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Asthma Management 1
Asthma Management
30
Pharmacology
Graduate
08/31/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
Diagnostic Methods (Physical)
Definition
  • Respiratory - Wheezing, Crackling, tachypnea
  • Increased nasal secretions, nasal polyps
  • Eczema, Atopic dermatitis
Term
Diagnostics (Medical History)
Definition
  • Frequency, pattern, and symptoms
  • Triggers
  • Family History
Term
Diagnostic Methods (Tests)
Definition

Hyperexpansion of chest x-ray

Spirometery

Term

12 + years old

Symptoms

(Intermittent, Mild, Moderate, Severe)

Definition

Intermittent: =< 2 Days

Mild: > 2days/week

Moderate: Daily

Severe: Throughout the day

Term

12 + years old

Nighttime awakenings

(Intermittent, Mild, Moderate, Severe)

Definition

Intermittent: =< 2x/Month

Mild: 3-4x/month

Moderate: >=1x/week(not nightly)

Severe: 7x/Week

Term

12 + years old

LABA use for control

(Intermittent, Mild, Moderate, Severe)

Definition

Intermittent: =<2days/week

Mild: >2 days/week

Moderate: Daily

Severe: Several times per day

Term

12 + years old

Interference with normal activity

(Intermittent, Mild, Moderate, Severe)

Definition

Intermittent: None

Mild: Minor

Moderate: Some

Severe: extremely limited

Term

12 + years old

Lung function

(Intermittent, Mild, Moderate, Severe)

Definition

Intermittent: FEV1>80%predicted

Mild: FEV1 =>80%predicted

Moderate: FEV1= 60-80% predicted (FEV1/FVC reduc. 5%)

FEV 1 =< 60% predicted (FEV1/FVC reduced 5%)

Term

5-11 years old

Lung Function

(Intermittent, Mild, Moderate, Severe)

 

Definition

Intermittent: FEV1>80% predicted, FEV1/FVC > 85%

Mild: FEV1=> 80% predicted, FEV1/FVC > 80%

Moderate: FEV1 60-80% prediceted, FEV1/FVC 75-80%

Severe: FEV1=< 60% predicted FEV1/FVC< 75%

Term

0-4 years old

Nighttime awakenings

(Intermittent, Mild, Moderate, Severe)

 

Definition

Intermittent: 0

Mild: 1-2x/ month

Moderate: 3-4x/month

Severe: >1x/month

Term
Pharmacologic Therapy (8 classes of drugs)
Definition
  • Corticosteroids
  • Mast Cell stabilizers
  • LABA
  • Leukotriene modifiers
  • Methylxantines
  • Monoclonal antibodies
  • SABA
  • Anticholinergics
Term
Goals of therapy (6)
Definition
  • Prevent chronic symptoms
  • Prevent exacerbations
  • Maintain normal activity levels
  • Maintain normal pulmonary function
  • Optimize drug therapy
  • Satisfy patient's and Families' goals for care
Term

Initiation of therapy

(12 and older, 5-11, and 4 and under)

Definition

12+: do not start past step 4 or 5

5-11: do not start past 3 or 4

4 and under: do not start past step 3

Term
Ages 12 and up therapy for all 6 steps
Definition

Step1: SABA PRN

Step2: Low dose ICS or (MCS, LTRA, theophylline)

Step 3: Low dose ICS + LABA, LTRA, or Theoph (or med dose ICS)

Step 4: Med-dose ICS + LABA

Step 5: High-Dose ICS + LABA (Consider Omalizumab)

Step6: High Dose ICS + LABA + Oral Corticosteroids (Consider omalizumab)

Term
Difference between 5-11 and 12+ stepwise therapy
Definition
Step 5 and 6 do not have omalizumab
Term
Ages 0-4 stepwise therapy (all 6)
Definition

Step1: SABA PRN

Step2: Low dose ICS

Step 3: Med Dose ICS

Step 4: Med-dose ICS + LABA or Singulair

Step 5: High Dose ICS + LABA or Singulair

Step 6: High Dose ICS + LABA or Singulair + Oral corticosteroids

Term
Inhaled corticosteroids
Definition

Most effective long-term control - NOT for acute

some evidence suggests double or quadruple dose for exacerbation

Dosage forms: MDI, DPI, Diskus, nebules

Dosage Frequency: daily or twice daily

Term
Leukotriene
Definition

Alternative Tx, not prefered

ADE: Possible association with suicidal behavior

Dosage: Once daily at bedtime

Zafirlukast and Zileuton - p450 Inhib. Monitor hepatic enzymes

Term
LABA
Definition

Moderate or severe asthma

ADE: rapid heart rate and Dizziness

Not intended for Monotherapy or acute symptoms

Term
LABA-ICS combo products
Definition

Not used for acute symptom relief or exacerbations

Dosage: MDI, Diskus

Dosage frequency: twice daily

Term
Mast Cell Stabilizers
Definition

Alternative Treatment

May be used as preventive treatment

ADE: Cough, Bad taste in mouth, throat irritation

Patient counseling: not for acute asthma, 4 weeks till benefits

Term
SABA
Definition

Always part of patients regimen

Rapid acting bronchodilaters

ADE: Rapid Heart rate, headache, dizziness

Term
Anticholinergics
Definition

Not for long term treatment. Only for hospital/ER

ADE: Dry mouth, dizziness, upset stomach, vision changes

Alternate in patients who cant tolerate SABA

Term
Systemic Corticosteroids
Definition

Short courses of oral corticosteroids to gain immediate control of asthma.

May cause hyperglycemia, report signs/symptoms of infection, take full course

 

Term
Prednisolone 0-4, 5-11, 12+
Definition

0-4 yrs:1mg/kg/day 3-10 days

5-11 yrs: 40-60mg/day

12+: 40-80 mg/day

Term
GREEN ZONE
Definition

PEF >= 80

No symptoms

Maintenance treatment reduce symptoms

Term
Yellow Zone
Definition

PEF >= 50-79%

  • Symptoms: Wheezing, coughing, chest tightness, shortness of breath, decrease in activity
  • Contact healthcare professional
  • Treatment -- SABA maintenance - PO Corticoid

 

Term
RED ZONE
Definition

PEF <=50%

  • Symptoms: harder to breath, unable to sleep or minimal
  • Contact physician and Visit ER
  • Treatment: SABA + PO Corticoid + change + additional

 

Term

Managing Exacerbations at Home

 

Definition
  • Intial - SABA

Good Initial -- Double dose ICS for 7-10 days

Incomplete -- Add oral steroid

Poor -- add oral, call phys or ER

Term
ER Management
Definition

ABX is purulent sputum or pneumonia

Decrease Intubation via MgSulfate, Terbuataline: IV Beta-Agonist, Heliox, mixture of helium/oxygen for improved gas exchange

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