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PHM 702: Pulm and ToXXX > Ass-thma (Chronic) > Flashcards

Ass-thma (Chronic) Flashcards

(44 cards)

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1
Q

SABA agents for asthma

A
  • albuterol
  • levalbuterol - more potent
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2
Q

ICS agents for asthma

A
  • Ciclesonide
  • Fluticasone - higher risk of sore throat/hoarseness
  • Beclomethasone - smaller particles → better lung penetration
  • Mometasone
  • Budesonide
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3
Q

LABA agents for asthma

A
  • Salmeterol
  • Formoterol
  • Vilanterol
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4
Q

LAMA agents for asthma

A
  • Tiotropium
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5
Q

Leukotriene modifiers for asthma

A

Leukotriene D4 antags
- Montelukast
- Zafirlukast - DDI warfarn, theophylline

5-lipooxygenase inhibitor
- Zileuton - DDI theophylline

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6
Q

Biologics for asthma

A
  • Omalizumab
  • Mepolizumab
  • Reslizumab
  • Benralizumab
  • Dupilumab
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7
Q

SABA application in asthma therapy

A
  • short acting beta agonists
  • Rescue therapy
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8
Q

Inhaled corticosteroid application in asthma therapy

A

First line maintenance - dosed BID (except for Arnuity QD and mometasone QD OR BID)

AVOID in aute bronchospasm and status asthmaticus

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9
Q

LABA application in asthma therapy

A
  • long acting beta agoists

Maintenance therapy - must be used in COMBO with ICS ← has a BBW of asthma-related death if used as monotherapy

ICS/formoterol (speficially, budesonide/formoterol), can be used as a rescue

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10
Q

LAMA application in asthma therapy

A

Maitenance therapy

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11
Q

Leukotriene modifier application in asthma therapy

A

Maintenance for persistent asthma

If using montelukast for exercise, take 2hrs prior

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12
Q

Theophylline application in asthma therapy

A

Not frequetly used d/t high risk of AE, DDI (CYP3A4), and narrow window (5-15mcg/mL)
- also less effective than ICS

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13
Q

Biologics application in asthma therapy

A
  • In pts with severe allergic or eosinphilic asthma
  • Admined in healthcare setting
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14
Q

SABA MOA

A

stimulate beta 2 receptor in lungs → relaxation of bronchial smooth muscle → bronchodilation (does NOT address inflammation)

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15
Q

Inhaled corticosteroid MOA (asthma)

A
  • Reduce chronic airway inflammation; decrease airway hypersensitivity
  • Reduce risk of exacerbations → reduced hospital admissions and death
  • Improve lung function → peak expiratory flow rate increases
  • Reduce symptoms
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16
Q

LABA MOA

A

stimulate beta 2 receptor in lungs → relaxation of bronchial smooth muscle → bronchodilation (does NOT address inflammation)

  • same as SABA
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17
Q

LAMA MOA

A

Inhibit the action of ACh at the M3 muscarinic receptor in bronchial smooth muscle → bronchodilation

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18
Q

Leukotriene modifiers MOA (asthma)

Study These Flashcards
A

Block pro-inlammatory leukotrienes at receptor sites → reduce airway constriction and mucus secretion

19
Q

Theophylline MOA

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A

Block phosphodiesterase, increase cAMP → release of epinephrine from adrenal medulla cells → brochodilation, CNS and cardiac stimualtion, diuresis, gastric acid secretion

Caffeine is an active metabolite

20
Q

Biologics for asthma MOA

Study These Flashcards
A

Targets
- IgE: allergic response
- IL-4: inflammation
- IL-5: eosinophils

21
Q

SABA AE

Study These Flashcards
A
  • Tremor, shakiness
  • Lightheadedness
  • Cough
  • Palptations
  • Hypokalemia
  • Tachycardia
  • Hyperglycemia
22
Q

Inhaled corticosteroids for asthma AE

Study These Flashcards
A

USE LOWEST DOSE POSSIBLE
- step down when asthma is well controlled, decrease dose 25-50% after 3 months of stability

Oropharyngeal candidiasis
Dysphonia

Growth concerns in children (not clinically significant)

Hyperglycemia
Increased risk of fractures

23
Q

Leukotriene modifiers for asthma AE

Study These Flashcards
A
  • HA
  • URI
  • GI
  • Psych - montelukast only
    • aggressive behavior
    • AMS
24
Q

Theophylline AE

Study These Flashcards
A

Nausea
Loose stools
HA
Tachycardia
Insomnia
Tremor, Nervousness

AVOID in: CV hx, hyperthyroid, PUD, seizures

25
Clinical pearls regarding inhaler types
- Avoid DPIs in children <4 - Shake MDIs - Do NOT shake DPI - Avoid DPI in milk protein allergies (except budesonide) - DPI may contain lactose
26
Systemic corticosteroids use in assthma
Can be used for management of exacerbation ← short course that does NOT need to be tapered off
27
Epinephrine inhlaer in asthma
OTC epinephrine inhaler is nonselective → AE for tachycardia, HTN → DO NOT USE
28
Cromolyn in asthma
Neb exists but is not preferred
29
Asthma
characterized by **intermittent or persistent** presence of highly variable degrees of **airflow obstruction** from airway wall **inflammation** and bronchial smooth muscle **constriction**
30
Asthma signs/symptoms
- dyspenea - wheezing - SOB - chest tightness - dry, hacking cough - variable expiratory airflow - signs of atopy - reduced O2 saturation s/s tend to worsen at night and early morning and vary over time in intensity
31
Asthma triggers
- viral infections - allergens - tobacco smoke/enviroment - exercise - stress/emotions **- drugs/preservatives (asa, nsaids, sulfites, non-selective beta blockers, bezalkonium chloride)** - occupational stimuli
32
Asthma risk factors
- higher exposure to residential allergens - socioeconomic disparities(shortage of PCPs in minority communities; language and literacy barriers) - underuse of asthma medications - second hand tobacco somke - allergen exposure - urbanization - RSV - family size (smaller family, higher risk) - decreased exposure to common childhood infectious agents
33
Atopy risk factors
1. eczema 2. allergic rhinitis 3. allergic asthma
34
Mild asthma
Asthma that is **controlled** by step 1 or 2
35
Moderate asthma
Asthma that is **controlled** by step 3 or 4
36
Severe asthma
Asthma that is **controlled** by step 5
37
Asthma symptom assessment (the checklist)
In the past 4 weeks, has the patient had: - daytime asthma s/s more than 2x a week - any night waking d/t asthma - **SABA** use for s/s more than 2x a week (*EXCLUDE if using before exercise*) - activity limitation d/t asthma
38
Asthma comorbidities
- obesity - chronic rhinusinusitis - GERD - confirmed food allergy - anx - depression - preggers
39
Risk factors for developing fixed airflow limitation
- low birth weight - lack of ICS treatment - exposure to tobacco smoke, etc. - low FEV1 - chronic mucus hypersecretion - sputum or blood eosinophilia
40
Long term goals of astha management care
- symptom control - risk reduction for future exacerbations
41
Why ICS instead of SABA alone?
- pts with mild asthma can have severe exacerbations - ICS is preventative - SABA only increases risk for exacerbations - Low dose ICS reduces asthma related hospitalzations and death - Patients who experience severe exacerbations have better long-term lung function if on an ICS
42
What is the first thing we do when a patient comes in with partly controlled or uncontrolled asthma
CHECK INHALER TECHNIQUE and adherence
43
Stepping down asthma therapy
- Appropriate time for step down: >3 months of good asthma control - Reduce CIS dose by 25-50% at 2-3 month intervals (can go all the way down to PRN ICS/formoterol) - Do NOT completely stop ICS unless needed to temporarily confirm dxx
44
Non-pharm interventions for asthma
- smoking cessation - physical activity - remove sensitizers - avoid medications that may worsen asthma (NSAIDs or beta blockers) - Remediation of dampness or mold in homes - sulingual immunotherapy

PHM 702: Pulm and ToXXX (14 decks)

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