Flashcards in Asthma Deck (50):
Normal FEV1/FVC = ?
What FEV1/FVC value signifies obstruction?
What are common triggers for asthma?
Allergens, humidity, exercise, smoke
What is the preferred route for SABAs?
Why? Gets to site quicker and less ADEs
Exercise induced asthma - DOC
SABA - Albuterol 2 puffs 15 min before exercise
LABA - Formoterol DPI 1 puff 15 min before exercise
What is the preferred inhaled SABA?
Inhaler or neb
Albuterol - indications
Reversible bronchospasm (BBW) and EIA
*What are some oral SABAs?
Albuterol syrup and tabs
Metoproterenol syrup and tabs
Beta 2 agonists - side effects
Reduction in o2 sat (b/c opens unused spaces)
What is considered a "good candidate" for bronchodilators?
Increase of 200 mL or 12% in FEV1 compared to baseline
Formoterol - class and dosing
1 puff bid
Onset 5-15 min x 12 hrs
When should LABA be used?
Only in combo with an asthma controller med -> never alone!
Use in long term patients that are not adequately controlled with other meds
Who requires a LABA in combination formulation with a corticosteroid?
Peds and adolescents
ex. Budesonide + Formoterlol (Symbicort) and Fluticasone +Salmeterol (Advair)
Why do LABAs have a black box warning?
Increased risk of asthma related deaths -> Taper off ASAP
Not for acute exacerbations!
*ICS - MOA
Inhibits cytokine-induced production of pro inflammatory proteins
Indirect: suppresses inflammation, increased production of beta 2 receptors (improves response), decrease mucous
When should corticosteroids be stepped down?
Once controlled, decrease dose by 25% q 2 weeks for 8 weeks
Corticosteroids - side effects
Effects in bone growth (slower but catches up)
What classes can be used in patients that need/want to avoid steroids?
Mast cell stabilizers (cromolyn and nedocromil)
Leukotriene modifiers (montelukast)
*Corticosteroids - counseling
Right order (bronchodilator first)
Daily use (not for exacerbations)
Rinse mouth to prevent thrush
Mast cell stabilizers - ADEs
Bad taste, GI
Which drug can be given for mod-severe persistent allergic asthma NOT controlled with inhaled steroids?
Acts as a receptor to IgE
Given in clinic q 2-4 wks
Why isn't theophylline used much?
Narrow therapeutic window (5-15 mcg/mL)
Lots of DDI
Treatment for acute asthma exacerbation
Albuterol (quick) + ipratropium (long acting)
Acute asthma exacerbation - DOC and dosing
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
*When are steroids given during acute asthma exacerbation?
Early in the attack if incomplete response to inhalers
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
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
*Asthma exacerbation - Treatment steps
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
If a pedi RR > 60, what should you do?
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
Budesonide Inhln Powder (pulmacort) - indication
ICS for asthma prophylaxis
*Montelukast (Singulair) - class
Leukotriene receptor antagonist
Albuterol - dosing
2 puffs q 4-6 hrs prn
Onset 5-8 min x 3-6 hours
Which is more effective…oral or inhaled SABA?
why? oral takes longer (onset 30 minutes) and needs regular dosing (generally TID-QID)
What is the only ICS approved for pregnancy?
Pulmacort (cat B)
Pulmacort - dosing
Adults - qd for mild asthma
Peds - bid
Onset 24 hrs, max benefit 1-2 wks
Montelukast (Singulair) - dosing
Qd in evening
*Corticosteroids - MOA
Inhibits cytokine-induced production of pro-flammatory proteins
*Mast cell stabilizers - MOA
no bronchodilation…prevents mast cells from releasing histamine
*Omalizumab (Xolair) - class?
IgE Antibody Inhibitor
*Omalizumab - MOA
inhibits the binding of IgE to the high-affinity IgE receptor on the surface of mast cells and basophils
*Omalizumab - only FDA approval
mod-severe persistent allergic asthma
*Formoterol and salmeterol - class?
*Albuterol and levalbuterol - class?
*Budesonide + Fomoterol (Symbicort) and Fluticasone + Salmeterol - class?
LABA + ICS
*Budesonide and Beclomethasone - class?
*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
*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
*Level of asthma control - "uncontrolled"
3+ features from partly controlled in last week