AsthmaFC Flashcards
What cells/cellular elements play a role in asthma?
mast cells, eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells
what are the classic signs/symptoms of asthma?
wheezing, breathlessness, chest tightness, coughing
what medications can be triggers for Astma?
ASA, NSAIDS, sulfites, and beta blockers
What are 4 brand names for albuterol?
Ventolin, Proventil, ProAir, Accuneb
What is the brand name of levalbuterol?
Xopenex- R isomer of levaalbuterol
When should patients taking a SABA know if they need to increase their maintenance therapy?
If they are using the SABA >2 days/week
What is the DOC for exercise induced bronchspasm?
SABA
What are the 2 LABA’s?
formoterol and salmetrerol
do no use as? The LABAS
do not use as monotherapy.
dosing frequency of LABAS
BID
what is the MOA of albuteroal and long acting beta agonists?
they are beta 2 agonists which cuase relaxation of the bronchial smooth muscle leading to bronchodilation
What are the combo products with LABA’s?
salmeterol + fluticasone = advair diskus
formoterol + budesonide = Symbicort
Side effects of SABAs
tremor, shakiness, lightheaded ness, cough, palpitations, hypokaelemia, tachycardi, hyperglycemia
What BBW is on LABA’s?
increase risk of asthma related deaths. Do not use as monotherapy;
What is a mast cell stabilizer? drug and MOA
cromolyn (Intal) - prevent mast cell release of histamine and leukotrienes by inhibiting degranulation after contact with allergens.
can you use for exercise? (mast cell stabilizers)
yes -15 mins prior
QVAR
beclomethasone
Pulmicort
budesonide
aerospan
flunisolide
Asmanex
momentasone
Flovent
fluticasone
Aerobid
flunisolide
What is the MOA of corticosteroids in asthma?
inhibit the inflammatory response, depresses migration of polymorphonucleur leukocytes, fibroblasts and others to prevent inflammation
what are examples of inhaled corticosteroids?
beclomethasone (QVAR HFA)Budenoside (Pulmicort)
Flunisolide (Aerospan, AEROBID) KNOW
Fluticasone (Flovent)
Mometasone (Asmanex)
What is an important counseling pt with inhaled corticosteroids?
rinse mouth after use to prevent oral candidiasis
In the Advair diskus, which medication dose varies?
The fluticasone (100, 250, 500 mcg) / salmeterol = 50 mcg
in the symbicort HFA, which medication dose varies?
The budesonide - 80 or 160 mcg + 4.5 formoterol
What is Dulera?
mometasone + formoterol
Which oral steroid is the most potent? least potent?
betamethasone, cortisone
what age is for advair discus vs advair HFA? Symbicort hfa?
greater than OR equal 4 years old, greater or equal to 12 years old ,12 years or greater
Is prednisone or methylprednisolone more potent?
methylprednisolone
singulair
montelukast
side effects of montelukast
HA, Dizzleness, URTIs ,can increase LFTs
montelukast is a major substrate of which CYP?
2C9
What is the MOA for theophylline?
blocks phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal cells, resulting in bronchodilation, diuresis, CNS and cardiac stimulation
what is the therapeutic lab range for theophylline?
5-15 mcg/ml
What are signs of theophylline toxicity?
persistant and repetitive vomiting, ventricular tachycardia, seizures
what is unique about theophylline kinetics?
first order followed by michaelis-Menten = saturable = small increase in dose can result in large increase in concentration
Theophylline is a major substrate of which CYP?
CYP1A2 and CYP3A4
What are some drugs that may increase theophylline due to 1A2 inhibition?
OC, acyclovir, cimetidine, cipro, fluvoxamine, isoniazid
What are some drugs that may increase theophylline due to 3A4 inhibition?
amiodarone, azole antifungals, clarithroymycin, erythromycin, diltiazem, verapamil, lova, ator, simvastatin, PIs
What is omalizumab? brand and MOA
XOLAIR - IgG monoclonal antibody that inhibits IgE binding to receptor on mast cells and basophils.
Who is Xolair indicated for?
Pts with moderate to severe persistent asthma in pts with positive skin test to perennial aeroallergen that is inadequately controlled by inhaled steroids
What is the dosing for Xolair?
based on body wt and pretreatment serum IgE levels- given SC every 2 or 4 weeks in doctors office
What are the zones for Peak Flow Meter?
Green = 80-100%
Yellow = 50-80%
Red = <50%
What is Foradil?
formoterol
oral steroid dose equivalents =
betamethasone = 0.6 mg
dexamethasone = 0.75 mg
methylprednisolone = 4 mg
prednisone = 5 mg
hydrocortisone = 20 mg
cortisone = 25 mg
exercise induced asthma
how long before you take SABA, LABA and Monetlukast
Saba Right away, Laba 15-30 mins before,Montelukast 2 hrs before (lasts 24 hrs)- but if you already use it for asthma daily DO NOT take extra dose!!
in pregnancy use? For asthma
albuterol (DOC) and budesonide (for long term control)
saba side effects
tremor, shakiness lightheadedness, cough, palpitations
long term side effects of coricosteroids? after how long?
after 1 month: cushings, growth issues, osteoporosis, dermal thinning, muscle wasting, moon facies, cataract, gluacoma, hypokalemia.
less than one month
fluid retention, weight gain, emotional instability, gi upset
belcomethasone HFA
qvar
fluticasone + salmeterol
advair
mometasone
asmanex
pulmicort respules (budesonide) for who?
ages 1-8
pulse therapy
w/ systemic steroids w/ rapid onset of action for 15 days after asthma attack.
oral steroids when?
prednisone daily or every other day.
leukotriene modifying agents
zafirlukast, montelukast, zileuton
caution with luekotriene agents
neuropsychiatric sxs- report to md if signs of aggressive behavior, agitation, hostility.
when do you use anticholinergics
for pts in emergency department with acute attacks.
xolair bbw
anaphylaxis. observe pts after it can happen w/in 2-24 hrs.
rescuers asthma
SABA, systemic IV steroids, and anticholinergics.
controllers astham
inhaled steroids, leukotriene modifying agents, theophylline, alaba, cromolyn omalizumab
step 1 of asthma tx
saba prn
step 2 of asthma tx
low dose ICS, alternative: cromolyn, theophylline, LTRA
step 3 of asthma tx
low dose ICS+ LABA or medium dose ICS last: low dose ICS + theophylline or LTRA
step 4 of asthma tx
medium dose ICS+LABA, alt: medium dose ICS + theolphlline, LTRA
step 5 of asthma tx
high dose ICS + LABA
step 6 of asthma tx
high dose ICS + LABA + oral corticosteroid
albuterol and levaalbuterol dose
1-2 inhalation q 4-6 hours
salmertol brand name and dose
serevent-1 inhalation BID, HFA is 2 inhalation BID
formoterol brand and direction
foradil 1 capsule via aerolizer BID
symbicort dose (COMBO)
2 inhalation BID
cromolyn brand and dose
intal 2-4 inhalation q 6-8 hours
monetelukast
10 mg daily in the evening. age 6 months to 5 years take 4 mg daily, 5-14 take 5 mg daily
advair direction
1 inhalation BID KNOW, NEVER wash- DRY Powder inside.
advail hfa
2 inhalation bid KNOW
symbicort hfa
2 inhalation bid
theophylline dose
200-600 mg daily. therapeutic range is 5-15
how to take
ten second breath, SHAKE prior, AND SHAKE BEFORE each dose. and wait 1 min between doses.
if pt uses more than x oral steroids asthma plan needs to be change
if pt needs ORAL ORAL ORAL steroids more than 3 times a year fix yo plan
hfa inhalers and ozone
dont damage the ozonemaintenance of sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation.
children aged X can start using
montelukast
zafirlukast
omalizumab
montelukast age 1 and up, zafirluekast age 5 and up
omalizumab age 12 and up
what monitor w/ zileuton
LIVER! not so much w/ other mast cell stabilizers. but make sure u monitor each month for first 3 months then 2-3 times a year
what sweetener is used in montelukast tablets
phenylalanine can be used!!do not use in pts w/ phenylketonuria
potassium and albuterol
rmr albuterol was used to LOWER potassium. hence over use can result in hypokalemia
decrease theophylline levels
carabamezepine and primidone
w/ oral thrush
get a spacer it helps, drink n spit water, its not contangoues
advair age
4 and up
alvesco
ciclosonide
peak flow
< 50% go to the hospital
