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31 Cards in this Set
- Front
- Back
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Classic s/s of asthma
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Wheezing
Breathlessness Chest tightness Coughing |
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Asthma Triggers
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Allergens
Drugs (ASA, NSAIDs, sulfites, nonselective BBs) Environmental Exercise Occupational Respiratory Infxns |
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Controllers
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Used on chronic, daily basis to keep asthma under control
Reduces inflammation Inhaled steroids, long acting beta-2 agonists, leukotriene modifying agents, theophylline, omalizumab |
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Relievers
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Used PRN to quickly reverse bronchoconstriction
Used preventively for exercise-induced bronchospasm Short acting beta-2 agonists, systemic steroids, anticholinergics |
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Beta-2 agonist MOA
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Bind to beta-2 receptors
Cause relaxation of bronchial smooth muscle --- causes bronchodilation Inhaled route is preferred |
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Albuterol
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Ventolin HFA, Proventil HFA, ProAir HFA
Short-acting beta-2 agonist 1-2 puffs q4-6 hrs prn 2.5 mg q4-8 hrs prn (neb) 2-4 mg q4-6 hrs PO prn |
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Levalbuterol
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Xopenex, Xopenex HFA
Short acting beta-2 agonist 1-2 puffs q4-6 hrs prn 0.63 mg or 1.25 mg q6-8 hrs prn (neb) |
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Short acting Beta-2 agonist Info
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SE - tremor, shakiness, lightheadedness, cough, palpitations, hypokalemia, tachycardia, hyperglycemia
Pregnancy Category C RESCUE INHALERS!!! If using > 2 days/wk, then increase maintenance therapy |
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Salmeterol
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Serevent Diskus
Long-acting beta-2 agonist 1 puff BID (Diskus) 2 puffs BID (HFA) |
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Advair Diskus, Advair HFA
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Salmeterol + fluticasone
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Symbicort
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Formoterol + budesonide
2 inhalations BID |
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Long-acting beta-2 agonist Info
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BLACK BOX --- increased risk of asthma-related deaths
**USE ONLY AS ADJUNCTIVE THERAPY, not monotherapy** Step down from LABA therapy as soon as asthma control is achieved and maintained Pregnancy Category C |
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Beclomethasone HFA
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QVAR
Inhaled corticosteroid 80-240 mcg/d (low dose); can go to > 480 mcg/d in high doses |
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Fluticasone
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Flovent HFA, Diskus
Inhaled corticosteroid 88-264 mcg/d, can go > 440 mcg/d (MDI) 100-300 mcg/d, can go > 500 mcg/d (Diskus) |
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Corticosteroid MOA
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Inhibits inflammatory response
Depresses migration of polymorphonuclear (PMN) leukocyctes and fibroblasts Reverses capillary permeability and lysosomal stabilization to prevent/control inflammation |
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Corticosteroid Info
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Contra - primary tx of status asthmaticus, acute tx
SE (inhaled) - dysphonia, thrush, cough, URTIs 1st line for maintenance control **Swish and spit after each use** |
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Oral steroids
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Used for severely uncontrolled asthma
Contra - live vaccines, systemic fungal infxns, varicella Must taper slowly if used > 14 days Short-term SE - increased appetite/weight gain, edema, emotional instability, increased BP, increased blood glucose Long-term SE - Cushing syndrome, hypokalemia, immunosuppression, amenorrhea, acne, insomnia, nervousness |
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Cortisone
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Oral corticosteroid (Short-acting)
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Hydrocortisone
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Solu-Cortef (inj.), Cortef (oral)
Oral corticosteroid (short-acting) |
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Corticosteroid dose equivalents
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Cortisone - 25 mg
Hydrocortisone - 20 mg Methylprednisolone/Triamcinolone - 4 mg Prednisone/Prednisolone - 5 mg Betamethasone - 0.6 mg Dexamethasone - 0.75 mg |
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Methylprednisolone
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Medrol, Solu-Medrol (Inj)
Oral corticosteroid (intermediate) |
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Prednisolone
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Millipred, Orapred, Prelone
Oral corticosteroid (intermediate) |
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Triamcinolone
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Kenalog (inj.)
Corticosteroid |
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Montelukast
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Singulair
Leukotriene receptor antagonist 10 mg QHS --- 1-5 y/o - 4 mg QHS --- 5-14 y/o - 5 mg QHS CYP 3A4, 2C9 substrate; 2C8/9 inhibitor |
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Leukotriene Receptor Antagonist (LTRAs) Info
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Inhibit leukotriene receptors D4 and E4 (montelukast only)
Contra - Hepatic impairment (zafirlukast), active liver disease (zileuton) SE - HA, dizziness, increased LFTs Warning - neuropsychiatric events, hepatotoxicity, systemic eosinophilia |
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Theophylline MOA
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Blocks phosphodiesterase causing increased cAMP --- promotes release of EPI
Results in bronchodilation, diresis, CNS and cardiac stimulation , gastric acid secretion NOT MOST EFFECTIVE*** Limited use |
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Theophylline
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200-600 mg daily
Range 5-15 mcg/mL --- measure peak after 3 days of PO dosing SE - N/D/HA, tachycardia, nervousness, tremor LD - 5 mg/kg IV aminophylline * 0.8 = PO theophylline |
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Theophylline Interactions
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Is a CYP 1A2, 3A4, 2C9, 2D6 substrate
Is inhibitor of 1A2 |
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Omalizumab
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Xolair
IgG monoclonal antibody - inhibits IgE binding on mast cells and basophils Moderate to severe persistent, allergic asthma **SHOULD ALWAYS BE GIVEN IN DR OFFICE** BLACK BOX - anaphylaxis, including delayed-onset |
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Exercise-Induced Bronchospasm (EIB)
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Pretreat --- SABAs, LABAs, or montelukast
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Pregnancy
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Albuterol - preferred SABA
Budesonide - preferred inhaled corticosteroid |
