Term
Intermittent Asthma
Symptoms:
Nighttime awakenings:
SABA use:
Interference with normal activity:
Lung Function: |
|
Definition
Symptoms: less than 2 days/week
Nighttime awakenings: <2x/month
SABA use: <2days/week
Interference with normal activity: non
Lung function:
-FEV1 normal between exacerbations
-FEV1 >80% of predicted
-FEV1/FVC is normal |
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Term
| Treatment of Intermittent Asthma |
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Definition
Long-term control: none needed
Quick Relief: SABA
Education:
-basic facts about asthma
-inhaler use |
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Term
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Definition
| relaxes bronchial smooth muscle through action on the beta 2 receptor |
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Term
Short-acting bronchodilators
B2 agonists |
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Definition
albuterol
levalbuterol
pirbuterol |
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Term
|
Definition
| Ventolin, Proventil, ProAir |
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Term
|
Definition
90 mcg/puff
2 puffs q4-6h prn symptoms |
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Term
Albuterol nebulizer solution
(less than 5 years old) |
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Definition
| 0.63 - 2.5 mg in 3 mL of saline q4-6h prn |
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Term
Albuterol nebulizer solution
(greater than 5 years old) |
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Definition
| 1.25 - 5 mg in 3 mL of saline q4-8h prn |
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Term
|
Definition
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Term
|
Definition
45 mcg/puff
2 puffs q4-6h prn |
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Term
Levalbuterol nebulizer solution
(less than 5 years old) |
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Definition
| 0.31 - 1.25 mg q4-6h prn symptoms |
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Term
Levalbuterol nebulizer solution
(5-11 years old) |
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Definition
| 0.31 - 0.63 mg q4-6h prn symptoms |
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Term
Levalbuterol nebulizer solution
(greater than 12 years old) |
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Definition
| 0.63 - 1.25 mg q4-6h prn symptoms |
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Term
|
Definition
Shake well before use
Inhaler should be primed before first use and if not used in 2 weeks (spray 4 puffs before using)
Patient should hold canister upright; make a tight seal around the mouthpiece, and breath in while pressing actuator slowly
Patient should hold breath for up to 10 seconds
Requires coordination for max effect |
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Term
Mild Persistent Asthma
Symptoms:
Nighttime awakenings:
SABA use:
Interference with normal activity:
Lung function: |
|
Definition
Symptoms: >2days/week but not daily
Nighttime awakenings: 3-4x/month
SABA use: >2days/week but not daily and not more than 1x/day
Interference with normal activity: minor
Lung function:
-FEV1 >80% of predicted
-FEV1/FVC is normal |
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Term
| Treatment of Mild Persistent Asthma |
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Definition
Long-term control: low dose ICS
Quick relief: SABA
Patient education:
-asthma facts
-proper inhaler technique
-role of each medication and proper use
-environmental factors |
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Term
|
Definition
beclomethasone (QVAR)
budesonide (Pulmicort)
ciclesonide (Alevsco)
Flunisolide (Flovent)
mometasone (Asmanex) |
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Term
|
Definition
Anti-inflammatory actions: suppress cytokine production
-reduce mucus production and secretion
-reduce bronchial hyperresponsiveness
-prevent and reverse airway remodeling
Improve response to B2 agonists
-increase number of B2 receptors |
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Term
| Beclomethasone brand name |
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Definition
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Term
| beclomethasone HFA inhaler (low dose) |
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Definition
| 80-240 mcg/day in divided doses BID |
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Term
| beclomethasone HFA inhaler (medium dose) |
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Definition
| 240-480 mcg/day in divided doses BID |
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Term
| beclomethasone HFA inhaler (high dose) |
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Definition
| >480 mcg/day in divided doses BID |
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Term
|
Definition
|
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Term
| budesonide flexhaler available strengths |
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Definition
| 90 mcg/puff, 180 mcg/puff DPI |
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Term
| budesonide flexhaler (low dose) |
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Definition
| 180-600 mcg/day in divided doses BID |
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Term
| budesonide flexhaler (medium dose) |
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Definition
| >600-1200 mcg/day in divided doses BID |
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Term
| budesonide flexhaler (high dose) |
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Definition
| >1200 mcg/day in divided doses BID |
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Term
| budesonide respules strenghts |
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Definition
suspension for nebulization
0.25/2mL, 0.5/2mL, 1mg/2mL |
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Term
|
Definition
Load med into inhaler (if necessary)
Device manipulated to release powder form of medication (twist, flip cap, etc)
Patient should breath out, place mouth around the mouthpiece, and inhale deeply and forcefully
Avoid breathing into the inhaler
Requires forceful breathing for max effect |
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Term
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Definition
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Term
| ciclesonide HFA inhaler strenghts |
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Definition
|
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Term
| ciclesonide HFA inhaler (low dose) |
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Definition
| 160-320 mcg/day in divided doses BID |
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Term
| ciclesonide HFA inhaler (medium dose) |
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Definition
| >320-640 mcg/day in divided doses BID |
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Term
| ciclesonide HFA inhaler (high dose) |
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Definition
| 640 mcg/day in divide doses BID |
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Term
|
Definition
|
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Term
| flunisolide HFA inhaler strength |
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Definition
|
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Term
| flunisolide HFA (low dose) |
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Definition
| 500-100 mcg/day in divided doses BID |
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Term
| flunisolide HFA (medium dose) |
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Definition
| >1000-2000 mcg/day in divide doses BID |
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Term
| flunisolide HFA inhaler (high dose) |
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Definition
| >2000 mcg/day in divided doses BID |
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Term
|
Definition
|
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Term
| fluticasone HFA inhaler strenghts |
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Definition
| 44 mcg/puff, 110 mcg/puff, 220 mcg/puff |
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Term
| fluticasone HFA inhaler (low dose) |
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Definition
| 88-264 mcg/day in divided doses BID |
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Term
| fluticasone HFA inhaler (medium dose) |
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Definition
| 264-440 mcg/day in divided doses BID |
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Term
| fluticasone HFA inhaler (high dose) |
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Definition
| >440 mcg/day in divided doses BID |
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Term
| fluticasone diskus DPI strength |
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Definition
|
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Term
|
Definition
|
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Term
|
Definition
| 110 mcg/puff, 220 mcg/puff |
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Term
| mometasone DPI (low dose) |
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Definition
| 220 mcg/day daily in the evening or in divide doses BID |
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Term
| mometasone DPI (medium dose) |
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Definition
| 440 mcg/day in the evening or in divided doses BID |
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Term
| mometasone DPI (high dose) |
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Definition
| >440 mcg/day in the evening or in divide doses BID |
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Term
|
Definition
oropharyngeal candidiasis
-oral thrush
-rinse mouth out after each use
dysphonia |
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Term
|
Definition
occur with high doses
growth suppression
osteoporosis
cataracts
dermal thinning
adrenal insufficiency
do not occur often |
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Term
| Patient education with ICS |
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Definition
Proper inhaler technique (DPI vs. HFA)
ICS do not have an immediate effect and should not be relied on for acute symptoms
Patients should rinse mouth out after each use to prevent oral thrush
Encourage compliance with therapy |
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Term
Moderate Persistent Asthma
Symptoms:
Nighttime awakenings:
SABA use:
Interference with normal activity:
Lung function: |
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Definition
Symptoms: daily
Nighttime awakenings: >1/week
SABA use: daily
Interference with normal activity: some
Lung function:
-FEV1 >60% to <80%
-FEV1/FVC is reduced 5% |
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Term
| Moderate Persistent Asthma Treatment |
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Definition
Long-term control:
-low to medium dose ICS
-LABA
Could also use:
-leukotriene modifier
-mas cell stabilizers
Quick relief:
-SABA |
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Term
|
Definition
salmeterol (Serevent)
formoterol (Foradil) |
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Term
|
Definition
work in same manner as SABA
salmeterol is a partial B2 agonist
formoterol is a full agonist
provide >12 hours of bronchodilation
formoterol has a shorter onset
neither is approved for quick relief |
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Term
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Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
| formoterol Aerolizer DPI strenghth |
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Definition
|
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Term
| formoterol Aerolizer DPI dose |
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Definition
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Term
| formoterol Perforomist strength |
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Definition
| 20 mcg/2mL solution for nebulization |
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Term
| formoterol Perforomist dose |
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Definition
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Term
|
Definition
Black Box Warning
-may increase risk of asthma-related death
-risk may be greater in blacks
Rare, paradoxical bronchospam
Tremor, anxiety, chest pain, palpitatoin, diarrhe, nausea |
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Term
| Patient counseling on LABA |
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Definition
LABA inhalers are not rescue inhalers
Those with separate LABA and ICS inhalers need to be sure to use BOTH
Proper use of inhaler |
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Term
| fluticasone and salmeterol brand name |
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Definition
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Term
| fluticasone and salmeterol DPI strengths |
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Definition
| 100/50 mcg, 250/50 mcg, 500/50 mcg |
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Term
| fluticasone and salmeterol HFA strengths |
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Definition
| 44/21 mcg, 115/21 mcg, 230/21 mcg |
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Term
| budesonide and formoterol brand name |
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Definition
|
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Term
| budesonide and formoterol HFA inhaler strenghts |
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Definition
|
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Term
| leukotriene receptor antagonists |
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Definition
zafirlukast (Accolate)
montelukast (Singulair) |
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Term
|
Definition
|
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Term
|
Definition
| blocks production of leukotrienes |
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Term
| leukotriene receptor antagonist MOA |
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Definition
| bind to and inhibit the LTD4 receptor |
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Term
|
Definition
|
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Term
| zafirlukast tablet strengths |
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
tablet 10 mg
chew tab 4 mg, 5 mg
granules 4 mg packet |
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Term
|
Definition
| 10 mg PO daily in the evening |
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Term
|
Definition
weak inhibitor of CYP2C8 and 2C9
major substrate of CYP2C9 and 3A4 |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
moderate CYP1A2 inhibitor
minor CYP1A2, 2C9, and 3A4 substrate |
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Term
|
Definition
Neuropsychotic events
Rare but serious Churg-Strauss syndrome
Increased hepatic transaminases |
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Term
|
Definition
|
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Term
|
Definition
| mast cell stabilizers prevent mast cells from releasing inflammatory mediators |
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Term
| cromolyn sodium brand name |
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Definition
|
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Term
| cromolyn sodium MDI strength |
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Definition
|
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Term
|
Definition
2-4 puffs (1600-3200 mcg)3-4 times daily
(as a prophylactic 2 inhalations 10-15 minutes before exposure) |
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Term
| cromolyn sodium solution for nebulizer strength |
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Definition
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Term
| cromolyn sodium solution dose |
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Definition
| 20 mg by inhalation 4 times daily |
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Term
|
Definition
high incidence of unpleasant taste in mouth
rare cardiac arrhythmia
coughing, dyspnea, sore throat
N/V/D is absorbed systemically |
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Term
Severe persistent asthma
Symptoms:
Nighttime awakenings:
SABA use:
Interference with daily life:
Lung function: |
|
Definition
Symptoms: throughout the day
Nighttime awakenings: often 7x/week
SABA use: several times daily
Interference with daily life: extremely limited
Lung function:
-FEV1 <60% of predicted
-FEV1/FVC reduced by >5% |
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Term
| Severe persistent asthma treatment |
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Definition
Long term control
-high dose ICS
-LABA
Other
-omalizumab
-oral corticosteroids
-theophylline
-LTRA |
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Term
|
Definition
|
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Term
|
Definition
anti-IgE antibody
binds to IgE receptor on mast cells and basophils |
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Term
|
Definition
150-375 mg SC q2-4 weeks
dose is determined by IgE levels and body weight |
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Term
|
Definition
black box warning - anaphylaxis
HA, injection site reactions, arthralgias, thrombocytopenia, pharyngitis, sinusitis, URTI |
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Term
|
Definition
bronchodilation through smooth muscle relaxation by inhibition of PDE3 and 4
increased diaphragm contraction through enhanced calcium uptake |
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Term
|
Definition
Starting: 10mg/kg/day (MAX 300mg/day)
Increase in 3 days to 400mg/day (children 16mg/kg/day) |
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Term
| theophylline serum conccentration |
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Definition
|
|
Term
|
Definition
Common
-diarrhea
-tremor
-irritability
-restlessness
-lipid changes
Toxicity
-N/V
-tachycardia
-jitteriness
-insomnia
-seizures
-cardiac tachyarrhytmia |
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Term
| Drugs that decrease clearance of theophylline |
|
Definition
cimetidine
macrolides
allopurinol
quinolones
ticlopidine
zileuton |
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Term
| Drugs the increase clearance of theophylline |
|
Definition
rifampin
carbamazepine
phenobarbital
phenytoin
smoking |
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Term
|
Definition
PEF or FEV1 <50% predicted personal best
Severe symptoms at rest
SABA use: 10 puffs of inhaler today
Duration of symptoms: 2 days |
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Term
| Treatment goals in a severe attack |
|
Definition
correction of hypoxia
rapid reversal of airflow obstruction
reduction of relapse
development of written asthma action plan |
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Term
| Initial treatment of an acute attack |
|
Definition
inhaled B2 agonist and anticholinergic nebulization every 20 minutes or continuously for 1 hour
oxygen therapy
-goal O2 saturation >90% |
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Term
| Corticosteroids in a severe attack |
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Definition
systemic
-all acute exacerbations
-IV is not better than PO
-treat for 3-10 days
-typically start PO prednisone 60 mg daily |
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Term
|
Definition
|
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Term
|
Definition
| non-selective muscarinic receptor blocker = bronchodilator |
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Term
|
Definition
nebulized treatment
used with SABA |
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Term
|
Definition
Treatment plan designed with the patient
Green = patient doing well on maintenance treatment
Yellow = asthma is getting worse
-how to use SABA
-if no improvement in 1 hour, prescription for oral steroid burst
Red = medical alert
-signs are same or worse as yellow zone
PF < 50% of best |
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Term
| Pharmacists Role in Asthma |
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Definition
inhaler technique
education on differences between inhaler types
when to use each inhaler
what to expect with each inhaler |
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