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Asthma Flashcards

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1
Q

True or false: Inflammation and bronchoconstriction with asthma is irreversible

A

False - it’s reversible with meds

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2
Q

Most common complication of asthma

A

Exacerbation

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3
Q

Diagnoses of asthma can be confirmed by…

A

Spirometry (FVC, FEV1)

Peak expiratory flow (using a peak flow meter)

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4
Q

What is the main determinant of asthma severity?

A 
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
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5
Q

What should be included in inhaler medication counseling?

A

Proper inhaler technique
Primig
Cleaning

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6
Q

Which vaccines are recommended in asthma patients?

A

Influenza
PPSV23 (Pneumovax)

Prevnar 13 only indicated in ages 6-18 if they’re on high dose steroids

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7
Q

When are ICS indicated?

A

Persistent asthma, FIRST-line for all persistent asthma patients

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8
Q

When are LABAs indicated?

A

EIB when needing longer control vs SABA

IN ADDITION TO ICS when ICS doesn’t adequately control symptoms

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9
Q

When are leukotriene receptor antagonists indicated?

A 
Montelukast
Alternative to LABA in addition to ICS
or
In addition to LABA/ICS combo
or EIB (take 2 hours prior to exercise, lasts up to 24 h)
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10
Q

When is theophylline indicated?

A

Pretty much never

You have to monitor serum drug concentrations

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11
Q

When are LAMA’s indicated

A

In addition to ICS+LABA if not controlling symptoms

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12
Q

When are monoclonal antibodies indicated?

A

Omalizumab, mepolizumab, or reslizumab

Omalizumab (XOLAIR) = severe allergic asthma
Mepolizumab (NUCALA) = severe eosinophilic asthma (SC)
Reslizumab (CINQAIR) = severe eosinophilic asthma (IV)

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13
Q

When should you advance therapy?

A

Whenever patients need to use their SABA > 2 days per week, have nighttime awakenings 1-3x/wk, and some limitations to normal activity

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14
Q

Xopenex

A

Levalbuterol

SABA, nebulizer OR MDI

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15
Q

Side effects of SABA’s

A 
Nervousness
Tremor
Tachycardia
Palpitations
Cough
HYPERGLYCEMIA
Low K
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16
Q

How many puffs per albuterol inhaler?

A

200 except Ventolin has 60

Should last 1 year (Proair, Proventil) or 3-4 months (Ventolin) if asthma well controlled

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17
Q

Serevent Diskus

A

Salmeterol

LABA MDI

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18
Q

Why must you never use LABA as monotherapy in asthma?

A

Increase in asthma related deaths

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19
Q

QVAR

A

Beclomethasone, ICS

MDI

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20
Q

Pulmicort Flexhaler

A

Budesonide

Also available as Pulmocort Respules nebulizer

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21
Q

Alvesco

A

Ciclesonide, ICS

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22
Q

Aerospan

A

Flunisolide, ICS

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23
Q

Flovent

Study These Flashcards
A

Fluticasone, ICS

Available as MDI, Diskus

24
Q

Arnuity Ellipta

Study These Flashcards
A

Fluticasone, ICS

25
Asmanex
Mometasone, ICS
26
Side effects of ICS?
Dysphonia (difficulty speaking), oral candidiasis (thrush), cough
27
Max dose Qvar
> 480 mcg
28
Max dose Pulmicort
> 1080
29
Max dose Flovent
> 440 mcg MDI | > 550 DPI
30
ICS indicated for asthma
QVAR (beclomethasone), Pulmicort (budesonide), Flovent (fluticasone), Asmanex (mometasone)
31
ICS indicated for COPD
No single ICS approved for COPD
32
LABA indicated for asthma
Salmeterol (Serevent)
33
LABA indicated for COPD
Salmeterol (Serevent) Formoterol (Perforomist, nebulizer) Indacaterol (Arcapta Neohaler)
34
LAMA indicated for asthma
Tiotropium (Spiriva Respimat only)
35
LAMA indicated for COPD
Tiotropium (Spiriva all products) Aclidinium (Tudorza) Glycopyrrolate (Seebri) Umeclidinium (Incruse Ellipta)
36
ICS/LABA Combos for Asthma
Symbicort (budesonide/formoterol) Advair (fluticasone/salmeterol) Dulera (mometasone, formoterol)
37
LAMA/LABA combos for asthma
None
38
LAMA/LABA combos for COPD
Bevespi (Glycopyrrolate/formoterol)
39
Triple therapy COPD
Trelegy
40
Which products do you NOT have to shake?
QVAR, Alvesco, Respimat
41
Singulair dose
Montelukast 10 mg daily in the evening age 6-14: 5 mg daily age 1-5: 4 mg daily
42
LTRAs
Leukotriene modifying agents Montelukast (SINGULAIR) or Zafirlukast (Accolate) or Zileuton (Zyflo)
43
Side effects of LTRAs
Montelukast | Headache
44
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
45
Phosphodiesterase inhibitor
Theophylline (Elixophyllin, Theo-24, Theochron) | Active metabolites caffeine and 3-methylxanthine
46
Side effects phosphodiesterase inhibitors
Theophylline | Nausea, vomiting
47
Conversion aminophylline to theophylline
Aminophylline contains 80% theophylline | Multiply by 0.8
48
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
49
Monoclonal antibody that inhibits IgE binding
Omalizumab (Xolair) | Indicated for severe allergic asthma
50
Dosing Xolair
Omalizumab SC every 2-4 weeks dose based on IgE levels and body weight Given at dr's office!!
51
Side effects Xolair
Injection site reactions
52
IL-5 Receptor antagonists
Mepolizumab (Nucala) - 100 mg SC every 4 weeks | Reslizumab (Cinqair) - 3 mg/kg IV every 4 weeks
53
Boxed warning IL-5 receptor antagonists
Reslizumab (Cinqair) - IV - anaphylaxis
54
Counseling for taking multiple inhalers
``` Use bronchodilator(s) first, then ICS Wait 60 seconds between each one ```
55
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
56
How to determine personal best for peak flow meter? How do you use this to determine zones?
Use it twice a day for 2-3 weeks, most frequent highest reading is your PB Green zone = 80-100% your PB (business as usual) Yellow zone = 50-80% your PB (use action plan) Red zone = < 50% personal best (alert, seek medical attention)

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