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Pharmacology Exam 2 > Asthma > Flashcards

Asthma Flashcards

(50 cards)

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0
Q

What FEV1/FVC value signifies obstruction?

A

< 0.70

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1
Q

Normal FEV1/FVC = ?

A

> 0.70

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2
Q

What are common triggers for asthma?

A

Allergens, humidity, exercise, smoke

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4
Q

What is the preferred route for SABAs?

A

Inhaled

Why? Gets to site quicker and less ADEs

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5
Q

Exercise induced asthma - DOC

A

SABA - Albuterol 2 puffs 15 min before exercise

LABA - Formoterol DPI 1 puff 15 min before exercise

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6
Q

What is the preferred inhaled SABA?

A

Albuterol

Inhaler or neb

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7
Q

Albuterol - indications

A

Reversible bronchospasm (BBW) and EIA

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8
Q

*What are some oral SABAs?

A

Albuterol syrup and tabs
Metoproterenol syrup and tabs
Terbutaline tabs

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9
Q

Beta 2 agonists - side effects

A

Tremor
Palpitations
Reduction in o2 sat (b/c opens unused spaces)

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10
Q

What is considered a “good candidate” for bronchodilators?

A

Increase of 200 mL or 12% in FEV1 compared to baseline

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11
Q

Formoterol - class and dosing

A

LABA

1 puff bid
Onset 5-15 min x 12 hrs

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12
Q

When should LABA be used?

A

Only in combo with an asthma controller med -> never alone!

Use in long term patients that are not adequately controlled with other meds

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13
Q

Who requires a LABA in combination formulation with a corticosteroid?

A

Peds and adolescents

ex. Budesonide + Formoterlol (Symbicort) and Fluticasone +Salmeterol (Advair)

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14
Q

Why do LABAs have a black box warning?

A

Increased risk of asthma related deaths -> Taper off ASAP

Not for acute exacerbations!

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15
Q

*ICS - MOA

A

Inhibits cytokine-induced production of pro inflammatory proteins

Indirect: suppresses inflammation, increased production of beta 2 receptors (improves response), decrease mucous

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15
Q

When should corticosteroids be stepped down?

A

Once controlled, decrease dose by 25% q 2 weeks for 8 weeks

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16
Q

Corticosteroids - side effects

A

Effects in bone growth (slower but catches up)
Adrenal suppression
Osteoporosis
Thrush (inhaler)

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17
Q

What classes can be used in patients that need/want to avoid steroids?

A

Mast cell stabilizers (cromolyn and nedocromil)

Leukotriene modifiers (montelukast)

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18
Q

*Corticosteroids - counseling

A

Inhaler technique
Right order (bronchodilator first)
Daily use (not for exacerbations)
Rinse mouth to prevent thrush

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19
Q

Mast cell stabilizers - ADEs

A

Bad taste, GI

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20
Q

Which drug can be given for mod-severe persistent allergic asthma NOT controlled with inhaled steroids?

Study These Flashcards
A

Omalizumab (xolair)

> 12 yrs
Acts as a receptor to IgE

Given in clinic q 2-4 wks
Expensive!

22
Q

Why isn’t theophylline used much?

Study These Flashcards
A

Narrow therapeutic window (5-15 mcg/mL)

Lots of DDI

23
Q

Treatment for acute asthma exacerbation

Study These Flashcards
A

Albuterol (quick) + ipratropium (long acting)

24
Q

Acute asthma exacerbation - DOC and dosing

Study These Flashcards
A

Albuterol
MID: 4-8 puffs q 20 min x 4 hrs
Neb: 2.5-5 mg q 20 min x 3 2.5-10 mg q 1-4 hrs prn
+
Ipratropium (Never use alone…always w/albuterol)
MDI: 8 inhalations q 20 min prn up to 3 hrs
Neb: 0.5 mg or 500 mcg q 20 min x 3

25
*When are steroids given during acute asthma exacerbation?
Early in the attack if incomplete response to inhalers
26
Steroids for acute asthma exacerbation - DOC and dosing
Adults - Prednisone 60 mg PO or methylprednisone 80 mg IV Peds - prednisolone 2 mg/kg PO x 5 days
27
What are the 3 alternative treatments (meds) for acute asthma exacerbation?
1. Mgso4 if not responding and trying to prevent intubation 2. Racemic epi if not responding to albuterol (SQ or neb) 3. Antibiotics if evidence of infection
28
*Asthma exacerbation - Treatment steps
1. Albuterol 2. Oral steroid 3. O2 (goal sat >95%) 4. Short acting theophylline if beta 2 agonist not available 5. If unresponsive to steroid + albuterol -> MgSO4
29
If a pedi RR > 60, what should you do?
Admit
30
An asthma attack is considered severe if...
Breathless at rest, hunched forward and/or talking in words Infant - stops feeding, agitated, drowsy, confused, bradycardia or resp >30
31
Budesonide Inhln Powder (pulmacort) - indication
ICS for asthma prophylaxis
32
*Montelukast (Singulair) - class
Leukotriene receptor antagonist
33
Albuterol - dosing
2 puffs q 4-6 hrs prn | Onset 5-8 min x 3-6 hours
34
Which is more effective…oral or inhaled SABA?
inhaled why? oral takes longer (onset 30 minutes) and needs regular dosing (generally TID-QID)
35
What is the only ICS approved for pregnancy?
Pulmacort (cat B)
36
Pulmacort - dosing
Adults - qd for mild asthma Peds - bid Onset 24 hrs, max benefit 1-2 wks
37
Montelukast (Singulair) - dosing
Qd in evening
38
*Corticosteroids - MOA
Inhibits cytokine-induced production of pro-flammatory proteins
39
*Mast cell stabilizers - MOA
no bronchodilation…prevents mast cells from releasing histamine
40
*Omalizumab (Xolair) - class?
IgE Antibody Inhibitor
41
*Omalizumab - MOA
inhibits the binding of IgE to the high-affinity IgE receptor on the surface of mast cells and basophils
42
*Omalizumab - only FDA approval
mod-severe persistent allergic asthma
43
*Formoterol and salmeterol - class?
LABA
44
*Albuterol and levalbuterol - class?
SABA
45
*Budesonide + Fomoterol (Symbicort) and Fluticasone + Salmeterol - class?
LABA + ICS
46
*Budesonide and Beclomethasone - class?
ICS
47
*Level of asthma control - "controlled"
daytime symptoms < 2 times/week, no limitations, no night symptoms, rescue inhaler < 2 times/week, normal lung function, no exacerbations
48
*Level of asthma control - "partly controlled"
any of the following in past week: symptoms > 2 times, any limitations, any night symptoms, rescue inhaler > 2 times, lung function <80% of personal best, any exacerbation this year
49
*Level of asthma control - "uncontrolled"
3+ features from partly controlled in last week
50
*Asthma - approaches to treatment based on control
controlled - maintain lowest controlling step partially controlled - consider stepping up uncontrolled - step up until controlled exacerbation - treat as exacerbation

Pharmacology Exam 2 (9 decks)

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