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17 Cards in this Set

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Stepwise management of asthma?
(7)
1) Classify by most severe sx
2) Quick control
3) Minimize b2 agonists
4) Teach self mgmt
5) Refer for step 4
6) Review q 1-6 mo, step down if possible
7) consider pt education, technique, adherance before step up
Dx criteria for mild intermittent asthma
Day sx: < x2/wk
Night: < x2/month

PEF or FEV > 80%
PEF variability < 20%
Tx for mild intermittent asthma
No daily med needed

Consider step up if short acting B2 > twice weekly

May need oral steroid burst for exacerbations
Dx criteria for mild persistent asthma
Day: > 2/wk but < 1/day
Night: > 2 nights/month

PEF or FEV1 > 80%
PEF variability 20-30%
Tx for mild persistent asthma
Preferred: Low dose inhaled corticosteroids

Alternative: cromolyn, leukotriene modifier, necrodomil or sus release theophylline to serum of 5-15 mcg/mL
Dx criteria for moderate persistent asthma
Sxs daily
Night sx > 1 night/wk

PEF or FEV1 60-80%
PEF variability > 30%
Basic maintenance tx for moderate persistent asthma
Preferred: low-med inh steroids

Alt: Inc inh steroids into med range OR low dose inh steroids and either leukotriene modifier or theophylline
Tx for moderate persistent asthma with frequent severe exacerbations
Preferred: inc inhaled steroids into medium range and add long acting B2

Alternate: Inc steroids (med range) and add either leukotriene modifier or theophylline
Dx criteria for severe persistent asthma
Continual day sx
Frequent night sx

PEF or FEV1 < 60%
PEF variability > 30%
Tx for severe persistent asthma
Preferred: High dose inhaled steroid and long-acting B2

Alternate: Systemic corticosteroid 2mg/kg/day (step down asap)
Categories of asthma drugs (7)
Short and long acting beta agonists,
corticosteroids (inhaled or oral),
leukotriene receptor antagonists,
methylxanthines,
mast cell stabilizers, anticholinergics,
anti-IgE monoclonal antibody
MOA and distribution of beta2 agonists
cause relaxation of bronchial smooth muscle and bronchodilation.

Poorly absorbed orally, so typically administered by inhalation
MOA and distribution of corticosteroids
Decrease inflammation, interfere with allergic cascade.
PO have systemic effects used for short burst of treatment
Inhaled corticosteroids are used for maintenance, have fewer systemic effects than oral dosing.
MOA of leukotriene receptor antagonists
interrupt the allergic cascade by blocking action of leukotrienes (proinflammatory chemicals). Administered orally
MOA of mast cell stabilizers
Inhibits cell activation through effect on chloride channels – inhibits mast cell degranulation, inhibits the inflammatory response of eosinophils, and nedocromil inhibits coughing through action on airway nerves
MOA of Anti-IgE monoclonal antibody
prevent IgE from binding to mast cells, but doesn’t activate the IgE that is already bound.

Administered subcutaneously
Examples of mast cell stabilizers
Cromolyn and nedocromil