracts

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16
Q

what are the effects of low dose inhaled steroids

A

growth suppression in childrengrowth velocity may be altered

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17
Q

What are Inhaled corticosteroids

A

BudesonideFluticasoneMometasoneCiclesonideBeclomethasone

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18
Q

What are step 2 alternatives to low dose inhaled steroidsage>12

A

Mast cell stabilizers: cromolyn (now only used via nebulizer)nedocromilLTRA(more effective)montelukast, ZafirlukastTheyophilline( has a lot of side effects) related to caffeine narrow therapeutic index

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19
Q

How do mast stabilizers work?

A

stabilize mast cellsblock chloride channelscan be used as preventative therapy for exercise unknown allergiesgreat safety profile but questionable efficacy

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20
Q

What are LTRA drugs

A

Montelukast or Zafirlukastthey interfere with leukotriene mediators

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21
Q

What are things to watch for with people who are on LTRA

A

Think they start with L so they affect the liver (ALT)hepatitisCan cause depression in children (kids want to jump off a mountain)

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22
Q

How does Zafirlukast interaction and CYP problems

A

food decreases bioavailabilityCYP 2C9 inhibitorincreased warfarin levels

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23
Q

what is theophylline metabolized by?

A

CYP1A2 & CYP3A4

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24
Q

What is used for step 3 in asthmaticsage>12

A

Medium dose ICS (1st)or Low dose ICS & LABAor Low dose ICS+LTRA,theophylline, Zeluton

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25
Q

what is really important about using a LABA

A

it has no anti-inflammatory properties never use as mono therapy

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26
Q

What is the black box warning with LABAs

A

increased risk of asthma exacerbation and asthma related death with regular use of LABA

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27
Q

what are two kinds of LABAs

A

Salmeterol and Formoterol (faster think stars with F like F1 race car)

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28
Q

what is so special about mometasone

A

you only need to take it once

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29
Q

what should be used in Step 4 asthmaage>12

A

medium dose+LABAorMed dose ICS+LTRAorTheophylline, or Zileuton or Tiotropium

30
Q

what to use with step 5 asthmaticsAge>12

A

High dose ICS+LABA and consider omalizumab

31
Q

what to use with step 6 asthmaticsAge>12

A

High dose ICS+LABA+ oral steroid and consider omalizumab

32
Q

how does omalizumab work

A

bind to portion of IgE antibody preventing the binding to its high affinity receptor on mast cells and basophils

33
Q

what are some adverse effects of omalizumab

A

urticaria and anaphylaxis

34
Q

what are some oral steroids

A

prenisolone, prednisone, methylprenisolone

35
Q

what are some non-pharmacologic treatment

A

avoid triggersremove carpetvacuumwindows closedair filters

36
Q

what is the first line treatment for exercise induced bronchospasms

A

SABA

37
Q

what is second like for EIB

A

LTRA

38
Q

what is the last line for EIB

A

cromolyn

39
Q

If a patient has asthma and GERD how do you treat them

A

treat the GERD because it is often that if you stop it that will relieve the asthma symptoms

40
Q

what are COPD risk factors

A

smokingalpha1 antitrypsinoccupationair pollutioninfectionsocioeconomic status

41
Q

what is the hallmark of COPD

A

dyspnea

42
Q

what are some other classic symptoms of COPD

A

chronic coughsputum production

43
Q

what are the two 24 hour long acting LABA

A

vilanterolindacterol

44
Q

what is a 12 hour acting LABA

A

arformoterol

45
Q

Why is tiotropium a better anticholinergic

A

more selective and has a higher affinity for muscarinic receptor

46
Q

what has been shown to increase survival in chronic respiratory failure?

A

oxygenneed to have levels >90%

47
Q

In COPD patients who experience exacerbations what is first line treatment

A

oxygen 1st then SABA2nd line-short acting anticholinergicsteroid

48
Q

what 3 cardinal symptoms must present for use of antibiotics in an exacerbation

A

increased dyspneasputum volumesputum purulenceonly need two of the 3 symptoms if purulent sputum is one of them or a person on a ventilator

49
Q

how long do you give the antibiotics for?

A

7-10 days

50
Q

what are the nighttime awakenings for intermittentages 5yo> what is their stage?

A

less than or = 2Step 1

51
Q

what are the nighttime awakenings for mildages 5yo> what is their stage?

A

3-4x/monthstep 2

52
Q

what are the nighttime awakenings for moderateages 5yo> what is their stage?

A

> 1x/week but not nightlystep 3

53
Q

what are the nighttime awakenings for severeages 5yo> what is their stage?

A

7x/weekstep 4or5

54
Q

what are the nighttime awakenings for intermittentages 0-4yo what is their stage?

A

0stage 1

55
Q

what are the nighttime awakenings for mildages 0-4yo what is their stage?

A

1-2x/monthstep 2

56
Q

what are the nighttime awakenings for moderateages 0-4yo what is their stage?

A

3-4x/monthstep 3

57
Q

what are the nighttime awakenings for severeages 0-4yo what is their stage?

A

> 1x/weekstep 3

58
Q

For ages 0-4 what is step 1 asthma treatment

A

SABA

59
Q

For ages 0-4 what is step 2 asthma treatment

A

Low dose ICS

60
Q

For ages 0-4 what is step 3 asthma treatment

A

medium dose ICS

61
Q

For ages 0-4 what is step 4 asthma treatment

A

medium dose ICS & montelukast or LABA

62
Q

For ages 0-4 what is step 5 asthma treatment

A

high dose ICS & montelukast or LABA

63
Q

For ages 0-4 what is step 6 asthma treatment

A

High dose ICS & montelukast/LABA & oral steroids

64
Q

when would you consider stepping down asthma meds

A

when asthma has been controlled for at least 3 months

65
Q

what is the treatment for age 5-11 step 1

A

SABA PRN

66
Q

what is the treatment for age 5-11 step 2

A

Low dose ICSalternate:LTRA or theophylline

67
Q

what is the treatment for age 5-11 step 3

A

med dose ICS or low dose ICS+LABA or LTRA or theophylline

68
Q

what is the treatment for age 5-11 step 4

A

med dose ICS+LABAalternatemed dose ICS+LTRA or theo

69
Q

what is the treatment for age 5-11 step 5

A

high dose ICS+LABAalternatehigh dose ICS+LTRA or theo

70
Q

what is the treatment for age 5-11 step 6

A

high dose ICS+LABA+ oral steroidalternateHigh dose ICS+LTRA/theo+oral steroid

Pharmacology (14 decks)

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