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Pharm Test 5 > Lecture Asthma and COPD > Flashcards

Lecture Asthma and COPD Flashcards

1
Q

s/s of asthma:

A

Sense of breathlessness, Tightening of the chest, Wheezing, Dyspnea, Cough

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2
Q

FEV1

A

Forced expiratory volume in 1 second

compared to predicted normal value in healthy person similar age, sex, height, & weight

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3
Q

FVC

A

Forced vital capacity

FVC is total volume exhaled

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4
Q

FEV1/FVC

A

fraction (%) of vital capacity exhaled during 1st second of exhale

85% = normal adult
75% = in asthma
70% = older adult
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5
Q

spirometry assesses:

A

FEV1 and FVC

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6
Q

PEF

A

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%

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7
Q

Asthma drug treatment order:

A

Anti-Inflammatory Drugs

  1. Glucocorticoids – inhaled and oral
  2. Leukotriene modifiers
  3. Cromolyn
  4. IgE Antagonist: Omalizumab

Bronchodilators

  1. Beta2 Agonists – Short Acting (SABA) and Long Acting (LABA)
  2. Methylxanthines: Theophylline
  3. Anticholinergics
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8
Q

__ are the main treatment for asthma.

A

Corticosteroids

anti-inflammation

Used for prophylaxis of chronic asthma

  1. Dosed on a daily fixed schedule (NOT prn)
  2. NOT used for rescue
  3. MOST EFFECTIVE ASTHMA DRUG
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9
Q

inhaled glucocorticoids

A

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 &amp; glaucoma
beclomethasone	[QVAR]
budesonide		[Pulmicort]
ciclesonide		[Alvesco]
flunisolide		[AeroBid]
fluticasone		[Flovent]
mometasone		[Asmanex]
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10
Q

oral glucocorticoids

A

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

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11
Q

Nursing care for glucocorticoids:

A
  1. Monitor for HTN, GI bleeding, diabetes, visual changes
  2. Monitor height in children
  3. Assess bone mineral density
  4. Rinse mouth AFTER EACH USE!
  5. If given with LABA- give LABA FIRST then the steroid
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12
Q

If a glucocorticoid and LABA are given together, give ___ first.

A

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

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13
Q

Leukotriene Modifiers (LTRA)

A

anti-inflammatory
(indirect bronchodilation)

Used for prophylaxis of chronic asthma

  1. 2nd line agent
  2. NOT used for rescue
  3. 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]

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14
Q

Cromolyn

A

Mast cell stabilizer (anti-inflammatory, NO bronchodilation)

Used for prophylaxis of chronic asthma, exercise induced bronchospasm (EIB), allergic rhinitis

  1. 2nd line agent
  2. NOT used for rescue
  3. nebulizer – inhaled

Adverse Effects

  1. Safest of all asthma meds
  2. cough and bronchospasm
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15
Q

omalizumab [Xolair]

A

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

  1. Injection-site reactions
  2. Viral infection
  3. Upper respiratory infection
  4. Sinusitis
  5. Headache
  6. Pharyngitis
  7. Cardiovascular events
  8. Malignancy
  9. Life-threatening anaphylaxis
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16
Q

inhaled short acting beta2 agonist (SABA)

A

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]

17
Q

inhaled long acting beta 2 agonist (LABA)

A

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]
18
Q

oral long acting beta 2 agonist

A

long term control in patients. Bronchodilator

FIXED schedule, not PRN

Adverse effects:
Tremor
Excessive dose – angina pectoris, tachydysrhythmias

Albuterol [VoSpire ER]
Terbutaline

19
Q

Pt wheezing? Ask “have you used your rescue inhaler?”

A

NO – use it!! -> SABA

YES – then nebulized albuteral and systemic glucocorticoid

20
Q

theophylline

A

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

21
Q

theophylline toxicity

A

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

  1. Stop theophylline
  2. activated charcoal with cathartic
  3. lidocaine for dysrhythmias
  4. IV diazepam for seizures
22
Q

theophylline interactions

A

**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

23
Q

anticholinergic bronchodilators

A

**ipratropium
tiotropium,
aclidinium

AE’s: anticholinergic effects - can’t see, can’t pee, can’t spit, can’t sh*t

24
Q

COPD treatment drugs

A

bronchodilators (LABA, long acting anticholinergics, theophylline)

anti-inflammatory (glucocorticoids - given with LABA)

roflumilast

long term O2 therapy prescribed in later stages to decrease mortality

25
Q

roflumilas [Daliresp]

A

a drug for COPD

reduces inflammation, cough, and excessive mucus production

AEs – diarrhea, anorexia, wt loss, nausea, HA, back pain, insomnia, depression

Pharm Test 5 (11 decks)

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