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34 Cards in this Set
- Front
- Back
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Asthma Compliane |
30-70% do not comply, requires comanagement with family |
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Asthma |
Chronic disorder, variable recurring airflow obstruction, hyperresponsiveness and underlying inflammation |
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Diagnosis of Asthma |
Wheezing episodes, Hx recurrent cough, Sx worse at night, Sx improve with bronchodilator, Spirometry (FEV1 </= 70) (FEV1/FVC >80%) |
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Impairment v. Risk |
Impairment: Present QOL and intensity of current sx
Risk: Future likelihood of exacerbations, progressive loss of lung function, med adverse effects |
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Inhaled Corticosteroids |
Block late-phase reaction to allergen, reduce airway hypperresponsiveness, and inhinit inflammatory cell migration/activation
ICS for long term control; oral systemic for prompt control when initiating long-term control therapy;
Add as adjunct when repeated exacerbations of COPD (3/3years)
2-4 days for onset, 4wks for full efficacy
Generally twice daily dosing
Trush, dysphonia, coughing, cataracts |
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Cromolyn sodium (Intal) & Nedocromil (Tilade) |
Stabilize mast cells, interfere with chloride channel function
Alternative treatment of mild persistent asthma, Can be used as preventative prior to exposure to exercise or unavoidable exposure to known allergens
Not widely available |
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Omalizumab (Xolair) |
Anti-IgE, prevents binding of IgE to receptors on basophils and mast cells
Given sc every 2-4 weeks
Adjunctive therapy for >/ 12 yo c allergies and severe persistent asthma.
Risk of anaphylaxis |
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Montelukast, Zileuton & Zafirlukast |
Leukotriene antagonists - alternative treatment of mild persistent asthma, can be used as adjunctive with ICS
Children >5 and adults, PO administration, take on empty stomach
Liver function monitoring essential, some nonresponders, CYP450 enzyme inhibitor
HA, somnolence, dry mouth |
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Salmeterol & Formoteral |
LABA's - BD c onset of 1 hr duration of at least 12 hrs, preferred adjunctive to ICS in Step 3
Not to be used as monotherapy
Used in combo with ICS in moderate - severe asthma (children >= 5 to adults)
Risk of severe exacerbations c daily use |
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Methylxanthines (Theophylline) |
Mild to moderate BD used as alternative adjunctive therapy with ICS
Mild anti-inflammatory effects
Third line therapy for COPD. esp nocturnal bronchospasm
Monitoring of serum theophylline is essential
Interactions!!! |
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Albuterol, Levalbuterol(Xopenex), Pirbuterol |
SABA, short acting BD that relax smooth muscle. PRN asthma, scheduled in COPD
Work in minutes duration 4-6 hr
Therapy of choice for acute sx and prevention of EIB
Overuse is warning, tacchycardia, arrhythmias, hypokalemia, N&V
Rule of twos: >2x/wk, awaken >x2/month, refill >2x/yr |
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Ipratropium (Atrovent), Oxitropium |
Blocks action of acetylcholine in bronchial smooth muscle, decreases sputum volume
First line for stable COPD
Can be used 3-4x/day for short term management of acute asthma exacerbations
Dry mouth, metallic taste, urinary retention, constipation |
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Oral Corticotherapy |
Burst for acute exacerbations, sometimes pulse therapy
No taper needed if duration < 14 days Taper off fast initially, slower at end Every other day recommended
5 bursts/ year = dependence, need to evaluate control
Bursts effective in COPD exacerbations, no benefit >2week treatment
Fluid retention(mineral) Gluco :glaucoma, muscle weakness, gi ulcers, osteoporosis, HPA suppression |
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COPD |
Airflow limitation due to airway limitation due to airspace and airway disease that is partially reversible
4th leading cause of death
Stage 1 FEV1> 80%, FEV1/FVC < 70 Stage 2 50%<FEV1<80%, FEV1/FVC <70 SOB c exertion Stage 3 30%<FEV1<80%, FEV1/FVC < 70 exacerbations, decreased exercise capacity Stage 4 30%<FEV1<80%, + CRF, cor pulmonale, pulm HTN, hypoxia |
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Chronic Bronchitis |
Presence of chronic productive cough for 2 months of each of two successive years
hypertrophy of airway smooth muscle, enlarged mucus glands, mucus plugging in small airways |
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Emphysema |
Enlargement of respiratory air spaces & destruction of aveolar septra |
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tiotropium (Spiriva) |
Long acting anticholinergic first line for long term management of moderate COPD - increases FEV1, decreases exacerbations
1 puff/day
GI/GU obstruction, renal impairment, blurred vision |
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Acetylcysteine (Mucomyst) |
In cystic fibrosis or bronchiactasis possibly |
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ABX in COPD Exacerbation |
Use in patients who have three or more of the following: Increased sputum, fever, leukocytosis, dyspnea, chest Xray changed
Commonly used: Doxycycline, Amoxicillin, Erythromycin, ZPak, Augmentin
2nd line: Flouroquinolones, 3rd Ceph |
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Oxygen Therapy |
Shown to prolong survival
>/= 15 hours to day for impact Alleviates right heart failure, enhances neuropsychological function, improves functional status
Instituted when O2Sat <88%, pulmonary HTN, peripherial edema, hematocrit > 55% |
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Chronic ABX therapy |
For patients that are plagued with persistent exacerbations
Low dose macrolide
Vaccination recommended |
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Cilomilast, Roflumilast |
Phosphodiesterase-4 Inhibitors
Decrease inflammation, promote smooth muscle relaxation leading to increased FEV1 and dyspnea
Nausea, Diarrhea, Weightloss |
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Antiproteases |
Indicated for augmentation for alpha antitrypsin decificiency |
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COPD combination medications |
QVA149 - LABA + LAMA in trials
Meclidinium bromide (LAMA) & vilanterol (LABA)
Relovair LABA & ICS once daily dosing |
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Aclidimium bromide (Tudorza Pressair) |
Long Acting Muscarinic Antagonist for COPD
Paradoxical bronchospasm, urinary retention, cough |
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Azithromycin for COPD |
Side effects outweighed benefits |
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Nicotine Replacement |
Recommended for 2-3 months
Patch+ method: patch with oral/nasal on top of for cravings
Higher when used in combo with behavioral smoking counseling program |
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Transderm Nicotine Patch |
Dose: 21 mg 4-6 wks unless less 45 kg or less than 1/2 pack/day
Monitor BP
Potentiates medications including beta blockers, insulin, antidepressants |
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Nicotine Gum |
Chew and park - otherwise ineffective and GI SE
Dose 4 mg for more than 25 cig/day, 2 mg for less
Jaw pain, HA, GI upset |
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Nicotine lozenges |
4 mg for those who smoke within 30 minutes of awakening
2 mg dose for other smokers
1-2 lozenges/hr for 5 weeks, dose reductionover next 6 wk |
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Nicotine Inhaler |
Absorbed orally
6 to 16 catridges/day for 6-12 weeks, gradually decreased over next 6-12 weeks
Not recommended for those with asthma |
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Nicotine Nasal Spray |
Produces a nicotine peak in 10 minutes through nasal mucosa
Nasal irritation, rhinitis, sneezing, tearing |
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Buproprion (Zyban) |
Start 1 week before quit date, continue up to 6 months
F/U within 1-2 weeks of starting due to risk of suicidal events
Lowers seizure threshold, agitation, dry mouth, headache |
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Varenicline (Chantix) |
Partial agonist at nicotinic receptor, superior to buproprion
Start week before quit date
F/U in 2 weeks for neuropsychiatric SE |
