Asthma Flashcards
1
Q
What part of the lungs does asthma affect?
A
bronchi (airway)
Causes expiratory airflow limitation
2
Q
How is an asthma diagnosis confirmed?
A
Spirometry and pulmonary function tests
3
Q
If the FEV1 increases by >____% the asthma is consider reversible
A
12
4
Q
What is FEV1
A
How much air can be exhaled in 1 second
5
Q
What is FVC
A
The max volume of air that is exhaled after taking a breath
6
Q
What is FEV1/FVC
A
Percentage of total air capacity that can be forcefully exhaled in one second
7
Q
What is peak expiratory flow rate (PEFR) used for?
A
Monitoring control as par of the asthma action plan
8
Q
Common asthma triggers
A
Genetics Polution Cigarettes Cold air Pets Dust, pollen, cockroaches Perfume Drugs (ASA, NSAIDs, non-selective BB)
9
Q
Common asthma comorbid conditions
A
Infections (colds/viruses) Allergic rhinitis GERD Obesity OSA Anxiety Stress Depression
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
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
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
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
14
Q
What dosage form is preferred in asthma?
A
Inhaled
Reduced toxicity and delivered directly to lung
15
Q
What does frequent use of SABA rescue inhaler indicate?
A
Worsening asthma control
16
Q
What medications are rescue medications?
A
Inhaled low dose ICS + formoterol SABA Systemic steroids Inhaled epinephrine Inhaled SAMAs (aka anticholinergics)
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
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
19
Q
What is first-line for all patients with persistent asthma
A
ICS
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
21
Q
What asthma medication is commonly used in children?
A
Oral leukotriene receptor antagonists (LTRAs)
22
Q
What mAb is used or severe allergic asthma?
A
Omalizumab
23
Q
What mAb is used for severe eosinophilic asthma?
A
Mepolizumab
Resilzumab
Benralizmab
Dupilumab
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
25
What makes asthma considered not well controlled?
| If asthma is considered not well controlled, what should you do to their treatment?
Sx/use of SABA >2d/w, nighttime awakenings 1-3x/week, some limitations to normal activity
Step up 1 step
26
What makes asthma considered very poorly controlled?
| If asthma is considered very poorly controlled, what should you do to their treatment?
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)
27
What is starting treatment for intermittent asthma
PRN low-dose ICS + formoterol or
| Low-dose ICS taken whenever SABA is taken
28
What is starting treatment for mild asthma
Daily low-dose ICS or
| PRN low-dose ICS + formoterol
29
What is starting treatment for moderate asthma
Low-dose ICS + LABA
Low-dose ICS + LTRA
Medium dose ICS
30
What is starting treatment for severe asthma
Medium-dose ICS + LABA
| High-dose ICS + tiotropium or LTRA
31
Beta-2 agonist MOA
bind to beta-2 agonist receptors causing relaxing of bronchial smooth muscle
32
What medications are SABAs?
Albuterol (ProAir, Proventil, Ventolin)
Levalbuterol
Racepinephrine
Epinephrine
33
What medications are LABAs?
Salmeterol
34
LABA BBW
Increased risk of asthma-related deaths (need to use in combo with ICS)
35
What medications are ICS?
Beclomethasone (QVAR Redihaler)
Budesonde (Pulmicort)
Fluticasone (Flovent, Arnuity) + salmeterol (Advair) + vilanterol (Breo)
Mometasone + fomoterol (Dulera)
36
What medications are
Budesonide + formoterol
Mometasone + formoterol
B+F - Symbicort
| M+F - Dulera
37
ICS SE and important counseling points
SE: dysphonia (difficulty speaking), thrush
| Rinse mouth and spit to prevent thrush
38
What combination is preferred to control Asthma? COPD?
ICS and ICS/LABA - asthma
| LABA, LAMA, LABA/LAMA - COPD
39
What ICS are used for asthma?
Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent, Arnuity)
40
What LABA is used in asthma?
Salmeterol
41
What LAMA is used in asthma?
Tiotropium (Spiriva)
42
What ICS/LABA combos are used in asthma?
Budesonide/formoterol (Symbicort)
Fluticasone/salmeterol (Advair)
Mometasone/formoterol (Dulera)
Fluticasone/vilanterol (Breo)
43
What LAMA/LABAs combos are used in asthma?
NONE
44
What brand name identifiers are used for MDIs?
HFA, Respimat
45
What brand name identifiers are used for DPIs?
Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler
46
How are MDI and DPI doses delivered?
MDI - Aerosolized liquid
| DPI - fine powder
47
How are MDIs and DPIs administered?
MDI - Slow, deep inhalation while pressing the canister
| DPI - Quick, forceful inhalation - no need to press anything
48
Can you use a spacer for MDIs or DPIs?
MDI - yes
| DPI - no
49
Do you need to shake MDIs or DPIs prior to use?
MDI - required
| DPI - do NOT shake
50
What does MDI mean
Metered-dose inhaler
51
What does DPI mean
Dry powder inhaler
52
Leukotriene modifying agents (LTRAs) MOA
| montelukast vs zafirlukast vs zileuton
inhibit leukotriene mediators of airway inflammation
Montelukast - inhibits LTD4
Zafirlukast - inhibits LTD4 and LtE4
Zileuton - inhibits leukotriene formation
53
Leukotriene modifying agent BBW, warnings
BBW: montelukast - neuropsychiatric events
Warnings: neuropsychiatric events
54
Theophylline MOA
blocks phosphodiesterase, increasing cAMP and release of epinephrine from adrenal medulla cells causing bronchodilation diuresis, CNS and cardiac stimulation, and gastric acid secretion
55
Theophylline active metabolites
caffeine and 3-methylxanthine
56
Theophylline toxicity sx
persistent vomiting, arrhythmias, seizures
57
Theophylline to aminophylline conversion
ATM
| Amionphylline -- Thophylline Multiply by 0.8
58
What medications increase theophylline levels
Ciprofloxacin, zileuton, zafirlukast
59
What medications decrease theophylline levels?
carbamazepine, fosphenytoin, phenobarbital, phenytoin, primidone, rifampin, ritonavir
60
Anticholinergic MOA
inhibit muscarinic cholinergic receptors leading to bronchodilation
61
What long-acting anticholinergic is FDA approved for asthma in children > 6?
Tiotropium (spiriva)
62
Omalizumab (Xolair) MOA and indication
MOA: inhibits IgE binding to mast cells and basophils
Indication: severe, persistent allergic asthma in pts >6 with positive skin test
63
Omalizumab BBW and administration note
BBW: anaphylaxis
Note: must be administered in a healthcare setting under medical supervision
64
Interleukin receptor antagonist medications
IL-5: mepolizumab, resilzumab, and benralizumab
| IL-4 and IL-3: dupilumab
65
Mepolizumab (Nucala) drug class and administration route
IL-5 receptor antagonist
| SQ q4w
66
Reslizumab (Cinquair) drug class and administration route
IL-5 receptor antagonist
| IV q4w
67
Reslizumab (Cinquair) BBW
anaphylaxis
68
Benralizumab (Fasenra) drug class and administration
IL-5 receptor antagonist SQ q4w x 3 doses then q8w
69
Dupilumab (Dupixent) drug class and administration route
IL-3 and IL-4 receptor antagonist SQ every other week
70
What medications are preferred for exercise-induced bronchospasm? How long do they last?
```
SABAs or low-dose ICS
+ formoterol
Take 5-15 mins before
exercise
SABA lasts ~2-3 hours
SABA + formoterol
lasts ~12 hours
```
71
What ICS is preferred
| in pregnancy?
budesonide
Goal is to control
asthma in pregnancy
72
How long will an
albuterol inhaler
last someone with
good asthma control?
12 months
73
```
What is the minimum
amount of time
someone should wait
between 2
inhalations?
```
60 seconds
74
Which should you use
first, bronchodilator
or ICS? Why?
```
Bronchodilator - will
allow airway to open
up and corticosteroid
will travel deeper
into the lung
```
75
What to do if peak
flow meter indicates
80-100% of personal
best?
Good control
Follow routine
maintenance plan
76
What to do if peak
flow meter indicates
50-80% of personal
best?
Caution - worsening
lung function
Patient requires
action plan
77
What to do if peak
flow meter indicates
<50%
```
Seek medical
attention
Action plan includes
rescue inhaler,
possibly steroids and
going to the
emergency department
```
78
When should montelukast be taken?
in the evening
