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
Chronic Treatment with PO Steroids
Alternate-day schedule Minimize SE Interrupts growth Long acting preparations should not be used
26
Newer Steroid Agents
``` Advair Diskus (fluticasone + salmeterol) Combivent MDI (ipratropium + albuterol) ```
27
Examples of Mast Cell Stabilizers
Cromolyn (Intal) | Nedocromil (Tilade)
28
Action of Mast Cell Stabilizers
Don't influence airway tone Inhibit degranulation of mast cells Prevent release of chemical mediators
29
When are mast cell stabilizers most effective?
Seasonal disease
30
Examples of Leukotriene Inhibitors
Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Leutrol, Zyflow)
31
MOA of Leukotriene Inhibitors
Suppress action of sisterly leukotriene
32
Benefits of Leukotriene Inhibitors
``` Improvement in FEV1, asthma exacerbations Improvement in frequency of SABA use Safe in children 6-14 Minimal SE Effective with steroids or LABA ```
33
How can leukotriene inhibitors affect the dose of inhaled corticosteroids?
Reduce higher doses
34
SE of Leukotriene Inhibitors
LFT abnormalities | Headache
35
Example of Anti-IgE Monoclonal Antibodies
Omalizumab
36
MOA of Omalizumab
Inhibits the binding of IgE to mast cells | Doesn't promote mast cell degranulation
37
Intermittent Asthma Treatment
PRN SABA
38
Mild Persistent Asthma Treatment
PRN SABA Low dose ICS or cromolyn or nedocromil 2nd line: leukotriene modifier or theophylline
39
Moderate Persistent Asthma Treatment
PRN SABA | ICS medium dose or low-medum dose ICS + LABA or SR Theophylline or oral beta agonist
40
If needed Moderate Persistent Asthma Treatment
Medium-high ICS + LABA or SR Theophylline or oral LABA
41
Severe Persistent Asthma Treatment
PRN SABA | High dose ICS + LABA or SR Theophylline or oral LABA + Oral corticosteroids
42
Misc. Treatment of the Allergic Asthmatic
Elimination of causative agents | Desensitization or immunotherapy not proven highly effective
43
Environmental Changes for Asthmatic Patient
Change of occupation or relocation of dwelling | Eliminating aerosal sprays
44
Immunizations of the Asthmatic Patient
Influenza vaccination | Pneumococcal vaccine