Lecture Asthma and COPD Flashcards
s/s of asthma:
Sense of breathlessness, Tightening of the chest, Wheezing, Dyspnea, Cough
FEV1
Forced expiratory volume in 1 second
compared to predicted normal value in healthy person similar age, sex, height, & weight
FVC
Forced vital capacity
FVC is total volume exhaled
FEV1/FVC
fraction (%) of vital capacity exhaled during 1st second of exhale
85% = normal adult 75% = in asthma 70% = older adult
spirometry assesses:
FEV1 and FVC
PEF
Peak expiratory flow
maximal rate of airflow during expiration
On a Peak Flowmeter - Colors are individualized to patient’s personal best.
Patient sets the indicators
Green zone = 80-100%
Yellow zone = 50-80%
Red zone = <50%
Asthma drug treatment order:
Anti-Inflammatory Drugs
- Glucocorticoids – inhaled and oral
- Leukotriene modifiers
- Cromolyn
- IgE Antagonist: Omalizumab
Bronchodilators
- Beta2 Agonists – Short Acting (SABA) and Long Acting (LABA)
- Methylxanthines: Theophylline
- Anticholinergics
__ are the main treatment for asthma.
Corticosteroids
anti-inflammation
Used for prophylaxis of chronic asthma
- Dosed on a daily fixed schedule (NOT prn)
- NOT used for rescue
- MOST EFFECTIVE ASTHMA DRUG
inhaled glucocorticoids
very effective & safer than systemic (oral)
1st line for asthma inflammation – most pts should use
Almost no side effects inhaled
Adverse effects (Inhaled) 1. adrenal suppression 2. oropharyngeal candidiasis 3. dysphonia (hoarseness) 4. slowed growth in children (doesn’t change end height, just slows the growth) 5. promotion of bone loss 6. increased risk of cataracts & glaucoma
beclomethasone [QVAR] budesonide [Pulmicort] ciclesonide [Alvesco] flunisolide [AeroBid] fluticasone [Flovent] mometasone [Asmanex]
oral glucocorticoids
for moderate to severe persistent asthma or management of acute exacerbations of asthma or COPD
When other drugs fail. Use for short periods
Adverse side effects (oral): adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, growth suppression in children
methylprednisone [Medrol]
prednisolone [Orapred]
prednisone
Nursing care for glucocorticoids:
- Monitor for HTN, GI bleeding, diabetes, visual changes
- Monitor height in children
- Assess bone mineral density
- Rinse mouth AFTER EACH USE!
- If given with LABA- give LABA FIRST then the steroid
If a glucocorticoid and LABA are given together, give ___ first.
LABA
LABA – long acting beta agonist
LABA is a bronchodilator, so opens up airway; use it first and then use the steroid (glucocorticoid) so more steroid gets into the lungs
Leukotriene Modifiers (LTRA)
anti-inflammatory
(indirect bronchodilation)
Used for prophylaxis of chronic asthma
- 2nd line agent
- NOT used for rescue
- ONLY po (not inhaled)
Adverse Effects
1. GI upset, rhinitis, headache, caution with liver impairment
2. neuropsychiatric effects: depression, suicidal thinking & behavior
(possible behavior change in a child -> therefore parents should watch for this in their kids (misbehaving, depressiong, etc.))
Zileuton [Zyflo]
zafirlukast [Accolate]
montelukast [Singulair]
Cromolyn
Mast cell stabilizer (anti-inflammatory, NO bronchodilation)
Used for prophylaxis of chronic asthma, exercise induced bronchospasm (EIB), allergic rhinitis
- 2nd line agent
- NOT used for rescue
- nebulizer – inhaled
Adverse Effects
- Safest of all asthma meds
- cough and bronchospasm
omalizumab [Xolair]
anti-inflammatory (bronchodilation)
Used for ≥12 years old with moderate to severe asthma
(1) ALLERGY RELATED AND
(2) cannot be controlled with inhaled corticosteroid
SubQ injection
>$10,000 per year
Note “mab” means monoclonal antibody and made in the lab!
Adverse Effects
- Injection-site reactions
- Viral infection
- Upper respiratory infection
- Sinusitis
- Headache
- Pharyngitis
- Cardiovascular events
- Malignancy
- Life-threatening anaphylaxis
inhaled short acting beta2 agonist (SABA)
Bronchodilator with an
immediate onset – lasts 2-6 hours. Used prn for ongoing attack or for EIB – exercised induced bronchospasm.
Adverse effects: tachycardia, angina, tremor
Albuterol [ProAir HFA, Proventil HFA, Ventolin HFA, AccuNeb]
Levalbuterol [Xopenex]
inhaled long acting beta 2 agonist (LABA)
bronchodilator used for long-term control in patients with frequent attacks. It has a slower onset – lasts up to 12 hours.
Fixed schedule, NOT prn.
NOT used as a rescue inhaler and always used with glucocorticoid in asthma.
Adverse effects:
tachycardia, angina, tremor
increased risk of severe asthma & asthma-related deaths when used alone - NEVER see a LABA as solo therapy! ALWAYS combined with a glucocorticoid
“terol’s” aclidinium bromide [Tudorza Pressair] arformoterol [Brovana] formoterol [Foradil Aerolizer, Perforomist] indacaterol [Arcapta Neohaler] salmeterol [Serevent Diskus]
oral long acting beta 2 agonist
long term control in patients. Bronchodilator
FIXED schedule, not PRN
Adverse effects:
Tremor
Excessive dose – angina pectoris, tachydysrhythmias
Albuterol [VoSpire ER]
Terbutaline
Pt wheezing? Ask “have you used your rescue inhaler?”
NO – use it!! -> SABA
YES – then nebulized albuteral and systemic glucocorticoid
theophylline
bronchodilator (Methylxantines)
Used for long-term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids
PO (IV available)
Narrow therapeutic range: plasma level 10 – 20 mcg / mL
(not used a lot bc of narrow therapeutic range and Risk for toxicity)
cousins are aminophylline and dyphylline
theophylline toxicity
Toxicity Levels – KNOW THIS!!
<20 mcg/mL - AEs uncommon
20 – 25 mcg/mL - N/V/D, insomnia, restlessness
>30 mcg/mL - severe dysrhythmias & convulsions ( i.e. V. fib)
Death from cardiorespiratory collapse
TOXICITY TREATMENT
- Stop theophylline
- activated charcoal with cathartic
- lidocaine for dysrhythmias
- IV diazepam for seizures
theophylline interactions
**Caffeine
**tobaccos/marijuana (levels will rise so consult provider if want to quit while on theophylline)
Decrease levels
a. Phenobarbital
b. Phenytoin
c. Rifampin
Increase levels
a. Cimetidine
b. fluoroquinolone antibiotics
anticholinergic bronchodilators
**ipratropium
tiotropium,
aclidinium
AE’s: anticholinergic effects - can’t see, can’t pee, can’t spit, can’t sh*t
COPD treatment drugs
bronchodilators (LABA, long acting anticholinergics, theophylline)
anti-inflammatory (glucocorticoids - given with LABA)
roflumilast
long term O2 therapy prescribed in later stages to decrease mortality
