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pharmacology > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

Asthma: Pathophysiology

A
  • Chronic inflammatory disorder of airways
  • Recurrent episodes of wheezing, breathlessness, and chest tightness
  • Airflow obstruction is reversible
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2
Q

Asthma: Classifications

A

Classifications:
- Mild persistent, moderate persistent, and severe persistent

Slightly differing definitions for adults and children

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3
Q

Asthma: Goals of Therapy

A

Reduce impairment

  • Prevent chronic symptoms
  • Reduce use of inhaled short-acting beta agonists
  • Maintain normal or near-normal pulmonary function
  • Maintain normal activity levels
  • Meet patient/family expectations of asthma care

Reduce risk

  • Prevent recurrent exacerbations & minimize ER visits & hospitalizations
  • Prevent loss of lung function
  • Provide optimal therapy with minimal ADRs
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4
Q

Asthma Step Therapy

A
  • First, determine severity of asthma symptoms
  • Go to Step Therapy Chart, and start at recommended step
  • The GINA Guidelines prefer an aggressive approach to gaining quick control
  • Assess patient’s response ever 2-3 months
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5
Q

Asthma- Mild: Pharmacodynamics

A
  • Use step 1 therapy
  • Use short-acting beta2 agonists, as needed, for symptoms
  • Patients have symptoms when exposed to triggers (upper respiratory infections, allergens, chemical inhalants)
  • Exercise can be mild intermittent
  • Patients need an annual flu shot
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6
Q

Asthma- Mild: Treatment

A

Treat with low dose inhaled corticosteroid medication daily
- Low dose inhaled corticosteroids are the mainstay for patients of all ages

Use beta agonists as needed; if using 2 days or more per week, then step up therapy

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7
Q

Asthma- Moderate: Treatment

A

Treat with medium-dose inhaled corticosteroids
- or low-dose inhaled steroids plus leukotriene receptor modifier

Short-acting beta agonists may be used

Exacerbations may require oral corticosteroids

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8
Q

Asthma- Severe Persistent Asthma: Treatment

A

Step 4 therapy

  • Medium-dose inhaled corticosteroids plus long-acting beta agonist
  • Or medium-dose inhaled corticosteroid and a leukotriene modifier or theophylline

Step 5 therapy
- High-dose inhaled corticosteroids plus long-acting beta agonists

Step 6 therapy
- High-dose inhaled corticosteroids plus long-acting beta agonists and oral corticosteroids

Requires consultation with asthma specialist

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9
Q

Asthma: Monitoring

A

Once control is achieved, the patient is seen every 2-3 months to determine if a step-up or -down in therapy is indicated

The GINA Guidelines recommend that the dose of inhaled corticosteroids be reduced about 25-50% every 2-3 months to the lowest possible dose to maintain control

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10
Q

Asthma: Managing Exacerbations

A

Treat with oral steroids to regain control

Use a short burst

  • Adults: 40-60 mg/day for up to 5-10 days
  • Children: 1-2 mg/kg/day (max 50 mg/day) for 3-10 days

If not effective, then step up therapy

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11
Q

Asthma: Home Management

A

Assessing severity
- Risk factors for fatal asthma attack include: previous severe exacerbations requiring intubation or ICU admission, 2 or more hospitalizations or 3 ED visits in the past year, use of more than 2 short acting beta agonist inhalers per month, worsening asthma, low socioeconomic status

In-home Treatment

  • Increased use of inhaled beta agonist (2-6 puffs every 20 minutes)
  • Oral corticosteroiuds
  • Good response: stepped up therapy for several days
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12
Q

Asthma: Pregnant Patients

A

Monitor asthma symptoms at each prenatal visit

Inhaled beta agonists are the drug of choice

Inhaled corticosteroids are the long-term drug of choice

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13
Q

Asthma: Pediatric Patients

A

Three categories of wheezing in children younger than age 5 years

  • Transient early wheezing
  • Persistent early-onset wheezing
  • Late-onset wheezing/asthma

The GINA Guidelines have treatment categories for 0-5 years & 5-11 years

Stepwise approach is similar in adults and children but not the same

  • Some medications are not approved or should not be used in children
  • Long-acting beta agonists should not be prescribed singly but need to be combined with an inhaled corticosteroid
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14
Q

Asthma: Challenges in Pediatrics

A

Delivering medication to children

  • Use aerochamber with mask for infants and young children
  • Use spacer for all children
  • Home nebulizer is an option

School-age and adolescent children: need to use inhalers at school

  • Need education & observation of self-administration
  • Will need note to school about use of medication at school
  • Asthma action plan provided to school nurse
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15
Q

Asthma: Older Adults

A

Determine if symptoms are reversible (asthma) or not (possibly COPD)

Medications

  • Increased ADRs
  • Interactions with medications taken for chronic medical conditions (beta blockers)
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16
Q

Asthma: Special Situations

A

Seasonal Allergies
- Start long-term control medications more than 1 month before allergy season starts

Cough variant asthma

  • Trial of bronchodilator
  • Same stepwise management

Exercise Induced Asthma (EIA)
- Most asthmatics have EIA

17
Q

Asthma: Treatment for EIA

A
  • Short acting beta agonist 15 minutes before exercise (2 to 3 hours)
  • Salmeterol lasts 10-12 hours (cannot use if using as long-term care medication)
  • Mask or scarf over mouth if EIA is cold-induced
  • Leukotriene modifier may help
18
Q

Asthma: Monitoring

A

The GINA Guidelines recommend ongoing monitoring of the following six areas:

  • Signs and symptoms
  • Pulmonary function
  • Quality of life and functional status
  • History of asthma exacerbations, pharmacotherapy
  • Patient-provider communication
  • Patient Satisfaction
19
Q

Asthma: Outcome Evaluation

A

Optimal outcome is being able to do activities of daily living with minimal asthma symptoms

Refer to an asthma specialist:

  • If there is difficulty achieving or maintaining control
  • If immunosuppressive therapy is being considered
  • Any adult who requires step 4 therapy or child who requires step 3 therapy
20
Q

Asthma: Patient Education

A

Written asthma action plan include:

  • Overall treatment plan
  • Specific drug therapy
  • Drugs as part of treatment regimen
  • Adherence issues

Review asthma action plan routinely, at least every 6 months

21
Q

COPD: Definition and Risk Factors

A

Definition:

  • Condition of chronic airflow limitation
  • Progressive and heterogeneous
  • Involves airways and lung parenchyma

Risk Factors:

  • Smoking
  • Occupational exposure
22
Q

COPD: Diagnosis and Classifications

A

Diagnosis
- Spirometry Tests: positive when forced expiratory volume in 1 second (FEV1) & forced vital capacity (FVC) is less than 70%

Classifications:
- Mild, moderate, severe, very severe

23
Q

COPD vs. Emphysema

A

Patients with COPD

  • Are obese
  • Are diagnoses as chronic with copious sputum production
  • Suffer from hypoxemia, cyanosis, & carbon dioxide retention

Patient with Emphysema

  • Are older and thinner at diagnosis
  • Are barrel chested and breathe through pursed lips
  • Suffer from dyspnea
24
Q

COPD: Pathophysiology

A

Acute and chronic inflammation

Cellular proliferation changes

Environmental triggers implicated in immune response

25
Q

COPD: Manifestations

A

Emphysema

  • Closely linked to cigarette smoking
  • Structural changes are the same in smokers

Chronic Bronchitis
- Closely linked to cigarette smoking and other inhaled irritants

26
Q

COPD: Suggested Therapies

A

Bronchodilators, Corticosteroids, O2, antibiotics, Leukotrienes, Alpha-trypsin augmentation therapy, immunizations, Smoking cessation

27
Q

COPD Therapies: Bronchodilators

A

Beta agonists
- Short acting vs long acting vs ultra-long acting

Methalyxanthin
- Selective Phosphodiesterase (PDE)

Muscarinic Agents
- Reduce exacerbations and hospitalizations

28
Q

COPD Therapies: Corticosteroids

A

Inhaled
- Work as both monotherapy & in combination with inhaled bronchodilators

Oral
- Work for short-term treatment as they shorten recovery time, improve lung function, & decrease hypoxemia

PDE-4 Inhibitors
- Create bronchial relaxation and decrease activation of the immune response

29
Q

COPD Therapies: Oxygen

A

Used short term during acute exacerbations

Used long term in chronically hypoxemic patients

Should be saturated to greater than 90%

Improves exercise tolerance, neuropsychological functions, and quality of life

30
Q

COPD Therapies: Antibiotics

A

Based on local resistance patterns

Amoxicillin/clavulanic acid

Tetracycline

Macrolide antibiotics

Second line: respiratory fluoroquinolones

31
Q

COPD Therapies: Leukotrienes & Alpha-Trypsin Augmentation

A

Leukotrienes
- No data to support use in COPD

Alpha-trypsin augmentation

  • Used in patients with emphysema related to genetic alpha1 antitrypsin deficiency
  • Not used in patients with alpha1 antitrypsin deficiency
32
Q

COPD Therapies: Immunizations

A

Influenza Vaccine
- Should be administered annually between October and January

Pneumococcal Vaccine
- Should be administered every 6 years regardless of age

33
Q

COPD Therapies: Smoking Cessation

A

Patients with COPD must stop smoking

Smoking cessation benefits include ventilatory function returning to a nearly normal age-related rate

34
Q

COPD: Monitoring

A

Signs and symptoms

Pulmonary function

Pharmacotherapy

Quality of life

35
Q

COPD Monitoring: Signs and Symptoms

A

Monitor sputum for color changes

Report any symptoms of respiratory infection

Remain indoors, and report signs of respiratory distress during times of poor outdoor air quality

Use bronchodilators or oxygen

36
Q

COPD: Pharmacotherapy

A
  • Patients should bring medications on every visit to provider
  • Assess amount of beta2 agonists
  • Assess use of inhaled bronchodilators
  • Assess changes in respiratory therapy
  • Review written medication management plan
37
Q

COPD Monitoring: Quality of Life

A

Assess tolerance of activities of daily living

Assess tolerance to exercise, activity level, and nutrition

Assess financial burden of illness

38
Q

COPD: Patient Education

A

Discuss treatment plan and drug therapy

Discuss reasons for taking the drug and drugs as part of the total treatment plan, and adherence issues

Focus on maintaining optimal pulmonary function and quality of life

Teach self-management

pharmacology (25 decks)

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