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AsthmaFC Flashcards

1
Q

What cells/cellular elements play a role in asthma?

A

mast cells, eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells

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2
Q

what are the classic signs/symptoms of asthma?

A

wheezing, breathlessness, chest tightness, coughing

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3
Q

what medications can be triggers for Astma?

A

ASA, NSAIDS, sulfites, and beta blockers

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4
Q

What are 4 brand names for albuterol?

A

Ventolin, Proventil, ProAir, Accuneb

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5
Q

What is the brand name of levalbuterol?

A

Xopenex- R isomer of levaalbuterol

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6
Q

When should patients taking a SABA know if they need to increase their maintenance therapy?

A

If they are using the SABA >2 days/week

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7
Q

What is the DOC for exercise induced bronchspasm?

A

SABA

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8
Q

What are the 2 LABA’s?

A

formoterol and salmetrerol

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9
Q

do no use as? The LABAS

A

do not use as monotherapy.

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10
Q

dosing frequency of LABAS

A

BID

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11
Q

what is the MOA of albuteroal and long acting beta agonists?

A

they are beta 2 agonists which cuase relaxation of the bronchial smooth muscle leading to bronchodilation

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12
Q

What are the combo products with LABA’s?

A

salmeterol + fluticasone = advair diskus
formoterol + budesonide = Symbicort

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13
Q

Side effects of SABAs

A

tremor, shakiness, lightheaded ness, cough, palpitations, hypokaelemia, tachycardi, hyperglycemia

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14
Q

What BBW is on LABA’s?

A

increase risk of asthma related deaths. Do not use as monotherapy;

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15
Q

What is a mast cell stabilizer? drug and MOA

A

cromolyn (Intal) - prevent mast cell release of histamine and leukotrienes by inhibiting degranulation after contact with allergens.

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16
Q

can you use for exercise? (mast cell stabilizers)

A

yes -15 mins prior

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17
Q

QVAR

A

beclomethasone

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18
Q

Pulmicort

A

budesonide

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19
Q

aerospan

A

flunisolide

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20
Q

Asmanex

A

momentasone

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21
Q

Flovent

A

fluticasone

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22
Q

Aerobid

A

flunisolide

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23
Q

What is the MOA of corticosteroids in asthma?

A

inhibit the inflammatory response, depresses migration of polymorphonucleur leukocytes, fibroblasts and others to prevent inflammation

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24
Q

what are examples of inhaled corticosteroids?

A

beclomethasone (QVAR HFA)Budenoside (Pulmicort)
Flunisolide (Aerospan, AEROBID) KNOW
Fluticasone (Flovent)
Mometasone (Asmanex)

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25
What is an important counseling pt with inhaled corticosteroids?
rinse mouth after use to prevent oral candidiasis
26
In the Advair diskus, which medication dose varies?
The fluticasone (100, 250, 500 mcg) / salmeterol = 50 mcg
27
in the symbicort HFA, which medication dose varies?
The budesonide - 80 or 160 mcg + 4.5 formoterol
28
What is Dulera?
mometasone + formoterol
29
Which oral steroid is the most potent? least potent?
betamethasone, cortisone
30
what age is for advair discus vs advair HFA? Symbicort hfa?
greater than OR equal 4 years old, greater or equal to 12 years old ,12 years or greater
31
Is prednisone or methylprednisolone more potent?
methylprednisolone
32
singulair
montelukast
33
side effects of montelukast
HA, Dizzleness, URTIs ,can increase LFTs
34
montelukast is a major substrate of which CYP?
2C9
35
What is the MOA for theophylline?
blocks phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal cells, resulting in bronchodilation, diuresis, CNS and cardiac stimulation
36
what is the therapeutic lab range for theophylline?
5-15 mcg/ml
37
What are signs of theophylline toxicity?
persistant and repetitive vomiting, ventricular tachycardia, seizures
38
what is unique about theophylline kinetics?
first order followed by michaelis-Menten = saturable = small increase in dose can result in large increase in concentration
39
Theophylline is a major substrate of which CYP?
CYP1A2 and CYP3A4
40
What are some drugs that may increase theophylline due to 1A2 inhibition?
OC, acyclovir, cimetidine, cipro, fluvoxamine, isoniazid
41
What are some drugs that may increase theophylline due to 3A4 inhibition?
amiodarone, azole antifungals, clarithroymycin, erythromycin, diltiazem, verapamil, lova, ator, simvastatin, PIs
42
What is omalizumab? brand and MOA
XOLAIR - IgG monoclonal antibody that inhibits IgE binding to receptor on mast cells and basophils.
43
Who is Xolair indicated for?
Pts with moderate to severe persistent asthma in pts with positive skin test to perennial aeroallergen that is inadequately controlled by inhaled steroids
44
What is the dosing for Xolair?
based on body wt and pretreatment serum IgE levels- given SC every 2 or 4 weeks in doctors office
45
What are the zones for Peak Flow Meter?
Green = 80-100% Yellow = 50-80% Red = <50%
46
What is Foradil?
formoterol
47
oral steroid dose equivalents =
betamethasone = 0.6 mg dexamethasone = 0.75 mg methylprednisolone = 4 mg prednisone = 5 mg hydrocortisone = 20 mg cortisone = 25 mg
48
exercise induced asthma how long before you take SABA, LABA and Monetlukast
Saba Right away, Laba 15-30 mins before,Montelukast 2 hrs before (lasts 24 hrs)- but if you already use it for asthma daily DO NOT take extra dose!!
49
in pregnancy use? For asthma
albuterol (DOC) and budesonide (for long term control)
50
saba side effects
tremor, shakiness lightheadedness, cough, palpitations
51
long term side effects of coricosteroids? after how long?
after 1 month: cushings, growth issues, osteoporosis, dermal thinning, muscle wasting, moon facies, cataract, gluacoma, hypokalemia. less than one month fluid retention, weight gain, emotional instability, gi upset
52
belcomethasone HFA
qvar
53
fluticasone + salmeterol
advair
54
mometasone
asmanex
55
pulmicort respules (budesonide) for who?
ages 1-8
56
pulse therapy
w/ systemic steroids w/ rapid onset of action for 15 days after asthma attack.
57
oral steroids when?
prednisone daily or every other day.
58
leukotriene modifying agents
zafirlukast, montelukast, zileuton
59
caution with luekotriene agents
neuropsychiatric sxs- report to md if signs of aggressive behavior, agitation, hostility.
60
when do you use anticholinergics
for pts in emergency department with acute attacks.
61
xolair bbw
anaphylaxis. observe pts after it can happen w/in 2-24 hrs.
62
rescuers asthma
SABA, systemic IV steroids, and anticholinergics.
63
controllers astham
inhaled steroids, leukotriene modifying agents, theophylline, alaba, cromolyn omalizumab
64
step 1 of asthma tx
saba prn
65
step 2 of asthma tx
low dose ICS, alternative: cromolyn, theophylline, LTRA
66
step 3 of asthma tx
low dose ICS+ LABA or medium dose ICS last: low dose ICS + theophylline or LTRA
67
step 4 of asthma tx
medium dose ICS+LABA, alt: medium dose ICS + theolphlline, LTRA
68
step 5 of asthma tx
high dose ICS + LABA
69
step 6 of asthma tx
high dose ICS + LABA + oral corticosteroid
70
albuterol and levaalbuterol dose
1-2 inhalation q 4-6 hours
71
salmertol brand name and dose
serevent-1 inhalation BID, HFA is 2 inhalation BID
72
formoterol brand and direction
foradil 1 capsule via aerolizer BID
73
symbicort dose (COMBO)
2 inhalation BID
74
cromolyn brand and dose
intal 2-4 inhalation q 6-8 hours
75
monetelukast
10 mg daily in the evening. age 6 months to 5 years take 4 mg daily, 5-14 take 5 mg daily
76
advair direction
1 inhalation BID KNOW, NEVER wash- DRY Powder inside.
77
advail hfa
2 inhalation bid KNOW
78
symbicort hfa
2 inhalation bid
79
theophylline dose
200-600 mg daily. therapeutic range is 5-15
80
how to take
ten second breath, SHAKE prior, AND SHAKE BEFORE each dose. and wait 1 min between doses.
81
if pt uses more than x oral steroids asthma plan needs to be change
if pt needs ORAL ORAL ORAL steroids more than 3 times a year fix yo plan
82
hfa inhalers and ozone
dont damage the ozonemaintenance of sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation.
83
children aged X can start using montelukast zafirlukast omalizumab
montelukast age 1 and up, zafirluekast age 5 and up omalizumab age 12 and up
84
what monitor w/ zileuton
LIVER! not so much w/ other mast cell stabilizers. but make sure u monitor each month for first 3 months then 2-3 times a year
85
what sweetener is used in montelukast tablets
phenylalanine can be used!!do not use in pts w/ phenylketonuria
86
potassium and albuterol
rmr albuterol was used to LOWER potassium. hence over use can result in hypokalemia
87
decrease theophylline levels
carabamezepine and primidone
88
w/ oral thrush
get a spacer it helps, drink n spit water, its not contangoues
89
advair age
4 and up
90
alvesco
ciclosonide
91
peak flow
< 50% go to the hospital

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