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52 Cards in this Set
- Front
- Back
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which classifications of asthma require daily med therapy |
mild perisistant, moderate persistant, and severe persistant |
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which are the most effective long term control meds for asthma |
those that attenuate the underlying inflammation characteristic of asthma |
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Inhaled corticosteroids |
LONG TERM "CONTROL" 1. beclomethasone dipropionate 2. budesonide 3. flunisolide 4. fluticasone propionate 5. mometasone furoate 6. triamcinolone acetonide 7. ciclesonide |
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Inhaled corticosteroid indications/ place in therapy |
-long term prevention of symptoms
-supression, control, and reversal of inflammation
- reduce need for oral corticosteroids
-most potent and effective anti-inflammatory meds available |
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inhaled corticosteroid MOA |
1. anti inflammatory - block LATE reaction to allergen and reduce airway hyperresponsiveness -inhibit cytokine production, adhesion, protein activation and inflammatory cell migration
2. reverse beta2 receptor downregulation - inhibit microvascular leakage
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Inhaled corticosteroids adverse effects |
1. local - candidiasis, cough, dysphoria
2. low-medium doses - suppression of growth velocity in children
3. high doses - systemic effects |
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what should adults consider while taking inhaled corticosteroids |
supplements of calcium and vitamin d |
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systemic corticosteroids |
LONG TERM "CONTROL" 1. methylprednisolone 2. prednisolone 3. prednisone |
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systemic corticosteroids indications/ place in therapy |
1. short term (3-10 days) burst to gain prompt control of uncontrolled asthma
2. long term prevention of symptoms in severe presistent asthma only
3. supression, control, and reversal of inflammation |
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Systemic corticosteroids MOA |
same as ICS |
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Systemic corticosteroids side effects |
1. short term use -hyperglycemia -increased appetite -fluid retention -weight gain -mood alterations -HTN -peptic ulcer
2. long term -adrenal axis supression -growth supression -HTN -diabetes -cushings syndrome -muscleweakness -impaired immune function |
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what is considered long term use for systemic corticosteroids |
2mg/kg or more of prednisone euivalent or 20mg/dl of prednisone for greater than 1 month |
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what to do to decrease toxicity of systemic corticosteroids |
alternate day morning or 3pm dosing |
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what should not be administered to patients on systemic corticosteroids |
varicella vaccine (unless dose is d/c for 1 month) |
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mast cell stabilizers |
LONG TERM "CONTROL" 1. cromolyn sodium 2. nedocromil |
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mast cell stabliizers indication |
1. long term prevention of symptoms in mild presistent asthma (alternative, not preferred)
2. preventative rx prior to exposure to exercise or known allergen |
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mast cell stabilizers MOA |
1. anti inflammatory -blocks eraly and late reaction to allergen -interferes with chloride channel function -stabilizes mast cell membrane -inhibits release of mediators from eosinophils
2. inhibits acute response to exercise, cold dry air, and SO2 |
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Mast cell stabilzers side effects |
1. cough 2. irritiation 3. unpleasant taste (nedocromil) |
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why are mast cell stabilizers not preferred |
4-6 weeks for max benefit |
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immuno-modulators |
LONG TERM "CONTROL" 1. omalizumab |
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immuno-modulators indications |
1. long term control and prevention of symptoms in adults (over 12) who have moderate or severe persistent allergic asthma who are inadequately controlled with ICS (used as ADJUNCT)
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immuno-modulators MOA |
-recombinant DNA-derived humanized monoclonal antibody that binds to circulating IgE preventing it from binding to the high affinity receptors on basophils and mast cells
2. decreases mast cell mediator release from allerge exposure
3. decreases number of receptors on basophils and submucosal cells |
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immuno-modulators side effects |
1. pain at injection site 2. anaphylaixx 3. malignant neoplasms
(must be refridgerated and administered in physicians office) |
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leukotriene receptor antagonists |
LONG TERM "CONTROL" 1. montelukast (greater than 1 year old) -ceiling effect 2. zafirlukast (greater than 5 years old) - take 1 hr before or 2 hours after meals - int with warfarin - monitor ALT
*selective for competitive inhibitor of CysLT1 receptor |
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leukotriene receptor antagonists indications |
1. long term contorl and prevention in mild persistent asthma (not preferred) |
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5 lipoxygenase inhibitor |
LONG TERM "CONTROL" 1. zileuton - watch out for elevated liver enzymes (monitor LFT) - int with warfarin |
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5 lipoxygenase inhibitor indication |
1. long term control and prevention of mild persistent asthma in older than 12 yo
2. may be used in combo with ICS in moderate persistent asthma
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5 lipoxygenase inhibitor MOA |
inhibits production of leukotrienes from AA (LTB4 and cysteinyl) |
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long acting beta2 agonist |
LONG ACTING "CONTROL" 1. formoterol 2. salmeterol 3. albuterold sustained release |
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LABA indications |
1. long term prevention of symptoms 2. added to ICS 3. prevention of EIB |
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LABA MOA |
1. bronchodilation - increases cAMP
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LABA side effects |
1. tachycardia 2. skeletal muscle tremor 3. hypokalemia 4. QT prolongation 5. uncommon life threatening exacerbations |
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methylxanthines |
LONG TERM "CONTROL" 1. theophylline |
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methylxanthines indications |
1. long term control and prevention in mild persistent can be used with ICS
NOT PREFERRED |
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methylxanthines MOA |
1. bronchodilation - phosphodiesterase inhibition - adenosine antagonism
2. decreases t lymphocyte nmbers
3. increases diaphragm contractility and mucociliary clearence |
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reoutine serum conc monitoring in methylxanthines |
because its toxic and has narrow therapeutic range
-adults 5-15 -children 5-10 -if lower consider 10% dose reduction
signs of toxicity: severe headache, tachycardia, N/V |
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short acting beta 2 agonists |
QUICK RELEIF 1. albuterol 2. levalbuterol 3. pirbuterol |
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SABA indications |
1. relief of acute symptoms
2. preventative tx for EIB prior to exercise
3. DOC for acute bronchospasm |
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SABA MOA |
bronchodilation - increase in cAMP
-activity resides in R entantiomer
(levalbuterol contains only R entantiomer) |
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SABA side effects |
1. tachycardia 2. muscle tremor 3. hypokalemia 4. increased lactic acid 5. hyperglycemia |
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anticholinergics |
QUICK RELIEF 1. ipratropium bromide |
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anticholinergic MOA |
1. bronchodilation -competitive inhibition of muscarinic cholinergic receptors
2. reduces intrinsic vagal tone of airways
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anticholinergic side effects |
1. dry mouth 2. increased wheezing
*only reverses cholinergically mediated bronchospasm (b-blocker induced) |
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gold standard in diagnosing asthma |
pulmonary function testing (spirometry) -reveals obstruction |
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obstructive defect |
asthma, COPD, cystic fibrosis - decrease if FEV1, normal FVC, cecrease in FEV1/FVC and FEV1/FEV6 |
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restrictive defect |
pulmonary fibrosis, sarcoidosis, obesity, NM disease -decrease in FEV1 and FVC, normal or increased FEV1/FVC and FEV1/FEV6 |
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Reversibility |
indicated by and increase in FEV1 of greater than 200ml and greater than 12% from baseline after inhalation of a SABA |
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possible differential diagnoses in children |
1. upper airway diseases 2. obstructions involving large or small airways 3. aspiration 4. GERD |
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possible differential diagnoses in adultls |
1. COPD 2. CHF 3. Pulmonary Embolism 4. Obstruction 5. Cough secondary to drugs (ace i) |
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when is severity most easily measured |
in a patient who is not receiving long term control meds |
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reduced impairment |
1. prevent chronic symptoms 2. less than 2 d/w of quick releif 3. near normal pulmonary function 4. normal activity levels 5. meets satisfication
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reduced risk |
1. prevent recurrent exacerbations and minimize need for ED or hospital
2. prevent progressive loss of lung function
3. provide optimal pharm. with minimal side effects |
