Chapter 41: Asthma Flashcards
(113 cards)
1
Q
What is asthma?
A
A disease that affects the airways (bronchi) of the lungs
2
Q
What are the characteristics of asthma?
A
Chronic airway inflammation and bronchoconstriction
3
Q
What does bronchoconstriction cause?
A
Narrowed airways leading to airflow obstruction
4
Q
What results from airflow obstruction in asthma?
A
Expiratory airflow limitation (difficulty with exhalation)
5
Q
What are the classic symptoms of asthma?
A
Wheezing, breathlessness, chest tightness, and coughing
6
Q
What is the most common complication of asthma?
A
Exacerbations, also called asthma attacks
7
Q
What does FEV1 measure?
A
How much air can be forcefully exhaled in one second
8
Q
What does FVC stand for and what does it measure?
A
Forced Vital Capacity; the maximum volume of air exhaled after a deep breath
9
Q
What does the FEV1/FVC ratio indicate?
A
The percentage of total air capacity that can be forcefully exhaled in one second
10
Q
What is the significance of an FEV1 increase > 12% post-bronchodilator?
A
It is consistent with asthma diagnosis (considered reversible)
11
Q
Fill in the blank: An asthma diagnosis should be confirmed with _______.
A
spirometry
12
Q
What rescue inhaler use frequency indicates intermitent asthma?
A
2 days or less per week
13
Q
What rescue inhaler use frequency indicates mild persistent asthma?
A
more than 2 days/week but not daily
14
Q
What rescue inhaler use frequency indicates moderate persistent asthma?
A
Daily
15
Q
What rescue inhaler use frequency indicates severe persistent asthma?
A
Several time per day
16
Q
What is the preferred delivery vehicle for asthma medications?
A
Inhaled forms.
17
Q
What are the two classifications of asthma drugs?
A
Relievers (rescue inhalers) and controllers (maintenance drugs).
18
Q
What do relievers do?
A
Rapidly open airways within minutes of inhalation to treat acute symptoms.
19
Q
List asthma rescue drugs
A
- Low-dose inhaled corticosteroid (ICS) + formoterol.
- Inhaled SABA
- Systemic steroids
- SAMAs
20
Q
What is the preferred reliever regimen for asthma?
A
Low-dose inhaled corticosteroid (ICS) + formoterol.
21
Q
Brand names available for Low-dose inhaled corticosteroid (ICS) + formoterol?
A
- Budesonide + formoterol (Symbicort)
- Mometasone + formoterol (Dulera)
22
Q
What is formoterol?
A
A long-acting beta-2 agonist (LABA) with fast onset.
23
Q
What is the role of short-acting beta-2 agonists (SABAs) in asthma treatment?
A
Used intermittently for acute asthma symptoms and can quickly reverse bronchoconstriction.
24
Q
Fill in the blank: Controllers, or maintenance inhalers, are taken on a _______ basis.
A
daily.
25
What class of medications is the first line maintenance drug for all asthma patients?
ICS
26
What should LABAs be used with to treat asthma?
An inhaled corticosteroid (ICS).
27
What are injectable monoclonal antibodies used for in asthma treatment?
Add-on treatment in persistent severe asthma.
28
Name one monoclonal antibody used for severe allergic asthma.
Omalizumab.
29
Fill in the blank: Mepolizumab, reslizumab, benralizumab, and dupilumab are used for _______ asthma.
severe eosinophilic.
30
What is Tezepelumab used for?
Severe asthma, regardless of eosinophil counts or biomarkers.
31
What is the only LAMA approved for asthma?
Tiotropium (Spiriva Respimat)
32
Which asthma patients should receive Low-dose ICS-formoterol or albuterol?
All asthma patients need a rescue inhaler
33
What step of asthma treatment is indicated for symptoms less than 2 times per month?
Step 1(intemittent) includes using as-needed low-dose ICS-formoterol.
34
What should be initiated if asthma symptoms or need for SABA is ≥ 2 times per month?
Step 2 may include SABA + low-dose ICS taken together.
35
What combination of medications is used at Step 3 for asthma treatment?
Low-dose ICS-formoterol + SABA or ICS-SABA
## Footnote
This step is for symptoms on most days or nighttime awakenings ≥ 1x/week.
36
Which step indicates that symptoms are daily and waking at night ≥ 1x/week?
Step 4, medium-dose ICS-formoterol or medium-dose ICS-LABA may be used.
37
What do beta-2 agonists bind to?
Beta-2 receptors, causes relaxation of bronchial smooth muscle and leads to bronchodilation.
38
What are SABAs used for?
Acute asthma symptoms
39
What is the current recommendation for using SABAs?
Should be used with an ICS
40
What are LABAs used as part of?
Rescue therapy or maintenance therapy
## Footnote
LABAs are used in combination with an ICS.
41
When should a LABA be added to treatment?
Before increasing to high-dose ICS
42
What is the dosing for Albuterol (ProAir HFA) as a SABA?
1-2 inhalations Q4-6H PRN
43
What are common side effects of beta-2 agonists?
Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, hypokalemia
44
What is the boxed warning for LABAs?
Risk of asthma-related deaths if used alone
45
Fill in the blank: Most albuterol inhalers contain ______ inhalations per canister.
200 inhalations
46
What is the recommended timing for using EIB medication?
Use 2 inhalations 5 minutes prior to exercise
47
Albuterol brand names
1. ProAir
2. Proventil
3. Ventolin
48
Salmeterol brand name
Serevent Diskus
49
What do corticosteroids inhibit?
The inflammatory response
50
How are ICSs used for acute symptoms?
In combination with formoterol or a SABA for rescue treatment.
51
What is the maintenance treatment for asthma using ICSs?
Monotherapy or combination therapy (with a LABA) to control symptoms.
52
Beclomethasone brand name
QVAR RediHaler
53
Budesonide brand name
Pulmicort Flexhaler
54
Fluticasone brand names
* Flovent
* Arnuity Ellipta
55
Brand name for Fluticasone+Salmeterol
Advir
(ICS+LABA)
56
Brand name for Fluticasone + Vilanterol
Breo Ellipta
(ICS+LABA)
57
Mometasone brand name
Asmanex
58
List generic and brands for all ICS+LABA combinations
1. Fluticasone + Salmeterol (Advir)
2. Fluticasone + Vilanterol (Breo Ellipta)
3. Budesonide + Formoterol (Symbicort)
4. Mometasone + Formoterol (Dulera)
59
What warnings are associated with high doses of ICSs?
Can cause adrenal suppression, risk of fractures, growth retardation in children, and immunosuppression.
60
What are common side effects of ICSs?
* Dysphonia (difficulty speaking)
* Oral candidiasis (thrush)
* Cough
* Hyperglycemia
61
What is recommended to prevent thrush when using ICSs?
Rinse mouth with water and spit out after each use.
62
What special feature does Alvesco have?
It is an MDI that does not need to be shaken before use.
63
What should be used with Pulmicort Respules?
Only with a jet nebulizer connected to an air compressor.
64
What is unique about QVAR RediHaler?
It is a breath-activated aerosol that does not need shaking or a spacer.
65
What is the generics and brand name for the triplet therapy approved for asthma?
Trelegy Ellipta (LAMA/LABA/ICS)
1. Umeclidinium
2. Vilanterol
3. Fluticasone
66
What are the two main types of inhaler devices?
Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs)
## Footnote
This includes breath-actuated DPIs.
67
What is the brand name identifier for MDIs?
HFA, Respimat or no suffix (e.g., Symbicort, Dulera)
68
What type of delivery method do MDIs use?
Aerosolized liquid
69
What inhalation technique is required for MDIs?
Slow, deep inhalation while pressing the canister
70
What is the benefit of using a spacer with MDIs?
Helpful in patients incapable of hand-breath coordination and decreases risk of thrush (with ICS)
71
Which MDIs do not require a spacer?
QVAR RediHaler, Alvesco and Respimat products, and Atrovent HFA
72
When should MDIs be shaken?
Before first use and if not used for a certain period of time
73
What should you not do with QVAR RediHaler?
Do not shake
74
What are examples of DPIs?
Diskus, Ellipta, Pressair, HandiHaler, RespiClick, Flexhaler
75
What inhalation technique is required for DPIs?
Quick, forceful inhalation (breath activated dose delivery)
76
Is a spacer needed for DPIs?
Not needed except for Flexhaler (prior to first use)
77
Which leukotriene does montelukast inhibit?
Leukotriene D4 (LTD4)
78
What is the mechanism of action of zileuton?
5-lipoxygenase inhibitor that inhibits leukotriene formation
79
What is the brand name for montelukast?
Singulair
80
For what additional conditions is montelukast approved?
* Allergic rhinitis
* Exercise-induced bronchoconstriction
81
What is the dosing for montelukast in adults?
10 mg daily in the evening
82
What is the dosing for montelukast in children aged 6-14 years?
5 mg daily in the evening
83
What is the dosing for montelukast in children aged 1-5 years?
4 mg daily in the evening
84
What are the boxed warnings for montelukast?
Neuropsychiatric events, including suicidal thoughts or actions
85
How can montelukast granules be administered?
Directly in the mouth, dissolved in breast milk or formula, or mixed with a spoonful of applesauce, carrots, rice, or ice cream use within 15 min of opening the packet
86
How should zafirlukast be stored?
Protected from moisture and light; dispense in original container
87
What are the active metabolites of Theophylline?
* caffeine
* 3-methylxanthine
88
What weight is used for the oral loading dose of Theophylline?
IBW (or TBW if < IBW)
89
What is the therapeutic range for Theophylline?
5-15 mcg/mL
90
When should the peak level of Theophylline be measured?
At steady state, after 3 days of oral dosing
91
What are signs of Theophylline toxicity?
* Persistent vomiting
* Arrhythmias
* Seizures
92
How do you convert aminophylline to theophylline?
Multiply by 0.8
93
How do you convert theophylline to aminophylline?
Divide by 0.8
94
List drugs that can increase theophylline levels
1. Carbamazepine
2. Fosphenytoin
3. Phenobarbital
4. Phenytoin
5. Primidone
6. Rifampine
7. Ritonavir
95
What is the FDA-approved anticholinergic for asthma in patients ≥ 6 years with a history of exacerbations?
Tiotropium (Spiriva Respimat)
96
What are the effects of anticholinergics on the airway?
They inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone, leading to bronchodilation.
97
What type of asthma is suitable for treatment with monoclonal antibodies?
Severe asthma that remains uncontrolled despite maximized treatment with inhaled medications
98
What should be determined prior to starting treatment with monoclonal antibodies for asthma?
The patient's specific asthma phenotype
99
What is the mechanism of action of Omalizumab (Xolair)?
Inhibits IgE binding to the IgE receptor on mast cells and basophils
100
What is the indication for Omalizumab?
Severe allergic asthma
101
How often should Omalizumab (Xolair) be administered?
SC Every 2 or 4 weeks based on pretreatment IgE serum levels and body weight
102
What is required before initiating Omalizumab therapy?
Initiate in a healthcare setting under medical supervision for the first three doses
103
What must be documented before using Omalizumab?
Allergic asthma with a positive skin test
104
What is the boxed warning associated with Omalizumab?
Anaphylaxis can occur at any point in treatment
105
What is the administration route and frequency for Reslizumab (Cinqair)?
Administer IV once every 4 weeks
106
What is the boxed warning for Reslizumab?
Anaphylaxis; patients must be observed after administration
107
What is the indication for Tezepelumab (Tezspire)?
Severe asthma of any kind
108
What is the administration frequency for Tezepelumab (Tezspire)?
Administer SC every 4 weeks
109
What should a patient do if prescribed more than 1 inhalation of medication at a time?
The patient should wait 60 seconds between each one.
110
What is a nebulizer?
A device that turns liquid medication into a fine mist.
111
What is the recommended frequency for cleaning spacers?
At least once a week
112
Name common spacers used for inhalation therapy.
* AeroChamber
* OptiHaler
* OptiChamber
113
What is a peak flow meter used for?
it is handheld devices that measure the peak expiratory flow rate.
