Module 5: Respiratory (a) Flashcards
(43 cards)
1
Q
Asthma
-Definition
A
- Chronic inflammatory dz of the airway
2. External stimuli cause inflammatory cells to release mediators (ex: histamine, Leukotriene’s) causing asthma symptoms
2
Q
Goal of Asthma Therapy
-2 domains?
A
- Reducing impairment
- Prevent chronic symptoms
- Infrequent use of SABA
- Maintain near normal PF
- Maintain normal activities
- Meet patients’/families’ satisfaction w/ care - Reducing Risk
- Prevent exacerbations, ED visits and hospitalizations
- Prevent loss of lung function/growth
- Optimal treatment w/ little to no adverse events
3
Q
Goal of Asthma Therapy
-Domain 1 (Reducing Impairment)
A
- Reducing impairment
- Prevent chronic symptoms
- Infrequent use of SABA
- Maintain near normal PF
- Maintain normal activities
- Meet patients’/families’ satisfaction w/ care
4
Q
Goal of Asthma Therapy
-Domain 2 (Reducing Risk)
A
- Reducing Risk
- Prevent exacerbations, ED visits and hospitalizations
- Prevent loss of lung function/growth
- Optimal treatment w/ little to no adverse events
5
Q
Asthma
-Quick Relief Therapy
A
- Bronchodilators
- SABA’s
- Anticholinergics - Systemic Corticosteroids
- Inhaled Corticosteroids + formoterol (LABA)
6
Q
Asthma
-New 2020 recommendations
A
- SABA’s are recommended in conjunction w/ ICS for management of asthma-related symptoms
- Less effective than inhaled beta agonists—slower onset of action and aches less Bronchodilation
7
Q
SABA
-Indication
A
- Acute PRN treatment of Bronchospasm
2. Treatment at the start of respiratory tract infection w/ ICS**
8
Q
SABA’s
-MOA
A
- Activates adenlyate cyclase and increases cAMP thereby relaxing smooth muscle and relieving broncho-constriction.
- Onset = 5 minutes
9
Q
SABA’s
-Contraindication and S/E
A
- Ischemic heart dz
- HTN, arrhythmia
- Seizures and hyperthyroidism
Caution with:
- Tricyclics, MAO inhibitors
- Antagonized by beta blockers
- SABA’s and beta blockers can block each other
10
Q
SABA’s
-A/E
A
- Tachycardia & palpitations
- Tremor
- Hypokalemia
- Hyperglycemia
- Headache and dizziness
11
Q
SABA
-Albuterol Inhaler availability/dosing?
A
- MDI ProAir, Ventolin, Proventil 90mcg/spray (All brand name; expensive)
Admin:
-2 puffs every 4-6hrs PRN wheezing - For Exercise induced Asthma:
- 2 puffs inhaled 5-30 minutes before exercise
12
Q
SABA
-Albuterol Nebulizer dosages and admin?
A
- 2.5mg/3ml (0.083%)
- 5mg/ml (0.5%)
Bronchospasm
-2.5mg per neb q6-8hrs PRN Max dose 10mg/day (4 total doses daily)**
Acute Bronchospasm**
-2.5-5mg per neb q20 min x3 AND CALL 911
13
Q
SABA
-Levalbuterol (Xopenex) Dosing per age
A
- > 4 yrs = MDI 45mcg/spray 2 puffs q4-6 hrs PRN
- 6-11 yrs =0.31mg - 0.63 mg NEB TID PRN
- > 12 yrs = 0.63 - 1.25 mg NEB TID PRN
14
Q
Antimuscarinics/Anticholinergics
- Info
A
- Short and Long acting
- Used MOST frequently in COPD
- Ipratropium-Albuterol (Combivent)
- Second-line quick relief medication for asthma
Not supported by GINA
15
Q
Long Term Asthma Control
-Examples
A
- Inhaled Corticosteroids (GOLD STANDARD)**
- Leukotriene modifiers
- Cromolyn
- Methylxanthines
- LABA’s
- Immunomodulators
16
Q
Inhaled Corticosteroids
-Info?
A
- Used to reduce symptoms, reduce exacerbations, and reduce use of SABA, while improving PF
- Used for Mild and Persistent asthma
- Intermittent asthma for quick relief therapy
- Add-on + SABA at the start of a worsening or a respiratory tract infection**
17
Q
Inhaled Corticosteroids
-MOA & Onset
A
- Reduce eosinophils and mast cells in airways
- Reduce airway hyperresponsiveness by reducing inflammation
- Reduce responsiveness to histamine, exercise, allergens or irritants
- Onset = 2 weeks of continuous therapy for max effectiveness
18
Q
Inhaled Corticosteroids
-Caution w/ Children
A
- Can stunt growth with children
- Use lowest dose w/ a spacer with children under 5 yrs old. - Less risk than oral corticosteroids
- Pregnancy/lactating risk of fetal adrenal suppression
19
Q
Inhaled Corticosteroids
-A/E
A
- Oropharyngeal Candidiasis (THRUSH)
- RINSE mouth after use**
20
Q
Inhaled Corticosteroids
-Use in pregnancy?
A
- Use Pulmicort as drug of choice during pregnancy
21
Q
Inhaled Corticosteroids
-Medication examples?
A
- Beclomethasone (Qvar)
- Budesonide (Pulmicort)
- Ciclesonide (Alvesco)
- Fluticasone (Flovent)
- Mometasone (Asmanex)
22
Q
Leukotriene Modifiers
-Info
A
- Alt treatment option for mild persistent asthma
- Adjunct w/ ICS 12 years and older - MOA
- Blocks binding of leukotrienes to receptors recurring contraction of smooth muscle, vascular permeability, mucus secretions and activation of inflammatory cells
23
Q
Leukotriene Modifiers
-Contraindications/Caution & A/E’s
A
- Contraindicated for reversal of ACUTE BRONCHOSPASM
- NOT for ACUTE. Maintenance - Increased bleeding risk w/ Coumadin and aspirin
A/E
- Headache >10%**
- dizziness, weakness
- GI
- Myalgias
- Fever
24
Q
Leukotriene Modifiers
-Psych?
A
- In younger children, these meds can cause MOOD INSTABILITY** PSYCH
25
Leukotriene Modifiers
| -Montelukast (Singulair)
1. Adult: 10 mg
2. Pediatric 1-5yrs: 4 mg
3. 6-14 yrs: 5 mg
Caution with Pregnancy and Lactation
Often given at night**
26
Cromolyn
| -Info
1. Mast cell stabilizer
2. Alt Therapy in children for step 2
- Prevents exercise induced asthma
MOA:
-Blocks chloride channels and modulate mast cell mediator release
Caution:
-Renal/hepatic impairment
A/E:
-Unpleasant taste, rash, sore throat, cough
27
Cromolyn
| -Dosing
1. Adult: 20 mg QID per nebulizer initially
2. Pediatric: >2 yrs 20 mg QID per nebulizer initially
Pregnancy/Lactating: NO RISK**
Not used a lot in primary care*
28
Methylxanthines
| -Info
1. Alt treatment for adolescents and adults w/ mild persistent asthma
2. MOA
- Inhibits phosphodiesterase, preventing breakdown of cAMP, causing smooth muscle to relax and preventing release of histamine and leukotrienes
29
Methylxanthines
| -Contraindications & A/E’s
1. Contraindicated in:
- Allergy to CORN products
- Not recommended <12 yrs
- Not for Acute asthma exacerbations
A/E’s
- Life threatening ARRHYTHMIA’S
- HA
- N/V/D
- restlessness, seizures & palpitations
Can Cause TOXICITY
30
Methylxanthines
| -Exemplar Drug
1. Theophylline is exemplar drug
2. Max dose in adults 600 mg/day
3. Avoid in pregnant women
4. Monitor blood levels every 6 months for TOXICITY’S**
31
Methylxanthines
| -Therapeutic Levels?
1. Adults: 5-15 mcg/ml
| 2. Peds: 5-10 mcg/ml
32
LABA’s
| -Info
1. Used in combination w/ ICS for treatment of MODERATE PERSISTENT ASTHMA
2. MOA
- Activates adenylate cyclase & ⬆️cAMP ➡️ relaxing smooth muscle and relieving bronchoconstriction
33
LABA’s
| -Contraindication/Caution & A/E’s
Same cautions and A/E’s as SABA’s**
Ex:
-Ischemic heart dz, HTN, arrhythmia, seizures, hyperthyroidism
Caution w/:
-Tricyclics, MAO inhibitors; antagonized by beta blockers
A/E’s:
-Same as SABA’s
34
LABA’s
| -How to Use?
1. NEVER used as Monotherapy
- Used as adjunct with ICS**
- Does not replace ICS
2. NOT for acute exacerbations
3. Can use ICS + formoterol (LABA) for ACUTE SYMPTOMS
35
LABA’s
| -Black Box Warning
1. Increase risk of asthma related death
36
ICS/LABA Combo Therapy?
1. Advair (Fluticasone/Salmeterol)
- NOT used in pregnancy/lactation
2. Symbicort (Budesonide/Formoterol)**
- ICS/LABA Combo that can be used as MAINTENANCE or RESCUE per GINA guideline**
37
Proper Use of Inhaler
| -Steps**
1. Shake inhaler for 2-5 seconds
2. If not used for >48 hrs, Prime the inhaler by depressing canister once
3. Sit up straight or stand and breath out all the way
4. Slowly breath in THEN depress canister once already breathing in
- Continue breathing in for 3-5 seconds until lungs are full
5. Hold breath for 10 seconds and wait 1 minute between puffs
6. RINSE MOUTH then spit out
7. Re-cap and store
38
Immunomodulators
| -Exemplar/Info
1. Omalizumab (Xolair) for SEVERE PERSISTENT ASTHMA
2. MOA
- Prevents IgE from binding to mast cells and basophils leading to decrease mediators
3. NOT for acute attack
A/E’s
-Anaphylaxis, URI, headache, bruising at injection site
Should be prescribed and administered by specialist** NOT FOR PRIMARY CARE
39
Systemic Corticosteroids
| -Info
1. Treatment in ACUTE moderate/severe asthma exacerbation
2. MOA
- Inhibit cytokine and mediator release, inhibit IgE synthesis
- Suppress inflammatory process & suppress airway inflammation and edema
3. Peak reached in 1-2 hrs
- 5 day-2 week coarse recommended
40
Systemic Corticosteroids
| -Contraindications/Cautions?
1. Untreated infection
2. Lactation
3. Alcohol intolerance
4. DM w/ increase BG
- with quinolones- TENDON RUPTURE
41
Fluoroquinolones & Systemic Corticosteroids??
1. Increase risk of TENDON RUPTURE
42
Systemic Corticosteroids
| -A/E’S
1. ANAPHYLAXIS
2. Adrenal insufficiency
3. Cushing’s syndrome
4. Edema
5. Hypokalemia
43
Systemic Corticosteroids
| -How to administer?
1. Short-course “BURST” treatment
2. Adults:
- 40-60 mg daily for 5-14 days
3. Peds
- 1-2mg/kg/day divided QD-BID x 3-10 days
4. Can be administered w/out tapering
5. Continue until peak expiratory rate is 80% or symptoms resolve
