RESPIRATORY Flashcards
GOAL OF FEV1
> / 90%
goal of using reliever therapy
<2/wk
when should LABA be used in asthma
only if patient is already taking ICS
List the ICS inhaler
beclomethasone budesonide, ciclesonide, fluticasone furoate, fluticasone propionate and mometasone
which drug are LABA
which has slow and rapid acting
salmeterol, formoterol, indacaterol, vilanterol
**formoterol is rapid acting, the rest is short acting
can budesonide/formoterol be used as rescue? what about salmeterol/ICS?
formoterol/ budesonide can be used as rescue as it is rapid acting,
salmeterol/ ICS is not
** note budesonide/formoterol can be use as rescue and controller therapy
what is in triple therapy
LAMA+LABA+ICS ( trelegy and enerzair)
list LAMA agent
tiotropium,
Aclidinium, glycopyrronium and umeclidinium
LAMA approved for asthma
tiotropium
list SAMA?
Ipratropium
which delivery methods of inhaler is best for children <5 years old
MDI with spacer
role of montelukast
2nd line, steroid sparing and may be add on to low dose ICS in patient with concomitant rhinitis
Differences in the management of asthma in young children versus adults include:
LTRAs and anti-allergic agents may play a greater role in children versus adults.
LABAs are not first-line adjunctive therapy in children under 5 years of age.
what should we monitor for when using ICS
patient with history of glaucoma should have Intraocular pressure check periodically
exercise induced bronchospasm ( EIB)
It is defined as a reduction in FEV1 of 15-20% after exercise
is there ICS/LAMA combo
no, there is ICS/LABA
which agent is safe in pregnancy
Short-acting inhaled beta2-adrenergic agonists, theophylline and inhaled corticosteroids (particularly budesonide) have been used extensively and are considered safe for use in pregnancy; however, theophylline may worsen gastroesophageal reflux, can cause nausea, and has a narrow therapeutic index, so avoid if possible. Accumulating evidence indicates montelukast may be used safely during pregnancY
diagnosis of COPD
FEV1: FVC <0.7
GOLD spirometry severity criteria
mild FEV1 > 80%
moderate: FEV1 50-80%
severe: 30-50%
very severe <30%
for COPD, which only intervention can slow down FEV1 decline
SMOOKING CESSATION
what does it mean when asthma is control
SEE pic
what does it mean when asthma is control
SEE pic
which LAMA is approved for asthma
tiotripium
when is mepolizumab indicated
add-on therapy in adult patients with severe eosinophilic asthma who are poorly controlled on ICS plus an additional agent and who have a blood eosinophil count >150 cells/mcL
adverse effects of montelukast
Headache (common), abdominal pain, flulike symptoms. Neuropsychiatric effects (e.g., depression, agitation/aggression, hallucinations, suicidal ideation)
asthma affects which inflammatory cells and COPD?
Asthma: eosinophilic vs COPD=
How to manage AECOPD
1: scheduled SABA+/ LAMA
2: pred 30-50mg x 5-10 days
3: add antibiotic if change in sputum purulence AND increased sputum volume or increased dyspnea
which antibiotic for AECOPD?
low risk: amox, doxy, TMP/SMX, Clarithromycin, azithromycin, cefuroxime, cefprozil
HIGH risk ( >4 exacebation, chronic steroid use): amox/clav, levo or moxi
role of Roflumilast
Roflumilast may be considered for add-on therapy to existing triple therapy (ICS/LAMA/LABA or LAMA + ICS/LABA) for people with COPD who have had at least 1 exacerbation in the past year
treatment of asthma exacerbation
SAMA+ SABA concurrent
add steroid
