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Asthma Flashcards

1
Q

True or false: Inflammation and bronchoconstriction with asthma is irreversible

A

False - it’s reversible with meds

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2
Q

Most common complication of asthma

A

Exacerbation

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3
Q

Diagnoses of asthma can be confirmed by…

A

Spirometry (FVC, FEV1)

Peak expiratory flow (using a peak flow meter)

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4
Q

What is the main determinant of asthma severity?

A 
Frequency of inhaler use
Intermittent = less than 2 days/week
Mild = more than 2 days/week but not daily
Moderate = daily use
Severe = several times per day
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5
Q

What should be included in inhaler medication counseling?

A

Proper inhaler technique
Primig
Cleaning

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6
Q

Which vaccines are recommended in asthma patients?

A

Influenza
PPSV23 (Pneumovax)

Prevnar 13 only indicated in ages 6-18 if they’re on high dose steroids

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7
Q

When are ICS indicated?

A

Persistent asthma, FIRST-line for all persistent asthma patients

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8
Q

When are LABAs indicated?

A

EIB when needing longer control vs SABA

IN ADDITION TO ICS when ICS doesn’t adequately control symptoms

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9
Q

When are leukotriene receptor antagonists indicated?

A 
Montelukast
Alternative to LABA in addition to ICS
or
In addition to LABA/ICS combo
or EIB (take 2 hours prior to exercise, lasts up to 24 h)
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10
Q

When is theophylline indicated?

A

Pretty much never

You have to monitor serum drug concentrations

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11
Q

When are LAMA’s indicated

A

In addition to ICS+LABA if not controlling symptoms

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12
Q

When are monoclonal antibodies indicated?

A

Omalizumab, mepolizumab, or reslizumab

Omalizumab (XOLAIR) = severe allergic asthma
Mepolizumab (NUCALA) = severe eosinophilic asthma (SC)
Reslizumab (CINQAIR) = severe eosinophilic asthma (IV)

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13
Q

When should you advance therapy?

A

Whenever patients need to use their SABA > 2 days per week, have nighttime awakenings 1-3x/wk, and some limitations to normal activity

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14
Q

Xopenex

A

Levalbuterol

SABA, nebulizer OR MDI

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15
Q

Side effects of SABA’s

A 
Nervousness
Tremor
Tachycardia
Palpitations
Cough
HYPERGLYCEMIA
Low K
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16
Q

How many puffs per albuterol inhaler?

A

200 except Ventolin has 60

Should last 1 year (Proair, Proventil) or 3-4 months (Ventolin) if asthma well controlled

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17
Q

Serevent Diskus

A

Salmeterol

LABA MDI

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18
Q

Why must you never use LABA as monotherapy in asthma?

A

Increase in asthma related deaths

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19
Q

QVAR

A

Beclomethasone, ICS

MDI

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20
Q

Pulmicort Flexhaler

A

Budesonide

Also available as Pulmocort Respules nebulizer

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21
Q

Alvesco

A

Ciclesonide, ICS

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22
Q

Aerospan

A

Flunisolide, ICS

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23
Q

Flovent

A

Fluticasone, ICS

Available as MDI, Diskus

24
Q

Arnuity Ellipta

A

Fluticasone, ICS

25
Q

Asmanex

A

Mometasone, ICS

26
Q

Side effects of ICS?

A

Dysphonia (difficulty speaking), oral candidiasis (thrush), cough

27
Q

Max dose Qvar

A

> 480 mcg

28
Q

Max dose Pulmicort

A

> 1080

29
Q

Max dose Flovent

A

> 440 mcg MDI

> 550 DPI

30
Q

ICS indicated for asthma

A

QVAR (beclomethasone), Pulmicort (budesonide), Flovent (fluticasone), Asmanex (mometasone)

31
Q

ICS indicated for COPD

A

No single ICS approved for COPD

32
Q

LABA indicated for asthma

A

Salmeterol (Serevent)

33
Q

LABA indicated for COPD

A

Salmeterol (Serevent)
Formoterol (Perforomist, nebulizer)
Indacaterol (Arcapta Neohaler)

34
Q

LAMA indicated for asthma

A

Tiotropium (Spiriva Respimat only)

35
Q

LAMA indicated for COPD

A

Tiotropium (Spiriva all products)
Aclidinium (Tudorza)
Glycopyrrolate (Seebri)
Umeclidinium (Incruse Ellipta)

36
Q

ICS/LABA Combos for Asthma

A

Symbicort (budesonide/formoterol)
Advair (fluticasone/salmeterol)
Dulera (mometasone, formoterol)

37
Q

LAMA/LABA combos for asthma

A

None

38
Q

LAMA/LABA combos for COPD

A

Bevespi (Glycopyrrolate/formoterol)

39
Q

Triple therapy COPD

A

Trelegy

40
Q

Which products do you NOT have to shake?

A

QVAR, Alvesco, Respimat

41
Q

Singulair dose

A

Montelukast
10 mg daily in the evening
age 6-14: 5 mg daily
age 1-5: 4 mg daily

42
Q

LTRAs

A

Leukotriene modifying agents
Montelukast (SINGULAIR)
or Zafirlukast (Accolate) or Zileuton (Zyflo)

43
Q

Side effects of LTRAs

A

Montelukast

Headache

44
Q

Counseling montelukast granules

A

Mix in 5 mL of breast milk or formula or mixed with a spoonful of applesauce, carrots, rice, or ice cream
Use within 15 mins of opening the packet

45
Q

Phosphodiesterase inhibitor

A

Theophylline (Elixophyllin, Theo-24, Theochron)

Active metabolites caffeine and 3-methylxanthine

46
Q

Side effects phosphodiesterase inhibitors

A

Theophylline

Nausea, vomiting

47
Q

Conversion aminophylline to theophylline

A

Aminophylline contains 80% theophylline

Multiply by 0.8

48
Q

Considerations with theophylline

A

Lots of drug interactions (major substrate 1A2, minor substrate 3A4 and 2E1)
Therapeutic drug monitoring (goal 5-15 mcg/mL)
Saturatable kinetics - small inc in dose lead to large inc in concentration
Dose using total body weight

49
Q

Monoclonal antibody that inhibits IgE binding

A

Omalizumab (Xolair)

Indicated for severe allergic asthma

50
Q

Dosing Xolair

A

Omalizumab
SC every 2-4 weeks
dose based on IgE levels and body weight
Given at dr’s office!!

51
Q

Side effects Xolair

A

Injection site reactions

52
Q

IL-5 Receptor antagonists

A

Mepolizumab (Nucala) - 100 mg SC every 4 weeks

Reslizumab (Cinqair) - 3 mg/kg IV every 4 weeks

53
Q

Boxed warning IL-5 receptor antagonists

A

Reslizumab (Cinqair) - IV - anaphylaxis

54
Q

Counseling for taking multiple inhalers

A 
Use bronchodilator(s) first, then ICS
Wait 60 seconds between each one
55
Q

Counseling for using peak flow meter

A

Use every morning upon awakening and use before the use of any asthma medications
Blow out as hard and fast as possible

56
Q

How to determine personal best for peak flow meter? How do you use this to determine zones?

A

Use it twice a day for 2-3 weeks, most frequent highest reading is your PB
Green zone = 80-100% your PB (business as usual)
Yellow zone = 50-80% your PB (use action plan)
Red zone = < 50% personal best (alert, seek medical attention)

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