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Flashcards in Asthma Deck (56):
1

True or false: Inflammation and bronchoconstriction with asthma is irreversible

False - it's reversible with meds

2

Most common complication of asthma

Exacerbation

3

Diagnoses of asthma can be confirmed by...

Spirometry (FVC, FEV1)
Peak expiratory flow (using a peak flow meter)

4

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

5

What should be included in inhaler medication counseling?

Proper inhaler technique
Primig
Cleaning

6

Which vaccines are recommended in asthma patients?

Influenza
PPSV23 (Pneumovax)


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

7

When are ICS indicated?

Persistent asthma, FIRST-line for all persistent asthma patients

8

When are LABAs indicated?

EIB when needing longer control vs SABA
IN ADDITION TO ICS when ICS doesn't adequately control symptoms

9

When are leukotriene receptor antagonists indicated?

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)

10

When is theophylline indicated?

Pretty much never
You have to monitor serum drug concentrations

11

When are LAMA's indicated

In addition to ICS+LABA if not controlling symptoms

12

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)

13

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

14

Xopenex

Levalbuterol
SABA, nebulizer OR MDI

15

Side effects of SABA's

Nervousness
Tremor
Tachycardia
Palpitations
Cough
HYPERGLYCEMIA
Low K

16

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

17

Serevent Diskus

Salmeterol
LABA MDI

18

Why must you never use LABA as monotherapy in asthma?

Increase in asthma related deaths

19

QVAR

Beclomethasone, ICS
MDI

20

Pulmicort Flexhaler

Budesonide
Also available as Pulmocort Respules nebulizer

21

Alvesco

Ciclesonide, ICS

22

Aerospan

Flunisolide, ICS

23

Flovent

Fluticasone, ICS
Available as MDI, Diskus

24

Arnuity Ellipta

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)