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done spring meds > asthma > Flashcards

asthma Flashcards

1
Q

3 meds for asthma

A

bronchodilators - SABA, LABA

Steroids

combinations steroids and LABA

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2
Q

Tiotropium, what class, when to use it?

A

long acting anticholingeric - used as an add on for asthma - as a ‘controller’

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3
Q

when is theophylline not recommended

give steroid to preschool kids with acute exacerbations or wheezing episodes?

A

For children 6-11 years

not recommended

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4
Q

when to use ipratropium?

A

short acting anticholingeric -
in emergency case when transfering pt to ER

use ipratropium, SABA and systemic corticosteroid

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5
Q

why high dose of SABA bad for you?

what is considered high dose?

A

cause asthma related death

200 doses/month - more than 3 a week

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6
Q

what cardiac drug no good in asthma and why

A

BB - cardiac death

try to use cardio selected BB to reduce risk

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7
Q

True or false

1 Salmeterol (Serevent) – b2 agonist – long acting bronchodilators OL ending is beta agonist is a useful rescue medication.

2 Long acting beta agonists (e.g. Formoterol Oxeze) are steroid sparing.

3 Fluticasone (Flovent) 125 mcg/puff is equivalent to Beclomethasone (Q-Var) 125 mcg/puff.

4 Leukotriene receptor antagonists (Montelukast Singulair) are effective for asthma in ASA sensitive patients.

5 Metered Dose Inhalers with Spacers are as effective as nebulizers.

A

1 false

2 True

3 True

4 – True – 1400 ASA NSAIDs produce leukotrinines

5 True

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8
Q

when do you consider asthma not controlled 2

A

Regular controller indicated when FOUR or more doses per week or

once or more per week to relieve nightime symptoms

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9
Q

Primary differerence btwn kids under 12 ?

A

– increase or double ICS in under 12

over 12, add LABA to low ICS not double ICS

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10
Q

what two drug combo not recommended with kids under 12?

A

single inhaler therapy combination of budesonide and formoterol

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11
Q

Ipratropium

A

acts on parasympathetic, agonist to bronchoconstriction (rarely used - in emergency only

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12
Q

egs of

‘Relievers’ 2

‘Controllers’ 3

Bronchodilators 2

A

(intermittent symptoms)
1S hort/fast-acting beta2-agonists SABA

2 Ipratropium – acts on parasympathetic, agonist to bronchoconstriction (rarely used - in emergency only) anticholingeric

‘Controllers’ (maintenance therapy) Anti-inflammatory medications

1 Inhaled and/or oral glucocorticosteroids
2 Leukotriene receptor antagonists
3 Antiallergic agents – anti IgE (cromoglycate/DC, nedocromil)

Bronchodilators

1 Long acting, inhaled beta2-agonists (salmeterol, formoterol) LABA
2 Theophylline (rarely) – last resort
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13
Q

LABA SE

A

headache, tremor, nervousness, palpitations/
tachycardia/ arrhythmia.

Hypokalemia and hyperglycemia can occur at high doses.

These are usually related to stimulation of the beta receptors and are dose-related.

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14
Q

anticholingeric - eg? MOA

things to consider?

A

ipratropium/tiotropium

Competitive inhibition of muscarinic cholinergic receptors. – blocks bronchosconstriction
reduces airway intrinsic vagal tone.
May decrease mucous gland secretion

consider

Slow onset (30 minutes) but a long duration of action (4 – 6 hours)
Bronchodilation is less than with salbutamol
Does not reduce exercise induced bronchospasm
Does not modify reaction to antigen
Role – add-on to salbutamol in emergency treatment of acute asthma - if pt has lots of s.e with ventolin then can use atrovent, but still always have ventolin for acute emergency

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15
Q

ICS - MOA

contra? 3

A

Anti-inflammatory:
Suppress the generation of cytokines, recruitment of airway eosinophils and release of inflammatory mediators.

Blocks late reaction to allergens and reduces airway hyperresponsiveness

CONTRAINDICATIONS/PRECAUTIONS
1 Patients with untreated fungal, bacterial or tuberculosis infections – cuz suppressing immune system
2 Hypersensitivity to components (e.g. milk/lactose (diskus – has lactose) allergy for Flovent)
3 Pregnancy (risks and benefits should be weighed).

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16
Q

which ICS has less sore throat effects

which needs to be on low dose to prevent bone problems? how low?

A

Ciclesonide

Beclomethasone under 250

17
Q

other names for :

fluticasone

budesonide

cyclosonide

Beclomethasone

A

flovent - orange diskus

pumicort - looks like a penis

Alvesco

Vanceril
QVAR

18
Q

SE of ICS

2 locals

4 systemics

A 
Local (most common):
Oral candidiasis (rinse and gargle after inhalation)

Hoarseness, dysphonia, sore throat – affects larynx, could lose range of singing

Systemic:
Linear Growth (children):  low to medium doses may decrease growth velocity (1 cm) in the first year, but reach predicted height when treated for long periods of time
Bone Mineral Density:  a small dose-dependent reduction in BMD has been reported for patient > 18 y (>7.5 mg oral daily for > 3months; >400  mcg Beclomethasone  ICS) – to be on alendronate

Cataracts: High cumulative lifetime doses may increase slightly the prevalence of cataracts

HPA - hypothal, pitutuary , adrenal gland Suppression: - decrease endogenours cortisol, atrophy of gland - rare

19
Q

2 reason why need to rinse ICS after use

A

avoid thrush

to reduce systemtic absorption, especially beclomethasone cuz have slow first pass effect

20
Q

MOA of LABA

half life?

eg? slow fast? for kids?

good for acute asthma?

LABA should only be used as “add-on” therapy to low dose ICS (>12 yrs and adults) {add to medium dose ICS for kids 6 -11)

A

Bronchodilation:
Relaxes bronchial smooth muscle by stimulating beta-2 receptors which increases cAMP and produces functional antagonism to bronchoconstriction.
- 12 hours half life

salmeterol - slow onset - good for kids above 4
Formoterol fumarate - fast onset - no good for kids under 6

no- Don’t use LABA alone cuz its only working on the muscle tone alone, not helping with inflammation

good for add on therapy with low ICS

21
Q

(Advair)

Symbicort

A

Salmeterol + fluticasone LABA and ICS

Formoterol + Budesonide

22
Q

Moa of leukotrinie receptor antagonist

good for what type of asthma attack (what trigger)?

comparable to LABA or ICS?

A

Mechanism of action:
Inhibit actions of leukotrienes (biochemical mediators released from mast cells, eosinophils, and basophils) and therefore prevent contraction of airway smooth muscle, increased vascular permeability, increased mucous secretions and attraction and activation of inflammatory cells in the airways.

May be useful in ASA induced asthma – cuz ASA stimulates leukotrines release

May be “steroid sparing”
Less effective than low dose ICS
Less effective than LABA as add on therapy

23
Q

MONITORING for LeukoRA?

considerations

A

LRA for LFT monitoring

Asthma controller - improvement in symptoms can occur in two days – no use in severe asthma
Signs and symptoms of hepatic injury
Routine monitoring:
Baseline and periodic LFT’s (including AST, ALT)

has lots of interactions 
Empty stomach (BID)

Drug Interactions - CYP2C9 enzyme substrate; CYP2C9 and 3A3/4 enzyme inhibitor

Aspirin: increase plasma levels of zafirlukast by 45%
Erythromycin: decrease mean plasma levels of zafirlukast by 40% due to a decrease in zafirlukast bioavailability.

Theophylline: decrease mean plasma levels of zafirlukast by 30%, no effects on plasma theophylline levels were observed.

Warfarin: clinically significant increase in INR. Closely monitor INR of patients on warfarin & zafirlukast, and adjust anticoagulant dose accordingly.

24
Q

moa of mast cell stabilizer

consider?

A

Mechanism of action:
Stabilize mast cell membranes to prevent release of inflammatory mediators
Block early and late reaction to allergen
Side effects: rare
Ketotifen (oral) – sedation (8 – 10 %), weight gain (>5%)

Have to take it before you get the reaction or before introduction of allgergen

Only good to know when spring from a tree, take a few weeks orally before the season starts

Maximum effect delayed 4 – 6 weeks
Beneficial to prevent exercise-induced asthma (especially if someone is intolerant to beta-2 agonists)

25
Q

Theophylline Moa

multiple SE

narrow therapeutic range

A

Mechanism of action
Competitive antagonist of adenosine ( which decreases mast cell mediators and smooth muscle constriction)

Inhibits phosphodiesterase thereby increasing intracellular cyclic AMP (in airway smooth muscle) – at high levels

Stimulates diaphram to contract – help in copd

SE similar to coffee: CNS,GI,CV, N,V,D, headache , irritability, insomnia , tachycardia

26
Q

when to use oral steroid?

SE?

A

burst therapy/ severe asthma exac

headache, insomnia, mood swings, GI upset, fluid retention and aseptic necrosis of femoral and humeral heads (rare)

When stopped, need to be on inhaled corticosteroid, if not rebound

Other s.e – euphoria,,, but can get disophoria

27
Q

Indications for IgE? 3

how is it given?

A

controller

Moderate to severe asthma in >12 y
Documented aeroallergens, elevated serum IgE
On high dose ICS + one additional controller

SC once or twice monthly (14 week trial)

28
Q

which drugs Does not reduce exercise induced bronchospasm

A

anticholingeric

29
Q

useful for ASA induced asthma?

monitor what when using this?

A

LRA

LFTS

30
Q

THEOPHYLLINE moa? consider?

A
  • Competitive agonist of adenosine (decreases mast cell mediators and smooth muscle contraction)
  • Inhibits phosphodiesterase (increases cAMP)
  • Effective as add on therapy
  • Lots of side effects
  • Many drug interactions
31
Q

when to use oral steroid,, SE?

A
  • Burst therapy for worsening symptoms in severe exacerbations
  • Prednisone 30-50mg qam x 5 days
  • S/E: headache, insomnia, mood swiongs, GI upset, fluid retention, aseptic necrosis
  • No need to taper with short course

done spring meds (8 decks)

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