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6020 Advanced Pharm Test 3 COMPLETE ☑️ > Module 5: Respiratory (a) > Flashcards

Module 5: Respiratory (a) Flashcards

1
Q

Asthma

-Definition

A
  1. Chronic inflammatory dz of the airway

2. External stimuli cause inflammatory cells to release mediators (ex: histamine, Leukotriene’s) causing asthma symptoms

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2
Q

Goal of Asthma Therapy

-2 domains?

A
  1. Reducing impairment
    - Prevent chronic symptoms
    - Infrequent use of SABA
    - Maintain near normal PF
    - Maintain normal activities
    - Meet patients’/families’ satisfaction w/ care
  2. Reducing Risk
    - Prevent exacerbations, ED visits and hospitalizations
    - Prevent loss of lung function/growth
    - Optimal treatment w/ little to no adverse events
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3
Q

Goal of Asthma Therapy

-Domain 1 (Reducing Impairment)

A
  1. Reducing impairment
    - Prevent chronic symptoms
    - Infrequent use of SABA
    - Maintain near normal PF
    - Maintain normal activities
    - Meet patients’/families’ satisfaction w/ care
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4
Q

Goal of Asthma Therapy

-Domain 2 (Reducing Risk)

A
  1. Reducing Risk
    - Prevent exacerbations, ED visits and hospitalizations
    - Prevent loss of lung function/growth
    - Optimal treatment w/ little to no adverse events
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5
Q

Asthma

-Quick Relief Therapy

A
  1. Bronchodilators
    - SABA’s
    - Anticholinergics
  2. Systemic Corticosteroids
  3. Inhaled Corticosteroids + formoterol (LABA)
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6
Q

Asthma

-New 2020 recommendations

A
  1. SABA’s are recommended in conjunction w/ ICS for management of asthma-related symptoms
    - Less effective than inhaled beta agonists—slower onset of action and aches less Bronchodilation
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7
Q

SABA

-Indication

A
  1. Acute PRN treatment of Bronchospasm

2. Treatment at the start of respiratory tract infection w/ ICS**

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8
Q

SABA’s

-MOA

A
  1. Activates adenlyate cyclase and increases cAMP thereby relaxing smooth muscle and relieving broncho-constriction.
  2. Onset = 5 minutes
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9
Q

SABA’s

-Contraindication and S/E

A
  1. Ischemic heart dz
  2. HTN, arrhythmia
  3. Seizures and hyperthyroidism

Caution with:

  1. Tricyclics, MAO inhibitors
  2. Antagonized by beta blockers
    - SABA’s and beta blockers can block each other
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10
Q

SABA’s

-A/E

A
  1. Tachycardia & palpitations
  2. Tremor
  3. Hypokalemia
  4. Hyperglycemia
  5. Headache and dizziness
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11
Q

SABA

-Albuterol Inhaler availability/dosing?

A
  1. MDI ProAir, Ventolin, Proventil 90mcg/spray (All brand name; expensive)
    Admin:
    -2 puffs every 4-6hrs PRN wheezing
  2. For Exercise induced Asthma:
    - 2 puffs inhaled 5-30 minutes before exercise
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12
Q

SABA

-Albuterol Nebulizer dosages and admin?

A
  1. 2.5mg/3ml (0.083%)
  2. 5mg/ml (0.5%)

Bronchospasm
-2.5mg per neb q6-8hrs PRN Max dose 10mg/day (4 total doses daily)**

Acute Bronchospasm**
-2.5-5mg per neb q20 min x3 AND CALL 911

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13
Q

SABA

-Levalbuterol (Xopenex) Dosing per age

A
  1. > 4 yrs = MDI 45mcg/spray 2 puffs q4-6 hrs PRN
  2. 6-11 yrs =0.31mg - 0.63 mg NEB TID PRN
  3. > 12 yrs = 0.63 - 1.25 mg NEB TID PRN
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14
Q

Antimuscarinics/Anticholinergics

- Info

A
  1. Short and Long acting
  2. Used MOST frequently in COPD
  3. Ipratropium-Albuterol (Combivent)
    - Second-line quick relief medication for asthma

Not supported by GINA

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15
Q

Long Term Asthma Control

-Examples

A
  1. Inhaled Corticosteroids (GOLD STANDARD)**
  2. Leukotriene modifiers
  3. Cromolyn
  4. Methylxanthines
  5. LABA’s
  6. Immunomodulators
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16
Q

Inhaled Corticosteroids

-Info?

A
  1. Used to reduce symptoms, reduce exacerbations, and reduce use of SABA, while improving PF
  2. Used for Mild and Persistent asthma
  3. Intermittent asthma for quick relief therapy
    - Add-on + SABA at the start of a worsening or a respiratory tract infection**
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17
Q

Inhaled Corticosteroids

-MOA & Onset

A
  1. Reduce eosinophils and mast cells in airways
  2. Reduce airway hyperresponsiveness by reducing inflammation
  3. Reduce responsiveness to histamine, exercise, allergens or irritants
  4. Onset = 2 weeks of continuous therapy for max effectiveness
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18
Q

Inhaled Corticosteroids

-Caution w/ Children

A
  1. Can stunt growth with children
    - Use lowest dose w/ a spacer with children under 5 yrs old.
  2. Less risk than oral corticosteroids
  3. Pregnancy/lactating risk of fetal adrenal suppression
19
Q

Inhaled Corticosteroids

-A/E

A
  1. Oropharyngeal Candidiasis (THRUSH)

- RINSE mouth after use**

20
Q

Inhaled Corticosteroids

-Use in pregnancy?

A
  1. Use Pulmicort as drug of choice during pregnancy
21
Q

Inhaled Corticosteroids

-Medication examples?

A
  1. Beclomethasone (Qvar)
  2. Budesonide (Pulmicort)
  3. Ciclesonide (Alvesco)
  4. Fluticasone (Flovent)
  5. Mometasone (Asmanex)
22
Q

Leukotriene Modifiers

-Info

A
  1. Alt treatment option for mild persistent asthma
    - Adjunct w/ ICS 12 years and older
  2. MOA
    - Blocks binding of leukotrienes to receptors recurring contraction of smooth muscle, vascular permeability, mucus secretions and activation of inflammatory cells
23
Q

Leukotriene Modifiers

-Contraindications/Caution & A/E’s

A
  1. Contraindicated for reversal of ACUTE BRONCHOSPASM
    - NOT for ACUTE. Maintenance
  2. Increased bleeding risk w/ Coumadin and aspirin

A/E

  • Headache >10%**
  • dizziness, weakness
  • GI
  • Myalgias
  • Fever
24
Q

Leukotriene Modifiers

-Psych?

A
  1. In younger children, these meds can cause MOOD INSTABILITY** PSYCH
25
Q

Leukotriene Modifiers

-Montelukast (Singulair)

A
  1. Adult: 10 mg
  2. Pediatric 1-5yrs: 4 mg
  3. 6-14 yrs: 5 mg

Caution with Pregnancy and Lactation

Often given at night**

26
Q

Cromolyn

-Info

A
  1. Mast cell stabilizer
  2. Alt Therapy in children for step 2
    - Prevents exercise induced asthma

MOA:
-Blocks chloride channels and modulate mast cell mediator release

Caution:
-Renal/hepatic impairment

A/E:
-Unpleasant taste, rash, sore throat, cough

27
Q

Cromolyn

-Dosing

A
  1. Adult: 20 mg QID per nebulizer initially
  2. Pediatric: >2 yrs 20 mg QID per nebulizer initially

Pregnancy/Lactating: NO RISK**

Not used a lot in primary care*

28
Q

Methylxanthines

-Info

A
  1. Alt treatment for adolescents and adults w/ mild persistent asthma
  2. MOA
    - Inhibits phosphodiesterase, preventing breakdown of cAMP, causing smooth muscle to relax and preventing release of histamine and leukotrienes
29
Q

Methylxanthines

-Contraindications & A/E’s

A
  1. Contraindicated in:
    - Allergy to CORN products
    - Not recommended <12 yrs
    - Not for Acute asthma exacerbations

A/E’s

  • Life threatening ARRHYTHMIA’S
  • HA
  • N/V/D
  • restlessness, seizures & palpitations

Can Cause TOXICITY

30
Q

Methylxanthines

-Exemplar Drug

A
  1. Theophylline is exemplar drug
  2. Max dose in adults 600 mg/day
  3. Avoid in pregnant women
  4. Monitor blood levels every 6 months for TOXICITY’S**
31
Q

Methylxanthines

-Therapeutic Levels?

A
  1. Adults: 5-15 mcg/ml

2. Peds: 5-10 mcg/ml

32
Q

LABA’s

-Info

A
  1. Used in combination w/ ICS for treatment of MODERATE PERSISTENT ASTHMA
  2. MOA
    - Activates adenylate cyclase & ⬆️cAMP ➡️ relaxing smooth muscle and relieving bronchoconstriction
33
Q

LABA’s

-Contraindication/Caution & A/E’s

A

Same cautions and A/E’s as SABA’s**
Ex:
-Ischemic heart dz, HTN, arrhythmia, seizures, hyperthyroidism

Caution w/:
-Tricyclics, MAO inhibitors; antagonized by beta blockers

A/E’s:
-Same as SABA’s

34
Q

LABA’s

-How to Use?

A
  1. NEVER used as Monotherapy
    - Used as adjunct with ICS**
    - Does not replace ICS
  2. NOT for acute exacerbations
  3. Can use ICS + formoterol (LABA) for ACUTE SYMPTOMS
35
Q

LABA’s

-Black Box Warning

A
  1. Increase risk of asthma related death
36
Q

ICS/LABA Combo Therapy?

A
  1. Advair (Fluticasone/Salmeterol)
    - NOT used in pregnancy/lactation
  2. Symbicort (Budesonide/Formoterol)**
    - ICS/LABA Combo that can be used as MAINTENANCE or RESCUE per GINA guideline**
37
Q

Proper Use of Inhaler

-Steps**

A
  1. Shake inhaler for 2-5 seconds
  2. If not used for >48 hrs, Prime the inhaler by depressing canister once
  3. Sit up straight or stand and breath out all the way
  4. Slowly breath in THEN depress canister once already breathing in
    - Continue breathing in for 3-5 seconds until lungs are full
  5. Hold breath for 10 seconds and wait 1 minute between puffs
  6. RINSE MOUTH then spit out
  7. Re-cap and store
38
Q

Immunomodulators

-Exemplar/Info

A
  1. Omalizumab (Xolair) for SEVERE PERSISTENT ASTHMA
  2. MOA
    - Prevents IgE from binding to mast cells and basophils leading to decrease mediators
  3. NOT for acute attack

A/E’s
-Anaphylaxis, URI, headache, bruising at injection site

Should be prescribed and administered by specialist** NOT FOR PRIMARY CARE

39
Q

Systemic Corticosteroids

-Info

A
  1. Treatment in ACUTE moderate/severe asthma exacerbation
  2. MOA
    - Inhibit cytokine and mediator release, inhibit IgE synthesis
    - Suppress inflammatory process & suppress airway inflammation and edema
  3. Peak reached in 1-2 hrs
    - 5 day-2 week coarse recommended
40
Q

Systemic Corticosteroids

-Contraindications/Cautions?

A
  1. Untreated infection
  2. Lactation
  3. Alcohol intolerance
  4. DM w/ increase BG
    - with quinolones- TENDON RUPTURE
41
Q

Fluoroquinolones & Systemic Corticosteroids??

A
  1. Increase risk of TENDON RUPTURE
42
Q

Systemic Corticosteroids

-A/E’S

A
  1. ANAPHYLAXIS
  2. Adrenal insufficiency
  3. Cushing’s syndrome
  4. Edema
  5. Hypokalemia
43
Q

Systemic Corticosteroids

-How to administer?

A
  1. Short-course “BURST” treatment
  2. Adults:
    - 40-60 mg daily for 5-14 days
  3. Peds
    - 1-2mg/kg/day divided QD-BID x 3-10 days
  4. Can be administered w/out tapering
  5. Continue until peak expiratory rate is 80% or symptoms resolve

6020 Advanced Pharm Test 3 COMPLETE ☑️ (7 decks)

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