Week 6 - Final Review Flashcards
Who is at risk for toxicity when using methylxanthines and why?
- Older adults are at higher risk as medication is metabolized by the liver
- People with liver dysfunction
- Heart disease (require lower doses)
- Smoking causes increased clearance so if stop smoking levels will rise to toxic levels
INITIAL doses are based on age and weight.
What is the first line of treatment for asthma and COPD?
Manage with an inhaled ______________ as needed.
Glucocorticoid
What are the day/night symptoms associated with intermittent asthma?
Daytime
- Symptoms two days a week or less
Nighttime
- Symptoms two times per month or less
What are the day/night symptoms associated with mild persistent asthma?
Day
- Symptoms more than 2x per week but less than daily
Night
- 3-4 times a month
What are the day/night symptoms associated with moderate persistent asthma?
Day
- Symptoms daily
Night
- More than once per week but less than nightly
What are the day/night symptoms associated with severe persistent asthma?
Day
- Several times per day
Night
- Often nightly
Examples of SABAs
- Albuterol
- levalbuterol
Benefits of using SABAs
- Taken to relieve an ongoing attack.
- Quick acting
- Can be taken prior to exercise to prevent an attack from occurring
Patient education for SABAs
- Proper inhaler technique
- Daily assessment of peak expiratory flow
- Keep a record of symptoms, attacks, intensity, affect on normal activity and SABA useage
- 1 minute between inhalations for metered dose or dry powder
- Do not exceed prescribed doseage
Why is it important to know the frequency a patient is using their SABA?
So you can determine whether the dose is effective or whether you need to adjust their treatment.
Examples of LABAs
- Aclidinium
- Arformoterol
- Formoterol
- Indacaterol
- Oladaterol
- salmeterol
LABA
Long acting beta agonists
SABA
Short acting beta agonist
Benefits of using a LABA
- Provide long term control of symptoms.
- Dosing is on a fixed schedule (not PRN)
(Must be used with a glucocorticoid in asthma)
LABA use in COPD
Can be used without a glucocorticoid because it does not pose the same risk of death in COPD as it does in asthma.
Inhaled corticosteroid examples
- budesonide
- fluticasone
Benefits of using inhaled corticosteroids
- Suppress inflammation
—- reduce bronchial hyperreactivity and mucous production - Especially effective for asthma prophylaxis and management of COPD exacerbations
- Significant long-term control of symptoms
At what point would an oral steroid be prescribed?
When symptoms cannot be controlled with a safer medication (inhaled glucocorticoid or beta2 agonist) due to potential for toxicity.
Generally prescribed for moderate to severe persistent asthma or COPD.
When would roflumilast be indicated for a COPD patient?
- exacerbation prophylaxis
- patients with severe COPD with a primary chronic bronchitis component
- history of frequent exacerbations
Second line drug
How does nicotine replacement work?
Smoker receives a pharmaceutical source of nicotine to replace the nicotine in cigarettes and then gradually withdraw the replacement nicotine.
Patient education for nicotine patches.
Should be applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. The site should be changed daily and not used again for 1 week.
Patient education for nicotine gum
- Chew the gum slowly and intermittently for approximately 30 minutes
- Patients should not eat or drink for 15 minutes before chewing and while chewing
- Gum should only be used for a maximum of 6 months
Patient education for nicotine nasal spray
- Do not use other tobacco products.
- Spray technique
- 1 spray in each nostril
Contraindications for Wellbutrin
Caution in patient with history of:
- anorexia
- alcohol withdrawal
- cocaine use
- psychiatric disease
- seizure
What is the recommended length of treatment for bupropion for smoking cessation?
12 weeks
What is multi-drug resistant TB?
Resistant to isoniazid and rifampin
What is extensive-drug resistant TB?
Resistant to isoniazid and rifampin and all fluoroquinolones and at least one injectable second line anti-TB drug
Treatment of TB in a pregnant person, what all should be included?
- Rifabutin is the safest during pregnancy.
- CDC reports that benefits justify the risks for isoniazid, rifampin and pyrazinamide.
What is a secondary use of isoniazid?
Prophylaxis for someone who has been exposed to TB.
Examples of decongestants
- Phenylephrine
- Pseudoephedrine
- Naphazoline
- Oxymetazoline
- Tetrahydrozoline
- xylometazoline
What drug class for allergic rhinitis, colds and coughs have no significant drug interactions?
Expectorants
For asthma, a LABA has been prescribed, what other medication must a LABA be used with?
Glucocorticoid
What are some benefits of using ICS?
- Very effective
- safer than systemic
- usually minor adverse reactions
What education can you provide a patient for ICS use?
Rinse mouth after use due to the risk of oropharyngeal candidiasis and dysphonia (hoarseness and difficulty speaking)
What are some prevention strategies to prevent COPD exacerbations? (Select all that apply)
a. Pulmonary rehab
b. physical activity
c. pneumonia and flu vaccinations
d. Nutrition counseling
All of the answers are correct
What are risk factors for fatal asthma attacks?
- Uncontrolled asthma
- Recent hospitalization
- Exposure to triggers
At what point is a patient prescribed an oral glucocorticoid?
Moderate to severe persistent asthma or for management of acute exacerbation of asthma or COPD to bring symptoms under control.
Roflumilast (select all that apply)
a) Reduces inflammation
b) Not intended during pregnancy
C) Approved for asthma
d) First-line drug for COPD
A&B
Approved only for COPD
Used as second line drug
Used for exacerbations prophylaxis in patients with severe COPD with a primary chronic bronchitis component.
A patient has been have SOB/wheezing 2 days a week with nighttime awaking’s 2 times a month, and has had one exacerbation in the last year. She is currently using a her SABA and a low dose IGC. What are the next steps? Is she well controlled?
Well controlled, reevaluate her in 1-6 months.
Consider stepping down if well controlled for 3 months.
MOA for a long acting B2RA
A sympathomimetic drug that activates B2 adrenergic receptors. This promotes broncho dilation and thus relieving bronchospasm. Has limited role in suppressing histamine release in the lung
What is the first step (medication) in asthma and COPD control?
SABA
A patient wakes up at night a few times a week, has been using his SABA DAILY, and has been experiencing symptoms DAILY, and states he cannot make it up a flight of stairs without trouble breathing. What is the severity of his asthma symptoms and what Step would he be considered?
He is step 3, Moderate persistent.
Not well controlled.
SABA prn, low dose IGC + LABA or Medium dose IGC
Anti-inflammatory agents
- Glucocorticoid
- Cromolyn
- Monoclonal antibodies
- leukotriene receptor agonists
Categories of Bronchodilators
- B2 Andrenergic agents
- Methylxanthines
- Anticholinergic
Glucocorticoid most effective for…
long-term control of airway inflammation
Cromolyn used for…
Prophylaxis for mild to moderate asthma.
Monoclonal antibodies used for…
allergy-related asthma and eosinophilic asthma (high levels of WBCs in the lungs).
Omalizumab for allergy related and Ben ralizumab, mepliz, and resliz are for eosinophilic
Leukotriene Receptor Antagonists are used as….
second line therapy to reduce inflammation and bronchoconstriction
B2 Adrenergic Agonists are prescribed for…
- exercise induced bronchoconstriction
- COPD exacerbations
- maintenance therapy
Methylxanthines are used for…
Maintenance therapy for chronic stable asthma
Use ONLY if B2 or anticholinergics are not appropriate.
