Chapter 11: Drugs For Treating Asthma Flashcards
What is asthma?
A disease of diffuse airway inflammation caused by a variety of triggering stimuli, resulting in partially or completely reversible bronchoconstriction
Name some symptoms and signs of asthma:
- dyspnea
- chest tightness
- cough
- wheezing
Name the signs and symptoms of a fatal asthma attack.
- use of accessory muscles of respiration
- HR > 120 bpm
- resps > 25-30 breaths/min
- difficulty speaking
- altered level of consciousness
- quiet chest
- diaphoresis
- inability to lie supine
- cyanosis
- SpO2 < 90%
- progressive agitation or anxiety
- sense of fear or impending doom
- sense of progressive breathlessness or air hunger
What are the 2 general classes of asthma medications?
- quick-relief or rescue medications
- long-term control medications
Name 3 short-acting rescue drugs.
- short-acting beta-agonists (SABA)
- anticholinergics
- systemic (oral) corticosteroids
How are SABAs used? How do they work?
- first choice for quick relief of asthma symptoms
- relax bronchiole smooth muscle (bronchodilators)
- quickly opens airways
- also used before exercise to prevent EIB
How quickly do SABAs work and how long do they last?
- starts within minutes
- lasts for 2-4 hours
What is the most common SABA? What is the route of administration?
- Albuterol
- administered by a metered-dose inhaler (MDI)
When is nebulized treatment used?
For people who have difficulties coordinating MDIs and spacers
What is PEF?
Peak expiratory flow
Pharmacological intervention is necessary for asthma patients who have:
- PEF < 80% of personal or predicted best
- lack of response to SABA treatment
- symptoms: coughing, breathlessness, wheezing, chest tightness, use of accessory muscles for breathing
ATs should administer up to _____ puffs of SABA in 1 hour, reassessing the patient response to treatment every _____ min.
- 3
- 5-10 min
What steps should be taken with a severe asthma episode with poor response (PEF < 60% of personal or predicted best)?
- Add prescribed oral corticosteroid drug
- Repeat SABA treatment immediately
- Add prescribed inhaled anticholinergic medication
- Immediately transport the patient to a hospital emergency department
Which asthma patients should be transported to the emergency department?
Patients who do not respond or have severe symptoms or a PEF persistently < 80% of baseline
How do anticholinergics work?
- reduce mucus and open airways by inhibiting muscarinic cholinergic receptors and reducing intrinsic vagaries tone of the airway
- these take longer to be effective than SABAs but may be used as an alternative bronchodilator for patients who do not tolerate SABAs.
Administration of ______ provides additive benefit to SABAs in moderate to severe asthma exacerbations.
Anticholinergics
Name a popular anticholinergic.
Ipratropium (Atrovent)
How do systemic (oral) corticosteroids work?
- reduce inflammation, swelling, mucus production in the airways of a person with asthma
- not short acting, but used for moderate and severe exacerbations as an adjunct to SABAs to speed recovery and prevent recurrence of exacerbations
Systemic (oral) corticosteroids are unnessarey for patients who…
Patients whose PEF normalizes after 1 or 2 bronchodilator doses
Describe dosing of prednisone for asthma.
- higher doses (50-60 mg, once a day) prescribed for management of more severe exacerbations require in-patient care
- lower doses (40 mg, once a day) prescribed for outpatient treatment of milder exacerbations
- treatment duration of 5-7 days is recommended
The most effective long-term-control medications are those that…..
- attenuate the underlying inflammation characteristic of asthma
- help to control asthma and prevent asthma attacks
Name 4 long-term asthma control medications:
- inhaled corticosteroids (ICS)
- long-acting beta-agonists (LABAs)
- inhaled mast cell stabilizers
- leukotriene modifiers
What is the most potent and consistently effective anti-inflammatory medication currently available for long-term control of asthma?
Inhaled corticosteroids (ICS)
How do inhaled corticosteroids work?
- block late-phase reaction to allergens
- reduce airway hyper responsiveness
- inhibit inflammatory cell migration and activation
Name some clinical effects of ICS:
- reduction in severity of symptoms
- improvement in PEF, asthma control, and quality of life
- diminished airway hyper responsiveness
- prevention of exacerbations
- reduction in the need for systemic corticosteroid medications
- reduced emergency department care, hospitalizations, and deaths due to asthma
- possible attenuation of loss of lung function
Name a common ICS.
Fluticasone (Flovent)
Name 2 combinations of corticosteroids and LABAs.
- fluticasone and salmeterol (Advair)
- budesonide and formoterol (Symbicort)
How long do LABAs last?
Duration of bronchodilation of > 12 hours after a single dose
LABAs should be used in combination with:
- ICS for long term control and prevention of symptoms in moderate or severe persistent asthma
- SABAs for management of acute symptoms
Why is frequent and chronic use of LABAs discouraged?
This may disguise poorly controlled persistent asthma
What is the onset of action for LABAs?
> 30 min
Name a common LABA.
Salmeterol (serevent diskus)
LABA medications are available in what forms?
Dry powder that is taken using a dry powder inhaler (DPI)
Describe DPIs.
- does not contain propellants or any other ingredients, only the medication
- contains up to 60 doses of medication
- has a dose indicator that counts down the number of doses remaining
How do inhaled mast cell stabilizers work?
Stabilize mast cells and interfere with chloride channel function
How are inhaled mast cell stabilizers used?
- alternative, but not preferred medication for the treatment of mild persistent asthma
- also used as preventive treatment prior to exercise or unavoidable exposure to known allergens
Name a common inhaled mast cell stabilizer.
Cromolyn sodium
Inhaled mast cell stabilizers have lower efficacy, but may be considered for _____. Regular controller therapy with ______ or a combination of _______ and ______ to be used as needed is preferred/
- EIB
- ICS
- SABAs
- corticosteroids
How are leukotriene modifiers used?
May be used for the treatment of certain conditions associated with allergic response or asthma
Leukotriene are released from where?
- mast cells
- basophils
- eosinophils
_______ _______ ______ is the pathophysiology of asthma, including airway edema, smooth muscle contraction, and altered cellular activity associated with the ______ process.
- leukotriene receptor occupation
- inflammatory
How do leukotriene-receptor antagonists work?
Prevent leukotriene from binding to their receptors
Name a common leukotriene modifier.
Montelukast (singulair)
How are leukotriene modifiers administered?
Orally as tablets
Why does montelukast (Singulair) have limited availability for use?
- increased risk of adverse consequences
- must be monitored
- possible mental health side effects - black box warning
How can ATs determine the effectiveness of asthma medication?
- assessing the severity of the asthma with lung function measures
- recording vital signs (including pulse ox and peak flow meter readings)
- performing a physical examination to identify signs and symptoms
Bronchodilator treatments are limited to a maximum of ____ for the first hour, then _____ per hour thereafter.
- 3
- 1
Long-term strategies for controlling asthma focuses on what 3 things?
- preventing exacerbation
- reducing impairment
- reducing risk
Describe the green zone of asthma control.
- 80-100% of personal best
- good control, no asthma symptoms
- if taking LABA, should continue taking them even when peak flow numbers fall in the yellow or red zones
Describe the yellow zone of asthma control.
- 50-79% of personal best
- signals caution: the patient’s asthma is getting worse
- follow patient’s written asthma plan and add quick relief medications (SABA)
- prescriber may need to adjust asthma medications
Describe the red zone of asthma control
- < 50% of personal best
- signals medical alert
- add or increase quick-relief medicines (SABA) according to instructions in the written asthma action plan
- call EMS immediately
What does someone with well-controlled asthma look like?
- few, if any, asthma symptoms
- few, if any, awakenings during the night caused by asthma symptoms
- no need to take time off from school or work due to asthma
- few or no limits on full participation in physical activities
- no emergency department visits
- no hospital stays
- few or no side effects from asthma medicines
How can ATs prevent exacerbation of EIB?
- encourage physical activity
- encourage an extended warm up
- teach patients to take treatment before exercise
- understand the use, misuse and abuse of SABAs
- consider long-term control medication
For prophylaxis, use _______ (such as _____), inhaled ______ min before exercise.
- a rapid acting SABA
- Albuterol
- 10-15
Excessive overuse of a SABA can lead to…
- increased tolerance to the medication
- results in decreased effectiveness
The frequent need (____ times per day) for SABA therapy during practice or an athletic event should cause concern.
3 or more
LABAs should generally be used only for asthma _______ and _______. They are usually combined with an ______ ______.
- prophylaxis
- control
- inhaled corticosteroid
