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Pharm Exam 3
Asthma management
55
Pharmacology
Graduate
10/22/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
Goals of therapy for asthma
Definition

1. Prevent chronic symptoms

2. Require <2 days/wk of inhaled SABA for quick refief symptoms

3. Maintain near normal pulm. funx

4. maintain normal activity levels

5. meet expectations of satisfying asthma care

Term
Goals of asthma therapy in reducing risk...
Definition

1. Prevent recurrent exacerbations-minimized ED visits

2. Prevent loss of lung funx

-or reduced lung growth in childer

3. Provide optimal pharmtherapy with minimal adverse effects

Term
Review of systems- pulmonary signs of asthma 
Definition

1.  Coughing (pediatrics)

2. Wheezing

3. Shortness of breath

4. difficulty breathing (like through a straw)

5. Hypoxia

Term
Normal FEv1/FVC with age
Definition

8-15yo = 85%

20-35 = 80%

40-59 = 75%

60-80 = 70%

Term
Classifying asthma severity
Definition

Intermediate = step 1

persistent:

mild=step2

moderate=step 3 or 4

severe=step 5 or 6

Term
Underlying cause of asthma:
Definition
inflammatory airway disorder
Term
Key priniciple of therapy:
Definition
regulation of chronic airway inflammation
Term
Overview of asthma medications: Controller medications
Definition

1. Daily

2. Long-term control

3. Anti-inflammatory

Term
Overview of asthma: Reliever Medications
Definition

1. As needed

2. Quick relief

3. Bronchodilators

Term
Prevent and treat inflammation
Definition
Corticosteroids (inhaled and systemic)
Term
Prevent inflammation:
Definition
Leukotriene modifiers (singular)
Term

Beclomethasone (QVAR)

Budesonide (Pulmicort)

Fluticasone (Flovent)

Mometasone (Asmanex)

Ciclesonide (Alvesco)

 

Definition
Inhaled corticosteroids
Term

Prednisone (generic)

Methylprednisolone (medrol, sulumderol)

Prednisolone (Prelone)

Definition
Systemic (Oral/IV) Corticosteroids
Term
(3) key things about corticosteroids do:
Definition

1.Improve asthma, control more effectively than long term control meds

 

2.Reduce impairment and risk of exacerbations

 

3.Does not alter progression of underlying severity of the disease

Term

inhaled corticosteroids

1. Response

2. Max Effects

Definition

           1. Reduce airway inflammation        

      -dec. airway hyperresponsiveness

-Dec PRN albuterol use

 

2. Max effect

-oral: 6-24 hrs

                    -Inhaled: days to weeks (maybe months)

-Not for rescue

 

Term
Budesonide Respules
Definition

0-4 yo

low: 0.25-0.5mg/d

med: >0.5-1.0mg/d

high: >1.0mg/d

 

5-11yo

low: 0.5mg/d

med: 1.0mg/d

High: 2.0mg/d

 

Reported AE:

Respiratory infections, rhinitis, otitis media, vomiting, diarrhea

 

Term
Minimizing risks with ICS
Definition

1. monitor growth

2. use lowest possible dose

3. Administer with spaces or holding chambers

4. teach to "spit and rinse"

5. consider long acting beta agonist to low/med dose ICS rather than using high dose ICS

Term
Inhaled local CS side Effects:
Definition

dysphonia

thrush

cough/throat

irritation

Impaired growth (High dose)

Term
Systemic CS side effects (Oral, IV)
Definition

Fluid retention

muscle weakness

ulcers

malaise

Impaired wound healing

N/V, HA

osteoporosis (adults)

Cataracts (adults)

Glaucoma (adults)

Term
Long-acting beta2-agonists
Definition

Indication: daily long-term control (bronchodilate)

 

Mechanism: long term stimulation of beta2 receptors

 

Advantages:

-blunt exercise induced symptoms for longer time

-dec. nocturnal symptoms

-improve quality of life

 

 

Term
Long acting beta2-agonists
Definition

Not for exacerbations

 

onset: 30 min (salmeterol)

5-10min (formoterol)

 

Peak: 1-2 hours (salm)

15 min-1hr (form)

 

Duration of effect: up to 12 hours

Term
Long acting beta2-agonists indications
Definition

Not used as monotherapy

 

not a sub for anti-inflammatory therapy

 

Used in combo with ICS for long term control and prevent symptoms in mod or severe persistent asthma

Term
Best use for Long acting Beta2-agonists
Definition

1. Combination therapy (with ICS)

2. Useful for nocturnal symptoms

3. Useful for exercise-induced asthma when taken 30 min before exercise

Term

LABA

1. Fluticasone + Salmeterol

 

Definition
Advair
Term

LABA

 Budesonide + Formoterol

Definition
Symbicort
Term

LABA

Mometasone + Formoterol

Definition
Dulera
Term

Zileuton 

Montelukast 

Zafirlukast

Definition

Leukotriene Modifiers

 

Leukotriene receptor antagonist

 

Zileuton - 5 lipoxygenase inhibitor

Term
Benefits and indications for leukotriene modifiers
Definition

1. Improve lung funx

2. dec. need for short-acting B2 agonists

3. prevent exacerbations

 

Indictations:

-asthma and allergic rhinitis

-exercise induced asthma

-seasonal and perennial allergic rhinitis

**not preferred combo therapy

Term

Theo-Dur

Slo-Bid

Slo-Phyllin

Theo-lair

Definition
Theophylline (xanthines)
Term
Theophylline (Xanthines)
Definition

1. Long term control med

2. Taken by mouth (or IV in hospital)

3. Requires serum concentration monitoring

4. MANY drug interactions

5. Adverse effects (GI, CV, CNS)

Term
Relivers: Short-acting beta2-agonists
Definition

1. most effective for relief of acute bronchospasm

2. inc need for these meds= uncontrolled asthma

3. regularly scheduled use not indicated - use as needed

-may lower effect

-may inc airway hyperresponsiveness

Term

Albuterol

levalbuterol

Pirbuterol

Terbutaline

Metaproterenol

Isoetharine

Definition
Reliever: short acting Beta2 agonist
Term

Short acting beta2-agonists

onset-

peak effect-

duration of effect-

 

Definition

onset: 5-10 min

peak effect: 15-30 min

Duration of effect: up to 8 hrs

-depends on underlying inflammation

-exercise induced: 2-3 hrs

Term

Short- acting beta2 agonists side effects

 

Definition

tremor

inc heart rate

palpitations

 

Acute:

hyperglycemia

hypokalemia

hypomagnesemia

Term
Short acting beta agonists dosage:
Definition

Usually 2 puffs PRN

 

Acute exacerbations:
up to 4-8 puffs q20min

 

 

Term
When to use systemic corticosteroids "burst therapy"
Definition

Indications - "quick" (6-24hrs) relief of inflammation

 

when:

1. albuterol doesnt work- beta2 agonist

2. gradual deterioration

3. establish "control" in an existing or newly diagnosed patient

Term

Primatene Mist

-epinephrine

 

Primatene tablets

-ephedrine

-guaifenesin

Definition
Non-prescription medications
Term
Methods of medication delivery
Definition

1. Metered-dose inhalers

2. Dry-powder inhalers

3. nebulization

4. oral medications

5. intravenous medications

Term
HFA vs. CFC
Definition

1.  softer, mist-like spray

2. warmer puff

3. lower spray force

4. no priming when used more than 2 wks

5. need spacer?

6. need to clean actuator every wk

Term
Metered dose inhalers
Definition

1. 10-30% actuated drugs delivered to lungs

2.  propellant is driving force

3. slow inhaltion (<30L/min)=3-5sec

4. requires priming for first dose

Term
Dry powder inhalers
Definition

-Breath actuated

-require minimal hand-lung coordination

-requires a fast inhalation (>60L/min)

-delivers 10-20% of dose to airways

Term
DPI Diskus
Definition
Fluticasone (Flovent) and Fluticasone-salmeterol (advair) (12+ and 4+)
Term
DPI aerolizer
Definition

Formoterol (foradil)=long acting beta agonist

=need to load dose manually

Term
DPI handiHaler
Definition

Tiotropium (spiriva)

Need to load dose manually

Term
Use of spacers:
Definition

1. allows evaporation of propellant prior to inhalation

2. good for poor hand-lung coordination

3. no clinical advantage over proper use of MDI's

4. Decreases oropharyngeal deposition

-reduce hoarseness and thrush

 

Term
nebulized products (for 2+)
Definition

1. beta agonists

2. corticosteroids

3. anticholinergics

Term
Indicators of poor asthma control
Definition

1. awakens at night with symptoms

2. Has an urgent care visit

3. Has increased need for albuterol

4. Rule of "two's"

 

=Step up therapy needed

Term
Before increasing medications check:
Definition

1. inhaler technique

2. adherence to prescribed regimen

3. environmental changes

4. also consider alternative diagnoses

Term

Asthma control test (25 points) scoring

 

Definition

>20 well-controlled

16-19 not well-controlled

<15 very poorly controlled

Term
MN community measurement criteria:
Definition

1. needs to be documented in chart:

a. asthma is well-controlled and indicated by Q's

b. Not at elevated risk of exacerbation

c. asthma education documented in chart

d. asthma management plan in chart

Term
Rule of two's:
Definition

1. relief inhaler >2 times/wk

2. awake at night more than >2/mo

3.refill quick relief inhaler >2/yr

Term
Monitor:
Definition

1. patient adherence to regimen

2. inhaler technique

3. freq of albuterol use

4. freq of oral corticosteroid "burst" therapy

5. side effects of meds

Term
How to assess a case while on therapy
Definition

1. given diagnosis

2. treat acute symptoms

3. assess day and night time symptoms and pulm function

4. classify severity or control

5. select/adjust pharmacotherapy

Term
Exercise induced bronchospasm
Definition

1. Diagnosis: hx of cough, sob, chest pain or tightness, wheezing or endurance problems during exercise

 

2. must inform coaches and teachers

 

3. 15% decrease in PEFR or FEV1

Term
Exercise induced bronchospasm management strategies
Definition

1. SABA used before exercise lasts 2-3hrs

2. LABA may prevent EIB for 10-12 hrs

3. controller therapy with dec EIB

4. a lengthy warmup period before exercise may preclude medications

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