Q3 Pulm Flashcards
First line for asthma tx
ICS - Beclomethasone, budesonide, fluticasone, mometasone
- with rescue SABA/LABA - albuterol, levalbuterol/salmeterol, formoterol.
What therapy is useful for nocturnal symptoms of asthma?
LABAs - salmeterol and formoterol.
How do SABAs/LABAs work?
Beta2 agonists that relax the airway smooth muscle by stimulating beta 2 receptors in the airway.
Since SABAs are not 100% selective, what other things do they affect?
Can affect cardiac and skeletal muscle B1 receptors. = tachycardia, muscle tremors.
What medications can be used Off Label for asthma? MOA?
Anti Cholinergic - although mostly used in COPD.
Ipatropium (SAMA) and Tiotropium (LAMA)
MOA - inhibit Muscarinic acetylcholine receptors in the lungs to inhibit bronchoconstriction.
What LTRA is used in asthma and what is its MOA?
Leukotrienes receptor antagonist (LTRA) - anti inflammatory
Monteleukast.
What is theophylline and is it used in asthma?
Methylxantine - anti-inflammatory properties and bronchodilator by relaxing smooth muscle in lungs
Not typically used in asthma - ICS are better.
What meds are reserved for treatment resistant asthma?
Immunomodulators (monoclonal antibodies)
Omalizumab and Mepolizumab and reslizumab.
SABA/LABA onset and duration
SABA - 30min/ 3-5hrs
LABA - 30-60min/>12hrs
LABAs are best combined with _____
ICS
What is the agent of choice for long term asthma therapy? Clinical considerations?
ICS.
Educate patient to rinse mouth out with water after use (to prevent oral thrush)
Oral steroids should be used ______
Short term - <2weeks
Step 1 reliever and controller
Step 2
Step 3
Step 4
Step 5
Step 1 = PRN ICS - formoterol and PRN SABA
Step 2 = Daily low dose ICS or PRN low dose ICS - formoterol OR daily LTRA and low dose ICS whenever SABA is taken + PRN SABA
Step 3 = daily low dose ICS-LABA or medium dose ICS + PRN SABA
Step 4 = Daily Medium dose ICS-LABA or high dose ICS and add-on tiotropium or LTRA + PRN SABA
Step 5 = daily high dose ICS-LABA, refer for phenotypic assessment, and add on therapies, Low dose OCS but consider SEs + PRN SABA
Class A, B, C, D for COPD
A = low symptom burden (mMRC 0-1, CAT <10) and low airflow limitation (grade 1-2 GOLD)
B = high symptom burden (mMRC >=2, CAT >=10) and low airflow limitation (grade 1-2 GOLD)
C = low symptoms burden, high airflow limitation (3-4GOLD)
D = high symptom burden, high airflow limitation
Class C COPD tx?
Class A?
B?
D?
C = LAMA
A = ??
B = ??
D = LAMA or LAMA+LABA (if highly symptomatic CAT>20) or ICS+LABA (eosinophils>=300).
When should corticosteroids be added in COPD therapy?
In FEV1<60%
Therapy for COPD:
Bronchodilators: B2 agonists (S+L), Anticholinergics (S+L), Methylxanthines.
Corticosteroids
Other clinical considerations for COPDers?
Flu vaccine yearly, PPSV23 vaccine x1 to all COPD patients. If over 65, then repeat if it’s been >5 years
PCV13 EVERYONE over 65
Hh
Free form drawings
A LABA should be added when?
When a patient is not maintained with ICS
SABAs should not be overused because?
decrease efficiency over time.
MOA of Leukotrienes receptors?
Leukotrienes are chemicals released when exposed to an allergen. If they receptors are blocked, then they can’t mount as intense an immune response.
T/F: bronchodilator’s should not be used to treat COPD because COPDers do not have an “adequate response” to them (<80%)
False. The can still improve symptoms and improve activity tolerance.
Meds used in tx of COPD
Bronchodilators
- beta 2 agonists (SABA and LABA)
- Anticholinergics (LAMA/SAMA)
- corticosteroids.
Duration of therapy for pneumonias:
T/F: if a CAP patient is a febrile for 48-72hours and stable, treatment may be discontinued before the 5 days.
CAP at least 5 days.
HAP and VAP 7 days
True