Asthma + COPD ppt Flashcards
What should you Rx for group B (COPD)?
1) Anoro Ellipta: One inhalation (umeclidinium 62.5 mcg/vilanterol 25 mcg) once daily
or
2) Tiotropium (Spiriva Handihaler): one 18mcg capsule Qday + Salmeterol (Serevent) 50 mcg BID
What should be considered for group E COPD if eosinophils are >300?
Triple therapy with Trelegy (one inhalation Qday)
What should you Rx group A COPD?
1) Albuterol
or
2) Ipratropium (Atrovent HFA: 17 mcg/actuation)
For COPD you should switch to ICS/LABA/LAMA in what 2 scenarios?
1) Dual therapy fails and eosinophils ≥ 100 / µL (0.3x109/L)
2) If monotherapy fails (LABA or LAMA) and eosinophils ≥ 300 / µL (0.3x109/L)
What is Trelegy?
ICS/LABA/LAMA
What do you do if Trelegy fails for COPD and eosinophils are <300 and FEV1 <50%?
Add on roflumilast (Daliresp)
or
Add on azithromycin (Zithromax)
What do you do if Trelegy fails and eosinophils are >300?
Add on dupilumab (Dupixent) 300 mg IV every other week
How should you Tx an uncomplicated moderate/severe (2-3 Sx) exacerbation of COPD?
1) Prednisone 40mg Qday 5-7 days
2) Azithromycin, Cefdinir, or Doxycycline (doxy best)
How should you Tx a complicated moderate-severe (2-3 Sx) exacerbation of COPD?
1) Prednisone 40mg Qday 5-7 days
2) Augmentin or Levaquin
True or false: For kids under 6, no controller treatment is necessarily indicated for Step 1 of asthma Tx
True
What do you add to Tx a complicated moderate-severe (2-3 Sx) exacerbation of COPD if your pt is in long term care?
PO: Levaquin
IV: Piperacillin / tazobatam or cefepime
True or false: for kids <6 in step 3, you should just double the ICS dose instead of adding a LABA
True
What is Tiotropium also called and how is it dosed?
Spiriva Respimat 1.25 mcg/actuation: Two inhalations (2.5 mcg) Qday
True or false: Tiotropium has anticholinergic side effects
True
What asthma med should be administered at night?
Montelukast
Advair: What kind of med is it? How is it administered?
LABA/ ICS:
-Diskus: 1 inhalation BID; 4+ y/o
-HFA: 2 puffs BID; >12 y/o
What are the initial and daily doses for Budesonide Nebulizer Solution (Pulmicort) if the pt has been:
1) Previously treated with bronchodilators alone
2) Previously treated with inhaled corticosteroids
3) Previously treated with oral corticosteroids
1) Initial: 0.25 mg twice daily or 0.5 mg once daily; maximum daily dose: 0.5 mg/day
2) Initial: 0.25 mg twice daily or 0.5 mg once daily; maximum daily dose: 1 mg/day
3) Initial: 0.5 mg twice daily or 1 mg once daily; maximum daily dose: 1 mg/day
Asmanex (mometasone furoate DPI):
1) What type of med is it?
2) What are the low, medium, and high doses for adults?
there will be a question abt this med
1) ICS
2) Low: 110/110-220
Medium: 220-440/ >220-440
High: >440/>440
Symbicort Dosing:
1) What is the max daily dose in adults?
2) What abt in 12-17 y/os?
3) What abt in <12y/os?
4) What is a low-med dose in adults?
5) What abt a med-high dose?
1) Up to 12 inhalations/day (maintenance + relief)
2) 11 inhalations
3) 8 inhalations
4) Budesonide 80 mcg/formoterol 4.5 mcg [1-2 puffs 1-2x/day]
5) Budesonide 160 mcg/formoterol 4.5 mcg
What is the max dose of prednisone in adults and kids?
60mg (5-7 days adults; 3-5 days kids)
Albuterol 90 mcg (SABA): how is it administered?
1 – 2 inhalations every 4 to 6 hours as needed (don’t forget to prime inhaler)
What are the differences between track 1 Tx for steps 1-2, and steps 3 and 4 for adult asthma?
Steps 1-2: PRN ICS-formoterol
Step 3: Maintenance ICS-formoterol [low dose]
Step 4: Maintenance ICS-formoterol [med. dose]
(Reliever for all track 1 steps is the ICS-formoterol)
With adult asthma track 2, when should the switch from ICS to ICS-LABA be made?
Step 2: Low dose maintenance ICS
Step 3: Low dose maintenance ICS-LABA
Step 4: Med. dose maintenance ICS-LABA
(Reliever for all track 2 steps is ICS-SABA or SABA)
When should you add on a LAMA for both tracks 1 and 2 of adult asthma Tx?
Step 5
If an adult asthma pt has daily Sx or wakes up more than 1x a week at night and low lung function, or has had a recent exacerbation, what step should they be?
Step 4
If an adult asthma pt has Sx most days or wakes 1x a week or more at night and low lung function, what step should they be?
Step 3
If an adult asthma pt has Sx less than 3-5 days a week with normal/ mildly reduced lung function, what step are they?
Step 1 or 2
What are steps 1 and 2 for kids 6-11 with asthma?
Step 1: PRN low dose ICS whenever SABA taken
Step 2: Daily low dose ICS (daily LTRA optional)
Reliever for all steps: SABA (or ICS-formoterol in steps 3-4)
If a pt aged 6-11 has asthma Sx 2-5 days a week, what step are they? (Tx?)
Step 2
(Tx: daily low dose ICS + PRN SABA)
If a pt ages 6-11 has asthma Sx most days or is waking 1 or more times a week, what step are they?
Step 3
(tx: low dose ICS-LABA or med. dose ICS + PRN SABA or very low-dose MART)
What are the criteria for step 4 asthma for 6-11 year olds?
Waking 1x or more per wk, Sx most days, + low lung function
List steps 1-4 for under 5 year olds with asthma
1) Step 1: short course ICS at viral illness onset
2) Step 2: daily low dose ICS [daily LTRA optional]
3) Step 3: double low dose ICS
-consider specialist
4) Step 4: cont. controller + refer to specialist
(All steps: SABA PRN)
