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128 Cards in this Set
- Front
- Back
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NP may refer or consult for which pts with asthma?
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newly diagnosed pts, those with underlying cardiac disease, pt over 60, pt with COPD, those in respiratory distress, PEFR < 100, those with extreme dyspnea, or pts with side effects from bronchodilator therapy (tremor, tachycardia).
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Management is primarily carried out by pt, with visits for follow up q ?
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6 months, once stable. Pt should bring MDIs, PF meter, and readings for evaluation.
|
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Pt should be carefully educated re:?
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proper use of bronchodilator and corticosteroid therapies. Return demonstration should be performed regularly to evaluate use of MDIs or other drug delivery devices and use of PEF meter.
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|
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Treatment of step one disease is via prn?
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short term beta agonist bronchodilators.
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Examples of SABA's are:?
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Albuterol (Ventolin, Proventil)
1-2 puffs QID prn Xoponex Metaproterenol (Allupent, Metapril) 2 puffs up to 12/day [orbiterp; acetate (Maxair) 2 puffs up to 12 per day |
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Which SABA would be best for pts with issues with hand coordination (arthritis to use)?
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Macair (pirbuterol acetate)
its breath acctuated must adhere to dosing schedule |
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SABAs are considered?
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“rescue” meds. Pt needs to understand that if recommended dosage is being exceeded, pt needs to be re-evaluated.
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Two puffs of SABA should be administered how long prior to exercise ?
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30 minutes
|
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SABA should maintain adequate airway function for how long?
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4 hours, eliminating irritable airway response to exercise.
|
|
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For step two treatment, add?
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an anti-inflammatory agent. ICS
|
|
|
Inhaled corticosteroids examples are?
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Fluticasone propionate (Flovent) 44, 110, or 220 mcg/inhalation doses. Start pt on bronchodilator for first time on 44 mcg/puff, 2 puffs BID to max 440mcg BID.
Beclomethasone dipropionate (Vanceril, Beclovent), 2 puffs, TID or QID, or 4 puffs BID Triamcinolone acetate (Azmacort) same as beclomethasone. |
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Teaching re ICS will focus on?
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pt must rinse mouth with H2O after use, rinse canisters and spacer as well, use bronchodialator first, then steroid inhaler, 1 min in b/t each puff
not IMMEDIATE takes 1-2 weeks to work |
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**pt must rinse mouth with water after use
|
rinse canisters and
or spacer devices as well |
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Step three Asthma meds are?
Ex? |
LABAs
Salmeterol (Servent) 2 puffs bid |
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Long acting beta agonist may be added to control?
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nocturnal symptoms,
|
|
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e.g of step 3 med is?
|
LABA
|
|
|
Step 4 med is ?
|
po steroid
|
|
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Step four caution?
|
adrenal suppression and death can occur with withdrawal from long term PO steroid use. Pt also needs evaluation
monitoring for osteoporosis: consider calcium supplementation prn. |
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Leukotriene inhibitors are commonly used, what are ex for pts over 12?
|
zafirlukast (Accolate) and zileutron (Zyflo)
|
|
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How long does it take for Leuk Inhib to take effect?
|
induce bronchodilation within 2 hours of use.
|
|
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Zafirlukast is a ?
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leukotriene receoptor antagonist
|
|
|
leukotriene is a?
|
substance released by mast cells in response to various asthma triggers, which is in part responsible for the increased mucus production, bronchoconstriction and eosinophil infiltration that results.
|
|
|
Zileutron? Caution with Zileutron?
|
inhibits the synthesis of all leukotrienes through enzyme inhibition. LFTs must be monitored for baseline and periodically with Zyflo.
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|
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Montelukast (Singulair) may be used in children as young as ?
|
2 years of age.
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|
|
Theophylline is not recommended for asthma treatment since?
|
the availability of short and long term beta agonists and corticosteroids have been widely used for the past decade.
|
|
|
Theophylline requires?
|
serum monitoring to maintain therapeutic levels, interferes with many drugs and can induce dysrhythmias and urinary retention.
|
|
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Theophylline side effects include?
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increase in the secretion of gastric acid, aggravating GERD
|
|
|
Side effects of PO corticosteroids also can include?
|
hyperglycemia development, cataract formation, easy bruising, unwanted hair growth, thinning skin, GI bleed, mood disturbance, and osteoporosis.
|
|
|
Short term courses of theophylline are associated with ?
|
insomnia, depression, anxiety, insulin resistance in diabetics, worsening glaucoma, hypokalemia and sodium retention in hypertensives, which may induce CHF from fluid retention.
|
|
|
Beta agonists may ?
|
worsen the simple tremor of aging or Parkinson’s. Overdose of beta agonists can induce tachycardia, tremor, and hypokalemia.
|
|
|
Inhaled corticosteroids require?
|
mouth rinsing to prevent oropharyngeal candidiasis and dysphonia.
|
|
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Drug interactions of ICS with?
|
diuretics, non potassium sparing, have additive hypokalemic effects with prednisone.
|
|
|
Beta adrenergic blockers also worsen?
|
asthma and block the therapeutic action of beta adrenergic bronchodilators.
|
|
|
Even beta adrenergic blocking eye drops may be absorbed from conjunctiva &?
|
to aggravate asthma (e.g. Timoptic). Pilocarpine has same effect. If no alternative treatment is available, check peak flow before and after treatment.
|
|
|
ACE inhibitors may induce ?
|
cough, aggravating asthma.
|
|
|
Re-evaluate pts whose asthma doesn’t improve with therapy. Consider:?
|
1) allergies
|
|
|
NP may refer or consult for which pts with asthma?
|
newly diagnosed pts, those with underlying cardiac disease, pt over 60, pt with COPD, those in respiratory distress, PEFR < 100, those with extreme dyspnea, or pts with side effects from bronchodilator therapy (tremor, tachycardia).
|
|
|
Management is primarily carried out by pt, with visits for follow up q ?
|
6 months, once stable. Pt should bring MDIs, PF meter, and readings for evaluation.
|
|
|
Pt should be carefully educated re:?
|
proper use of bronchodilator and corticosteroid therapies. Return demonstration should be performed regularly to evaluate use of MDIs or other drug delivery devices and use of PEF meter.
|
|
|
Treatment of step one disease is via prn?
|
short term beta agonist bronchodilators.
|
|
|
Examples of SABA's are:?
|
albuterol (Ventolin, Proventil) 1-2 puffs QID prn
|
|
|
SABAs are considered?
|
“rescue” meds. Pt needs to understand that if recommended dosage is being exceeded, pt needs to be re-evaluated.
|
|
|
Two puffs of SABA should be administered how long prior to exercise ?
|
30 minutes
|
|
|
SABA should maintain adequate airway function for how long?
|
4 hours, eliminating irritable airway response to exercise.
|
|
|
For step two treatment, add?
|
an anti-inflammatory agent. ICS
|
|
|
What do Leukotriene inhibitors do?
|
improve lung function, improve symptoms
decrease need for rescue meds more helpful IN PTS WHO ARE SENSITIVE TO ASA |
|
|
How long does it take for Leukotriene inhibitors to work?
|
w/i 2 hrs of use
|
|
|
pt must rinse mouth with water after use
|
rinse canisters and
or spacer devices as well |
|
|
Step three Asthma meds are?
|
LABA
|
|
|
When is Asthma at its worst?
|
nocturnal symptoms bronchospasm
|
|
|
e.g of step 3 med is?
|
LABA
Servent (Salmeterol) 2 puffs bid |
|
|
Step 4 med is ?
|
po steroid
|
|
|
Step four caution?
|
adrenal suppression and death can occur with withdrawal from long term PO steroid use. Pt also needs evaluation
monitoring for osteoporosis, consider calcium supplementation prn. |
|
|
Leukotriene inhibitors are commonly used, what are ex for pts over 12?
|
zafirlukast (Accolate) and zileutron (Zyflo)
What do Leukotriene inhibitors do? |
|
|
How long does it take for Leuk Inhib to take effect?
|
induce bronchodilation within 2 hours of use.
|
|
|
Zafirlukast is a ?
|
leukotriene receoptor antagonist
|
|
|
leukotriene is a?
|
substance released by mast cells in response to various asthma triggers, which is in part responsible for the increased mucus production, bronchoconstriction and eosinophil infiltration that results.
|
|
|
Zileutron? Caution with Zileutron?
|
inhibits the synthesis of all leukotrienes through enzyme inhibition. LFTs must be monitored for baseline and periodically with Zyflo.
|
|
|
Montelukast (Singulair) may be used in children as young as ?
|
2 years of age.
|
|
|
Theophylline is not recommended for asthma treatment since?
|
the availability of short and long term beta agonists and corticosteroids have been widely used for the past decade.
|
|
|
Theophylline requires?
|
serum monitoring to maintain therapeutic levels, interferes with many drugs and can induce dysrhythmias and urinary retention.
|
|
|
s/s of asthma are?
|
prob with expiration, decreased PEF rate, hyperresonance, hyperinflation (CXR)
|
|
|
Theophylline side effects include?
|
increase in the secretion of gastric acid, aggravating GERD,increasing insomnia or lowering seizure threshold. Blood levels are increased by heart failure, liver disease, erythromycin, cimetidine, and ketoconazole.
|
|
|
Side effects of PO corticosteroids also can include?
|
hyperglycemia development, cataract formation, easy bruising, unwanted hair growth, thinning skin, GI bleed, mood disturbance, and osteoporosis.
|
|
|
Short term courses of theophylline are associated with ?
|
insomnia, depression, anxiety, insulin resistance in diabetics, worsening glaucoma, hypokalemia and sodium retention in hypertensives, which may induce CHF from fluid retention.
|
|
|
Beta agonists may ?
|
worsen the simple tremor of aging or Parkinson’s. Overdose of beta agonists can induce tachycardia, tremor, and hypokalemia.
|
|
|
Luedotriene Receptor Antatgonists end in ?
|
-lukast
|
|
|
Drug interactions of ICS with?
|
diuretics, non potassium sparing, have additive hypokalemic effects with prednisone.
|
|
|
Beta adrenergic blockers also worsen?
|
asthma and block the therapeutic action of beta adrenergic bronchodilators.
|
|
|
Even beta adrenergic blocking eye drops may be absorbed from conjunctiva &?
|
to aggravate asthma (e.g. Timoptic). Pilocarpine has same effect. If no alternative treatment is available, check peak flow before and after treatment.
|
|
|
ACE inhibitors may induce ?
|
cough, aggravating asthma.
|
|
|
Re-evaluate pts whose asthma doesn’t improve with therapy. Consider:?
|
1) allergies
|
|
|
Treatment of step one disease is via prn?
|
short term beta agonist bronchodilators.
|
|
|
Examples of SABA's are:?
|
Albuterol or Ventolin, Proventil 1-2 puffs QID prn, metaproterenol (Allupent, Metapril), 2 puffs up to 12 per day,pirbuterol acetate (Maxair), 2 puffs up to 12 per day.
|
|
|
SABAs are considered?
|
“rescue” meds. Pt needs to understand that if recommended dosage is being exceeded, pt needs to be re-evaluated.
|
|
|
Two puffs of SABA should be administered how long prior to exercise ?
|
30 minutes
|
|
|
SABA should maintain adequate airway function for how long?
|
4 hours, eliminating irritable airway response to exercise.
|
|
|
For step two treatment, add?
|
an anti-inflammatory agent. ICS
|
|
|
Inhaled corticosteroids examples are?
|
Fluticasone propionate (Flovent) 44, 110, or 220 mcg
inhalation doses. Start pt on bronchodilator for first time on 44 mcg puff, 2 puffs BID to max 440mcg BID.Beclomethasone dipropionate (Vanceril, Beclovent), 2 puffs, TID or QID, or 4 puffs BID,Triamcinolone acetate (Azmacort) same as beclomethasone. |
|
|
Nedocromil and Cromolyn are?
|
Mast cell stabilizer, but LTM such as Montelukast (Singular) or Zafirlukast (Accolate) or Zileuton (Zyflo) are better
|
|
|
Which LTM will require LFT monitoring?
|
Zileuton (Zyflo)
|
|
|
Step three Asthma meds are?
|
LABA
|
|
|
Long acting beta agonist may be added to control?
|
nocturnal symptoms,
|
|
|
Beta bronchodialators
long and shor end in ? |
-terol
|
|
|
Xopenex is ?
|
SABA
levalbuterol supposed to give greater bronchdilation with fewer SE |
|
|
Step four caution?
|
adrenal suppression and death can occur with withdrawal from long term PO steroid use. Pt also needs evaluation
monitoring for osteoporosis, consider calcium supplementation prn. |
|
|
Leukotriene inhibitors are commonly used, what are ex for pts over 12?
|
zafirlukast (Accolate) and zileutron (Zyflo)
What do Leukotriene inhibitors do? |
|
|
How long does it take for Leuk Inhib to take effect?
|
induce bronchodilation within 2 hours of use.
|
|
|
Zafirlukast is a ?
|
leukotriene receoptor antagonist
|
|
|
leukotriene is a?
|
substance released by mast cells in response to various asthma triggers, which is in part responsible for the increased mucus production, bronchoconstriction and eosinophil infiltration that results.
|
|
|
Zileutron? Caution with Zileutron?
|
inhibits the synthesis of all leukotrienes through enzyme inhibition. LFTs must be monitored for baseline and periodically with Zyflo.
|
|
|
Montelukast (Singulair) may be used in children as young as ?
|
2 years of age.
|
|
|
Clinical effects of LTM take how long to see the effects?
|
1- 2 weeks
|
|
|
Theophylline requires?
|
serum monitoring to maintain therapeutic levels, interferes with many drugs and can induce dysrhythmias and urinary retention.
|
|
|
names of corticosteroids end in ?
|
-one
-ide Fluticasone (Flovent), prednisone, Brdesonide (Pulmicort) |
|
|
Theophylline side effects include?
|
increase in the secretion of gastric acid, aggravating GERD,increasing insomnia or lowering seizure threshold. Blood levels are increased by heart failure, liver disease, erythromycin, cimetidine, and ketoconazole.
|
|
|
Side effects of PO corticosteroids also can include?
|
hyperglycemia development, cataract formation, easy bruising, unwanted hair growth, thinning skin, GI bleed, mood disturbance, and osteoporosis.
|
|
|
Short term courses of theophylline are associated with ?
|
insomnia, depression, anxiety, insulin resistance in diabetics, worsening glaucoma, hypokalemia and sodium retention in hypertensives, which may induce CHF from fluid retention.
|
|
|
Beta agonists may ?
|
worsen the simple tremor of aging or Parkinson’s. Overdose of beta agonists can induce tachycardia, tremor, and hypokalemia.
|
|
|
Inhaled corticosteroids require?
|
mouth rinsing to prevent oropharyngeal candidiasis and dysphonia.
|
|
|
Drug interactions of ICS with?
|
diuretics, non potassium sparing, have additive hypokalemic effects with prednisone.
|
|
|
Beta adrenergic blockers also worsen?
|
asthma and block the therapeutic action of beta adrenergic bronchodilators.
|
|
|
Even beta adrenergic blocking eye drops may be absorbed from conjunctiva &?
|
to aggravate asthma (e.g. Timoptic). Pilocarpine has same effect. If no alternative treatment is available, check peak flow before and after treatment.
|
|
|
ACE inhibitors may induce ?
|
cough, aggravating asthma.
|
|
|
Re-evaluate pts whose asthma doesn’t improve with therapy. Consider:?
|
allergies, Not taking all prescribed meds during periods of wellness, MDI technique problems
|
|
|
Management is primarily carried out by pt, with visits for follow up q ?
|
6 months, once stable. Treatment of step one disease is via prn?
|
|
|
Examples of SABA's are:?
|
albuterol (Ventolin, Proventil) 1-2 puffs QID prn
|
|
|
SABAs are considered?
|
“rescue” meds. Pt needs to understand that if recommended dosage is being exceeded, pt needs to be re-evaluated.
|
|
|
Two puffs of SABA should be administered how long prior to exercise ?
|
30 minutes
|
|
|
SABA should maintain adequate airway function for how long?
|
4 hours, eliminating irritable airway response to exercise.
|
|
|
For step two treatment, add?
|
an anti-inflammatory agent. ICS
|
|
|
Inhaled corticosteroids examples are?
|
|
|
|
Teaching re ICS will focus on?
|
|
|
|
pt must rinse mouth with water after use
|
rinse canisters and
or spacer devices as well |
|
|
Step three Asthma meds are?
|
LABA
|
|
|
Long acting beta agonist may be added to control?
|
nocturnal symptoms,
|
|
|
e.g of step 3 med is?
|
LABA, salmeterol (Serevent), 2 puffs BID
|
|
|
Step 4 med is ?
|
po steroid
|
|
|
Step four caution?
|
adrenal suppression and death can occur with withdrawal from long term PO steroid use. Pt also needs evaluation
monitoring for osteoporosis, consider calcium supplementation prn. |
|
|
Leukotriene inhibitors are commonly used, what are ex for pts over 12?
|
zafirlukast (Accolate) and zileutron (Zyflo)
What do Leukotriene inhibitors do? |
|
|
How long does it take for Leuk Inhib to take effect?
|
induce bronchodilation within 2 hours of use.
|
|
|
Zafirlukast is a ?
|
leukotriene receoptor antagonist
|
|
|
leukotriene is a?
|
substance released by mast cells in response to various asthma triggers, which is in part responsible for the increased mucus production, bronchoconstriction and eosinophil infiltration that results.
|
|
|
Zileutron? Caution with Zileutron?
|
inhibits the synthesis of all leukotrienes through enzyme inhibition. LFTs must be monitored for baseline and periodically with Zyflo.
|
|
|
Montelukast (Singulair) may be used in children as young as ?
|
2 years of age.
|
|
|
Theophylline is not recommended for asthma treatment since?
|
the availability of short and long term beta agonists and corticosteroids have been widely used for the past decade.
|
|
|
Theophylline requires?
|
serum monitoring to maintain therapeutic levels, interferes with many drugs and can induce dysrhythmias and urinary retention.
|
|
|
Beta adrenergic blocking agents with theophylline can ?
|
induce cardiac arrhythmias and myocardial damage.
|
