Asthma Flashcards
What rescue inhaler use Characterizes intermittent asthma severity?
<=2 days per week
What rescue inhaler use shows persistent mild severity?
> 2 days per week but not daily or >1x/day
What rescue inhaler use shows persistent moderate asthma severity?
Daily
What rescue inhaler use shows persistent severe severity?
Several times per day
What vaccines should asthma patients get?
Annual flu
Pneumovax 23
Patients should only get Prevnar if they are 6-18 who require high dose oral steroids
What drug is first line for all patients with persistent asthma?
ICS
What agent should never be used alone in asthma and is a preferred add on?
LABA
What drug is used for severe allergic asthma?
Mab: Omalizumab
When should you maintain current asthma therapy or consider step down?
Consider step down if controlled for at least 3 months
- Symptom use: of SABA <= 2 days per wk, nightime <=2 days per wk , no limitations on activity
When should you consider stepping therapy up for asthma patients?
SABA > 2 days per wk
When should you consider stepping asthma therapy up 1-2 steps?
Using SABA several times a day
What is the recommended therapy for intermittent asthma? 2 things
SABA as needed
COnsider low dose ICS to prevent exacerbations
Step 2 what should be added for mild persistent asthma
Low dose ICS, controller
What should be added for Step 3 moderate persistent asthma?
Low dose ICS + LABA OR medium dose ICS
What should be addd in step four for persistent severe asthma?
Medium dose ICS + LABA
What should be added in step 5 fpr severe persistent asthma?
High dose ICS + LABA
Step 6 severe persistent asthma?
Add oral steroid
What is added for Step 1,2,3,4,5,6
- SABA, consider low dose ICS
- Add ICS for sure low dose
- Low dose ICS + LABA or increase ICS
- Increase dose of ICS +LABA
- Hign dose ICS + LABA
- Add oral sterois
Albuterol dosing?
MDI/DPI 1-2 inhalations Q4-6
Boxed warning for ProAir Respiclick?
Severe hypersens milk protein
SEs of albuterol? 7
- Nervousness
- Tremor
- Tachcardia
- Palpitations
- COugh
- Hyperglycemia
- Decreased K
Serevent Diskus?
Salmeterol
Boxed warning for serevent diskus?
Increase asthma related deaths only used in combo with asthma
Qvar
Beclomethasone
Pulmicort Flexhaler
Budesonide
Pulmicort Respules
Budesonide Nebulaizer
Flovent
Arnuity Ellipta?
Fluticasone
SEs of Inhaled corticosteroids? 3
- Dsyphania difficulty speaking
- Oral candiasis
- Cough
How to prevent oral candiasis in asthma?
Rinse mouth after use
use a spacer
What is the only ICS available as a nebulizer?
Pulmicort respulesL Budesonide
What is a high dose of QVAR?
>480 mcg
What is a high dose of pulmicort?
>1080
What is a high dose fluticasone MDI?
>440
What is a high dose of fluticasone DPI?
>500
What is a high dose of mometasone MDI
>400
What is a high dose of mometasone DPI?
>440
Special note about QVAR and Alvesco?
They do not need to be shaken
Main ICSs for asthma? 3
QVAR, Pulmicort, Flovent
One LABA used for Asthma and COPD
Salmeterol
Serevent
4 combo ICS LABA for Asthma
- Symbicort
- Advair, Airduo
- Dulera
- Breo Ellipta
Breo Ellipta?
Fluticasone/vilanterol
Dulera
Mometasone/formeterol
Advair, Airduo
Fluticasone/salmeterol
What are the DPI names? 7
- Diskus
- Ellipta
- Pressair
- Handihaler
- Neohaler
- Respiclick
- Flexhaler
What dosage forms does singulair com ein?
Tablet, chewable, packet
3 dosing ranges for Singulair
- >14, 10 mg in the evening
- 6-14, 5 mg in the evening
- 1-5, 4 mg in the evenin
Singlulair warning?
Neuropsych events
Theophylline therapeutic levels
5-15 mcg/mL
How do you convert theophylline to aminophylline
ATM amino to theo x 0.8
theo to amino / 0.8
What 7 drugs can increase theophylline levels
- CYP1A2 inhibiton
- Ciprofloxacin
- fluvoxamine
- cimetidine
- propranolol
- zafirlukast
- zilueton
Xolair
Omalizumab
Xolair administration?
In a medical setting given SC
Anaphylaxis can occur
What does Xolair do?
IgE binding inhibitoon
only for allergic asthma
Who is at higher risk for developing COPD?
alpha-1 antitrypsin def
Difference in asthma and COPD?
Asthma the limitation in airflow is medically reversible
COPD: Not fully reversible
What is required for COPB diagnosis?
Spirometry
What FVC confirms COPD?
FVC<70
Pts exacerbation history and CAT/mMRC score to put them in category A
0 or 1 exacerbation not leading to hosptalization
CAT <10
mMRC 0-1
Exacerbation hx to put you in COPD category A or B
0 or 1 not leading to hospitalization
CAT and mMRC score putting you in category D or B
CAT>= 10
mMRC >= 2 `
Exacerbation history to put you in category C or D
>= 2 exacerbations or 1 putting you in the hospital
Recommended treatment for category A
SABA or SAMA PRN
Category B treatment
LAMA or LABA
Pt group C
LAMA
Patient Group D
LAMA + LABA
Atrovent HFA
Ipratropium
Combivent REspimat
Ipratropium + albuterol
Spiriva Handihaler
Tiotropium
Brovana
Arformeterol R-Isomer of formeterol
Daliresp
Roflumilast
MOA of daliresp
PDE-4 inibitor incres cAMP redcing inflammation in the lungs