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CDM 1 Exam 3 > Respiratory: PCOL + Asthma 2 > Flashcards

Respiratory: PCOL + Asthma 2 Flashcards

1
Q

DPI

A

Dry powder inhalers

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2
Q

EIB

A

Exercise induced bronchospasm

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3
Q

HFA

A

Hydrofluoroalkane

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4
Q

ICS

A

Inhaled Corticosteroids

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5
Q

LTRA

A

Leukotriene Receptor Antagonists

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6
Q

LABA

A

Long acting B2 agonists

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7
Q

LAMA

A

Long acting muscarinic antagonists

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8
Q

MDI

A

Metered dose inhaler

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9
Q

OCS

A

Oral corticosteroids

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10
Q

SABA

A

Short acting B2 agonist

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11
Q

SAMA

A

Short acting Muscarinic Antagonists

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12
Q

SMI

A

Soft mist inhaler

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13
Q

Albuterol brand

A

ProAir, Proventil, Ventolin

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14
Q

Ipratropium brand

A

Atrovent

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15
Q

Salmeterol brand

A

Servant diskus

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16
Q

Theophylline brand

A

Theo-24, Theo-Dur

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17
Q

Montelukast brand

A

Singulair

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18
Q

Fluticasone brand

A

Flonase

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19
Q

Beclomethasone brand

A

Qvar

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20
Q

Budesonide brand

A

Pulmicort, Rhinocort

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21
Q

Prednisone brand

A

Deltasone

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22
Q

Fluticasone/salmeterol brand

A

Advair

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23
Q

Budesonide/formoterol brand

A

Symbicort

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24
Q

Mometasone/formoterol brand

A

Dulera

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25
Q

Omalizumab brand

A

Xolair

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26
Q

Mepolizumab brand

A

Nucala

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27
Q

Dupilumab brand

A

Dupixent

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28
Q

SABA MOA

A

Act on B2 receptor, activating cytoplasmic G proteins which activate adenylyl cyclase to produce cAMP which decreased unbound intracellular calcium, producing smooth muscle relaxation and mast cell membrane stabilization

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29
Q

What does mast cell membrane stabilization do?

A

Decreases histamine release

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30
Q

SABA treatment options

A

“-erol are beta agonists”

albuterol - onset quick 5-10min
Levalbuterol

OTC: Epinephrine and Ephedrine

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31
Q

SABA adverse drug reactions

A 
Tremor
Anxiety
Tachycardia
Hypokalemia
Hypomagnesemia
Hyperglycemia
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32
Q

SABA drug interactions

A

Beta blockers (using B1 selective will reduce SE)
diuretics
Sympathomimetics

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33
Q

Things to monitor with SABA?

A

Symptoms
HR
K

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34
Q

SABA patient education

A

Place in therapy

inhalation device technique

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35
Q

SAMA Mechanism of Action

A

competitive inhibition of muscarinic receptors in airways thereby preventing bronchoconstriction mediated by vagal nerve

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36
Q

SAMA Treatment options

A

Ipratropium - slower onset 15-30min compared to albuterol…used as add on

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37
Q

Any benefit of using Levalbuterol vs Albuterol

A

Not really

Costs much $$$$

not really worth it

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38
Q

SAMA adverse effects

A

Dry mouth

abnormal taste

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39
Q

SAMA precautions

A

Narrow-angle Glaucoma
Prostatic hyperplasia
Bladder-neck obstruction

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40
Q

Drug interactions SAMA

A

Anticholinergic meds

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41
Q

SAMA Monitoring

A

Symptoms

Urinary retention in older men

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42
Q

Pt education for SAMA

A

Place in therapy

inhalation device technique

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43
Q

LABA mechanism of action

A

same as SABA but longer acting

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44
Q

LABA treatment options

A

** Salmeterol, olodaterol, formoterol **

Albuterol tab, arfomoterol, indacaterol

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45
Q

Salmeterol

A

< 20 min onset of action

Duration: 12hrs

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46
Q

Formoterol

A

<5 min onset
Duration: 12hrs

mixed between albuterol (fast onset) and long duration like Salmeterol

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47
Q

LABA Adverse reactions

A 
Tremor
Anxiety
Tachycardia
Hypokalemia
Hypomagnesemia
Hyperglycemia
Cough w/ indacterol
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48
Q

LABA Drug interactions

A

Other meds that prolong QTc

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49
Q

What to monitor LABA

A

Symptoms

ADR (HR, K+, Mg, Glucose)

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50
Q

PT education for LABA

A

Inhalation device training, rationale for use (controller therapy)

Not for acute SOB (potential exception with formoterol in the beclomethasone/formoterol combination which may be used as a maintenance and reliever treatment in asthma)

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51
Q

LAMA Mechanism of action

A

Inhibition of M1-5 receptors, bronchodilator due to M3 activity in lungs

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52
Q

LAMA treatment options

A

Tiotropium

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53
Q

Bronchodilator medications

A 
Albuterol
Ipratropium
Ipratropium/Albuterol
Salmeterol
Olodaterol
Tiotropium
Theophylline
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54
Q

Anti-inflammatory agents

A 
Montelukast
Roflumilast
Azithromycin
Fluticasone
Beclomethasone
Budesonide
Prednisone
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55
Q

Combination Therapy meds

A

tiotropium/olodaterol
fluticasone/salmeterol
budesonide/formoterol
fluticasone/umeclidinium/ vilanterol

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56
Q

Biologics

A

omalizumab
mepolizumab
dupilumab
trezepelumab

57
Q

LAMA adverse reactions

A 
Dry mouth
Bitter/metalic taste
Constipation
Urinary Retention
Worsened narrow-angle glaucoma
58
Q

LAMA drug interactions

A

Anti-cholinergic medications

59
Q

What to monitor LAMA

A

symptoms, ADR

60
Q

Patient education LAMA

A

role in therapy

inhalation device training

61
Q

LAMA/LABA Treatment options

A

Tiotropium/Olodaterol (Stilt Respimat)

62
Q

Methylxanthine Mechanism of Action

A

Smooth muscle relaxation/bronchodilation via inhibition of PDE thereby decreasing the degradation of cAMP to AMP; potentially also mild anti-inflammatory activity via PDE4 inhibition; inhibition of adenosine receptors

63
Q

Methylxanthine treatment options

A

Theophylline

64
Q

Methylxanthine adverse effects

A

All are dose related, highest risk of LA Bronchodilator

Headache
Insomnia
Nausea
Heartburn
Arrhythmias
Grand mal convulsions
65
Q

Methylxanthine drug interactions

A

CYP3A3 and CYP1A2 drugs

66
Q

Methylxanthine monitoring paramaters

A

Theophylline lvls

5-15mcg = adult
5-10 mcg = children

Symptoms

67
Q

Pt education Methylxanthine

A

place in therapy

side effects + signs/symptoms of toxicities

68
Q

Anti-inflammatory medications classes

A 
Steroids (OCS/ICS)
Mast cell stabilizers
Leukotriene Modifiers
Macrolide antibiotics
Phosphodiesterase 5 inhibiters (PDE4)
69
Q

Systemic Corticosteroids (OCS) Mechanism of action

A

Modifies gene expression of cells leading to gene activation or suppression

Block late reaction to allergen and reduce airway hyperresponsiveness

Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation

Reverse β2 receptor down-regulation

70
Q

Systemic Corticosteroids Treatment options

A

Prednisone**

Prednisolone
methylprednisolone

“-one” are systemic corticosteroids

71
Q

Systemic Corticosteroids Adverse reactions

A

Negative feedback onto Hypothalamus and Anterior pituitary

long list of side effects

72
Q

Systemic Corticosteroids Drug-interactions

A 
Fluoroquinolone (inc tendon rupture)
oral antidiabetics (inc Hyperglycemia)
CYP3A4 interactions
73
Q

Monitoring paramaters Systemic Corticosteroids

A

Clinical improvement
SE (BP, BG, mental stauts, electrolyte panels)
Growth

74
Q

Patient education of Systemic Corticosteroids

A

All the side effects

75
Q

Adverse Drug reactions Inhaled Corticosteroids

A

** Thrush **

Cough
Dysphonia
Delayed childhood growth
Bunch of others

76
Q

How to reduce adverse drug events ICS

A

Spacers or valved holding chambers (can reduce thrush)
Rinse after inhalation (to reduce thrush)
use lowest dose possible

77
Q

Monitoring parameters ICS

A

Growth

Disease outcomes

78
Q

Pt education ICS

A

Use a spacer/holding chamber

rinse mouth after inhalation

79
Q

Drug interactions with ICS

A

Protease inhibitors
Ketoconazole

CYP450-CYP3A4

80
Q

ICS/LABA combo patient education

A

No need to rinse mouth after PRN ICS/formoterol use in asthma

81
Q

Max daily dose of Formoterol for MART therapy in asthma

A

54mcg

82
Q

When is asthma usually worse?

A

in the morning or at night

83
Q

Macrolide antibiotics MOA

A

Macrolide antibiotics bind to the 50s ribosomal subunit preventing protein synthesis, also has anti-inflammatory effects

84
Q

Treatment options Macrolide Antibiotics

A 
Azithromycin = add on in asthma
COPD = used for prevention of COPD exacerbations

have to balance benefit of risk vs reward of antibiotic resistance

85
Q

Phosphodiesterase-4 inhibitors MOA

A

Inhibit phosphodiesterase-4 (PDE-4) causing an increase in cAMP.

decreasing inflammatory cell activity, inhibition of fibrosis, relaxation of smooth muscle

86
Q

Roflumilast Warnings

A

Acute bronchospasm
Worsen Psychiatric events
Weight decrease
Don’t use with strong CYP- inducers

87
Q

Roflumilast ADR

A

GI disorders = go away over time
infections
muscle spasms
tremors

88
Q

monitoring parameters Roflumilast

A

Weight
FEV1
COPD exacerbations
Depression

89
Q

Patient education Roflumilast

A

side effects - weight loss, insomnia, depression

Place in therapy

90
Q

Drug interactions Roflumilast

A

Extensive CYP3A4 and CYP1A2 metabolism

91
Q

biologic targeting IgE

A

Omalizumab (Xolair)

92
Q

biologic targeting IL-4, IL-13

A

Dupilumab (Dupixent)

93
Q

biologic targeting IL-5

A

Mepolizumab (Nucala)

94
Q

Biologic targeting TLSP

A

Tezepelumab-ekko (Tezspire)

95
Q

Omalizumab (Xolair) mechanism of action

A

Binds to IgE, preventing it from binding to the high affinity receptors on basophils and mast cells

decreases # of high affinity receptors and mast cell mediated release of inflammatory mediators

96
Q

What to monitor Omalizumab

A

IgE levels
reduction in exacerbations and symptoms
improvements in FEV1
Side effects = anaphylaxis

97
Q

Omalizumab precautions

A

anaphylaxis = black box
parasitic infection
Fever/Rash

98
Q

Mepolizumab (Nucala) MOA

A

Humanized IgG1 monoclonal antibody against IL-5 preventing it from binding to its receptor on eosinophils thereby reducing blood, tissue, and sputum eosinophils

99
Q

What to monitor Mepolizumab

A

improvements in symptoms

100
Q

Patient education Mepolizumab

A

Side effects = hypersensitivity

101
Q

What to monitor Dupilumab

A

Improvement in symptoms
exacerbations
FEV1
side effects

102
Q

Patient education Dupilumab

A

Store in fridge
SQ injection training, sharps disposal
Advise to d/c and seek treatment if hypersensitivity

103
Q

TSLP mechanism of Action

A

Reduces TSLP impact in lungs

can use on a variety of different asthma types

104
Q

Adverse Drug Reactions with Dupilumab

A

injection site reactions
conjunctivitis
HSV infection

105
Q

Tezspire monitoring

A

asthma control

106
Q

Tezspire pt education

A

role in therapy
side effects
avoiding live vaccinations

107
Q

Tezspire precaution

A

avoid use of live attenuated vaccines

may put patients at risk of parasite infection

108
Q

Adverse drug reactions Tezspire

A 
Helminth infection
Hypersensitivity 
back pain
pharyngitis
Arthralgia (joint stiffness)
109
Q

ACT

A

Asthma Control Test

20-25 = well controlled
16-19 = not well controlled
5-15 = very poorly controlled
110
Q

GINA guidelines for Difficult-to-treat Asthma

A
  1. Confirm diagnosis
  2. Look for factors contributing symptoms/exacerbations
  3. Optimize therapy
  4. Review in 3-6 months
  5. Asses severe asthma phenotypes
  6. Consider other treatments
  7. Review response
  8. Continue to optimize therapy
111
Q

Before considering Adjusting therapy, consider…..

A 
Adherence
Inhaler Technique
Comorbid conditions
Persistent Allergan exposure
Incorrect diagnosis
112
Q

In patients <5 years, before stepping up therapy GINA recommends to…

A

try something different

113
Q

3 ways to adjust therapy

A

Day-to-Day = based on symptoms

Short Term = 1-2 weeks - when exposed to seasonal allergen or illness

Sustained = >2-3 months - when symptoms uncontrolled

114
Q

How to step-down therapy

A

if pt has good control for > 3 months

reduce ICS by 25-50%

close supervision of those with risk factors or exacerbation or persistent airflow limitation

115
Q

Mild asthma

A

well controlled on step 1/2 treatment

116
Q

Moderate asthma

A

well controlled on step 3/4 treatment

117
Q

Severe asthma

A

asthma remains uncontrolled despite high dose ICS/LABA or requires high dose ICS/LABA to maintain control

118
Q

Vaccinations for Asthma

A

Flu
Covid-19

Pneumococcal depends on reference

119
Q

Other therapies for Asthma

A

SCIT and SLIT (Subcu and Sublingual immunotherapy)

120
Q

NHLBI SCIT recommended as…

A

adjunct in those 5+ w/ mild/moderate allergic asthma

121
Q

GINA SLIT recommended in….

A

adults with Allergic Rhinitis and sensitization to house dust mite w/ suboptimally controlled asthma despite low dose ICS

only if FEV1 > 70%

122
Q

Bronchial Thermoplasty (BT)

A

procedure which uses heat to remove muscle tissues from the airways

not recommended by GINA

123
Q

**Modifiable Risk Factors for Asthma**

A 
> 1 Risk Factor of Exacerbations
> 1 Severe Exacerbations in the past year
Exposure to irritants (Tobacco, food allergies, allergens)
FEV1 < 60% predicted
Obesity
Psychological Conditions
Socioeconomic Problems
Sputum Eosinophilia
124
Q

Possible Non-pharmacolgical Therapy for Asthma

A 
Avoidance of irritants and triggers
Physical Activity
Healthy Diet
Weight Reduction
Education
Others
125
Q

Comorbid Asthma Conditions

A 
Allergic Rhinitis
Pregnancy
GERD
Obesity
Obstructive Sleep Apnea
Depression/Anxiety
Food Allergies
126
Q

Asthma Action Plans should have 2 aspects

A

Daily management

How to recognize and handle worsening asthma

127
Q

Patient Education for Asthma

A
  1. Facts about Asthma
  2. Medication therapy (SE, Proper technique, Role of med)
  3. Self monitoring
128
Q

Two ways to do Asthma Action plan

A

Symptom or Peak Flow based

129
Q

Peak Flow based action plan

A
  1. Find patients best peak flow

2. zones are determined by % of best peak flow

130
Q

Picking Peak Flow vs Symptomatic based plan

A

If bad perception of symptoms then peak flow might be easier to use.

131
Q

Asthma Exacerbations (Flare ups)

A

Acute or sub-acute episodes of progressively worsening SOB, cough, wheezing or chest tightness

132
Q

Signs and Symptoms of Asthma Exacerbations

A 
Inc RR, HR
prolonged expiratory phase
pronounced accessory muscle use
diaphoresis
difficulty lying supine, speaking
lethargy or reduced exercise tolerance
nasal flailing in your children
133
Q

Triggers for Asthma Exacerbations

A 
Respiratory infections
allergens
Seasonal changes
environment
emotions
exercise
drugs/preservatives
poor adherence to therapy
occupational stimuli
134
Q

ER/Hospital Management of Exacerbation

A

Supplemental O2 ( 93-95% children >12, 94-98% children <11

Ipratropium = reduce hospitalizations

add steroids

135
Q

How to handle asthma exacerbations at home?

A

Follow asthma action plan w/ close follow up

136
Q

ER/Hospital management drugs for exacerbation

A

Albuterol + Ipratropium
Prednisone
Magnesium

137
Q

Atropy

A

a genetic predisposition for the development of IgE-mediated response to common aeroallergens

138
Q

Bronchial Hyperresponsiveness (BHR)

A

Increased sensitivity of the airways to narrow in response to various stimuli

139
Q

Exercise Induced Bronchospasm (EIB)

A

Exercise-induced bronchospasm which can be pre-treated with certain bronchodilators

CDM 1 Exam 3 (10 decks)

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