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NAPLEX Review > Asthma > Flashcards

Asthma Flashcards

1
Q

What part of the lungs does asthma affect?

A

bronchi (airway)

Causes expiratory airflow limitation

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2
Q

How is an asthma diagnosis confirmed?

A

Spirometry and pulmonary function tests

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3
Q

If the FEV1 increases by >____% the asthma is consider reversible

A

12

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4
Q

What is FEV1

A

How much air can be exhaled in 1 second

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5
Q

What is FVC

A

The max volume of air that is exhaled after taking a breath

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6
Q

What is FEV1/FVC

A

Percentage of total air capacity that can be forcefully exhaled in one second

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7
Q

What is peak expiratory flow rate (PEFR) used for?

A

Monitoring control as par of the asthma action plan

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8
Q

Common asthma triggers

A 
Genetics
Polution
Cigarettes
Cold air
Pets
Dust, pollen, cockroaches
Perfume
Drugs (ASA, NSAIDs, non-selective BB)
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9
Q

Common asthma comorbid conditions

A 
Infections (colds/viruses)
Allergic rhinitis
GERD
Obesity
OSA
Anxiety
Stress
Depression
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10
Q 
How many 
Daytime symptoms
Nighttime awakenings
SABA rescue use
Activity limitations
Lung function (FEV1)
Treat with what step?
for intermittent asthma severity?
A 
DS: <2d/week
NTA: <2x/month
SABA use: <2d/week
Limitations: None
FEV1: >80%
Step 1
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11
Q 
How many 
Daytime symptoms
Nighttime awakenings
SABA rescue use
Activity limitations
Lung function (FEV1)
Treat with what step?
for persistent mild asthma severity
A 
DS: >2d/w
NTA: 3-4x/month
SABA use: >2 d/week but not daily
Limitations: Minor
FEV1: >80%
Step 2
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12
Q 
How many 
Daytime symptoms
Nighttime awakenings
SABA rescue use
Activity limitations
Lung function (FEV1)
Treat with what step?
for persistent moderate asthma severity
A 
DS: Daily
NTA: >1x/week
SABA use: Daily
Limitations: some
FEV1: 60-80%
Step 3
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13
Q 
How many 
Daytime symptoms
Nighttime awakenings
SABA rescue use
Activity limitations
Lung function (FEV1)
Treat with what step?
for persistent severe asthma severity
A 
DS: throughout the day
NTA: often (7x/week)
SABA use: Several times per day
Limitations: Extremely limited
FEV1: <60%
Step 4 or 5
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14
Q

What dosage form is preferred in asthma?

A

Inhaled

Reduced toxicity and delivered directly to lung

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15
Q

What does frequent use of SABA rescue inhaler indicate?

A

Worsening asthma control

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16
Q

What medications are rescue medications?

A 
Inhaled low dose ICS + formoterol
SABA
Systemic steroids
Inhaled epinephrine
Inhaled SAMAs (aka anticholinergics)
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17
Q

SABAs used to be used for asthma - what is used now? Why?

A

Inhaled low dose ICS + formoterol

Combo results in fewer exacerbations over SABA alone

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18
Q

What medications are controllers?

A 
Inhaled corticosteroids (ICS)
Inhaled LABAs
Oral leukotriene receptor antagonists (LTRAs)
Theophylline
Inhaled LAMAs (aka anticholinergics)
Injectable monoclonal antibodies
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19
Q

What is first-line for all patients with persistent asthma

A

ICS

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20
Q

What medication should not be used alone in asthma?

A

LABAs d/t increased risk of serious adverse outcomes

Preferred add-on agents to ICS

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21
Q

What asthma medication is commonly used in children?

A

Oral leukotriene receptor antagonists (LTRAs)

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22
Q

What mAb is used or severe allergic asthma?

A

Omalizumab

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23
Q

What mAb is used for severe eosinophilic asthma?

A

Mepolizumab
Resilzumab
Benralizmab
Dupilumab

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24
Q

What makes asthma considered well controlled?

If asthma is considered well controlled, what should you do to their treatment?

A

Sx/use of SABA <2d/w, nighttime awakenings <2x/month, no limitations to normal activity
Maintain current therapy, if controlled 3 months may step down treatment

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25
Q

What makes asthma considered not well controlled?

If asthma is considered not well controlled, what should you do to their treatment?

A

Sx/use of SABA >2d/w, nighttime awakenings 1-3x/week, some limitations to normal activity
Step up 1 step

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26
Q

What makes asthma considered very poorly controlled?

If asthma is considered very poorly controlled, what should you do to their treatment?

A

Sx/use of SABA several times daily, nighttime awakenings >4 days/week, normal activity extremely limited
Step up 1-2 steps (consider short course of oral steroids)

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27
Q

What is starting treatment for intermittent asthma

A

PRN low-dose ICS + formoterol or

Low-dose ICS taken whenever SABA is taken

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28
Q

What is starting treatment for mild asthma

A

Daily low-dose ICS or

PRN low-dose ICS + formoterol

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29
Q

What is starting treatment for moderate asthma

A

Low-dose ICS + LABA
Low-dose ICS + LTRA
Medium dose ICS

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30
Q

What is starting treatment for severe asthma

A

Medium-dose ICS + LABA

High-dose ICS + tiotropium or LTRA

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31
Q

Beta-2 agonist MOA

A

bind to beta-2 agonist receptors causing relaxing of bronchial smooth muscle

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32
Q

What medications are SABAs?

A

Albuterol (ProAir, Proventil, Ventolin)
Levalbuterol
Racepinephrine
Epinephrine

33
Q

What medications are LABAs?

A

Salmeterol

34
Q

LABA BBW

A

Increased risk of asthma-related deaths (need to use in combo with ICS)

35
Q

What medications are ICS?

A

Beclomethasone (QVAR Redihaler)
Budesonde (Pulmicort)
Fluticasone (Flovent, Arnuity) + salmeterol (Advair) + vilanterol (Breo)
Mometasone + fomoterol (Dulera)

36
Q

What medications are
Budesonide + formoterol
Mometasone + formoterol

A

B+F - Symbicort

M+F - Dulera

37
Q

ICS SE and important counseling points

A

SE: dysphonia (difficulty speaking), thrush

Rinse mouth and spit to prevent thrush

38
Q

What combination is preferred to control Asthma? COPD?

A

ICS and ICS/LABA - asthma

LABA, LAMA, LABA/LAMA - COPD

39
Q

What ICS are used for asthma?

A

Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent, Arnuity)

40
Q

What LABA is used in asthma?

A

Salmeterol

41
Q

What LAMA is used in asthma?

A

Tiotropium (Spiriva)

42
Q

What ICS/LABA combos are used in asthma?

A

Budesonide/formoterol (Symbicort)
Fluticasone/salmeterol (Advair)
Mometasone/formoterol (Dulera)
Fluticasone/vilanterol (Breo)

43
Q

What LAMA/LABAs combos are used in asthma?

A

NONE

44
Q

What brand name identifiers are used for MDIs?

A

HFA, Respimat

45
Q

What brand name identifiers are used for DPIs?

A

Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler

46
Q

How are MDI and DPI doses delivered?

A

MDI - Aerosolized liquid

DPI - fine powder

47
Q

How are MDIs and DPIs administered?

A

MDI - Slow, deep inhalation while pressing the canister

DPI - Quick, forceful inhalation - no need to press anything

48
Q

Can you use a spacer for MDIs or DPIs?

A

MDI - yes

DPI - no

49
Q

Do you need to shake MDIs or DPIs prior to use?

A

MDI - required

DPI - do NOT shake

50
Q

What does MDI mean

A

Metered-dose inhaler

51
Q

What does DPI mean

A

Dry powder inhaler

52
Q

Leukotriene modifying agents (LTRAs) MOA

montelukast vs zafirlukast vs zileuton

A

inhibit leukotriene mediators of airway inflammation
Montelukast - inhibits LTD4
Zafirlukast - inhibits LTD4 and LtE4
Zileuton - inhibits leukotriene formation

53
Q

Leukotriene modifying agent BBW, warnings

A

BBW: montelukast - neuropsychiatric events
Warnings: neuropsychiatric events

54
Q

Theophylline MOA

A

blocks phosphodiesterase, increasing cAMP and release of epinephrine from adrenal medulla cells causing bronchodilation diuresis, CNS and cardiac stimulation, and gastric acid secretion

55
Q

Theophylline active metabolites

A

caffeine and 3-methylxanthine

56
Q

Theophylline toxicity sx

A

persistent vomiting, arrhythmias, seizures

57
Q

Theophylline to aminophylline conversion

A

ATM

Amionphylline – Thophylline Multiply by 0.8

58
Q

What medications increase theophylline levels

A

Ciprofloxacin, zileuton, zafirlukast

59
Q

What medications decrease theophylline levels?

A

carbamazepine, fosphenytoin, phenobarbital, phenytoin, primidone, rifampin, ritonavir

60
Q

Anticholinergic MOA

A

inhibit muscarinic cholinergic receptors leading to bronchodilation

61
Q

What long-acting anticholinergic is FDA approved for asthma in children > 6?

A

Tiotropium (spiriva)

62
Q

Omalizumab (Xolair) MOA and indication

A

MOA: inhibits IgE binding to mast cells and basophils
Indication: severe, persistent allergic asthma in pts >6 with positive skin test

63
Q

Omalizumab BBW and administration note

A

BBW: anaphylaxis
Note: must be administered in a healthcare setting under medical supervision

64
Q

Interleukin receptor antagonist medications

A

IL-5: mepolizumab, resilzumab, and benralizumab

IL-4 and IL-3: dupilumab

65
Q

Mepolizumab (Nucala) drug class and administration route

A

IL-5 receptor antagonist

SQ q4w

66
Q

Reslizumab (Cinquair) drug class and administration route

A

IL-5 receptor antagonist

IV q4w

67
Q

Reslizumab (Cinquair) BBW

A

anaphylaxis

68
Q

Benralizumab (Fasenra) drug class and administration

A

IL-5 receptor antagonist SQ q4w x 3 doses then q8w

69
Q

Dupilumab (Dupixent) drug class and administration route

A

IL-3 and IL-4 receptor antagonist SQ every other week

70
Q

What medications are preferred for exercise-induced bronchospasm? How long do they last?

A 
SABAs or low-dose ICS
\+ formoterol
Take 5-15 mins before
exercise
SABA lasts ~2-3 hours
SABA + formoterol
lasts ~12 hours
71
Q

What ICS is preferred

in pregnancy?

A

budesonide
Goal is to control
asthma in pregnancy

72
Q

How long will an
albuterol inhaler
last someone with
good asthma control?

A

12 months

73
Q 
What is the minimum
amount of time
someone should wait
between 2
inhalations?
A

60 seconds

74
Q

Which should you use
first, bronchodilator
or ICS? Why?

A 
Bronchodilator - will
allow airway to open
up and corticosteroid
will travel deeper
into the lung
75
Q

What to do if peak
flow meter indicates
80-100% of personal
best?

A

Good control
Follow routine
maintenance plan

76
Q

What to do if peak
flow meter indicates
50-80% of personal
best?

A

Caution - worsening
lung function
Patient requires
action plan

77
Q

What to do if peak
flow meter indicates
<50%

A 
Seek medical
attention
Action plan includes
rescue inhaler,
possibly steroids and
going to the
emergency department
78
Q

When should montelukast be taken?

A

in the evening

NAPLEX Review (79 decks)

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