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Flashcards in Asthma meds Deck (79):
1

What are the major characteristics of asthma?

Variable airflow obstruction
Often reversible (w/ meds)

2

What is asthma?

Bronchial hyper-responsiveness to various triggers

3

What does chronic airway inflammation lead to?

Airway remodeling

4

What is the MC chronic disease of children?

Asthma

5

How many deaths occur from asthma each year?

5000

6

Are the deaths from asthma mostly preventable or unpreventable?

Preventable

7

Where do most deaths from asthma occur and why?

Out of the hospital
Inadequate therapy

8

What cells infiltrate with asthma?

Eosinophils
Mast cells

9

What are some mediators of asthma?

Prostaglandins
Thrombaxanes
Leukotrienes

10

What kinds of tx do we give to asthma pts?

Bronchodilators
Anti-inflammatory agents
Leukotriene receptor antagonists (LTRAs)
Anti-interleukin 5 (IL-5) antibodies

11

What kind of bronchodilators are there?

Beta 2 agonists
Anticholinergics
Theophylline

12

What kind of anti-inflammatory agents do we use for asthma?

Inhaled glucocorticosteroids (ICS)

13

What are the two classification groups for asthma?

Frequency of sx
Severity of sx

14

What is the breakdown of frequency of sx for asthma?

Intermittent (infrequent)
Persistent (frequent)

15

What is the breakdown of severity of sx for asthma?

Mild
Moderate
Severe

16

What is the frequency classification of asthma severity from step 2 to step 4?

Persistent

17

What is a hallmark dx study for asthma?

Abnormal PFTs that improve by >15% after bronchodilator therapy

18

What is the general approach to asthma tx?

Educate pt/caregivers
Pharmacotherapy
Individualization

19

What are the two main therapeutic options for asthma?

Bronchodilators
Inhaled corticosteroids

20

What are beta 2 agonists intended for with asthma?

Rescue medications for acute exacerbations

21

What are inhaled corticosteroids (ICS) good for with asthma?

Suppression of underlying inflammation

22

What kind of beta 2 agonists can treat asthma?

Long acting (LABA)
Short acting (SABA)

23

What kind of anticholinergics can treat asthma?

Short acting muscarinic antagonists (SAMA)
Long acting muscarinic antagonists (LAMA)

24

What is an example of LTRAs?

Montelukast

25

What are two more modern asthma txs?

Anti-IgE monoclonal antibodies
Anti IL-5 monoclonal antibodies

26

What is the asthma step 1 long term tx?

None

27

What is the asthma step 1 quick relief tx (intermittent)?

Short acting bronchodilator:
Inhaled beta 2 agonist PRN

28

What is the long term tx for step 2 asthma (mild persistent)?

Preferred: low dose daily ICS
Alternate: LRTA (montelukast)

29

What is the quick relief tx for step 2 asthma?

Short acting bronchodilator:
Inhaled beta 2 agonist (SABA)

30

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

31

What is the quick relief tx for step 3 asthma?

SABA

32

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

33

What is the short term tx for step 4 asthma?

SABA

34

What is the most effective bronchodilator?

Beta 2 agonists (B2A)

35

What are B2As specifically treating for asthma?

Intermittent bronchospasm

36

What conditions are B2As the drug of choice for?

Acute asthma
EIB

37

How do you increase the bronchoselectivity of B2As?

Inhalation

38

What are SABAs?

Rescue medications

39

What are some examples of SABAs?

Albuterol
Levalbuterol
Metaproterenol
Terbutaline
Pirbuterol

40

What is the onset of SABAs?

1-5 minutes

41

What is the duration of SABAs?

2-6 hours

42

What are LABAs?

Maintenance/control/prophylactic medications

43

What are some examples of LABAs?

Salmeterol
Formoterol
Indacatrol

44

What is the onset of LABAs?

5-15 minutes

45

What is the duration of LABAs?

>12 hours

46

What is a concerning issue with LABAs?

Increased asthma-related deaths

47

What are the anti-inflammatories for treating asthma?

Inhaled steroids

48

When do patients see sx improvement with ICS?

1-2 weeks

49

What do inhaled steroids avoid?

Systemic side effects

50

What are high dose systemic steroids used for?

SA
Severe asthma unresponsive to B2RAs

51

What is the systemic steroid used for asthma and how is it dosed? Also for how long do you give it?

Prednisone
PO 1-2 mg/kg/day
Divide BID or TID
3-10 days

52

What is the first line tx for persistent asthma?

Inhaled steroids

53

How do you minimize toxicities with corticosteroids?

Low moderate doses

54

How do you reduce systemic absorption with corticosteroids?

Mouth rinsing/spitting

55

How do you reduce oral thrush with corticosteroids?

BID dosing

56

What is another systemic corticosteroid for asthma? How is it administered?
What is the dosing?

Methylprednisolone
IV
Loading dose = 2 mg/kg
then 0.5-1 mg/kg q6

57

List 2 common inhaled steroids:

Beclomethasone
Fluticasone

58

What do anticholinergics inhibit?

Constrictive tone

59

Are cholinergic antagonists (anticholinergics) as potent beta 2 agonists?

No

60

Which cholinergic antagonists have poor absorption?

Quaternary NH4+

61

What are two cholinergic antagonists? And how long do they last?

Ipratropium 4-8 hours
Tiotropium > 24 hours

62

What is combivent comprised of?

Atrovent
Albuterol

63

Why is methylxanthines potency limited?

Narrow therapeutic index

64

When do toxic effects of methylxanthines appear?

> 15 mg/L

65

What is the therapeutic range of methylxanthines?

10-20 mg/L
*note overlap

66

What is the mOA of methylxanthines?

Phosphodiesterase III and IV inhibition

67

How often do you dose LTRAs (give a specific example)?

Montelukast qhs
QID
BID

68

What are LTRAs best used as?

Adjunct therapy

69

What is an issue with LTRAs Zafirlukast and Zileuton? What is the result?

Interact w/ warfarin
Prolong INR

70

What does Zileuton also do? How do you address this?

Increase theophylline levels
Cut theophylline dose by 1/2

71

What is another issue with both Zafirlukast and Zileuton?

Hepatotoxicity

72

How common is anaphylaxis w/ anti-IgE monocolonal antibodies?

1-2/1000

73

What do anti-IgE monoclonal antibody permit?

Reduced inhaled corticosteroid dose

74

What is the greatest draw back of anti-IgE monoclonal antibody?

Very expensive

75

What are anti-IgE monocolonal antibodies often used for?

Severe persistent asthma

76

What is a logistical problem with anti interleukin IL-5 antibodies?

Very expensive

77

What is great about anti-interleukin IL-5 antibodies?

Decreases exacerbations by 50%

78

What is a risk w/ anti-interleukin IL-5 antibodies?

Possible anaphylaxis

79

Key points about asthma meds:

Quick relief or long term
Anti-inflammatory agents
Tx is step wise
Preferred rescue meds = SABAs