Asthma meds Flashcards by Meagan Cuff

What are the major characteristics of asthma?

Variable airflow obstruction
Often reversible (w/ meds)

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What is asthma?

Bronchial hyper-responsiveness to various triggers

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What does chronic airway inflammation lead to?

Airway remodeling

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What is the MC chronic disease of children?

Asthma

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How many deaths occur from asthma each year?

5000

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Are the deaths from asthma mostly preventable or unpreventable?

Preventable

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Where do most deaths from asthma occur and why?

Out of the hospital

Inadequate therapy

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What cells infiltrate with asthma?

Eosinophils

Mast cells

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What are some mediators of asthma?

Prostaglandins
Thrombaxanes
Leukotrienes

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What kinds of tx do we give to asthma pts?

Bronchodilators
Anti-inflammatory agents
Leukotriene receptor antagonists (LTRAs)
Anti-interleukin 5 (IL-5) antibodies

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What kind of bronchodilators are there?

Beta 2 agonists
Anticholinergics
Theophylline

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What kind of anti-inflammatory agents do we use for asthma?

Inhaled glucocorticosteroids (ICS)

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What are the two classification groups for asthma?

Frequency of sx

Severity of sx

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What is the breakdown of frequency of sx for asthma?

Intermittent (infrequent)

Persistent (frequent)

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What is the breakdown of severity of sx for asthma?

Mild
Moderate
Severe

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What is the frequency classification of asthma severity from step 2 to step 4?

Persistent

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What is a hallmark dx study for asthma?

Abnormal PFTs that improve by >15% after bronchodilator therapy

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What is the general approach to asthma tx?

Educate pt/caregivers
Pharmacotherapy
Individualization

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What are the two main therapeutic options for asthma?

Bronchodilators

Inhaled corticosteroids

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What are beta 2 agonists intended for with asthma?

Rescue medications for acute exacerbations

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What are inhaled corticosteroids (ICS) good for with asthma?

Suppression of underlying inflammation

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What kind of beta 2 agonists can treat asthma?

Long acting (LABA)
Short acting (SABA)

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What kind of anticholinergics can treat asthma?

Short acting muscarinic antagonists (SAMA)

Long acting muscarinic antagonists (LAMA)

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What is an example of LTRAs?

Montelukast

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What are two more modern asthma txs?

Anti-IgE monoclonal antibodies | Anti IL-5 monoclonal antibodies

What is the asthma step 1 long term tx?

None

What is the asthma step 1 quick relief tx (intermittent)?

Short acting bronchodilator: | Inhaled beta 2 agonist PRN

What is the long term tx for step 2 asthma (mild persistent)?

Preferred: low dose daily ICS Alternate: LRTA (montelukast)

What is the quick relief tx for step 2 asthma?

Short acting bronchodilator: | Inhaled beta 2 agonist (SABA)

What is the long term tx for step 3 asthma (moderate persistent)?

Preferred: low dose ICS + LABA Or: medium dose ICS Or: low dose ICS + LRTA

What is the quick relief tx for step 3 asthma?

SABA

What is the long term tx for step 4 asthma (severe persistent)?

Preferred: medium or high dose ICS + LABA Or: medium/high dose ICS + LABA and/or LAMA Or: high dose ICS + LTRA/theophylline

What is the short term tx for step 4 asthma?

SABA

What is the most effective bronchodilator?

Beta 2 agonists (B2A)

What are B2As specifically treating for asthma?

Intermittent bronchospasm

What conditions are B2As the drug of choice for?

Acute asthma | EIB

How do you increase the bronchoselectivity of B2As?

Inhalation

What are SABAs?

Rescue medications

What are some examples of SABAs?

``` Albuterol Levalbuterol Metaproterenol Terbutaline Pirbuterol ```

What is the onset of SABAs?

1-5 minutes

What is the duration of SABAs?

2-6 hours

What are LABAs?

Maintenance/control/prophylactic medications

What are some examples of LABAs?

Salmeterol Formoterol Indacatrol

What is the onset of LABAs?

5-15 minutes

What is the duration of LABAs?

>12 hours

What is a concerning issue with LABAs?

Increased asthma-related deaths

What are the anti-inflammatories for treating asthma?

Inhaled steroids

When do patients see sx improvement with ICS?

1-2 weeks

What do inhaled steroids avoid?

Systemic side effects

What are high dose systemic steroids used for?

SA | Severe asthma unresponsive to B2RAs

What is the systemic steroid used for asthma and how is it dosed? Also for how long do you give it?

Prednisone PO 1-2 mg/kg/day Divide BID or TID 3-10 days

What is the first line tx for persistent asthma?

Inhaled steroids

How do you minimize toxicities with corticosteroids?

Low moderate doses

How do you reduce systemic absorption with corticosteroids?

Mouth rinsing/spitting

How do you reduce oral thrush with corticosteroids?

BID dosing

What is another systemic corticosteroid for asthma? How is it administered? What is the dosing?

Methylprednisolone IV Loading dose = 2 mg/kg then 0.5-1 mg/kg q6

List 2 common inhaled steroids:

Beclomethasone | Fluticasone

What do anticholinergics inhibit?

Constrictive tone

Are cholinergic antagonists (anticholinergics) as potent beta 2 agonists?

Which cholinergic antagonists have poor absorption?

Quaternary NH4+

What are two cholinergic antagonists? And how long do they last?

Ipratropium 4-8 hours | Tiotropium > 24 hours

What is combivent comprised of?

Atrovent | Albuterol

Why is methylxanthines potency limited?

Narrow therapeutic index

When do toxic effects of methylxanthines appear?

> 15 mg/L

What is the therapeutic range of methylxanthines?

10-20 mg/L | *note overlap

What is the mOA of methylxanthines?

Phosphodiesterase III and IV inhibition

How often do you dose LTRAs (give a specific example)?

Montelukast qhs QID BID

What are LTRAs best used as?

Adjunct therapy

What is an issue with LTRAs Zafirlukast and Zileuton? What is the result?

Interact w/ warfarin | Prolong INR

What does Zileuton also do? How do you address this?

Increase theophylline levels | Cut theophylline dose by 1/2

What is another issue with both Zafirlukast and Zileuton?

Hepatotoxicity

How common is anaphylaxis w/ anti-IgE monocolonal antibodies?

1-2/1000

What do anti-IgE monoclonal antibody permit?

Reduced inhaled corticosteroid dose

What is the greatest draw back of anti-IgE monoclonal antibody?

Very expensive

What are anti-IgE monocolonal antibodies often used for?

Severe persistent asthma

What is a logistical problem with anti interleukin IL-5 antibodies?

Very expensive

What is great about anti-interleukin IL-5 antibodies?

Decreases exacerbations by 50%

What is a risk w/ anti-interleukin IL-5 antibodies?

Possible anaphylaxis

Key points about asthma meds:

Quick relief or long term Anti-inflammatory agents Tx is step wise Preferred rescue meds = SABAs