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43 Cards in this Set
- Front
- Back
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What are the symptoms of mild intermittent asthma?
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- symptoms occur, on average, less than twoice a week
- no symptoms and normal peak expiratory flow rate between attacks - brief exacerbations last from a few hours to a few days and vary in intensity - night time symptoms occur less than twice a month - FEV1 or PEF (peak expiratory flow) greater than 80% of predicted value - PEF variability of less than 20% |
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What are the symptoms of mild persistent asthma?
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Symptoms occur MORE THAN TWICE A WEEK but no daily
Exacerbations AFFECT ACTIVITY night time symptoms occur more than twice a month FEV1 and PEF greater than 80% predicted PEF variability of between 20-30% |
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What are the symptoms of moderate persistent asthma?
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DAILY SYMPTOMS
daily use of a SABA exacerbations affect activity exacerbations occur more than twice a week or persist for days might time symptoms occur more than once a week FEV1 or PEF greater than 60%, less than 80% of the predicted value PEF variability greater than 30% |
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What are the symptoms of severe persistent asthma?
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CONTINUAL SYMPTOMS
exacerbations limit physical activity frequent exacerbations frequent night time symptoms FEV1 or PEF less than 60% of the predicted value PEF variability greater than 30% |
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What is asthma?
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A chronic inflammatory disorder involving mast cells, eosinophils, T lymphocytes, neutrophils, and epithelial cells
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MOA
B2 agonists Anticholinergics Corticosteroids |
B2 agonists
B2 stimulation results in an increase in cyclic AMP which acts on Ca to produce smooth muscle relaxation Anticholinergics inhibiting C-GMP cause a decrease in secretions and bronchodialation Corticosteroids CS depress synthesis of proinflammatory cytokines: IL-1, GM-CSF, IL-3, IL-5, IL-6, IL-8 |
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What do you use to monitor asthma?
What does a peak flow meter measure? Explain the zones of asthma Green zone Yellow zone Red zone What does red zone indicate? |
peak flow meter
PEF Green zone - 80-100% of personal best value Yellow zone - 50-79% of PBV Red zone - < 50% PBV Red zone - implement action plan |
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What do you use to monitor COPD?
What does spirometer measure? |
spirometer
FEV1 - forced expiratory volume in 1 sec FVC - forced vital capacity |
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Ventolin HFA (albeuterol)
Xopenex (levalbuterol) Maxair (pirbuterol) |
levo has less effect on heart, glucose, and potassium
hold your breath for 10 seconds on all inhalers Doses 2 INH q 4-6 hr |
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Servent Diskus (salmeterol)
Indication experation age restrictions ADR/OD Onset of action |
Indication
DOC for nocturnal asthma ADR/OD seizures, angina, HTN/hypotension, tachycardia, arrhythmias, nervousnes, HA, tremor, ry mouth, muscle cramps, palpitation, nausea Onset of action 30-60 min |
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Foradil Areolizer (formoterol)
Dose Counseling pts ONSET |
Dose
Inhale 1 capsule every 12 hr *capsules contain 12mcg of formoterol and 25 mg of lactose Counseling points - if any powder remains in the aerolizer, continue until gone - never wash aerolizer Onset of Action 5 min |
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Symbicort (budesonide/formoterol)
MOA Indications Dose Black Box Warning Contraindications |
MOA
corticosteroid/B2 agonist Indication Long-term maintenance treatment of asthma in pts 12 YEARS AND OLDER *NOT INDICATED FOR RELIEF OF BRONCHOSPASM Dose 2 INH q 12 hours max dose is 640/18 mcg/days BBW on all LABAs increased risk of asthma-related death if not used in conjunction with another form of long-term asthma control such as an inhaled corticosteroid *NO MONOTHERAPY Contraindications primary treatment of asthma |
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What are the non-specific B2 agonists?
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motoproterenol
isoproterenol WHY WOULD YOU USE THESE ANSWER YOU WOULDNT |
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What blood component often increases during an allergic response?
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eosinophils
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Atrovent (ipratropium)
MOA Dose ADR |
MOA
anticholinergic Indications COPD, Chronic bronchitis, emphasema, asthma Dose 2 inhalations QID 18mcg per INH ADR Dry mouth tachycardia Use in caution in pts with: glaucoma BPH bladder neck obstruction |
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Spiriva (tiotropium)
MOA Dose ADR |
MOA
Long acting, antimuscarinic (anticholinergic) agent, inhibition of M3-receptors at the smooth muscle leading to bronchodilation Dose I cap (18mcg) q d ADR xerstomia, constipation, tachycardia, blurred vision, glaucoma, urinary difficulty/retention |
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Brovana (arformoterol)
MOA Indication Co use of CYP2d6 inhibitors Extreme caution in these pts ADR |
MOA
LABA Indication COPD, chronic bronchitis and emphysema DOSE COPD - 15mcg q 12 hr in JET nebulizer (Pari C Plus or Pari Dura-Neb 3000) no does adj for renally or hepatically impaired Extreme caution is pts on MOA-Is, TCAs, or drugs known to prolong QTc interval ADR pain, chest pain, back pain, diarrhea, sinusitis |
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What are 3 actions corticosteroids have?
How quickly do corticosteroids improve B2 agonist responsiveness? Side effects of long term and higher doses of inhaled corticosterloids? two ADR of acute corticosteroid use? |
3 actions
- increases the number of B2 receptors - reducing mucous production and hypersecretion - inhibit inflammatory response How quick to improve B2 agonist Fx? 2 hours - prevents acute attacks for 4-12 hours Side effects chronic use? thrush, hoarseness, retardation of child growth, glaucoma, cataracts, bruising and thinning of skin acute ADR oral candida dysphonia *RINSE OUT MOUTH AFTER USE!! |
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One asthma drug known for oral candidiasis?
2 ways to minimize this? How long until a therapeutic benefit? |
triamcinolone
rinse mouth after use use spacer 1-2wks for improvement to start; gradual improvement after that for up to 12 months Pulmicort (budesonide) has quickest time to therapeutic effect |
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List the corticosteroids used in chronic asthma.
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More Fun Treatment For Better Breathing
Mometasone - ASMANEX Flunisolide - AEROBID Triamcinolone - AZMACORT Fluticasone - FLOVENT Budesonide - PULMICORT Beclomethasone - QVAR |
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mometasone
Indications children dose ADR Space device use |
Asmanex
Indications maintenance/proph therapy in pts over 4 Child dose 4-11 yrs 110 mcg q hs ADR HA, allergic rhinitis, pharyngitis, oral candidiasis, URI, sinusitis, dysmenorrhea, back pain, dyspepsia, nausea NO SPACER FOR THIS |
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flunisolide
MOA Indications child dose ADR Spacer use? |
Aerobid/Aerobid-M
MOA corticosteroid Indication maintenance/prophylactic therapy in pts 6 years of age and older child dose 2 INH BID morning and evening ADR Diarrhea, nausea, flu symptoms, sore throat, nasal congestion, HA, URI, candida CAN BE USED WITH SPACER SUCH AS - AEROCHAMBER |
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triamcinolone
Indications child dose ADR Spacer use? PO corticosteroid use to IHN triamcinolone |
MOA - corticosteroid
Indications - maintenance/proph therapy in pts 6 yrs of age and older Child dose 150-300 mcg BID ADR - sinusitis, pharyngitis, HA, back pain, **ORAL CANDIDIASIS** xerstomia comes w/ built in spacer Use in caution when patient is switching from oral corticosteroids to azmacort; some deaths due to adrenal insufficiency |
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fluticasone
Indications child dose ADR drug interaction |
Flovent
Indications maintenance/proph in pts 4 years or older child dose - Diskus - 50mcg bid HFA - 88 mcg BID ADR URI, sinusitis, N/V, fever, HA, facial and oropharyngeal edema Drug Interaction w/ ritonavir - can lead to cushings, adrenal suppression |
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What does HFA mean?
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HFA - hydrofluoroalkane - 'ozone-friendly' propellant
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budesonide
Indication ADR Spacer use? |
Pulmicort
Indication maintenance/proph therapy in pts 6 yrs and older ADR URI, pharyngitis, sinusitis, HA, candidiasis, nausea NO SPACER in turbhaler or flexhaler |
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budesonide RESPULES
indication Dose ADR monitoring |
indication
maintenance/proph therapy ages 12-8 years old Dose Nebulize (pari-LC-Jet Plus) 0.5mg qd or BID ADR URI, rhinitis, coughing, otitis media, diarrhea, gastgroenteritis, abdominal pain monitoring regular eye exams since budesonide respules can trigger glaucoma and cataract development |
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beclomethasone
Indication child dose ADR Spacer use |
Qvar
Indication maintenance/proph in pts 5 yrs and older child dose 40 mcg BID ADR HA, pharyngitis, URI, rhinitis, sinusitis, pain, nausea USE W SPACER |
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Ipratropium/albuterol HFA
Dose contraindication Ipratropium/albuterol nebulizer Indication Dose |
Combivent
Dose 2 INH QID **Max 12/day for COPD contraindication do not use if allergic to soya lecithin or related food products like soybeans and peanuts Duoneb Indication tx of bronchospasm w COPD in pats requiring more than one bronchodilator Dose 3ml vial in Pari-LC-Plus JET nebulizer; can use 2 more vials prn throughout day |
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fluticasone & salmeterol
dose discard after how long? |
advair diskus
dose 1 INH q 12 hr 100/50 250/50 500/50 discard after one month or after all doses gone |
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fluticasose & salmeterol HFA
indications Dose ADR Spacer? |
Advair HFA
indications long-term, BID maintenance treatment of asthma 12 years and older dose 2 INH q 12 hr max 230/21 NO SPACER |
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mometasone & formoterol
Indications Dose ADR Counseling pts BBW |
Dulera
Indications maint/proph for pts 12 and older Dose 2 inhalations twice daily; NO MORE ADR nasopharyngitis, sinusitis, HA; may have an increase in wheezing with Dulera, always keep rescue inhaler available to treat sudden SOB wheezing BBW: LABA increase risk of asthma related death; do no prescribe Dulera if pts asthma adequately controlled on other meds Counseling RINSE MOUTH wipe the inside and outside of mouth piece with dry cloth every 7 days, DO NOT WASH in WATER |
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When a patient is using a corticosteroid and a bronchodilator in separate administration device which one should I use first?
What should be inhaled fast? What should be inhaled slow? Will your albeuterol work if it has been left in a cold car? |
Use the bronchodilator first, wait several minutes, then use the steriod. This allows better penetration of the steroid.
FAST Inhalation aerolized B agonists/anticholinergics SLOW corticosteroids to decrease chance of thrush if albeuterol cold, try and bring to room temp, if time permits |
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Systemic corticosteroids
what is burst therapy intermediate therapy |
burst therapy is high dose for 5-7 days
1mg/kd/day prednisone, methylprednisolone, prednisolone intermediate therapy every other day prednisone prednisolone methylprednisolone triamcinolone |
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How do you convert prednisone to methylprednisolone?
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divide by 1.25
prednisone 20 mg / 1.25 = 16 mg methylprednisolone |
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Theophylline
MOA Indication Therapeutic serum level When is it toxic Symptoms of tox? |
MOA - bronchodilation, diuresis, cns and cardiac stimulation, and gastric acid secretion by blocking phosphodiesterase
Indication - 2 or 3 line asthma Therapeutic serum level: 5-20 mcg/ml Toxic at > 30mg 60% tox > 20 mg/L Toxicity Symptoms N/V, hyperactivity, seizures Ventricular arrhythmias could be first sign of tox then death (not all toxicities start out with the least severe symptoms) |
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Theophylline
Usual dose increased clearence decreased clearance |
10mg/kg/day
clearance increased by smoking clearance decreased by cimetidine, cipro, erythromycin, BBlockers LE inhibitors can cause LIFE THREATING TOXICITIES |
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Drug class that often exacerbates asthma?
What is the DOC for HTN especially w asthma pts or COPD pts on theophylline? |
BBlockers
ACE-I |
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Cromolyn
MOA Indication Dose ADR |
MOA - inhibits degranulation of mast cells
**mast cell stabilizer Indication: prophylaxis of chronic mild to moderate asthma Dose 2 inh. QID at regular intervals ADRs Remarkably non-toxic; however, may make acute attack worse |
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Zafirlukast
MOA Indication Dose LE inhibition/induction? Montelukast dose dosage-forms |
Accolate
MOA for both: inhibit leukotriene receptors CysLT1 Indication for both prophylaxis - chronic asthma Dose zafirlukast: 5-11 yrs 10mg bid 12 y/o greater - 20mg bid **1 hr before or 2 hr after meals Zafirlukast is a 2C9 inhibitor montelukast dose 6 mos - 23 mos: 4mg oral granules 2-5 yrs: 4mg chewable tab or gan 6-14: 5mg chew 15 & up: 10 mg chew give at hs can mix granules; once exposed to room air must be taken w/in 15 mins ONLY mix w applesause, carrots, rice, dairy |
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Zileuton
MOA indication dose warning metabolism |
Zyflo CR
MOA inhibitor of 5-lipoxygenae and thus inhibits leukotriene formation Indication proph acute asthma attack dose two 600 mg BID within 1 hr of morning and evening meal HEPATOTOXIC do LFTs q 3 months 2C9 inhibitor - more potent than zafirlukast |
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Status asthmaticus; what is it?
Adjunct therapy Effects how fast duration |
status asthmaticus is a medical emerency in which asthma symptoms are refractory to initial bronchodilator therapy in the ED
Adjunct therapy MgSO4; 25mg/kg, max 2 gm, IV Effects Bronchodilation, inhibits release of both histamine and acetylcholine Works within minutes duration ~2 hrs |
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Omalizumab
MOA Indication Dose ADR |
MOA
binds to circulating IgE antibodies in the blood, decreasing the amount of IgE antibodies available to bind mast cells Indication for 12 yo and older with moderate to severe persistent asthma who have a POSITIVE skin test or in vitro reactivity to a PERENNIAL AEROALLERGEN and whose symptoms are inadequately controlled w inhaled corticosteroids Dose 150-375 mg q 2-4 wks **max 150mg/inj. site ADR - malignancies and anaphylaxis 45% of time have injection site rxn; monitor patient after inj. |
