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BST2 > PT of Bronchial Asthma > Flashcards

PT of Bronchial Asthma Flashcards

1
Q

Goals of treatment:

A
  1. Achieve good control of symptoms
  2. Maintain normal activities level
  3. minimize risk of asthma related death
  4. Minimize exacerbations
  5. Minimize S/E
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2
Q

Nonpharmacologic therapy

A
  1. Teach self management skill
  2. Avoid allergenic triggers
  3. Smoking cessation
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3
Q

Pharmacotherapy

A
  1. Reliever
  2. Controller/preventer
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4
Q

Reliever

A
  1. Rapid onset - LABA
  2. SABA
  3. SAMA
  4. Short acting Theophylline
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5
Q

Controller/Preventers

A
  1. Corticosteroid
  2. LABA
  3. Leukotrine Modifier
  4. Immunomodulator
  5. LAMA
  6. Sustained release theophylline
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6
Q

SABA

A

Albuterol (salbutamol), isoproterenol, metaproterenol, terbuline

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7
Q

Frequent use of SABA associated with:

A
  1. increase risk of severe exacerbation
  2. Hospital admission
  3. Increase level of airway inflammation
  4. Death
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8
Q

Anticholinergic

A

Effective but not as potent as B2 agonist

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9
Q

Example of Anticholinergic SAMA and LAMA

A
  1. Ipratropium bromide - 4-8 H
  2. Triotropium bromide - 24 H
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10
Q

Inhaled ipratropium bromide- SAMA

A
  1. Only indicated as adjunctive in severe acute asthma
  2. does not imrpove outcome in chronic asthma
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11
Q

Why Tiotropium- LAMA should not be used as monotherapy (without ICS)

A

Increase risk of severe exacerbation

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12
Q

Adding LAMA to ICS-LABA

A

-No clinically important benefit for symptom

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13
Q

Methylxanthines - Theophylline

A

Bronchodilator & anti-inflammatory

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14
Q

Theophylline : Adverse effect

A

Potential DDI
-V&M, tachycardia, insomnia, tachyarrythmia
-plasma conc. should be monitored

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15
Q

SAMA potential alternative for SABa BUT,

A

Slower onset of action and higher risk of A/E- Not recommended for routine use

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16
Q

Sustained release theophylline

A

less effective than ICS and no more effective than oral sustained released b2 Agonist , Cromolyn, LT antagonist

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17
Q

Management with CS

A

Most potent and effective anti-inflammatory mdx available

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18
Q

Benefit ICS

A

-reduce symptom
-improve lung function and QOL
-reduce BHR
-reduce exacerbation
-reduce mortality

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19
Q

Mild desease

A

control with twice daily dosing

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20
Q

How to initiate CS?

A

Start with higher / more frequent dose - then tapered down once under control

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21
Q

Response to ICS

A

3-6 weeks

22
Q

ICS adverse effect ?

A

Oropharyngeal candidiasis (dose dependant)- reduce by gargle after using ICS & dysphonia - minimize using spacer

23
Q

Short term systemic CS are indicated in?

A

acute asthma/ exacerbation

24
Q

Pt with severe persistent asthma/ require chronic systemic CS…should use

A

Lowest possible dose-provide most clinical benefit (eg: Budesonide 200-400 mcg)

25
Q

ICS : preffered theraphy should be combined with ..

A

LABA , formoterol, salmeterol, arformoterol (never used alone)

26
Q

pt with mild asthma should start with…

A

Low dose ICS - Formeterol

27
Q

Can LABA provide significant protection against EIB?

A

Yes for 8-12 hours initially. but decrease with chronic regular use

28
Q

Nocturnal asthma is indicator of ?

A

Inadequate anti-inflammatory treatment

29
Q

Example of MCS

A

Cromolyn sodium , nedocromil sodium

30
Q

Discontinuation because:

A

Low efficacy

31
Q

effect of nsaid in asthma

A

Aspirin and other NSAIDs can induce bronchospasm and, in rare cases, this reaction can lead to death

32
Q

The main types of NSAIDs include:

A

aspirin
ibuprofen.
naproxen.
diclofenac.
mefenamic acid.
indomethacin.

33
Q

LT Modifier: LTR. Antagonist. Example?

A

Zafirlukast and Montelukast (oral), Zileuton

34
Q

Indication?

A

Reduce proinflammatory and BC effect of LT

35
Q

ICS vs LT modifier?

A

LTM less effective than ICS

36
Q

Montelukast adverse effect?

A

Neuropsychiatric events

37
Q

Zileuton

A

(oral) 5-lipoxygenase inhibitor - inhibit synthesis of LT . used on for 12 and >12 y/o

38
Q

Use of zileuton is limited because :

A

potential elevated hepatic enzyme and inhibit metabolism of some drugs (eg: theophylline and warfarin)

39
Q

when Use of zileuton, what should be monitored?

A

serum alanine aminotransferase

40
Q

Other controller : Immunomodulators. Example?

A

Omalizumab (anti-IgE)

41
Q

Omalizumab:
1. Indication
2. Dosage and Dosage form
3. DISADVANTAGE

A
  1. Monoclonal ab , prevent binding of IgE to basophil and mast cell (used in pt 6/>6 y/o)
  2. SC : 150 -375 mg (2-4 weeks interval)
  3. High cost (step 5) , combine with high dose ICS and LABA
42
Q

Other controller : Immunomodulators. Example?

A

Mepolizumab SC, Reslizumab IV, Benralizumab SC (anti-IL5)

43
Q

Indications??

A

Severe eosinophilic (allergy) asthma

44
Q

Combination ICS + LABA (more effective)

A

Varied dose ICS + fixed dose LABA

45
Q

Combination theraphy : 1st agent

A

Budesonide/Formoterol (DPI)
200/6
Relief and maintenance

46
Q

Assessment of Asthma control

A

-assess risk factor
-measure FEV1 at start of tx
–>potential risk factor: low FEV1 (<60%)
-blood eosinophils –>elevated FeNO ; in pt with allergic asthma taking ICS

47
Q

Types of inhaler:
MDI CS (preventer)
MDI B2 Agonist (reliever)

A

Brown
Blue

48
Q

DPI

A

drawn into lung when breath in

49
Q

Exacerbation of Asthma / Acute asthma

A

… can also happen to pt who dependant on SABA

50
Q

Evaluation of TE outcome: acute asthma

A
  1. monitor morning peak flow
  2. lung function –> spirometry/ peak flow –> 5-10 mins after each tx
  3. oxygen saturation

BST2 (10 decks)

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