Asthma/COPD Flashcards
Which lung function test is a good predictor of morbidity and mortality in COPD?
FEV1 - the amount of air expelled in 1 second. If it is low, this implies slowing of expiratory flow.
What is a FEV1/FVC value that indicates COPD?
<0.7
What are the PEF readings scale?
Green zone - 80-100% of personal best
Yellow zone - 50-80%
Red zone <50%
What do you do if you blow in the red zone?
- Low dose ICS + formoterol (like symbicort) as a rescue inhaler
- Take oral steroids if available
- MUST go to ER
What do you do if you blow in the yellow zone?
- PRN low dose ICS + formoterol
- Alternative - Low dose ICS with SABA
If in green zone after one hour - continue with LABA/ICS for 7-10d
If in yellow zone after one hour - add short course of oral steroids
When would you utilize FeNO guided treatment>
In children and adolescents with allergic or eosinophillic asthma
It is an exhaled nitric oxide test
what is the GOLD grading scale?
GOLD 1 (mild) - FEV1 >80%
GOLD 2 (Moderate) - FEV1 50-80%
GOLD 3 (severe) - FEV1 30-50%
GOLD 4 (very severe) - FEV1<30%
Describe the GOLD classification based on symptoms and history and it’s treatments
Which asthma/COPD combination increases risk of pneumonia?
LABA + ICS
What three vaccines are recommended for COPD patients?
Pneumococcal
Influenza
Tdap
Albuterol
Brand
Formulation + counseling + ages
MDI - Ventolin, proventil, Proair | reprime after 2 weeks of not using | for >4y.o
DPI - proair respiclick | discard after 13 months , for >4y.o
Nebulization for >2y.o
Syrup for >2y.o
Tablets IR and ER
Levalbuterol
Brand
Formulations + Age
Dose
Counseling
Xopenex
MDI - >4y.o
Nebulizer solution >6y.o
2 inhalations Q4-6 hours
Shake before use, prime if not used for >3 days, use a spacer, breath in slowly and deeply
For the nebulized vials, once it’s out of the foil, it’s good for one week
Beclomethasone
Brand
Formulation
Dose
Counseling
Qvar Redihaler
Breath-acuated inhaler
4-11 y.o - 40 or 80mcg BID
>12 - 40-80mcg 1-4puffs BID
Open cap, inhale deeply, hold breath, rinse mouth
Budesonide
Brand
Formulation + age
Counseling
Why is this one unique?
DPI - Pulmicort - >6y.o , quick forceful breath
Respules for nebulization - >1 y.o
This is the only steroid that comes in nebulization form and the only one that can be used in a one-year-old
Mometasone
Brand
Formulation + age
Dose + counseling
Storage
Asmanex HFA , >12y.o , 400mcg BID
Asmanex twistihaler DPI-
4-11 y.o - 110mcg PM
>12 - 220mcg PM
Inhale deeply and forcefully
Discard after 45 days
Fluticasone
Brand
Formulation + age+ dose
Flovent HFA MDI - >4y.o - 44mcg 2 puffs BID
Flovent Diskus DPI - >4y.o 50-250mcg BID
Arnuity Ellipta DPI - >5y.o once daily
Ciclesonide
Brand
Formulation + age + dose
Counseling
PK
Alvesco
MDI , >12y.o , 80-320mcg BID
Don’t shake
Is a prodrug and is converted to active drug in lung
What are the 4 systemic steroids for acute asthma attacks?
Dose?
Oral prednisone - 40-60mg QD 3-10days
Dexamethasone - 0.3-0.6mg/kg PO QD x 1-2d
Medrol dose pack
Rayos = delayed release prednisone
Least to most potent steroids
Cute Hot Pretty Pharmacists Makes Triple Digits Booooom
Cortisone
Hydrocortisone
Prednisolone
Prednisone
Methylpredisone
Triamcinolone
Dexamethasone
Betamethasone
How do systemic steroids affect Na+ and K+?
Na+ Increases
K+ decreases
What are your two LABA’s?
Salmeterol
Formoterol
Salmeterol
Brand
Combo’s + age + dose
Serevent Diskus , >4y.o , 1puff BID
w/fluticasone - Advair diskus/HFA - Diskus is >4y.o and HFA >12y.o
100/50, 250/50, 500/50
w/fluticasone - Airduo Respiclick - >12y.o
55/14, 113/14, 232/14
If I have 100/50 advair, which component is which?
100 = fluticasone (larger number is always the steroid)
50 = salmeterol
Formoterol
Combo’s + brand + age+ dose
Symbicort = w/budesonide , >6y.o , BID
Dulera = w/mometasone, >12y.o BID
