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Pharmacotherapeutics > Asthma (exam 2) > Flashcards

Asthma (exam 2) Flashcards

1
Q

causes of asthma

A

genetic disposition
environmental risk factors

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2
Q

what accounts for the most risk of asthma?

A

genetics

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3
Q

early phase reaction of asthma

A

triggered by activation of IgE

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4
Q

late phase reaction of asthma

A

6-9 hours post allergen inhalation
release of pro inflammatory mediators

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5
Q

characteristic symptom of asthma

A

wheezing - high pitched whistle sound

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6
Q

auscultation

A

listening to sounds from organs with a stethoscope

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7
Q

ronchi

A

expiratory wheezing heard on auscultation

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8
Q

signs of asthma

A

ronchi
dry hacking cough
signs of atopy (allergic rhinitis/atopic demraitits)
eosinophils and IgE in the blood

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9
Q

symptoms of asthma

A

SOB
chest tightness
coughing
wheezing

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10
Q

spirometry

A

tests lung function
measures FEV1 and FVC

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11
Q

FVC

A

forced vital capacity
max amount of air exhaled after max inspiration

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12
Q

FEV1

A

forced expiratory volume after 1 second
amount of air exhaled during the first second after max inhalation

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13
Q

FEV1/FVC

A

measures lung obstruction
75-80% depending on age group

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14
Q

peak expiratory flow

A

measures how fast a patient exhales during a forceful breath
correlates with FEV1

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15
Q

goal of peak expiratory flow

A

at least 80% of patients best

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16
Q

green zone of PEFR

A

80-100% of personal best

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17
Q

yellow zone of PEFR

A

50-80% of personal best

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18
Q

red zone of PEFR

A

less than 50% of personal best

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19
Q

variable symptoms of asthma

A

worse at night and awakening
worsened by triggers

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20
Q

history features associated with asthma diagnosis

A

family history
allergic rhinitis
atopic dermatitis

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21
Q

an exam may be

A

normal or bronchi may be heard

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22
Q

spirometry testing for asthma

A

reduced FEV1/FVC
reversibility of airflow obstruction

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23
Q

reversibility of airflow obstruction is measured by

A

12% improvement of FEV1 after bronchodilator
10% change in PEF when measured bid for 1-2 weeks

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24
Q

inhalation drug therapy

A

delivers at site of action
more rapid effect
reduces side effects
some only effective this way

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25
Q

oral and parenteral drug therapy

A

used for treatment of asthma exacerbations

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26
Q

metered dose inhaler (MDI)

A

canister filled with drug
shaken before use
primed on first use
releases drug as forcible spray

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27
Q

soft mist inhaler (SMI)

A

mist that leaves inhaler slowly
inhaled via a slow deep breath

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28
Q

dry powder inhaler (DPI)

A

drug as a powder
activated when patient breathes in

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29
Q

Jet/ultrasonic nebulizers

A

produces aerosol for inhalation

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30
Q

spacer devices

A

used with MDIs
decreases need for good hand-lung coordination

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31
Q

how long should you wait to do the second dose (if 2 puffs needed) in an MDI inhaler?

A

1 minute after first puff so second can penetrate the lungs better

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32
Q

difference between MDI and DPI inhalers

A

DPI you breath quick and deeply
MDI you breathe slow

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33
Q

short acting beta 2 agonists

A

albuterol
levalbuterol

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34
Q

indications for SABAs

A

rescue inhaler (reliever)
exercise induces bronchospasms

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35
Q

side effects of SABAs/LABAs

A

tachycardia
tremor
anxiety
increase gluconeogenesis
increase insulin secretion
mild drop in K

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36
Q

short acting cholinergic antagonists (SAMAs)

A

ipratropium
ipratropium/albuterol

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37
Q

indication for SAMAs

A

COPD
asthma exacerbation in those who cannot tolerate albuterol

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38
Q

side effects of SAMAs/LAMAs

A

dry mouth
nausea
constipation
metalic taste
urinary retention

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39
Q

inhaled corticosteroids (ICS)

A

fluticasone propionate
fluticasone furoate
beclomethasone
ciclesonide
budesonide
mometasone

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40
Q

inhaled corticosteroids are used for

A

maintenance/controller therapy

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41
Q

which is the drug of choice for asthma?

A

inhaled corticosteroids!

every patient with asthma should receive one of these!

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42
Q

exception of everyone with asthma receiving an ICS

A

children 5 and under with very mild asthma

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43
Q

ICS are dosed based on

A

potency

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44
Q

when are inhaled corticosteroids fully effective?

A

within 4-8 weeks

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45
Q

local adverse effects of ICS

A

dysphonia
oral thrush

46
Q

systemic adverse effects of ICS

A

osteoporosis
growth suppression (children)
cataracts
dermal thinning
adrenal insufficiency

47
Q

systemic adverse effects of inhaled corticosteroids only occur at

A

high doses

48
Q

how to manage dysphonia

A

decrease dose of ICS
use spacer

49
Q

how to manage oral thrush

A

use spacer
rinse and spit after inhaler use
treat with clotrimazole or nystatin

50
Q

how to manage osteoporosis

A

monitor bone density
add calcium and vitamin D

51
Q

in order to reduce side effect of ICS,

A

decrease ICS dose and add a LABA

52
Q

Long acting beta agonists (LABAs)

A

salmeterol
formoterol
vilanterol

53
Q

LABA approved for COPD

A

indacaterol
olodaterol

54
Q

what drugs should be avoided when on a LABA?

A

non selective beta blockers (carvedilol, labetalol, nadolol, propanolol)

55
Q

LABAs help reduce ICS dose by

56
Q

should LABAs be used as a mono therapy?

why?

A

NO! always with ICS

there is increased risk of deaths when LABAs are used alone

57
Q

combination ICS/LABAs

A

Advair diskus (fluticasone/salmeterol)
Symbicort (budesonie/formoterol)
dulera (mometasone/formoterol)
breo (fluticasone/vilanterol)

58
Q

why can Symbicort be used as needed?

A

formoterol has a quick onset of action (3 minutes)

59
Q

Max dosing of 12+ for Symbicort?

for ages 6-11?

A

12 inhalations/day

8 inhalations/day

60
Q

ICS/SABA combination inhaler

A

airspura
as needed treatment/prevention of bronchospasm ages 18 and up
moderate asthma only

61
Q

Long acting muscarinic antagonists (LAMAs)

A

tiotropium (Spiriva)
fluticasone/umexlidinium/vilanterol (trelegy)

62
Q

indications for LAMAs

A

COPD
second line therapy for asthma

63
Q

systemic corticosteroids

A

short bursts decrease toxicity
used for severe persistent asthma and acute exacerbations

64
Q

theophylline has a

A

narrow therapeutic index

65
Q

theophylline

A

potent bronchodilator
mild anti inflammatory agent

66
Q

drug interactions with theophylline

A

CYP1A2 inhibitors increase theophylline levels
CYP1A2 induces decrease theophylline levels

67
Q

why is theophylline not recommended

A

less effective than inhaled bronchodilators
slow onset of action
more adverse drug reactions
doesn’t treat airway inflammation

68
Q

adverse effects of theophylline

A

caffeine like side effects
cardiac tachyarrhythmias
seizures

69
Q

effects of leukotriene antagonists

A

improve FEV1 and PEF
reduce nocturnal awakenings
reduce B2 agonist use

70
Q

cisternal leukotrienes are correlated with

A

airway edema
smooth muscle contraction
altered cellular activity —> inflammatory process
symptoms of allergic rhinitis

71
Q

leukotriene inhibitors

A

Singulair - montelukast
accolate - zafirlukast
zyflo - zileuton

72
Q

which leukotriene inhibitors do you need to monitor neuropsychological events?

A

all of them!

montelukast, zafirlukast, zileuton

73
Q

which leukotriene inhibitors do you need to monitor liver function tests?

A

zafirlukast and zileuton

74
Q

Xolair (omalizumab)

A

anti IgE antibody
used for allergic asthma not controlled by ICS (6 and up)

75
Q

which biologics have a boxed warning for anaphylaxis?

A

omalizumab
reslizumab

76
Q

which biologics are approved for ages 6 and up

A

mepolizumab
omalizumab
dupilumab
brenralizumab

77
Q

which biologics are approved for ages 12 and up?

A

tezepelumab

78
Q

which biologics are approved for only adults

A

reslizumab

79
Q

recombinant IgE antibody

A

omalizumab

80
Q

IL4 antagonist

81
Q

IL5 antagonist

A

reslizumab
benralizumab
mepolizumab

82
Q

anti-Thymic stromal lymphopoietin (anti-TSLP)

A

tesepelumab

83
Q

goals for asthma treatment

A

achieve good control of symptoms
maintain normal activity levels
decrease risk of exacerbations
decrease risk of fixed airflow limitation
decrease risk of medication side effects

84
Q

GINAs 3 step cycle

A

assess the patient
adjust treatment
review response
(continuously repeated)

85
Q

non pharmacological treatment for asthma

A

avoid triggers
advice about exercise induced bronchospasm
avoid medications that worsen asthma
address dampness and mold

86
Q

which medications worsen asthma

A

NSAIDs
non-selective beta blockers

87
Q

controller

A

maintenance therapy use to prevent worsening symptoms
ICS, LABA, LTRA

88
Q

reliever

A

used PRN for shortness of breath and for exercise/allergen exposure
SABA, ICS-formoterol, ICS-SABA

89
Q

anti-inflammatory reliever (AIR)

A

reliever containing an ICS component
budenonide/formoterol
budesonide/albuterol

90
Q

maintenance and deliver therapy (MART)

A

use of ICS-formoterol as both controller and reliever

91
Q

patients ages _____ and older require an ______ inhaler

92
Q

when should step down therapy be considered?

A

if asthma is controlled for at least 3 months

93
Q

when should step up therapy be considered?

A

if asthma remains uncontrolled

94
Q

assessment of asthma control

A

symptoms
future risk of adverse outcomes

95
Q

treatment issues regarding asthma

A

inhaler technique
adherence to therapy

96
Q

risk factors for exacerbation

A

exposures
comorbidities
medications
lung function

97
Q

sustained step up therapy

A

step up therapy to the next level

98
Q

short term step up therapy

A

step up for 1-2 weeks if reversible risk factor

99
Q

day to day adjustment therapy

A

adjust number of PRN doses

100
Q

goal of step down is to

A

find the minimum effective treatment

101
Q

guidelines for stepping down therapy

A

reduce therapy 1 step
decrease ICS dosing by 25-50%

102
Q

mild asthma classification

A

well controlled on steps 1 or 2

103
Q

moderate asthma classification

A

well controlled on steps 3-4

104
Q

severe asthma

A

remains uncontrolled despite optimized treatment
or
asthma requiring high dose ICS-LABA to remain controlled

105
Q

why should nebulizers be avoided?

A

increases viral transmission

106
Q

indoor allergen mitigation

A

remove possible allergens
ex: pillow cover for dust mite allergy, air purifier, etc.

107
Q

immunotherapy

A

SQ as adjunct treatment of asthma in patients above 5
SCIT only started when asthma is controlled
SLIT not recommended

108
Q

role of fractional exhaled nitric oxide (FeNO) testing

A

measure of airway inflammation
only for ages 5 and up

109
Q

bronchial thermoplasty

A

uses heat to remove muscle tissue from airways
not recommended for most patients

110
Q

difference between GINA guidelines and NAEPP 2020 guidelines

A

NAEPP - step 1 is only a prn SABA, no ICS like GINA; ages 5-11 categorized together, GINA was ages 6-11

Pharmacotherapeutics (16 decks)

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