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Pharmacology Exam 2 > Asthma > Flashcards

Flashcards in Asthma Deck (50):
0

Normal FEV1/FVC = ?

> 0.70

1

What FEV1/FVC value signifies obstruction?

< 0.70

2

What are common triggers for asthma?

Allergens, humidity, exercise, smoke

4

What is the preferred route for SABAs?

Inhaled

Why? Gets to site quicker and less ADEs

5

Exercise induced asthma - DOC

SABA - Albuterol 2 puffs 15 min before exercise
LABA - Formoterol DPI 1 puff 15 min before exercise

6

What is the preferred inhaled SABA?

Albuterol

Inhaler or neb

7

Albuterol - indications

Reversible bronchospasm (BBW) and EIA

8

*What are some oral SABAs?

Albuterol syrup and tabs
Metoproterenol syrup and tabs
Terbutaline tabs

9

Beta 2 agonists - side effects

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

10

What is considered a "good candidate" for bronchodilators?

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

11

Formoterol - class and dosing

LABA

1 puff bid
Onset 5-15 min x 12 hrs

12

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

13

Who requires a LABA in combination formulation with a corticosteroid?

Peds and adolescents

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

14

Why do LABAs have a black box warning?

Increased risk of asthma related deaths -> Taper off ASAP 
Not for acute exacerbations!

15

*ICS - MOA

Inhibits cytokine-induced production of pro inflammatory proteins

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

15

When should corticosteroids be stepped down?

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

16

Corticosteroids - side effects

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

17

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

Mast cell stabilizers (cromolyn and nedocromil)

Leukotriene modifiers (montelukast)

18

*Corticosteroids - counseling

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

19

Mast cell stabilizers - ADEs

Bad taste, GI

20

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

Omalizumab (xolair)

>12 yrs
Acts as a receptor to IgE

Given in clinic q 2-4 wks
Expensive!

22

Why isn't theophylline used much?

Narrow therapeutic window (5-15 mcg/mL)
Lots of DDI

23

Treatment for acute asthma exacerbation

Albuterol (quick) + ipratropium (long acting)

24

Acute asthma exacerbation - DOC and dosing

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