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Respiratory Exam 1 - ASTHMA MEDICATIONS Flashcards

0
Q

Beclomethasone Dipropionate

A

Inhaled Corticosteroid

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1
Q

Fluticasone Propionate

A

Inhaled Corticosteroid

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2
Q

Budesonide

A

Inhaled Corticosteroid

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3
Q

Flunisolide

A

Inhaled Corticosteroid

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4
Q

Mometasone Furoate

A

Inhaled Corticosteroid

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5
Q

Triamcinolone Acetonide

A

Inhaled Corticosteroid

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6
Q

Ciclesonide

A

Inhaled Corticosteroid

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7
Q

Inhaled Corticosteroids - INDICATION

A

Long-term prevention of symptoms

Suppression, control, reversal of inflammation

Reduced need for oral corticosteroids

Most potent/effective inflammatory med. available

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8
Q

Inhaled Corticosteroids - MOA

A

Anti-inflammatory:
Block LATE reaction to allergen and reduce hyper-responsiveness
Inhibit cytokine production, adhesion, protein activation, and inflammatory migration & activation

Reverse B2 receptor down regulation

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9
Q

Inhaled Corticosteroids - AE

A

Local:
Cough, dysphonia, candidiasis

Low-medium doses:
suppression of growth in children

High doses:
Systemic effects

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10
Q

Inhaled Corticosteroids - CONSIDERATIONS

A

Wash mouth out

Adults:
Consider calcium & vitamin D supplements

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11
Q

Methylprednisolone

A

Systemic Corticosteroid

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12
Q

Prednisone

A

Systemic Corticosteroid

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13
Q

Prednisolone

A

Systemic Corticosteroid

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14
Q

Systemic Corticosteroids - INDICATIONS

A

Short term:
3-10 days to gain prompt control of inadequately controlled asthma

Long term:
prevention of symptoms of SEVERE PERSISTENT asthma ONLY

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15
Q

Systemic Corticosteroids - AE

A 
Hyperglycemia
Fluid retention
Weight gain
Hypertension
Growth suppression
Cushing's syndrome
Impaired immune function
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16
Q

Systemic Corticosteroids - CONSIDERATIONS

A

Use lowest effective dose
Long term: Alternate day AM dosing or 3pm daily dosing
Take with food
Do not administer varicella vaccine (wait one month after use)

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17
Q

Cromolyn Sodium

A

Mast Cell Stabilizer

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18
Q

Nedocromil

A

Mast Cell Stabilizer

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19
Q

Mast Cell Stabilizers - INDICATION

A

Long term prevention of symptoms in MILD PERSISTENT asthma

Preventative treatment prior to exercise or exposure to known allergen

**Used as an alternative but not preferred

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20
Q

Mast Cell Stabilizers - MOA

A

Anti-inflammatory:
Blocks EARLY & LATE reaction to allergen.
Interferes with chloride channel function. Stabilizes mast cell membrane & inhibits activation & release of mediators from eosinophils & epithelial cells.

Inhibits acute response to exercise, cold dry air, and SO2

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21
Q

Mast Cell Stabilizer - AEs

A

Cough
Irritation
Unpleasant taste (nedocromil)

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22
Q

Mast Cell Stabilizer - CONSIDERATIONS

A

may need 4-6 wks to determine max benefit

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23
Q

Omalizumab

A

Immunomodulator

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24
Q

Immunomodulator - INDICATION

A

Long term control & prevention of symptoms in adults who have MODERATE or SEVERE PERSISTENT asthma inadequately controlled by ICS

**ADJUNCT THERAPY

25
Q

Immunomodulator - MOA

A

Recombinant DNA-derived humanized monoclonal antibody that binds to CIRCULATING IgE - prevents it from binding to receptors on basophils & mast cells

Decreases mast cell mediator release from allergen exposure

Decreases number of receptors in basophils & submucosal cells

26
Q

Immunomodulator - AEs

A

Pain @ injection site

Anaphylaxis

27
Q

Immunomodulator - CONSIDERATIONS

A

Monitor for anaphylaxis

Must refrigerate

28
Q

Montelukast

A

Leukotriene Receptor Antagonists (LRTAs)

29
Q

Zafirlukast

A

Leukotriene Receptor Antagonists (LRTAs)

30
Q

Leukotriene Receptor Antagonists (LRTAs) - INDICATIONS

A

Montelukast:
Long term control of MILD PERSISTENT asthma in pts >1yo

Zafirlukast:
Long term control of MILD PERSISTENT asthma in pts >7yo

*ALTERNATIVE (not preferred)

**ADJUNCT with ICSs (Not preferred in pts >12yo compared to LABAs)

31
Q

Leukotriene Receptor Antagonists (LRTAs) - MOA

A

Selective competitive inhibitor of CysLT1 receptor

32
Q

Leukotriene Receptor Antagonists (LRTAs) - AEs

A

Zafirlukast:
Reversible hepatitis
Irreversible hepatic failure

33
Q

Leukotriene Receptor Antagonists (LRTAs) - CONSIDERATIONS

A

Montelukast:
Ceiling Effect

Zafirlukast:
Take 1hr before or 2hr after meals

34
Q

Zileuton

A

5-Lipoxygenase Inhibitor

35
Q

5-Lipoxygenase Inhibitor - INDICATION

A

Long term control & prevention of symptoms in MILD PERSISTENT asthma for pts >12yo

May be used with ICS as combo therapy in MODERATE PERSISTENT asthma in pts >12yo

*ALTERNATIVE (not preferred - less desirable than LTRAs)

36
Q

5-Lipoxygenase Inhibitor - MOA

A

Inhibits production of leukotriene from arachidonic acid (LTB4 & cysteinyl leukotrienes)

37
Q

5-Lipoxygenase Inhibitor - AEs

A

Elevated liver enzymes

38
Q

5-Lipoxygenase Inhibitor - CONSIDERATIONS

A

Monitor LFT

39
Q

Formoterol

A

Long-Acting B2-Agonist (LABA)

40
Q

Salmeterol

A

Long-Acting B2-Agonist (LABA)

41
Q

Albuterol (sustained release PO)

A

Long-Acting B2-Agonist (LABA)

42
Q

Long-Acting B2-Agonist (LABA) - INDICATIONS

A

Long term prevention of symptoms

ADDED to ICS
NOT to be used as monotherapy

NOT to be used to treat acute symptoms or exacerbations

LABA is preferred in combination with ICS in >12yo

43
Q

Long-Acting B2-Agonist (LABA) - MOA

A

Bronchodilation:

Smooth muscle relaxation following adenylate cyclase activation & increase in cAMP

44
Q

Long-Acting B2-Agonist (LABA) - AEs

A 
Tachycardia
Skeletal muscle tremor
Hypokalemia
Prolonged QT interval (OD)
Potential severe life-threatening exacerbations
45
Q

Long-Acting B2-Agonist (LABA) - CONSIDERATIONS

A

Daily use should not exceed 100mcg of Salmeterol OR 24mcg Formoterol

46
Q

Theophylline

A

Methylxanthines

47
Q

Methylxanthines - INDICATION

A

Long term control & prevention of MILD PERSISTENT asthma

Adjunct with ICS in MODERATE PERSISTENT asthma

Not preferred

48
Q

Methylxanthine - MOA

A

Bronchodilation:
Smooth muscle relaxation from phosphodiesterase inhibition & adenosine antagonism

May effect eosinophil infiltration into bronchial mucosa

Increases diaphragm contractility & mucociliary clearance

49
Q

Methylxanthine - AEs

A

LOTS
Dose related toxicities
Narrow TI

WHY NOT SEEN OFTEN

50
Q

Albuterol

A

Short-Acting B2-Agonist (SABA)

51
Q

Levalbuterol

A

Short-Acting B2-Agonist (SABA)

52
Q

Pirbuterol

A

Short-Acting B2-Agonist (SABA)

53
Q

Short-Acting B2-Agonist (SABA) - INDICATIONS

A

Relief of acute symptoms

Preventative treatment for EIB prior to exercise

*Therapy of choice

54
Q

Short-Acting B2-Agonist (SABA) - MOA

A

Bronchodilation:

Smooth muscle relaxation following adenylate cyclase activation & increase in cAMP

55
Q

Short-Acting B2-Agonist (SABA) - AEs

A 
Tachycardia
Muscle tremor
Hypokalemia
Increased lactic acid
Headache
Hyperglycemia
56
Q

Ipratropium Bromide

A

Anticholinergic

57
Q

Anticholinergic - INDICATIONS

A

Relief of acute bronchospasm

Provides ADDITIVE benefit to SABA in MODERATE-SEVERE asthma exacerbations

Alternative to pts intolerant to SABA

58
Q

Anticholinergic - MOA

A

Bronchodilation:
Competitive inhibitor of muscarinic cholinergic receptors

Reduces intrinsic vagal tone in airways - may block reflex bronchoconstriction to irritants

May decrease mucous gland secretion

59
Q

Anticholinergic - AEs

A

Dry mouth

Increased wheezing in some

60
Q

Anticholinergic - CONSIDERATIONS

A

ONLY reverses cholinergically mediated bronchospasm

Respiratory (4 decks)

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