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
