Asthma Pharm Flashcards
How do you manage asthma medication?
- the step up or step down method.
- You can gradually increase and add options or you can treat exacerbation sx with aggressive management and continue to attempt to reduce medication needs.
What are the classes of quick relief and long-term control asthma medications?
Quick relief:
-SABA, inhibit smooth muscle contraction
Long-term:
- anticholinergics
- corticosteroids
- mast cell stabilizing
- leukotriene modifiers
- methylxanthines
- prevent or reverse inflammation
- LABA; inhibit smooth muscle contraction
Administration techniques of asthma medication
-MDI- meter dosed inhaler, release aerosolized particles, use a spacer
Nebulizer:
-liquid medicine, provides nebulized particles with moist continueous airflow (good for peds)
Inhaled powder;
-Rotacaps, disc-haler, mechanical crushing of a tablet or capsule releases powder for inhalation
-systemic administration: oral or parenteral routes (SQ, IM, IV)
what are the main SABA medications ?
list some other SABA?
onset and duration of medication?
albuterol, proventil, ventolin
other SABA:
- Terbutaline(Brethine)- also used to prevent uterine contractions
- Bitolterol(Tornalate)
quick onset, lasts 4-6hrs
Increasing use more than 1 canister (200 puffs) per month signals_______.
lack of adequate asthma control.
Adverse effeccts of beta-2 agonists
- rare when given by inhalation:
- tachycardia
- tremor
- hypokalemia
- HA
- hyperglycemia
- increased lactic acid
Long acting beta2 agonist
- name 2 medications
- used for?
- onset and duration?
- what are some new LABA
-Salmeterol (servent)
Formoterol (Foradil)
- used for maintenane therapy, NOT rescue medication for breakthrough sx
- slow onset of 30mins, last 9-12hrs
New:
- Levalbuterol (Xopenex)
- Fenoterol (Berotec)
Anticholinergics -mediation namies -use -onset to action time -
- ipratropium bromide (atrovent)
- Tiotropium (Spiriva) (last 24hrs)
- used to enhance bronchodilation achieve by beta-agonists.
- slow to onset, 60-90min
Methylxanthines
- drug name
- uses
- therapuetic plasma concentration
- clearance is decreased by which population?
- clearance is increased by which population?
- Theophylline
- medium potency bronchodilator
- 10-15mcg/ml* narrow window, hard to achieve and maintain
- clearance decreased in:
- neonates
- elderly
- acute and chronic hepatic dysfunction
- cor pulmonale
- concurrent use of macrolide abx, quinolones, propranolol
- Clearance is increased in:
- children
- concurrent use of cigarettes, marijuana, phenobarbital, phenytoin
Theophylline
- how often are these given per day?
- most common side effects
- plasma levels ____; risk of seizure and cardiac arrhythmias
-give 1 or 2x/day
SE:
-insomnia, nervousness, N/V, anorexia, HA, tachycardia
-plasma levels greater than 30g/ml
Theophylline dosing & monitoring
-start with 16mg/kg/day or 400mg/day in divided doses
Monitoring:
- if stable check serum level every 6-12mo
- if unstable/toxicity/breakthrough sx recheck serum q3days
IV Methylxanthines
-what drugs
-dosage in children 9-16 & adults
-
Drug: aminophylline (IV theophylline)
Dose children: loading dose of 6mg/kg, infusion of 1.omg/kg/hr for next 12hr, 0.8mg/kg/hr thereafter
Adults dose: loading dose same as kids, maintenance dose 0.1-0.5/mg/kg/hr
Corticosteroids
- purpose
- use with ___ & ___.
purpose is to reduce airway inflammation
use with acute ilness and chronic disease
Inhaled steroids:
-when do you begin using these?
- SE
- after how much time of use do they offer beneficial effects?
-start aerosolized steroids in any pt who is not controlled by bronchodilator.
SE:
- thrush
- dysphonia
- larger doses:: adrenal suppression, cataract formation, decreased growth in children, interference with bone metabolism, purpura.
-2-4wks to produce beneficial effects.
Inhaled Steroid:
-list the 5 medications in order of their potency.
- Fluticasone (FLovent)
- Budesonide (Pulmicort)
- Beclomethasone (Beclovent or QVAR)
- Triamcinolone (Azmacort)
- Flunisolide (Aerobid)
