Therapeutics - Pediatric Asthma

Question 1

pediatric asthma is what age

Answer 1

6-11

Question 2

can kids “grow out” of asthma?

Answer 2

yes

Question 3

pharm. therapy recommended for acute asthma exacerbations for pediatrics

Answer 3

SABA + short acting anticholinergic (inhaled)

corticosteroids IV or PO

in the ER if asthma not controlled - IV magnesium
SQ/IV terbutaline/epinephrine is the airway is obstructed with mucus

Question 4

MAIN AGENT used during pediatric asthma exacerbation

Answer 4

albuterol

Question 5

outpatient pediatric dose for exacerbation

Answer 5

2-6 puffs q 20 mins then every 3-4 hours for the next 1-2 days

Question 6

true or false

albuterol and levalbuterol have the same efficacy

Answer 6

true

Question 7

can we use levalbuterol in a patient who had a prior AE to albuterol?

Answer 7

YES
better for kids with history of heart disease

Question 8

do we use MDI or nebulizer for peds during an exacerbation?

Answer 8

MDI has less SE and less time to administer it - better for mild-moderate asthma

but for severe exacerbations with lower airway obstruction - use higher doses during nebulization

Question 9

dry powder inhaler only for what age

Answer 9

4 and older - need to be able to breathe in hard enough

Question 10

role of ipratropium during pediatric exacerbation

Answer 10

add to SABA during exacerbation

Question 11

true or false

ipratropium has good evidence for hospitalized patients

Answer 11

FALSE - not recommended

Question 12

time until benefit is seen from systemic CS

Answer 12

4-6 hours

Question 13

use for systemic corticosteroids

Answer 13

for mod-severe exacerbations with SABA

Question 14

prednisolone vs dexamethasone treatment duration

Answer 14

prednisolone - 3-5 days

dexamethasone - 1-2 days

PO is preferred unless not able to tolerate

Question 15

***4 AE of systemic corticosteroids

Answer 15

gastritis
increase blood pressure
hyperglycemia
psychosis

(after multiple courses - bone density concern)

Question 16

2 injectable beta agonists and their AE

Answer 16

epinephrine, terbutaline

tachycardia, tremors, dysarrhythmias

Question 17

aminophylline is reserved for….

Answer 17

PICU settings and for pts not responsing to other adjunctive therapies

Question 18

1st line most effective therapy

Answer 18

INHALED CORTICOSTEROIDS!

Question 19

what do inhaled corticosteroids NOT do

Answer 19

do NOT modify the course of the disease

ie - will not stop mild asthma from becoming moderate

Question 20

optimize ___ intake when patient is on long term inhaled CS

Answer 20

vitamin D

Question 21

cromolyn reduces the need for…

Answer 21

B2 agonists

Question 22

can use ____ before a different inhaler to relax airway and prevent irritation

Answer 22

albuterol

Question 23

montelukast age of approval

Answer 23

12 months and older

Question 24

tiotropium age of approval

Answer 24

6 years and older

Question 25

when may specific allergy immunotherapy be effective

Answer 25

if the specific allergen is identified

Question 26

is there any CAM for asthma

Answer 26

no - not yet

Question 27

4 scenarios when we need to step up the pediatric patient's therapy

Answer 27

-wakes up at night with symptoms -urgent care visit -increased need for ICS/formoterol or SABA -more than 1 can of SABA per month but before increasing - make sure they're using inhaler properly, etc

Question 28

management of exercise induced asthma with: -SABA -cromolyn -LABA -leukotriene modifers

Answer 28

SABA - pretreat. lasts 2-3 hours cromolyn - use shortly before exercise. lasts 2 hours LABA - USE IS DISCOURAGED BEFORE EXERCISE. poorly controlled asthma may be disguised leukotriene - not very effective for this and has a very slow onset

Question 29

preferred reliever and controller for pregnant patients

Answer 29

reliver - albuterol controller- ICS (especially budesonide)

Question 30

should pregnant patients be given oral steroids for asthma

Answer 30

weigh risks vs benefits