Flashcards in Asthma Deck (56):
True or false: Inflammation and bronchoconstriction with asthma is irreversible
False - it's reversible with meds
Most common complication of asthma
Diagnoses of asthma can be confirmed by...
Spirometry (FVC, FEV1)
Peak expiratory flow (using a peak flow meter)
What is the main determinant of asthma severity?
Frequency of inhaler use
Intermittent = less than 2 days/week
Mild = more than 2 days/week but not daily
Moderate = daily use
Severe = several times per day
What should be included in inhaler medication counseling?
Proper inhaler technique
Which vaccines are recommended in asthma patients?
Prevnar 13 only indicated in ages 6-18 if they're on high dose steroids
When are ICS indicated?
Persistent asthma, FIRST-line for all persistent asthma patients
When are LABAs indicated?
EIB when needing longer control vs SABA
IN ADDITION TO ICS when ICS doesn't adequately control symptoms
When are leukotriene receptor antagonists indicated?
Alternative to LABA in addition to ICS
In addition to LABA/ICS combo
or EIB (take 2 hours prior to exercise, lasts up to 24 h)
When is theophylline indicated?
Pretty much never
You have to monitor serum drug concentrations
When are LAMA's indicated
In addition to ICS+LABA if not controlling symptoms
When are monoclonal antibodies indicated?
Omalizumab, mepolizumab, or reslizumab
Omalizumab (XOLAIR) = severe allergic asthma
Mepolizumab (NUCALA) = severe eosinophilic asthma (SC)
Reslizumab (CINQAIR) = severe eosinophilic asthma (IV)
When should you advance therapy?
Whenever patients need to use their SABA > 2 days per week, have nighttime awakenings 1-3x/wk, and some limitations to normal activity
SABA, nebulizer OR MDI
Side effects of SABA's
How many puffs per albuterol inhaler?
200 except Ventolin has 60
Should last 1 year (Proair, Proventil) or 3-4 months (Ventolin) if asthma well controlled
Why must you never use LABA as monotherapy in asthma?
Increase in asthma related deaths
Also available as Pulmocort Respules nebulizer
Available as MDI, Diskus
Side effects of ICS?
Dysphonia (difficulty speaking), oral candidiasis (thrush), cough
Max dose Qvar
> 480 mcg
Max dose Pulmicort
Max dose Flovent
> 440 mcg MDI
> 550 DPI
ICS indicated for asthma
QVAR (beclomethasone), Pulmicort (budesonide), Flovent (fluticasone), Asmanex (mometasone)
ICS indicated for COPD
No single ICS approved for COPD
LABA indicated for asthma
LABA indicated for COPD
Formoterol (Perforomist, nebulizer)
Indacaterol (Arcapta Neohaler)
LAMA indicated for asthma
Tiotropium (Spiriva Respimat only)
LAMA indicated for COPD
Tiotropium (Spiriva all products)
Umeclidinium (Incruse Ellipta)
ICS/LABA Combos for Asthma
Dulera (mometasone, formoterol)
LAMA/LABA combos for asthma
LAMA/LABA combos for COPD
Triple therapy COPD
Which products do you NOT have to shake?
QVAR, Alvesco, Respimat
10 mg daily in the evening
age 6-14: 5 mg daily
age 1-5: 4 mg daily
Leukotriene modifying agents
or Zafirlukast (Accolate) or Zileuton (Zyflo)
Side effects of LTRAs
Counseling montelukast granules
Mix in 5 mL of breast milk or formula or mixed with a spoonful of applesauce, carrots, rice, or ice cream
Use within 15 mins of opening the packet
Theophylline (Elixophyllin, Theo-24, Theochron)
Active metabolites caffeine and 3-methylxanthine
Side effects phosphodiesterase inhibitors
Conversion aminophylline to theophylline
Aminophylline contains 80% theophylline
Multiply by 0.8
Considerations with theophylline
Lots of drug interactions (major substrate 1A2, minor substrate 3A4 and 2E1)
Therapeutic drug monitoring (goal 5-15 mcg/mL)
Saturatable kinetics - small inc in dose lead to large inc in concentration
Dose using total body weight
Monoclonal antibody that inhibits IgE binding
Indicated for severe allergic asthma
SC every 2-4 weeks
dose based on IgE levels and body weight
Given at dr's office!!
Side effects Xolair
Injection site reactions
IL-5 Receptor antagonists
Mepolizumab (Nucala) - 100 mg SC every 4 weeks
Reslizumab (Cinqair) - 3 mg/kg IV every 4 weeks
Boxed warning IL-5 receptor antagonists
Reslizumab (Cinqair) - IV - anaphylaxis
Counseling for taking multiple inhalers
Use bronchodilator(s) first, then ICS
Wait 60 seconds between each one
Counseling for using peak flow meter
Use every morning upon awakening and use before the use of any asthma medications
Blow out as hard and fast as possible