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Pediatrics > Asthma Pharm > Flashcards

Asthma Pharm Flashcards

1
Q

Step Up Therapy

A

Start treatment at step appropriate to asthma severity at time of evaluation
Goal not achieved- gradually step up therapy until successful

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2
Q

Step Down Therapy

A

Treat exacerbation symptoms with aggressive management

Gradual reduction of long-term-control meds to lowest level possible

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3
Q

Types of Long-Term Control

A 
Anticholinergics
Corticosteroids
Mast cell-stabilizing agents
Leukotriene modifiers
Methylxanthines
LABA
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4
Q

Administration Techniques

A

MDI
Nebulizer
Inhaled powder
Systemic administration

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5
Q

Beta-2 agonists

A

Produce airway dilation
Stimulation of beta-adrenergic receptors
Decrease release of mediators

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6
Q

Short-acting Beta 2 Agonists

A

Acute attack

Prevention of exercise-induced bronchospasm

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7
Q

Long-acting Beta 2 Agonists

A

Prevention

Maintenance therapy

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8
Q

Examples of Short Acting B2 Agonist

A 
Albuterol
Proventil
Ventolin
Terbutaline (Brethine)
Bitolterol (Tornalate)
Pirbuterol (Maxair)
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9
Q

Adverse Effects of Beta-2 Agonists

A 
Tachycardia
Tremor
Hypokalemia
Headache
Hyperglycemia
Increased lactic acid
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10
Q

Examples of Long Acting Beta-2 Agonists

A

Salmeterol (Serevent)
Formoterol (Foradil)
Levalbuterol (Xopenex)
Fenoterol (Berotec)

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11
Q

What are LABA’s used for?

A

Maintenance therapy

Slower onset, long-lasting

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12
Q

Anticholinergics Antimuscarinic Agents

A 
Ipratropium bromide (Atrovent)
Tiotropium (Spiriva)
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13
Q

What can Ipratropium bromide enhance?

A

Bronchodilation achieved by beta-agonists

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14
Q

Types of Methylxanthines

A

Theophylline

Aminophylline

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15
Q

What is Theophylline for?

A

Maintenance therapy

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16
Q

Theophylline SE

A 
Insomnia
Nervousness
N/V
Anorexia
Headache
Tachycardia
Seizures
Cardiac arrhythmias
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17
Q

Theophylline Immediate Release Products

A 
Slo-Phyllin
Theolair
Quibron-T
Elixophillin
Bronkodyl
Theophylline generics
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18
Q

Theophylline Sustained Release Products

A 
Slo-bid Gyrocaps
Theo-24
Theobid
Theo-Dur
THeospan-SR
Theophylline SR generics
19
Q

MOA of Corticosteroids

A

Reduce airway inflammation

20
Q

Inhaled Steroids

A

Reduce airway reactivity

21
Q

SE of Corticosteroids

A 
Thrush
Dysphonia
Adrenal suppression (LD)
Cataract formation (LD)
Decreased growth in children (LD)
Interference with bone metabolism (LD)
Purpura (LD)
22
Q

Examples of Corticosteroids

A 
Fluticasone (Flovent)
Budesonide (Pulmicort)
Beclomethasone (Vanceril, Beclovent, QVAR)
Triamcinolone (Azmacort)
Flunisolide (Aerobid, Aerobid-M)
23
Q

Budesonide (Pulmicort)

A

First nebulizer steroid
Greater number symptom free days
Decreased B-agonist need
Reduced hospitalization rates

24
Q

Examples of PO Steroids for Acute Treatment

A

Methylprednisolone

Prednisone

25
Q

Chronic Treatment with PO Steroids

A

Alternate-day schedule
Minimize SE
Interrupts growth
Long acting preparations should not be used

26
Q

Newer Steroid Agents

A 
Advair Diskus (fluticasone + salmeterol)
Combivent MDI (ipratropium + albuterol)
27
Q

Examples of Mast Cell Stabilizers

A

Cromolyn (Intal)

Nedocromil (Tilade)

28
Q

Action of Mast Cell Stabilizers

A

Don’t influence airway tone
Inhibit degranulation of mast cells
Prevent release of chemical mediators

29
Q

When are mast cell stabilizers most effective?

A

Seasonal disease

30
Q

Examples of Leukotriene Inhibitors

A

Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Leutrol, Zyflow)

31
Q

MOA of Leukotriene Inhibitors

A

Suppress action of sisterly leukotriene

32
Q

Benefits of Leukotriene Inhibitors

A 
Improvement in FEV1, asthma exacerbations
Improvement in frequency of SABA use
Safe in children 6-14
Minimal SE
Effective with steroids or LABA
33
Q

How can leukotriene inhibitors affect the dose of inhaled corticosteroids?

A

Reduce higher doses

34
Q

SE of Leukotriene Inhibitors

A

LFT abnormalities

Headache

35
Q

Example of Anti-IgE Monoclonal Antibodies

A

Omalizumab

36
Q

MOA of Omalizumab

A

Inhibits the binding of IgE to mast cells

Doesn’t promote mast cell degranulation

37
Q

Intermittent Asthma Treatment

A

PRN SABA

38
Q

Mild Persistent Asthma Treatment

A

PRN SABA
Low dose ICS or cromolyn or nedocromil
2nd line: leukotriene modifier or theophylline

39
Q

Moderate Persistent Asthma Treatment

A

PRN SABA

ICS medium dose or low-medum dose ICS + LABA or SR Theophylline or oral beta agonist

40
Q

If needed Moderate Persistent Asthma Treatment

A

Medium-high ICS + LABA or SR Theophylline or oral LABA

41
Q

Severe Persistent Asthma Treatment

A

PRN SABA

High dose ICS + LABA or SR Theophylline or oral LABA + Oral corticosteroids

42
Q

Misc. Treatment of the Allergic Asthmatic

A

Elimination of causative agents

Desensitization or immunotherapy not proven highly effective

43
Q

Environmental Changes for Asthmatic Patient

A

Change of occupation or relocation of dwelling

Eliminating aerosal sprays

44
Q

Immunizations of the Asthmatic Patient

A

Influenza vaccination

Pneumococcal vaccine

Pediatrics (23 decks)

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