Asthma/COPD Flashcards
Asthma
Common chronic disorder Complex Characterized by Variable, recurring symptoms Airway inflammation Hyper-responsiveness Airflow obstruction
Treatment is relief inhalers and/or controller medications
Asthma treatment
reliever inhalers like beta agonist
controller medications inhaled corticosteroid or corticosteroid with long acting bronchodilator
Beta-adrenergic Agonists (beta-agonists)
Relax bronchial smooth muscle resulting in bronchodilation – non-selective versus selective
Selectivity for beta-2 receptors
on bronchial smooth muscle without tachycardia – albuterol, levalbuterol, salmeterol, formoterol (less cardiac stimulation)
Short (?) or long-acting (?)
rescue
up to 12 hours
LABA still have a
black box warning. Should not be used by themselves
Brhroncodialator ADR
palpitations, headaches, throat irritation
Alternative to bronchodilator
anti-cholinergic like ipatropium bromide
Combinations
anti-cholinergic/beta-agonist
Combinations ADR
AE: dry mouth, headache, cough, GI distress, headache, and anxiety
Methylxanthines
Chemically
related to caffeine
Methylxanthines long-term management of
persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.
Methylxanthines narrow
safey margin
Methylxantinges SE
nausea, vomiting, CNS stimulation (frequenty); dysrhythmias (high doses); nervousness and insomnia.
Methylxanthines significant interactmeions
with numerous other drugs
methlxanthines can be given
oral or IV
methylxanthine example
theophylline
methylxanine is used
not as often as before, but in instances where asthma has not been responsive to traditional medications
Inhaled Corticosteroids (ICS) Prevention
anti-inflammatory; mucus and edema reduction; sensitize bronchial smooth muscle to beta-agonist stimulation; reduce bronchial hyper-responsiveness to allergens
ICS
Qvar or Flovent
ICS used as
prevention medicaions
ICS are the preferred prevention medication and symtpmos improve in
1 to 2 weeks, up to 4 to 8 weeks maximum therpay
If patient has very severe asthma
LABA is added to ICS
ICS rarely have
systemic effects – SE – hoarseness, oropharyngeal candidiasis (education – rinse mouth out after use)
Long term effects of ICS
Long-term effects – requires careful, long-term follow-up studies
Patient ed for ICS
rinse mouth out. avoid thrush
Oral Corticosteroids (OC)
prednisone
Prednisone
used for uncontrolled symptoms. Should be used for the shortest time possible
oral corticosteroid dose and term
1-2mg/kg orally once a day x 5 to 7 days
40mg orally once a day x 5 to 7 days; could do a taper
oral corticosteroid ADR
adrenal gland atrophy, peptic ulcers, and hyperglycemia.
oral corticosteroid concern in children
growth retardation
Long term use of oral corticosteroids
have the potential to affect bone physiology in adults and childern
Oral corticosteroids adults who are at risk for
osteoporosis should receive periodic bone mineral density tests.
Oral Corticosteroids taken longer
than 14 days, corticosteroids should be discontinued slowly, by gradually reducing the dose
oral corticosteroids are
dose and time dependent; limit to less than 10 days
Additional treatment options for asthma
leukotriene modifiers and mast cell stabilizers
leukotriene modifiers
Reduce inflammation and ease bronchoconstriction
Leukotrienes
second line medications are mediators of the immune response that are involved in allergic and asthmatic reactions
leukotriene side effects
headache, cough, nasal congestion, or GI upset
Mast Cell Stabilizers
used for prevention
Inhibit release of histamine from mast cells & other chemical mediators of inflammation
Mast cell stabilizers example and use
Cromolyn
used 4 to 6 times a day due to short half life
cromolyn ADR
stinging or burning of the nasal mucosa, irritation of the throat, and nasal congestion bronchospasm and anaphylaxis (uncommon)
Monoclonal Antibodies
Xolair – attach to a specific receptor on a target cell or molecule
Evidence-Based Guidelines
Asthma Quick Care Reference Guide
Global Initiative for Asthma (GINA)
Asthma Patient Education
Side effects Asthma Control Tests Asthma Action Plan Rule of 2’s. Asthma triggers When to follow-up
Asthma control test
reviews symptoms a patient can have to determine if their asthma is under control
