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ATTH 5100 > Chapter 11: Drugs For Treating Asthma > Flashcards

Chapter 11: Drugs For Treating Asthma Flashcards

1
Q

What is asthma?

A

A disease of diffuse airway inflammation caused by a variety of triggering stimuli, resulting in partially or completely reversible bronchoconstriction

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2
Q

Name some symptoms and signs of asthma:

A
  • dyspnea
  • chest tightness
  • cough
  • wheezing
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3
Q

Name the signs and symptoms of a fatal asthma attack.

A
  • use of accessory muscles of respiration
  • HR > 120 bpm
  • resps > 25-30 breaths/min
  • difficulty speaking
  • altered level of consciousness
  • quiet chest
  • diaphoresis
  • inability to lie supine
  • cyanosis
  • SpO2 < 90%
  • progressive agitation or anxiety
  • sense of fear or impending doom
  • sense of progressive breathlessness or air hunger
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4
Q

What are the 2 general classes of asthma medications?

A
  • quick-relief or rescue medications
  • long-term control medications
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5
Q

Name 3 short-acting rescue drugs.

A
  • short-acting beta-agonists (SABA)
  • anticholinergics
  • systemic (oral) corticosteroids
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6
Q

How are SABAs used? How do they work?

A
  • first choice for quick relief of asthma symptoms
  • relax bronchiole smooth muscle (bronchodilators)
  • quickly opens airways
  • also used before exercise to prevent EIB
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7
Q

How quickly do SABAs work and how long do they last?

A
  • starts within minutes
  • lasts for 2-4 hours
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8
Q

What is the most common SABA? What is the route of administration?

A
  • Albuterol
  • administered by a metered-dose inhaler (MDI)
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9
Q

When is nebulized treatment used?

A

For people who have difficulties coordinating MDIs and spacers

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10
Q

What is PEF?

A

Peak expiratory flow

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11
Q

Pharmacological intervention is necessary for asthma patients who have:

A
  • PEF < 80% of personal or predicted best
  • lack of response to SABA treatment
  • symptoms: coughing, breathlessness, wheezing, chest tightness, use of accessory muscles for breathing
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12
Q

ATs should administer up to _____ puffs of SABA in 1 hour, reassessing the patient response to treatment every _____ min.

A
  • 3
  • 5-10 min
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13
Q

What steps should be taken with a severe asthma episode with poor response (PEF < 60% of personal or predicted best)?

A
  1. Add prescribed oral corticosteroid drug
  2. Repeat SABA treatment immediately
  3. Add prescribed inhaled anticholinergic medication
  4. Immediately transport the patient to a hospital emergency department
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14
Q

Which asthma patients should be transported to the emergency department?

A

Patients who do not respond or have severe symptoms or a PEF persistently < 80% of baseline

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15
Q

How do anticholinergics work?

A
  • reduce mucus and open airways by inhibiting muscarinic cholinergic receptors and reducing intrinsic vagaries tone of the airway
  • these take longer to be effective than SABAs but may be used as an alternative bronchodilator for patients who do not tolerate SABAs.
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16
Q

Administration of ______ provides additive benefit to SABAs in moderate to severe asthma exacerbations.

A

Anticholinergics

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17
Q

Name a popular anticholinergic.

A

Ipratropium (Atrovent)

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18
Q

How do systemic (oral) corticosteroids work?

A
  • reduce inflammation, swelling, mucus production in the airways of a person with asthma
  • not short acting, but used for moderate and severe exacerbations as an adjunct to SABAs to speed recovery and prevent recurrence of exacerbations
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19
Q

Systemic (oral) corticosteroids are unnessarey for patients who…

A

Patients whose PEF normalizes after 1 or 2 bronchodilator doses

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20
Q

Describe dosing of prednisone for asthma.

A
  • higher doses (50-60 mg, once a day) prescribed for management of more severe exacerbations require in-patient care
  • lower doses (40 mg, once a day) prescribed for outpatient treatment of milder exacerbations
  • treatment duration of 5-7 days is recommended
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21
Q

The most effective long-term-control medications are those that…..

A
  • attenuate the underlying inflammation characteristic of asthma
  • help to control asthma and prevent asthma attacks
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22
Q

Name 4 long-term asthma control medications:

A
  • inhaled corticosteroids (ICS)
  • long-acting beta-agonists (LABAs)
  • inhaled mast cell stabilizers
  • leukotriene modifiers
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23
Q

What is the most potent and consistently effective anti-inflammatory medication currently available for long-term control of asthma?

A

Inhaled corticosteroids (ICS)

24
Q

How do inhaled corticosteroids work?

A
  • block late-phase reaction to allergens
  • reduce airway hyper responsiveness
  • inhibit inflammatory cell migration and activation
25
Q

Name some clinical effects of ICS:

A
  • reduction in severity of symptoms
  • improvement in PEF, asthma control, and quality of life
  • diminished airway hyper responsiveness
  • prevention of exacerbations
  • reduction in the need for systemic corticosteroid medications
  • reduced emergency department care, hospitalizations, and deaths due to asthma
  • possible attenuation of loss of lung function
26
Q

Name a common ICS.

A

Fluticasone (Flovent)

27
Q

Name 2 combinations of corticosteroids and LABAs.

A
  • fluticasone and salmeterol (Advair)
  • budesonide and formoterol (Symbicort)
28
Q

How long do LABAs last?

A

Duration of bronchodilation of > 12 hours after a single dose

29
Q

LABAs should be used in combination with:

A
  • ICS for long term control and prevention of symptoms in moderate or severe persistent asthma
  • SABAs for management of acute symptoms
30
Q

Why is frequent and chronic use of LABAs discouraged?

A

This may disguise poorly controlled persistent asthma

31
Q

What is the onset of action for LABAs?

A

> 30 min

32
Q

Name a common LABA.

A

Salmeterol (serevent diskus)

33
Q

LABA medications are available in what forms?

A

Dry powder that is taken using a dry powder inhaler (DPI)

34
Q

Describe DPIs.

A
  • does not contain propellants or any other ingredients, only the medication
  • contains up to 60 doses of medication
  • has a dose indicator that counts down the number of doses remaining
35
Q

How do inhaled mast cell stabilizers work?

A

Stabilize mast cells and interfere with chloride channel function

36
Q

How are inhaled mast cell stabilizers used?

A
  • alternative, but not preferred medication for the treatment of mild persistent asthma
  • also used as preventive treatment prior to exercise or unavoidable exposure to known allergens
37
Q

Name a common inhaled mast cell stabilizer.

A

Cromolyn sodium

38
Q

Inhaled mast cell stabilizers have lower efficacy, but may be considered for _____. Regular controller therapy with ______ or a combination of _______ and ______ to be used as needed is preferred/

A
  • EIB
  • ICS
  • SABAs
  • corticosteroids
39
Q

How are leukotriene modifiers used?

A

May be used for the treatment of certain conditions associated with allergic response or asthma

40
Q

Leukotriene are released from where?

A
  • mast cells
  • basophils
  • eosinophils
41
Q

_______ _______ ______ is the pathophysiology of asthma, including airway edema, smooth muscle contraction, and altered cellular activity associated with the ______ process.

A
  • leukotriene receptor occupation
  • inflammatory
42
Q

How do leukotriene-receptor antagonists work?

A

Prevent leukotriene from binding to their receptors

43
Q

Name a common leukotriene modifier.

A

Montelukast (singulair)

44
Q

How are leukotriene modifiers administered?

A

Orally as tablets

45
Q

Why does montelukast (Singulair) have limited availability for use?

A
  • increased risk of adverse consequences
  • must be monitored
  • possible mental health side effects - black box warning
46
Q

How can ATs determine the effectiveness of asthma medication?

A
  • assessing the severity of the asthma with lung function measures
  • recording vital signs (including pulse ox and peak flow meter readings)
  • performing a physical examination to identify signs and symptoms
47
Q

Bronchodilator treatments are limited to a maximum of ____ for the first hour, then _____ per hour thereafter.

A
  • 3
  • 1
48
Q

Long-term strategies for controlling asthma focuses on what 3 things?

A
  • preventing exacerbation
  • reducing impairment
  • reducing risk
49
Q

Describe the green zone of asthma control.

A
  • 80-100% of personal best
  • good control, no asthma symptoms
  • if taking LABA, should continue taking them even when peak flow numbers fall in the yellow or red zones
50
Q

Describe the yellow zone of asthma control.

A
  • 50-79% of personal best
  • signals caution: the patient’s asthma is getting worse
  • follow patient’s written asthma plan and add quick relief medications (SABA)
  • prescriber may need to adjust asthma medications
51
Q

Describe the red zone of asthma control

A
  • < 50% of personal best
  • signals medical alert
  • add or increase quick-relief medicines (SABA) according to instructions in the written asthma action plan
  • call EMS immediately
52
Q

What does someone with well-controlled asthma look like?

A
  • few, if any, asthma symptoms
  • few, if any, awakenings during the night caused by asthma symptoms
  • no need to take time off from school or work due to asthma
  • few or no limits on full participation in physical activities
  • no emergency department visits
  • no hospital stays
  • few or no side effects from asthma medicines
53
Q

How can ATs prevent exacerbation of EIB?

A
  • encourage physical activity
  • encourage an extended warm up
  • teach patients to take treatment before exercise
  • understand the use, misuse and abuse of SABAs
  • consider long-term control medication
54
Q

For prophylaxis, use _______ (such as _____), inhaled ______ min before exercise.

A
  • a rapid acting SABA
  • Albuterol
  • 10-15
55
Q

Excessive overuse of a SABA can lead to…

A
  • increased tolerance to the medication
  • results in decreased effectiveness
56
Q

The frequent need (____ times per day) for SABA therapy during practice or an athletic event should cause concern.

A

3 or more

57
Q

LABAs should generally be used only for asthma _______ and _______. They are usually combined with an ______ ______.

A
  • prophylaxis
  • control
  • inhaled corticosteroid

ATTH 5100 (13 decks)

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