Asthma and Pharm Review Flashcards
Arsenal of Asthma medications
- inhaled corticosteroid
- short acting beta-2 agonist
- long acting beta-2 agonist
- combo inhaled steroid/long acting beta agonist
- leukotriene modifiers
Why might a spacer be used with an inhaler?
- used for those who have hard time coordinating the dose of med. leads to less deposition of med in mouth, thereby less systemic side effects.
- if pt notices heart racing or shakey feelings they might need spacer.
Inhalers come in two forms, what are they?
What is the main difference between the two?
Meter Dosed Inhaler (MDI)
Dry Powder Inhaler (DPI)
-main difference between the two is that the DPI is non-propellant and the MDI is propellant based
Basics of medication therapy for asthma
- determine the severity
- all patients need SABA for rescue
- prevention of symptoms is key
- control inflammation is key!*
Inhaled corticosteroids
- used for which steps of asthma?
- are more or less effective than leukotrienes
- used in all steps for PERSISTENT asthma
- more effective
Can short coursed of oral corticosteroids be used for periodic exacerbations?
-yes, but you dont take them off inhaler
Mechanism of Action: Inhaled Corticosteroid
-how long until maximum efficacy reached?
- lipophillic and enter cells in airway and bind to glucocorticoid receptors
- decrease eosinophils and mast cells in airway
- reduce inflamm thereby reducing airway hyper-reactivity
-2weeks
Long Term effects of Inhaled Corticosteroids
-decreases responsiveness to histamine, cholinergic agonists, exercise, allergens, and irritants
- reduce asthma syptoms
- improve lung function
CI of inhaled corticosteroids
- acute attacks, because it takes two weeks for efficacy, so you need to provide oral glucocorticosteroid (prednisone burts pack) to help cover them until the other starts working.
- use cautiously in child as can cause decreased linear growth.
- May have periodic delays and have their growth stepwise, there is no difference in their adult height. Kids who have chronic illness like asthma, if untreated they dont grow. they have low muscle mass, smaller than their peers or what their genetics describe. They put so much energy into trying to breathe that the body cant use the energy to grow.
Side effects of Inhaled Corticosteroids
- oralpharyngeal candidiasis
- dysphonia
- hoarseness
- HA
- Cough
- Cataracts
- decreased bone density
MOA Beta-2 agonsits
-activate adenylate cyclase and increase in cAMP therefore providing smooth muscle relaxation
CI of Beta-2 agonists
- use with caution in pt w/ ischemic heart disease, hypertension, arrhythmias, seizure, disorder of hyperthyroidism
Side effects of rescue beta-2 agonists
- tachycardia
- tremors
- hypokalemia
- hyperglycermia
- increased lactic acid
- HA
- Dizziness
Short Acting Beta Agonists
- used for?
- regularly scheduled dose?
- how much should you use per month?
- for tx of acute symptoms and for prevention of exercise induced symptoms.
- not regularly scheduled
- should not use more than one canister per month
Long Acting Beta Agonists
- used for?
- use for monotherapy?
- used in COMBO w/ ICS for long-term control of symptoms
- never used for monotherapy; takes too long to take effect to be useful in the event of emergency and it doesnt treat inflammation.
- So DO NOT use for acute exacerbation
Black Box Warning
warns of risk of asthma death, case study of solmeterol….as long as it is given with ICS it is safe to use.
Combo steroid/LABA
- what are some of these drugs?
- how often are they used?
-Advair (fluticasone/salmeterol)
Diskus; 1 inhalation 2x/daily
HFA: 2 puffs 2x/daily
-Symbicort (budesonide/formoterol)
2puff 2x/daily
-Dulera (mometasone/fomoterol)
2puffs 2x/daily
Leukotriene modifiers
- used as alternative to what class of drug?
- efficacy?
- important key component needed to start leukotriene modifier for asthma treatment.
- used as alternative to LOW dose ICS in mild persistent asthma
- efficacy is less than that of ICS
- they have to have allergic component to asthma to start this.
MOA leukotriene Receptor
block LTC4 snthase pathways and prevent leukotriene mediated bronchoconstriction and inflamm.
Leukotriene modifier
- what are some of these drugs?
- how often is it used?
- general info about the drug
- Accolate (Zafirlukast)
BID dosing, P450 enzyme inhibitor, take 1-2 hr before meals, SE include depression, insomnia, HA, monitor liver function
-Montelukast (Singular)
1x/daily, SE include depression, insomnia, agitiation, HA, DO NOT need to monitor liver function
-Zileuton (Zyflo)
causes decrease in production of leukotrienes, monitor liver function
Which drug is used more often, zafirlukast or montelukast? Why?
-Montelukast (Singular), it is cleaner drug w/o drug interactins, its cheaper, have same drug efficacy
How is zileuton (zyflo) different from Zafirlukast (Accolate) or montelukast (Singular)?
Zyflo works differently from the other two, works at differnt site that blocks produciton of leukotrienes, the other two block leukotriene action.
Symptoms of Allergic Rhinitis
- sneezing
- rhinorrhea
- nasal congestion
- itchy eyes, nose, palate
- postnasal drip
- cough
- irritability
- fatigue
- macopurulent drainage
- facial pain, presssure**
- loss of smell
What are red flag signs of allergic rhinitis on physical exam?
- Cobbelstoning
- Dennie Morgan lines
- Allergic shiners
- Allergic salute
- allergic crease
- boggy inferior turbinate
Most effective single maintenance therapy for allergic rhinitis?
-intranasal glucocorticoids
What medication is more effective than oral antihistamines for reliefe of nasal blockage, nasal discharge, sneezing, nasal itching and post nasal drip?
intranasal glucocorticoids
Time to efficacy of Intranasal glucocorticoids?
Side effects?
-onset of action is a few hours bt no noticeable effects for several days to week
- HA, epistaxis
- very little systemic absorption so minimal steroid side effects
Tx of Persistent moderate to severe allergic rhinitis
- start w/ INGC
- add topical antihistamine spray if not controlled (azelastine; astelin or Olopadine; patanase)
- or add an oral antihistamine/decongestatnt combination
- if still not controlled can add montelukast (singular)
