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Pharmacology > Asthma > Flashcards

Flashcards in Asthma Deck (29):
1

Asthma

a chronic disease of the airways that causes recurrent and distressing episodes

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Symptoms of asthma

wheezing, breathlessness, chest tightness, nighttime or early am coughing

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Asthma is triggered by

allergies, exercise, weather, certain foods, emotional states, outdoor pollution, smoke

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Difference between asthma and COPD

onset in mid-life, symptoms progress slowly, long smoking history, dyspnea during exercise, irreversible airflow in COPD, opposite in asthma+ allergy, rhinitis, family history

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Intermittent asthma

2x or less per week daytime symptoms, 2x or less per mo at noc

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Mild persistent

>2x/week daytime, 2x or less per mo at noc

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Moderate persisstent

daily during day, 1x per week at noc

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severe persistent

continual during day, frequent at noc

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All pts classified in persistent asthma category will require what

controller medication

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intermittent asthma treatment

short acting B2 agonist

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persistent mild asthma treatment

low dose corticosteroids, short acting B2 agonist

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persistent moderate asthma treatment

corticosteroids, LABA, SABA, alternatives or leukotriene modifiers, mast cell stabilizers

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persistent severe asthma treatment

coricosteroids, LABA, SABA, alternatives leukotriene modifiers, mast cell stabilizers, oral corticosteroids, theophylline; poorly controlled regardless of age

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Severity vs control

severity- the intrinsic intensity of the disease process, control- the degree to which the goals of therapy are met; severity is generally not discussed after diagnosis

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persistent asthma step 6

high dose ICS+LABA and oral corticosteroid

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Persistent asthma step 5

high dose ICS+LABA

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Persistent asthma step 4

medium dose ICS+LABA

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Persistent asthma step 3

low dose ICS+LABA or medium dose ICS

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Persistent asthma Step 2

low dose ICS

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Intermittent asthma step 1

SABA as needed

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The basic approach

for persistent asthma start with a low dose ICS. Add LABA if not well controlled. Once a LABA is added titrate up ICS to maximal dose if still not controlled

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if well controlled what do you do

after 3 months consider down stepping

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Alternative agents

Monteludast (Singulair), Zafirlukast ( Accolate), Zileuton (Zyflo); for persistent, moderate asthma

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Alternative agents MOA

leukotriene inhibitors, only available PO

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Alternative agents ADRs

well tolerated, agitation (anxiety, hallucinations, unusual dreams)

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Cromolyn (Intal)

alternative agents, mast cell stabilizer, only inhaler only, for persistent moderate asthma, very limited

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Omalizumab (Xolair)

anti-IgE therapy, if failed everything else do this, moderate to severe asthma; ADRs anaphylaxis, HA, thrombocytopenia

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Severe asthma, why do pts get hospitalized

non-adherence, continue exposure to triggers, incomplete assessment of co-morbidities, inadequate follow-up, pt response to meds

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Risk factors of mortality

severe exacerbation, 2+ hospitalizations, 3+ ED visists in last year, >2 canisters/mon, diff perceiving symptoms, low socioeconomic, psych probs, comobidities