Treatment of Obstructive Disease Flashcards
Classification of well controlled asthma
1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment
1) < 2 days/week
2) < 2x/month
3) > 80% FEV1, peak flow near normal
4) 0-1/uyear
5) SABA prn (<2x weekly)
Classification of not well controlled asthma
1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment
1) > 2 days/week
2) 1-3x/week
3) 60-80% FEV1
4) > 2/year
5) Low Dose ICS or
Low Dose ICS + LABA or medium dose ICS
Classification of poorly controlled asthma
1) symptoms how often
2) nighttime how often
3) FEV1
4) exacerbation requiring systemic corticosteroids
5) treatment
1) throughout day
2) > 4x/week
3) < 60% FEV1
4) > 2/year
5) medium dose ICS + LABA or
High dose ICS + LABA
if patient’s asthma is well controlled for at least 3 months
what do you do
step down if possible
Goals of asthma therapy
1) treat cough, chest tightness, wheezing, dyspnea
2) decr use of rescue SABA
3) decr night awakening
4) prevent exacerbations and muscle hypertrophy
What is good asthma management
1) routine monitoring of PFT
2) patient education
3) enviorn triggers
4) meds
What are long term control meds (4)
1) inhaled glucocorticoids = long term preferred for persistent asthma
2) long acting inhaled beta2 agonists = preferred supplement for use with inhaled GCs
3) leukotriene modifiers
4) omalizumab (anti-IgE)
5) inhibitors of IL-13 and IL-4 for Th2
Other long term options for asthma (4)
1) allergen immunotherapy = decr allergen tolerance effective for allergic rhinitis ad conjunctivitis
2) tiotropium = long acting anticholinergic for COPD NOT asthma
3) theophylline = large adverse effect
4) cromolyn sodium for exercise induced asthma
Quick relievers (rescue therapies) (3)
1) short acting beta2 agonists (albuterol) for exercise asthma and immediate
2) anticholinergics = COPD NOT ASTHMA; secondary relief in asthma exacerbations (not tiotropium)
3) systemic glucocorticoids = severe asthma + attacks
Beta adrenergic agonists
1) names of drugs
2) used for?
3) onset
4) administration
5) quick relievers vs. long term
1) albuterol, terbutaline, salmeterol, formoterol
2) asthma + COPD
3) oral = tachycardia, injectable, inhale
4) rapid onset
5) quick relief (4-6 hr) = albuterol
long term control = 12 hrs = salmeterol, formoterol
Mechanism of action of beta2 agonists
1) stim beta adrenergic receptor
2) relax smooth muscle
3) bronchodilation
inhibit resp secretions
Anticholinergics
1) names
2) uses
3) onset
4) admin form
5) quick relief vs long term controller
1) atropine, ipratropium, tiotropium
2) COPD NOT ASTHMA
3) rapid in min
4) inhaled
5) quick relief = 6 hrs = ipratropium
long term = 12 hrs = tiotropium
mechanism of anticholinergics
1) inhibit cholinergic receptor (ACh parasympathetic)
2) smooth muscle relax
3) bronchodilation
inhibit resp secretions
Systemic glucocorticoids
1) name
2) used for
3) onset
4) admin route
5) metabolism
6) peak action
1) hydrocortisone, prednisone, prednisolone, methylprenisolone
2) asthma exacerbation
3) 30-60 min
4) oral or IV
5) half life = 2-3 hrs
6) approx 8 hrs
mechanism of systemic gluococoritcoids
1) phospholipase inhib, inhib cytokine synthesis
2) anti inflamm, vasoconstrictor
Inhaled glucocorticoids
1) preferred when?
2) onset
3) admin route
4) metabolism
5) duration and peak action
1) long acting control for asthma and COPD
2) 30-60 min
3) inhaled
4) half life 2-3 hrs except fluticasone (7 hrs)
5) QD or BID; 8 hrs for 1 dose
Mechanism fo inhaled glucocorticoids
1) phospholipase inhib
2) inhib cytokine synth
3) anti inflamm and vasoconstrictor
Do you give ICS for children?
NO significant effect on growth
Long acting beta agonists
1) names
2) onset
3) admin route
4) duration of action
5) mechanism
1) salmeterol, formoterol
2) 15 min
3) inhaled
4) 8-12 hrs
5) beta adrenergic stim
BLACK BOX WARNING FOR LABA
MUST COMBINE WITH INHALED CORTICOSTEROID TO CONTROL INFLAMMATION
Challenges with lung delivery
1) airway bifurcation and decr airway caliber
2) entire blood volume thru longs so toxicity
3) changes inv ascular permeability –> incr interstitium –> XS extravascular fluid
Topical route
Pros
cons
Pros = better than systemic b/c directly deliver bypassing absoprtion, minimal systemic effects, rapid onset
Cons = require device, technique, waste
Oral route
Cons
Cons = requires absorption from GI tract first, greater side effects
parenteral route
Pros
Cons
Pros = bypass absoption so 100% available and rapid onset
Cons = greater side effects
