Asthma medications

Question 1

LTM or LTRA

Answer 1

leukotriene modifier (LTM) - montelukast (Singulair)
Leukotriene Receptor Antagonist (LTRA)

inhibits action of inflammatory mediator

Controller drug - prevention of inflammation

Question 2

ICS

Answer 2

inhaled corticosteroid
inhibit eosinophilic action and other inflammatory mediators
Controller drug - prevention of inflammation

Question 3

LABA

Answer 3

long-acting beta2-agonist - salmeterol or formoterol

have slightly increased risk for death from asthma

never use as a monotherapy - combine with ICS

Question 4

SABA

Answer 4

short-acting beta2-agonist
rescue medication
Albuterol or levalbuterol

Question 5

SABA use frequency of more than 2 days of use and less than optimal response to bronchodilator

Answer 5

persistent airway inflammation

Question 6

Asthma flare - what medications

Answer 6

rapidly acting, higher-potency anti-inflammatory therapy with an oral corticosteroid is needed

Question 7

Oral corticosteroids

Answer 7

Inhibit eosinophilic action and other inflammatory mediators

Treatment of acute inflammation as in an asthma flare.

no taper is needed if use is short-term

side effects: gastropathy, gastric ulcer, gastritis

Question 8

Beta2-agonist

SABA

Albuterol (Ventolin®,
Proventil®), pirbuterol
(Maxair®), levalbuterol
(Xopenex®)

Answer 8

Bronchodilation via stimulation of beta-2
receptor site

Rescue drugs for acute bronchospasm

Onset - 15 min
Duration - 4-6 hours

Question 9

Long-acting
beta2-agonists

LABA

(salmeterol [Serevent®],
formoterol [Foradil®])

Answer 9

Beta2-agonist; bronchodilation via stimulation of
beta-2 receptor site

Prevention of bronchospasm

Example: Salmeterol
• Onset of action 1 hr
• Duration of action 12 hr
• Indicated for prevention rather than treatment of bronchospasm

Patient should also have short-acting beta2-agonist as rescue drug

• LABA should never be used alone but in combination with ICS

Question 10

Theophylline

Answer 10

Mild bronchodilator, helps with diaphragmatic
contraction

Prevention of bronchospasm, mild antiinflammatory

• Narrow therapeutic index drug with numerous drug interactions
• Theophylline (1,3-dimethylxanthine) can indirectly stimulate both β1 and β2 receptors through release of endogenous catecholamines.
• Monitor carefully for toxicity by checking drug levels and clinical presentation
• Acute theophylline overdose presents as follows:

Nausea and vomiting
Abdominal pain
Tachycardia
Hypotension
Metabolic acidosis
Hypokalemia
Hypercalcemia
Hypophosphatemia
Hypomagnesemia
Hyperglycemia
Leukocytosis

Hemodialysis should be considered if the theophylline level is more than 100 mcg/mL in acute ingestions and more than 60 mcg/mL in chronic, as well as in patients who develop seizures, refractory hypotension that is unresponsive to fluids, or unstable dysrhythmias, regardless of the theophylline level.

Question 11

Asthma Control Test - patients 12 and older

Answer 11

Level of Control Based on Composite Score2

20 or higher = Controlled
16–19 = Not well controlled
15 or lower = Very poorly controlled