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Board Review > AsthmaFC > Flashcards

AsthmaFC Flashcards

1
Q

What cells/cellular elements play a role in asthma?

A

mast cells, eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells

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2
Q

what are the classic signs/symptoms of asthma?

A

wheezing, breathlessness, chest tightness, coughing

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3
Q

what medications can be triggers for Astma?

A

ASA, NSAIDS, sulfites, and beta blockers

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4
Q

What are 4 brand names for albuterol?

A

Ventolin, Proventil, ProAir, Accuneb

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5
Q

What is the brand name of levalbuterol?

A

Xopenex- R isomer of levaalbuterol

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6
Q

When should patients taking a SABA know if they need to increase their maintenance therapy?

A

If they are using the SABA >2 days/week

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7
Q

What is the DOC for exercise induced bronchspasm?

A

SABA

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8
Q

What are the 2 LABA’s?

A

formoterol and salmetrerol

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9
Q

do no use as? The LABAS

A

do not use as monotherapy.

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10
Q

dosing frequency of LABAS

A

BID

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11
Q

what is the MOA of albuteroal and long acting beta agonists?

A

they are beta 2 agonists which cuase relaxation of the bronchial smooth muscle leading to bronchodilation

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12
Q

What are the combo products with LABA’s?

A

salmeterol + fluticasone = advair diskus
formoterol + budesonide = Symbicort

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13
Q

Side effects of SABAs

A

tremor, shakiness, lightheaded ness, cough, palpitations, hypokaelemia, tachycardi, hyperglycemia

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14
Q

What BBW is on LABA’s?

A

increase risk of asthma related deaths. Do not use as monotherapy;

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15
Q

What is a mast cell stabilizer? drug and MOA

A

cromolyn (Intal) - prevent mast cell release of histamine and leukotrienes by inhibiting degranulation after contact with allergens.

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16
Q

can you use for exercise? (mast cell stabilizers)

A

yes -15 mins prior

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17
Q

QVAR

A

beclomethasone

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18
Q

Pulmicort

A

budesonide

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19
Q

aerospan

A

flunisolide

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20
Q

Asmanex

A

momentasone

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21
Q

Flovent

A

fluticasone

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22
Q

Aerobid

A

flunisolide

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23
Q

What is the MOA of corticosteroids in asthma?

A

inhibit the inflammatory response, depresses migration of polymorphonucleur leukocytes, fibroblasts and others to prevent inflammation

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24
Q

what are examples of inhaled corticosteroids?

A

beclomethasone (QVAR HFA)Budenoside (Pulmicort)
Flunisolide (Aerospan, AEROBID) KNOW
Fluticasone (Flovent)
Mometasone (Asmanex)

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25
Q

What is an important counseling pt with inhaled corticosteroids?

A

rinse mouth after use to prevent oral candidiasis

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26
Q

In the Advair diskus, which medication dose varies?

A

The fluticasone (100, 250, 500 mcg) / salmeterol = 50 mcg

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27
Q

in the symbicort HFA, which medication dose varies?

A

The budesonide - 80 or 160 mcg + 4.5 formoterol

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28
Q

What is Dulera?

A

mometasone + formoterol

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29
Q

Which oral steroid is the most potent? least potent?

A

betamethasone, cortisone

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30
Q

what age is for advair discus vs advair HFA? Symbicort hfa?

A

greater than OR equal 4 years old, greater or equal to 12 years old ,12 years or greater

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31
Q

Is prednisone or methylprednisolone more potent?

A

methylprednisolone

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32
Q

singulair

A

montelukast

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33
Q

side effects of montelukast

A

HA, Dizzleness, URTIs ,can increase LFTs

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34
Q

montelukast is a major substrate of which CYP?

A

2C9

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35
Q

What is the MOA for theophylline?

A

blocks phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal cells, resulting in bronchodilation, diuresis, CNS and cardiac stimulation

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36
Q

what is the therapeutic lab range for theophylline?

A

5-15 mcg/ml

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37
Q

What are signs of theophylline toxicity?

A

persistant and repetitive vomiting, ventricular tachycardia, seizures

38
Q

what is unique about theophylline kinetics?

A

first order followed by michaelis-Menten = saturable = small increase in dose can result in large increase in concentration

39
Q

Theophylline is a major substrate of which CYP?

A

CYP1A2 and CYP3A4

40
Q

What are some drugs that may increase theophylline due to 1A2 inhibition?

A

OC, acyclovir, cimetidine, cipro, fluvoxamine, isoniazid

41
Q

What are some drugs that may increase theophylline due to 3A4 inhibition?

A

amiodarone, azole antifungals, clarithroymycin, erythromycin, diltiazem, verapamil, lova, ator, simvastatin, PIs

42
Q

What is omalizumab? brand and MOA

A

XOLAIR - IgG monoclonal antibody that inhibits IgE binding to receptor on mast cells and basophils.

43
Q

Who is Xolair indicated for?

A

Pts with moderate to severe persistent asthma in pts with positive skin test to perennial aeroallergen that is inadequately controlled by inhaled steroids

44
Q

What is the dosing for Xolair?

A

based on body wt and pretreatment serum IgE levels- given SC every 2 or 4 weeks in doctors office

45
Q

What are the zones for Peak Flow Meter?

A

Green = 80-100%
Yellow = 50-80%
Red = <50%

46
Q

What is Foradil?

A

formoterol

47
Q

oral steroid dose equivalents =

A

betamethasone = 0.6 mg
dexamethasone = 0.75 mg
methylprednisolone = 4 mg
prednisone = 5 mg
hydrocortisone = 20 mg
cortisone = 25 mg

48
Q

exercise induced asthma
how long before you take SABA, LABA and Monetlukast

A

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!!

49
Q

in pregnancy use? For asthma

A

albuterol (DOC) and budesonide (for long term control)

50
Q

saba side effects

A

tremor, shakiness lightheadedness, cough, palpitations

51
Q

long term side effects of coricosteroids? after how long?

A

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

52
Q

belcomethasone HFA

A

qvar

53
Q

fluticasone + salmeterol

A

advair

54
Q

mometasone

A

asmanex

55
Q

pulmicort respules (budesonide) for who?

A

ages 1-8

56
Q

pulse therapy

A

w/ systemic steroids w/ rapid onset of action for 15 days after asthma attack.

57
Q

oral steroids when?

A

prednisone daily or every other day.

58
Q

leukotriene modifying agents

A

zafirlukast, montelukast, zileuton

59
Q

caution with luekotriene agents

A

neuropsychiatric sxs- report to md if signs of aggressive behavior, agitation, hostility.

60
Q

when do you use anticholinergics

A

for pts in emergency department with acute attacks.

61
Q

xolair bbw

A

anaphylaxis. observe pts after it can happen w/in 2-24 hrs.

62
Q

rescuers asthma

A

SABA, systemic IV steroids, and anticholinergics.

63
Q

controllers astham

A

inhaled steroids, leukotriene modifying agents, theophylline, alaba, cromolyn omalizumab

64
Q

step 1 of asthma tx

A

saba prn

65
Q

step 2 of asthma tx

A

low dose ICS, alternative: cromolyn, theophylline, LTRA

66
Q

step 3 of asthma tx

A

low dose ICS+ LABA or medium dose ICS last: low dose ICS + theophylline or LTRA

67
Q

step 4 of asthma tx

A

medium dose ICS+LABA, alt: medium dose ICS + theolphlline, LTRA

68
Q

step 5 of asthma tx

A

high dose ICS + LABA

69
Q

step 6 of asthma tx

A

high dose ICS + LABA + oral corticosteroid

70
Q

albuterol and levaalbuterol dose

A

1-2 inhalation q 4-6 hours

71
Q

salmertol brand name and dose

A

serevent-1 inhalation BID, HFA is 2 inhalation BID

72
Q

formoterol brand and direction

A

foradil 1 capsule via aerolizer BID

73
Q

symbicort dose (COMBO)

A

2 inhalation BID

74
Q

cromolyn brand and dose

A

intal 2-4 inhalation q 6-8 hours

75
Q

monetelukast

A

10 mg daily in the evening. age 6 months to 5 years take 4 mg daily, 5-14 take 5 mg daily

76
Q

advair direction

A

1 inhalation BID KNOW, NEVER wash- DRY Powder inside.

77
Q

advail hfa

A

2 inhalation bid KNOW

78
Q

symbicort hfa

A

2 inhalation bid

79
Q

theophylline dose

A

200-600 mg daily. therapeutic range is 5-15

80
Q

how to take

A

ten second breath, SHAKE prior, AND SHAKE BEFORE each dose. and wait 1 min between doses.

81
Q

if pt uses more than x oral steroids asthma plan needs to be change

A

if pt needs ORAL ORAL ORAL steroids more than 3 times a year fix yo plan

82
Q

hfa inhalers and ozone

A

dont damage the ozonemaintenance of sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation.

83
Q

children aged X can start using
montelukast
zafirlukast
omalizumab

A

montelukast age 1 and up, zafirluekast age 5 and up
omalizumab age 12 and up

84
Q

what monitor w/ zileuton

A

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

85
Q

what sweetener is used in montelukast tablets

A

phenylalanine can be used!!do not use in pts w/ phenylketonuria

86
Q

potassium and albuterol

A

rmr albuterol was used to LOWER potassium. hence over use can result in hypokalemia

87
Q

decrease theophylline levels

A

carabamezepine and primidone

88
Q

w/ oral thrush

A

get a spacer it helps, drink n spit water, its not contangoues

89
Q

advair age

A

4 and up

90
Q

alvesco

A

ciclosonide

91
Q

peak flow

A

< 50% go to the hospital

Board Review (65 decks)

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