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Naplex > Asthma > Flashcards

Asthma Flashcards

1
Q

General Information

A

Inflammation & bronchoconstriction → airway obstruction & expiratory airflow limitation

Classic Symptoms: Recurrent wheezing, breathlessness, chest tightness & cough

Reversible: If FEV ↑12% with medication |

Exacerbations: Can be mild, severe or fatal

Triggers: Allergens, dust |

Smoke, chemicals, weather |

Lifestyle: Stress/exercise |

Med: ASA, NSAID, BB | Respiratory infections |

Comorbidity: Allergy, GERD, Obesity, Sleep apnea, Anxiety, Depression

Diagnosis: Spirometry; tests forced vital capacity in 1 second to assess expiratory volume: FEV1/FVC

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2
Q

Asthma Tx Algorithm

A
  1. Classify asthma severity → 2. Initiate treatment
  2. F/U 2-6 wks: Review and determine if asthma is under control: step-up, maintain, down. Assess adherence, counsel, control risks, triggers, comorbids:

Avoid: Smoking, Triggers |

▪Exercise: Even if EIB | Vaccines: Flu, Pneumovax 23

  1. Follow up 1-6 months if controlled
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3
Q

Guide to Spacers & Nebulizers

A

Spacers: Open tubes btwn mouthpiece & MDI for kids, dexterity issue,↓thrush |

Clean: QW in warm water

Nebulizer: Liquid med → mist & inhaled thru face mask w/natural breathing.

Two types: Jet & ultrasound

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4
Q

General guidance of Inhaler use

A

> 1 Inhalation: Wait 60 sec between each inhalation > 1 Inhaler: Sequence = SABA → LABA/LAMA → ICS

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5
Q

Asthma in Pregnancy

A

SABA is a must; Preferred controllers: budesonide (ICS)

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6
Q

Peak Flow Meters

A

Monitor asthma control [Peak expiratory flow rate] QAM before meds|

Clean: QW

Essential: Technique & best effort

Blow HARD & FAST

Record highest of 3 attempts

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7
Q

Peak Flow Meter Color Guides

A

% of Personal best

Green > 80 - 100%

Yellow: 50-80% → Action Plan

Red: < 50% → ER

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8
Q

Exercise Induced Bronchospasm (EIB)

A

Preferred preventative: SABA 2 inh 5-15 mins before exercise lasts 2-3hrs

▪ Longer duration: salmeterol (LABA) 30mins before*

*Do not use if already using for asthma maintenance.

▪ Alternative: montelukast taken 2hr prior lasts >24hr

*EIB is often a marker for inadequate asthma control

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9
Q

Classifying Asthma Severity

A
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10
Q
  1. Initiate Tx
A
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11
Q
  1. Asthma Control
A
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12
Q

Dry Powder Inhalers (DPI)

A

Diskus, Ellipta, Pressair, Handihaler, Neohaler, RespiClick, Flexhaler

Delivery: Fine powdered medication NO propellant |

Admin: QUICK & FORCEFUL (no buttons)

Do NOT shake | No priming (Except Flexhaler)

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13
Q

Advair Diskus Instructions

A
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14
Q

Pulmicort Flexhaler Instructions

A
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15
Q

ProAir and Airduo RespiClick

A
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16
Q

Metered Dose Inhalers - Key Features

A

HFA, Respimat or no suffix

Aerosolized liquid med w/propellant: HFA, CFC

Admin: SLOW & DEEP while pressing canister ▪

Spacer: PTs unable to coordinate breathing & pressing

Shake well: except QVAR RediHaler, Alvesco & Respimats

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17
Q

Metered Dose Inhalers - Counseling

A
  1. Shake inhaler for 5 seconds before use ▪except QVAR RediHaler/Alvesco
  2. Breathe out fully
  3. Inhale SLOW & DEEP while pressing top of canister with index finger
  4. Hold breath 10s or as long as possible
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18
Q

Ventolin HFA & ProAir HFA Priming Instructions

A

Spray 4x (3 for Proair) away from face while shaking

▪Prime if > 14 days since last use or drop

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19
Q

Flovent HFA & Dulera Priming Instructions

A

Spray 4x away while shaking.

▪ Prime: 1 spray if > 7 days last use | > 5 for Dulera

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20
Q

Symbicort Priming Instructions

A

Spray 2x while shaking.

▪ Prime if > 7 days last use

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21
Q

Ventolin HFA & ProAir HFA Cleaning Instructions

A

Remove metal canister & rinse mouthpiece with warm H2O, then air dry. (1x/wk)

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22
Q

Flovent HFA Cleaning Instructions

A

Clean cotton swab w/H2O to clean where med sprays. Air dry.

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23
Q

Dulera & Symbicort Cleaning Instructions

A

Do NOT put in water. Use clean, dry cloth to wipe inside and outside of mouthpiece.

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24
Q

SAMA - Description

A

Inhibits cholinergic: Bronchodilation | acute exacerbation

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25
Q

SAMA agents

A

Ipratropium

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26
Q

SABA - Description

A

Rescue therapy for ALL patients

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27
Q

ProAir HFA

A

Albuterol

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28
Q

Respiclick

A

Albuterol

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29
Q

Proventil

A

Albuterol

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30
Q

Ventolin

A

Albuterol

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31
Q

Xopenex Concentrate
Xopenex HFA

A

Levalbuterol

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32
Q

Asthmanefrin Refill

A

Racepinephrine

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33
Q

Treatment Algorithm

A
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34
Q

Primatene Mist

A

Epinephrine

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35
Q

Albuterol Key features

A

90 mcg/inh | Most 200 inh; Ventolin (some): 60 inh MDI/DPI: 1 - 2 inh Q4-6H PRN

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36
Q

Levalbuterol Key features

A

R-isomer of albuterol

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37
Q

Racepinephrine key features

A

Non-selective - do not use

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38
Q

Epinephrine key features

A

FDA: Mild, intermittent

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39
Q

SABA - Safety

A

ADR: Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, ↓K

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40
Q

ICS Description

A

1st line for ALL patients: Inhibits inflammatory response: ↓sx, ↑lung function, ↑QOL and ↓exacerbations.

41
Q

QVAR Redihaler

A

Beclomethasone

42
Q

Pulmicort Flexhaler

Pulmicort Respules

A

Budesonide

43
Q

Flovent HFA

Flovent Diskus

A

Fluticasone

44
Q

Arnuity Ellipta

A

Fluticasone

45
Q

Alvesco

A

Ciclesonide

46
Q

Aerospan

A

Flunisolide

47
Q

Twisthaler

A

Mometasone

48
Q

Asmanex HFA

A

Mometasone

49
Q

QVAR Redihaler - Key features

A

NO shaking

51
Q

Which is the only ICS that can be nebulized?

A

Budesonide

52
Q

Pulmicort respules - key features

A

Budesonide

Only use with jet nebulizer

53
Q

Alvesco - key features

A

Ciclesonide

No shaking

54
Q

ICS - Safety

A

ADR: Dysphonia (difficulty speaking), Thrush*, Cough *Prevention: Rinse mouth & throat or use spacer

55
Q

LABA agents

A

Salmeterol

56
Q

Serevent Diskus

A

Salmeterol

57
Q

Salmeterol - Key features

A

Not for acute bronchospasm

NEVER use alone

58
Q

Salmeterol - Safety

A

BBW: ↑risk of asthma related death: only use if also receiving a long-term control (ICH) but not adequate

59
Q

Spiriva Respimat

A

Tiotropium

60
Q

ICS + LABA

Steps 1-5

A

Symbicort

Dulera

61
Q

ICS + LABA

Steps 1-5

Key features

A

Doses: Low, Medium, and High

62
Q

ICS + LABA: Steps 3-5

A

Advair

Diskus

HFA

AirDuo

Wixela Inhub

Breo Ellipta

63
Q

ICS + LABA: Steps 3-5 - key features

A

Doses: Medium and High

64
Q

Symbicort

A

Budesonide + Formoterol

65
Q

Dulera

A

Mometasone + Formoterol

66
Q

Advair Diskus

Advair HFA

A

Fluticasone + Salmeterol

67
Q

AirDuo

A

Fluticasone + Salmeterol

68
Q

Wixela Inhub

A

Fluticasone + Salmeterol

69
Q

Breo Ellipta

A

Fluticasone + Vilanterol

70
Q

Singulair

A

Montelukast

Available as tab, chew, and packet

71
Q

Montelukast description

A

Inhibits leukotriene D4 (LTD4)

72
Q

Accolate

A

Zafirlukast

73
Q

Zafirlukast description

A

Inhibits both LTD4 and LTE4

74
Q

Zyflo

Zyflo CR

75
Q

Zileuton description

A

5-lipooxygenase inhibitor: Inhibits leukotriene formation

76
Q

Singulair - Key features

A

6 - 14yo: 5mg QPM | 1 - 5yo: 4mg QPM Granules: Admin directly → mouth/mixed. Use 15min of opening

77
Q

Accolate - key features

A

Dispense in original container

78
Q

Leukotriene Modifying Agents - Safety

A

Warning: Neuropsych events

79
Q

Theophylline description

A

Blocks phosphodiesterase → ↑cAMP → EPI release → bronchodilation but also diuresis, CNS & cardiac stim

80
Q

Theo-24

A

Theophylline

81
Q

Theochron

A

Theophylline

82
Q

Elixophyllin

A

Theophylline

83
Q

Theophyllin - key features

A

Active metabolite: caffeine Conversion: Aminophylline → Theophylline x 0.8 [ATM]

84
Q

Theophylline - safety

A

Toxicity: persistent vomiting, arrhythmia, seizures

85
Q

Xolair

A

Omalizumab

86
Q

Omalizumab description

A

Inhibits IgE for > 6yo if +skin test & ICH inadequate Indication: Severe Allergic Asthma

87
Q

Xolair key features

A

Admin: SC q2-4w healthcare MD supervision

88
Q

Omalizumab safety

A

BBW: Anaphylaxis

89
Q

Interleukin Receptor Antagonists - Eosinophilic phenotype

A

Mepolizumab

Reslizumab

Benralizumab

Dupilumab

90
Q

Nucala

A

Mepolizumab

91
Q

Cinqair

A

Reslizumab

92
Q

Fasenra

A

Benralizumab

93
Q

Dupixent

94
Q

Xolair key features

A

Admin: SC q2-4w healthcare MD supervision

95
Q

Nucala key features

96
Q

Cinqair key features

97
Q

Fasenra key features

A

SC Q4w for 3 doses then Q8w

98
Q

Dupixent key features

99
Q

Cinqair - Safety

A

BBW: Anaphylaxis

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