Flashcards in Asthma meds Deck (79):
What are the major characteristics of asthma?
Variable airflow obstruction
Often reversible (w/ meds)
What is asthma?
Bronchial hyper-responsiveness to various triggers
What does chronic airway inflammation lead to?
What is the MC chronic disease of children?
How many deaths occur from asthma each year?
Are the deaths from asthma mostly preventable or unpreventable?
Where do most deaths from asthma occur and why?
Out of the hospital
What cells infiltrate with asthma?
What are some mediators of asthma?
What kinds of tx do we give to asthma pts?
Leukotriene receptor antagonists (LTRAs)
Anti-interleukin 5 (IL-5) antibodies
What kind of bronchodilators are there?
Beta 2 agonists
What kind of anti-inflammatory agents do we use for asthma?
Inhaled glucocorticosteroids (ICS)
What are the two classification groups for asthma?
Frequency of sx
Severity of sx
What is the breakdown of frequency of sx for asthma?
What is the breakdown of severity of sx for asthma?
What is the frequency classification of asthma severity from step 2 to step 4?
What is a hallmark dx study for asthma?
Abnormal PFTs that improve by >15% after bronchodilator therapy
What is the general approach to asthma tx?
What are the two main therapeutic options for asthma?
What are beta 2 agonists intended for with asthma?
Rescue medications for acute exacerbations
What are inhaled corticosteroids (ICS) good for with asthma?
Suppression of underlying inflammation
What kind of beta 2 agonists can treat asthma?
Long acting (LABA)
Short acting (SABA)
What kind of anticholinergics can treat asthma?
Short acting muscarinic antagonists (SAMA)
Long acting muscarinic antagonists (LAMA)
What is an example of LTRAs?
What are two more modern asthma txs?
Anti-IgE monoclonal antibodies
Anti IL-5 monoclonal antibodies
What is the asthma step 1 long term tx?
What is the asthma step 1 quick relief tx (intermittent)?
Short acting bronchodilator:
Inhaled beta 2 agonist PRN
What is the long term tx for step 2 asthma (mild persistent)?
Preferred: low dose daily ICS
Alternate: LRTA (montelukast)
What is the quick relief tx for step 2 asthma?
Short acting bronchodilator:
Inhaled beta 2 agonist (SABA)
What is the long term tx for step 3 asthma (moderate persistent)?
Preferred: low dose ICS + LABA
Or: medium dose ICS
Or: low dose ICS + LRTA
What is the quick relief tx for step 3 asthma?
What is the long term tx for step 4 asthma (severe persistent)?
Preferred: medium or high dose ICS + LABA
Or: medium/high dose ICS + LABA and/or LAMA
Or: high dose ICS + LTRA/theophylline
What is the short term tx for step 4 asthma?
What is the most effective bronchodilator?
Beta 2 agonists (B2A)
What are B2As specifically treating for asthma?
What conditions are B2As the drug of choice for?
How do you increase the bronchoselectivity of B2As?
What are SABAs?
What are some examples of SABAs?
What is the onset of SABAs?
What is the duration of SABAs?
What are LABAs?
What are some examples of LABAs?
What is the onset of LABAs?
What is the duration of LABAs?
What is a concerning issue with LABAs?
Increased asthma-related deaths
What are the anti-inflammatories for treating asthma?
When do patients see sx improvement with ICS?
What do inhaled steroids avoid?
Systemic side effects
What are high dose systemic steroids used for?
Severe asthma unresponsive to B2RAs
What is the systemic steroid used for asthma and how is it dosed? Also for how long do you give it?
PO 1-2 mg/kg/day
Divide BID or TID
What is the first line tx for persistent asthma?
How do you minimize toxicities with corticosteroids?
Low moderate doses
How do you reduce systemic absorption with corticosteroids?
How do you reduce oral thrush with corticosteroids?
What is another systemic corticosteroid for asthma? How is it administered?
What is the dosing?
Loading dose = 2 mg/kg
then 0.5-1 mg/kg q6
List 2 common inhaled steroids:
What do anticholinergics inhibit?
Are cholinergic antagonists (anticholinergics) as potent beta 2 agonists?
Which cholinergic antagonists have poor absorption?
What are two cholinergic antagonists? And how long do they last?
Ipratropium 4-8 hours
Tiotropium > 24 hours
What is combivent comprised of?
Why is methylxanthines potency limited?
Narrow therapeutic index
When do toxic effects of methylxanthines appear?
> 15 mg/L
What is the therapeutic range of methylxanthines?
What is the mOA of methylxanthines?
Phosphodiesterase III and IV inhibition
How often do you dose LTRAs (give a specific example)?
What are LTRAs best used as?
What is an issue with LTRAs Zafirlukast and Zileuton? What is the result?
Interact w/ warfarin
What does Zileuton also do? How do you address this?
Increase theophylline levels
Cut theophylline dose by 1/2
What is another issue with both Zafirlukast and Zileuton?
How common is anaphylaxis w/ anti-IgE monocolonal antibodies?
What do anti-IgE monoclonal antibody permit?
Reduced inhaled corticosteroid dose
What is the greatest draw back of anti-IgE monoclonal antibody?
What are anti-IgE monocolonal antibodies often used for?
Severe persistent asthma
What is a logistical problem with anti interleukin IL-5 antibodies?
What is great about anti-interleukin IL-5 antibodies?
Decreases exacerbations by 50%
What is a risk w/ anti-interleukin IL-5 antibodies?