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Asthma Flashcards

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1
Q

What is asthma?

A

Reversible inflammation

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2
Q

Asthma Pathophysiology

A

Mast cells, eosinophils, epithelial cells, macrophages, active T cells induce inflammation

inflammation is present between flare-ups.

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3
Q

Triggers of Asthma

A

Upper respiratory tract viral infections
Allergens, exercise, stress
Changes in the weather, laughter
Exposure to inhaled irritants (e.g., smoke, vehicle exhaust fumes, strong smells)
Gastroesophageal reflux disease (GERD)
Aspirin (in individuals sensitive to aspirin)
Exposure to sulfites

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4
Q

Diagnostic Criteria

A

Wheeze, shortness of breath, cough, and chest tightness
A hyper-responsiveness to an allergen or situation leads to these symptoms
The presence of variable airflow limitation:
Measured by spirometry
Airflow obstruction reversibility

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5
Q

Asthma Treatment Goals

A

Reduce impairment
Prevent chronic symptoms.
Reduce use of inhaled short-acting beta agonists.
Maintain normal or near-normal pulmonary function.
Maintain normal activity levels.
Meet patient/family expectations of asthma care.
Reduce risk
Prevent recurrent exacerbations and minimize emergency department (ED) visits and hospitalizations.
Prevent loss of lung function.
Provide optimal therapy with minimal adverse drug reactions (ADRs)

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6
Q

Rule of twos for asthma treatment

A

have asthma symptoms/attacks more than twice a week.
wakes up due to asthma symptoms more than twice a month
needs to take prednisone by mouth more than twice a year

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7
Q

Drug Therapy for Asthma

A

Beta 2 agonists
Short Acting Beta Agonist (SABA) for rescue
Long Acting Beta Agonist (LABA) for control
Glucocorticoids (ICS)
Leukotriene modifiers
Methylxanthines
Anticholinergics
Short Acting Methylxanthines
Anticholinergics (SAMA)
Long Acting Methylxanthines
Anticholinergics (LAMA)
Anti-IgE treatment

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8
Q

Short acting Beta2-AdrenergicAgonists drug examples

A

Albuterol (AccuNeb, Proventil HFA, ProAir HFA, Ventolin HFA) and Levalbuterol (Xopenex, Xopenex HFA)

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9
Q

Short acting Beta2-AdrenergicAgonists Side effects

A

SE: tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, hyperglycemia

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10
Q

Short acting Beta2-AdrenergicAgonists mechanism

A

Beta2-adrenergic agonists stimulate beta2-adrenergic receptors, increasing the production of cyclic 3’5’ adenosine monophosphate (cAMP).
Increased cAMP relaxes airway smooth muscle and increases bronchial ciliary activity.

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11
Q

Inhaled Corticosteriod (ics) drug examples

A

Beclomethasone HFA (Qvar)
Budesonide DPI (Pulmicort)
Fluticasone propionate HFA (Flovent HFA)
Mometasone HFA (Asmanex HFA).

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12
Q

Inhaled corticosteroids side effects

A

Adverse effects: oral candidiasis & dysphonia, sodium and water retention, edema, hyperglycemia, ^appetite and weight gain.

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13
Q

Inhaled corticosteroids mechanism

A

Corticosteroids reduce airway inflammation by inhibiting or inducing the production of end-effector proteins.

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14
Q

LONG acting Beta2-Adrenergic Agonists (laba) description

A

Beta2-adrenergic agonists stimulate beta2-adrenergic receptors, increasing the production of cyclic 3’5’ adenosine monophosphate (cAMP).
Increased cAMP relaxes airway smooth muscle and increases bronchial ciliary activity.
Patient

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15
Q

LONG acting Beta2-Adrenergic Agonists Drugs

A

Salmeterol, Formoterol,Aformoterol, Vilanterol

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16
Q

LONG acting Beta2-Adrenergic Agonists side effects

A

SE: tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, hyperglycemia

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17
Q

LONG acting Beta2-Adrenergic Agonists Black Box Warning

A

BBW: LABA’s assoc. with increased risk of asthma related deaths
**Must be used with an ICS-never solo therapy

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18
Q

Leukotriene modifiers

A
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19
Q

C0mbined ICS and LABA

A

Symbicort and Advair are maintenance inhalers that combine an inhaled corticosteroid (ICS) with a long-acting beta agonist (LABA). These inhalers are used daily to help control inflammation in the lungs and keep the airways open.

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20
Q

main differences between Symbicort and Advair

A

Symbicort: budesonide, 6 and up, formoterol
Advair: fluticasone, 4 and up, salmeterol

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21
Q

Mast Cell Stabilizers Asthma

A

Cromolyn:
Solution for nebulization (20 mg/2 Ml)-initial dose is 20 mg QID.
Once asthma symptoms controlled, dose may be tapered to lowest effective dose (e.g., 20 mg three to four times a day).
2-4 weeks to achieve maximum benefit.

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22
Q

Methylxanthines mechanism

A

Methylxanthine bronchodilators (theophylline, aminophylline) relax bronchial smooth muscle, enhance diaphragmatic contractility, and have a slight anti-inflammatory effect

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23
Q

Methylxanthines dose

A

Theophylline & aminophylline - dosed to target plasma drug concentration. Therapeutic theophylline serum drug concentration range -10–20 mg/L.

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24
Q

Methylxanthines delivery methods

A

PO tablets, elixir, solution, IV

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25
Methylxanthines side effects
Many drugs interact with Theophylline Adverse effect: tachycardia, tremor, n/v, GI, seizures if serum conc. > 35mg/L
26
Monoclonal Drugs example
Omalizumab (Xolair) is the only recombinant humanized monoclonal drug.
27
Monoclonal drug dosage
Omalizumab is indicated for treatment of persons with severe persistent allergic asthma with total serum IgE levels from 30 to 700 IU/mL. The dose is based on the total serum IgE and patient weight.
28
Monoclonal drug dosing considerations
Half life 20 days Assess response to treatment after 16 weeks
29
Monoclonal black box warning
BBW: may induce anaphylaxis
30
Injection for Moderate to Severe Persistent Asthma
XOLAIR
31
Xolair precautions
Allergic reactions can occur; therefore, first dose is always administered in the provider’s office.
32
Xolair candidates
moderate to severe persistent asthma in people 6 years of age and older nasal polyps in people 18 years of age and older chronic idiopathic urticaria (CIU, chronic hives without a known cause) in people 12 years of age
33
Xolair administration
Patients may inject themselves with prefilled syringe once they’ve been taught proper technique. 1 or more injections administered subq every 2-4 weeks
34
Bad Xolair side effects
Cancer Inflammation of your blood vessels. Fever, muscle aches, and rash. Parasitic infections Heart and circulation problems.
35
Xolair Black Box Warning by FDA
WARNING: ANAPHYLAXIS up to 1 year after administration
36
Common side effects of Xolair
12 years of age and older with asthma: joint pain in arms and legs, dizziness, feeling tired, itching, skin rash, bone fractures, and ear pain. 6 to less than 12 years of age with asthma: swelling inside nose, throat, or sinuses, headache, fever, throat infection, ear infection, abdominal pain, stomach infection, and nose bleeds. In adults with nasal polyps: headache, injection site reactions, joint pain, upper abdominal pain, and dizziness. In people with chronic idiopathic urticaria: nausea, headaches, swelling of the inside of your nose, throat or sinuses, cough, joint pain, and upper respiratory tract infection.
37
National asthma education and prevention program (NAEPP) Step 1 Asthma Treatment
SABA PRN
38
National asthma education and prevention program (NAEPP) Step 2 asthma Treatment
Low dose ICS Alternative : cromolyn, anti leukotriene, methyxanthines, or Nedocromil
39
National asthma education and prevention program (NAEPP) Step 3
Low dose ICS + LABA Or medium dose ICS Alternative Low dose ICS + antileukotriene, methyxanthine, or zileuton
40
Global Initiative for asthma (GINA) Step 1-2 controller and preferred reliever
As needed low dose ICS - formoterol Reliever: low dose ICS - formoterol
41
Global Initiative for asthma (GINA) Step 3 controller and preferred reliever
Low dose maintenance ICS - formoterol Reliever: low dose ICS - formoterol
42
Global Initiative for asthma (GINA) Step 1 controller and alternative reliever
Take ICS whenever SABA needed reliever: SABA
43
Global Initiative for asthma (GINA) Step 2 controller and alternative reliever
Low dose maintenance ICS reliever: SABA
44
Global Initiative for asthma (GINA) Step 3 controller and alternative reliever
Low dose maintenance ICS + LABA reliever: SABA
45
Why not treat with SABA alone?
Regular use of SABA, even for 1–2 weeks, is associated with increased airway hyperresponsiveness (ahr), reduced bronchodilator effect, increased allergic response, increased eosinophils (e.g. Hancox, 2000; Aldridge, 2000) Can lead to a vicious cycle encouraging overuse Over-use of SABA associated with exacerbations and mortality Starting treatment with SABA trains the patient to regard it as their primary asthma treatment The only previous option was daily ICS even when no symptoms, but adherence is extremely poor GINA changed its recommendation once evidence for a safe and effective alternative was available
46
Children 5 and younger GINA
47
Children 6-11 GINA
48
First-Line Treatment for Asthma
A short-acting rescue bronchodilator to be used as needed is required for all persons with asthma. Inhaled Corticosteroids are the mainstay for patients with asthma Chronic maintenance therapy with an asthma controller medication is indicated for persistent asthma: Low-dose ICS are indicated for persons with mild persistent asthma (Step 2). Medium-dose ICS are indicated for persons with moderate persistent asthma (Steps 3 and 4). High-dose ICS are indicated for persons with severe persistent asthma (Steps 5 and 6).
49
Managing Exacerbations
Treat with oral steroids to regain control. Use a short burst of prednisone Adults: 40 to 60 mg/day for 5 to 10 days Children: 1 to 2 mg/kg daily (maximum 60 mg/day) for 3 to 10 days Educate on early recognition of sx of decreased lung function and know the action plan for exacerbations
50
Medication Monitoring
Once control is achieved, the patient is seen every 1 to 6 months to determine if a step up or step down in therapy is indicated. The Expert Panel 3 Guidelines recommend the dose of inhaled corticosteroids be reduced about 25% to 50% every 2 to 3 months to lowest possible dose to maintain control.
51
Stepwise approach 0-4 Step 1
SABA PRN
52
Stepwise approach 0-4 Step 2
Preferred: Low Dose ICS Alternative: Cromolyn or montelukast
53
Stepwise approach 0-4 Step 3
Medium Dose ICS
54
Stepwise approach 0-4 Step 4
Medium dose ICS + LABA or montelukast
55
Stepwise approach 0-4 Step 5
High dose ICS + LABA or montelukast
56
Stepwise approach 0-4 Step 6
High dose ICS + LABA or montelukast Also oral steroids
57
Stepwise approach 5-11 Step 1
SABA PRN
58
Stepwise approach 5-11 Step 2
Preferred: Low dose ICS Alternative: cromolyn, nexocromil, LTRA, or Theophylinw
59
Stepwise approach 5-11 Step 3
Low dose ICS + LABA, LTRA, or theophylline Or Medium dose ICS
60
Stepwise approach 5-11 Step 4
Preferred: Medium Dose ICS + LABA Alternative: medium dose ICS + LTRA or theophylline

Asthma GINA (1 decks)

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