Term
| symptoms and severity of asthma |
|
Definition
| <2x/week- intermittent. >2x/week mild persistent, daily moderate persistent, throughout the day severe persistent (same for frequency of use of albuterol) |
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|
Term
| nighttime awakening and severity of asthma |
|
Definition
| <2x/month- intermittent, 3-4x/month- mild persistnet, >1x/week mod persistent, every night severe persistent |
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Term
[image]
Describe the pathway and where different drugs for asthma or COPD work along it |
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Definition
| ATP (AC) -> cyclic AMP -> bronchodilation -> PDE destroys cyclic AMP -> AMP. medications act on these enzymes to cause bronchodilation and inc production of cyclic AMP. Acetylcholine and adenosine -> bronchoconstriction. beta agonists activate adenylate cyclase -> inc cyclic AMP. muscarinic agonists inhibit effect of acetylcholine and prevents bronchoconstriction. theophylline and roflumilast inhibit PDE enzyme resulting in a dec in the destruction of cyclic AMP -> bronchodilation. Theophylline inhibits the effects of adenosine -> prevents bronchoconstriction |
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Term
| Albuterol/Levalbuterol vs Pirbuterol receptor selectivity |
|
Definition
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|
Term
| Step up approach for treatment of asthma |
|
Definition
| Intermittent (short acting beta agonist) -> low dose corticosteroid (alt leukotriene receptor agonist, theophylline) -> 2. inc dose of inhaled corticosteroid or add long acting beta agonist ->3. low inhaled corticosteroid and long acting beta agonist -> 4. med dose inhaled corticosteroid and long acting beta agonist (alt med inhaled corticosteroid + leukotriene receptor agonist/theophylline/zileuton -> 5. high dose inhaled corticosteroid + long acting beta agonist (omalizumab if allergies too) -> 6. high dose inhaled corticosteroid + long acting beta agonist + oral corticosteroids and omalizumab if allergies (short acting beta agonist as needed throughout) |
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Term
| short acting beta 2 agonists |
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Definition
| SABA, for acute bronchospasm, rescue inhaler, prevent exercise induced asthma. Albuterol (more potent), Levalbuterol, Pirbuterol. last 3-4 hrs |
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|
Term
| albuterol vs levalbuterol |
|
Definition
| enantiomers, albuterol is racemic mixture of S and R, levalbuterol is just the R isomer (no compelling evidence that levalbuterol is better, it is also more expensive) |
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Term
| long acting beta agonists |
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Definition
| Salmeterol (Serevent)(aerosol powder for inhalation), Formoterol (Foradil)(capsule for inhalation or solution through nebulizer), use in combination with inhaled corticosteroids. Black box warning- can inc the rate of asthma related death when used as monotherapy. work in ~2hrs, last ~12 hrs, give 2xday |
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|
Term
|
Definition
Salmeterol + fluticasone (Advair)
Formoterol + Budesonide (Symbicort)
Formeterol + Mometasone (Asmanex) |
|
|
Term
| inhaled corticosteroid MOA |
|
Definition
| direct local inflammatory, reduce hyperresponsiveness, inhibit inflammatory cell migration and activation, most beneficial and effective for long term control of asthma, reduce impairment in lungs and the risk of exacerbation in pts w asthma |
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|
Term
| inhaled corticosteroid drugs |
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Definition
| beclomethasone (bike in my zone), budesonide (bet on a zone), ciclesonide/desciclesonide (circle solid), flunisolide (fluky solid), fluticasone (flute in zone), mometasone (moment zone), triamcinolone (try my clone) |
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|
Term
| inhaled corticosteroid properties chart |
|
Definition
|
|
Term
| considerations for inhaled corticosteroids |
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Definition
| can cause systemic side effects, might affect growth velocity in pediatric pts, educate pts to rinse mouth w water after use (prevent fungal infection), takes ~1 week before it starts working |
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|
Term
| anticholinergic indications |
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Definition
| quick relief of mod-severe asthma in combination w short term beta agonist or as an alternative if pt is intolerant. reduces intrinsic vagal tone of airway |
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|
Term
| anticholinergic asthma drugs |
|
Definition
ipratropium (Atrovent)- metered dose inhaler or as solution to be administered through nebulization
tiotropium (Spiriva)- inhale contents of capsule |
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|
Term
| Blurred vision, xerstomia (dry mouth) and tachycardia are side effects of? |
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Definition
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|
Term
| pathway where leukotriene inhibitors work and leukotriene inhibitor MOA |
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Definition
| pts exposed to allergen -> mast cells and eos release inflammatory markers -> initiates inflammatory cascade -> conversion of arachidonic acid by 5-lipoxygenase enzyme to cysteinyl leukotrienes -> leukotrienes act on cystLT1 receptor -> symptoms of asthma (mucus secretion, bronchoconstriction). Zileuton (Zi-Neuton) inhibits the production of leukotrienes (5-lipoxygenase inhibitor). Drugs that block the action of leukotriene on receptors: Montelukast (Singulair)(Mountain cast), Pranlukast (Prank cast), Zafirlukast (Accolate) (Za fire cast) |
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Term
| leukotriene inhibitor agents indicated when |
|
Definition
| moderate to severe persistent asthma, recommended to use in combo w high dose corticosteroid and long term beta agonist. usually considered prior to chronic oral corticosteroids. not usually used as monotherapy |
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|
Term
| common side effect of Montelukast |
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Definition
|
|
Term
| can cause hepatic injury, inc liver enzymes, contraindicated in pts w hepatic impariment |
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Definition
|
|
Term
|
Definition
| work on inflammatory pathway. Cromolyn (Cromwell). Alternative agent for pts w mild persistent asthma. inferior to inhaled corticosteroids. can be used for exercise-induced bronchospasm. give as metered dose inhaler or nebulizer, can take 2-6 weeks to start working |
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Term
|
Definition
| block PDE enzyme, inc cyclic AMP -> bronchodilation (nonselective phosphodiesterase inhibitor) also anti inflammatory affect -> activation of histone, deacetylase enzyme, decreases the pro-inflammatory gene expression |
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Term
| Methylxanthine indicated for |
|
Definition
| alt for step up therapy for pts w mild persistent asthma or as adjunctive therapy w inhaled corticosteroids |
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|
Term
|
Definition
| give loading dose bc takes time to reach steady state. check blood lvl 30 min after loading dose bc can cause a lot of side effects and toxicity |
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Term
| has side effects of tachycardia, headache, hypertension, nausea, and vomitting and at very high doses can cause hematemesis, hyperglycemia, hyperkalemia, seizures |
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Definition
| methylxanthine (theophylline) (Elixophyllin) |
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|
Term
| Cimetidine, Macrolides, Quinolones, Systemic Viral Illnesses, Zileutin, and Propanolol affect Methylxanthine clearance how? |
|
Definition
| decrease, CYP3A4 inhibitors |
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|
Term
| Phenytonin, Rifampin, Carbamazepine, Smoking, Phenobarbital, High protein diet affect Methylxanthine clearance how? |
|
Definition
| increase, CYP3A4 inducers |
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Term
| Immunomodulators are indicated when for asthma |
|
Definition
|
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Term
|
Definition
| Omalizumaub (O mail mob) (Xolair)- sub q injection, Mepolizumab (me pale mob) (Nucala- sub q injection), Reslizumab (re sell mob) |
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|
Term
|
Definition
| Monoclonal IgG antibody that inhibits the IgE receptor binding on mast cells and basophils |
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Term
|
Definition
| long-term use decreases asthma exacerbations and corticosteroid use, alt agent for pts w sensitivity to allergens and severe persistent asthma. but doesn't have any effect on baseline of FEV1 ratio |
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|
Term
| has SE of anaphylactic reactions and injection-site reactions |
|
Definition
| Omalizumab, Mepolizumab, Reslizumab (Immunomodulators) |
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Term
|
Definition
| IgG monoclonal Ab that works by inhibiting the binding of interleukins to eosinophil cell surfaces |
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Term
|
Definition
| interleukin-5 receptor antagonist |
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Term
|
Definition
| add-on for maintenance treatment of severe asthma w an eosinophilic phenotype |
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|
Term
| Oral corticoteroids indication |
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Definition
| pts w poor asthma control, given as a short course up to 2 weeks, helps in reducing duration of symptoms and preventing hospitalization and relapse post-exacerbation |
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Term
| metered-dose inhaler, pt education |
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Definition
| inhaler w canister surrounded by plastic holder and mouthpiece, medication mixed w propellant. tell pt to shake before use, exhale before inhaling medication, seal mouthpiece w lips, breathe in slowly, hold for 10 sec then breathe out |
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Term
| dry-powder inhaler pt education |
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Definition
| hold discus in palm, push thumb grip until clicks into place, slide lever away, seal mouth around mouthpiece, breathe deeply and rapidly, hold breath 10 sec, close mouthpiece |
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|
Term
|
Definition
| used for administering dry-powder medications, twist and lift off cap to load dose, exhale, then twist twisthaler horizontally and breathe in rapidly and deeply then hold breath 10 sec, then close cap |
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|
Term
|
Definition
| helps in delivering a slow mist of the medication to patients |
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|
Term
| follow up for asthma pts depending on how well their symptoms are controlled |
|
Definition
well-controlled- 1-6 mo intervals
not well controlled- step up 1-2 steps, reeval in 2-6 weeks
poorly controlled- short course of oral corticosteroids |
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|
Term
|
Definition
| usually have worsening of symptoms, preferred to use albuterol as a rescue agent and bedesonide as a maintenance agent. avoid long-acting beta-agonists, avoid omalizumab and zileuton |
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Term
| reversible component of COPD |
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Definition
| causes small-airway disease, production of mucus and inflammatory cells, results in bronchial muscle contraction and airway resistance |
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Term
| irreversible component of COPD |
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Definition
| parenchymal destruction/lung tissue destruction, alveolar damage affecting gas exchange, results in loss of lungs being able to recoil and push the air outside of the lungs, these pts also have airway fibrosis |
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Term
| glucocorticoids and asthma vs COPD |
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Definition
| inhibit inflammation in asthma, variable effect in COPD |
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Term
|
Definition
| GOLD 1- FEV1 >80%, GOLD 2- 50-80% of predicted, GOLD 3- 30-50%, GOLD 4 <30% |
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|
Term
|
Definition
| Modified British Medical Research Council, questionnarie bc some pts can be at same GOLD lvl w diff symptoms, 0-4, greater # = worse dypsnea |
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|
Term
|
Definition
| COPD Assessment Test Score, incorporates other symptoms besides dyspnea, 0-40, higher number, worse symptoms |
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Term
| Combined assessment for COPD to determine A, B, C, D |
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Definition
|
|
Term
| Short acting beta-2 agonists for COPD |
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Definition
|
|
Term
| Long acting beta-2 agonists for COPD |
|
Definition
| arformoterol, formoterol, indacaterol (lasts 24 hrs), oldaterol, salmeterol, vilanterol |
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|
Term
| Anticholinergic agents for COPD |
|
Definition
short term- ipratropium
long-term- aclininium, tiotropium, umeclidinium |
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|
Term
| inhaled corticosteroids for COPD |
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Definition
| beclomethasone (bike in my zone), Budesonide (bet on a zone), Ciclesonide (circle solid), Fluticasone (flute in zone), Mometasone (moment zone) |
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|
Term
|
Definition
| Roflumilast (reduces inflammation and breakdown of cyclic AMP), adjunctive therapy for severe COPD pts or pts w prior history of hospitalization for acute exacerbation |
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|
Term
|
Definition
| 1st- short-acting muscarinic antagonist agent as needed or short-acting beta agonist. 2nd- long acting muscarinic antagonist or long-acting beta agonist or combo of short acting muscarinic antagonist + short-acting beta agonist. Alt- Theophylline |
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|
Term
|
Definition
| 1. long acting muscarinic antagonist or long-acting beta agonist 2. Combo of Long acting beta agonist + long acting muscarinic antagonist |
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|
Term
|
Definition
| 1. inhaled corticosteroid + long acting beta agonist or long acting muscarinic antagonist 2. long acting muscarining antagonist + long acting beta agonist |
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|
Term
|
Definition
1. inhaled corticosteroids + long acting beta agonist or long acting muscarinic agonist + long acting beta agonist
2. ICS + LAMA
or
ICS + LABA + LAMA
or
ICS + LABA + PDE4 inhibitor or
LAMA + LABA
or
LAMA + PDE4 inhibitor |
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|
Term
| Treatment for COPD Exacerbations |
|
Definition
| short term bronchodilators (short acting beta agoninst and/or short term muscarinic antagonist) and glucocorticoids (prednisone) |
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Term
| evaluating COPD A, B, C or D |
|
Definition
| 0-1 hospital admission A or B. 2 or more hospitalizations C or D. mMRC 0-1 or CAT <10 A or C, mMRC >=2 or CAT>=10 B or D then eval GOLD level |
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Term
| short term + long acting bronchodilators in COPD |
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Definition
| not supported to be effective in COPD, inc side effects. prefer anticholinergic bronchodilator + long-acting beta 2 agonist over short acting beta-2 agonist + long acting beta-2 agonist |
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|
Term
| has the side effects of sinus tachycardia and hypokalemia |
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Definition
|
|
Term
| inhaled corticosteroids help how w COPD |
|
Definition
| improve symptoms, lung fuction, quality of life, reduce exacerbation frequency, specifically in pts w FEV1 <60% |
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Term
| has the side effects of hoarseness of voice, skin bruising, oral candidiasis, pneumonia |
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Definition
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|
Term
| has side effects of diarrhea, nausea, weight loss, insomnia, anxiety, depression, suicidal ideation |
|
Definition
|
|
Term
| contraindicated in pts w moderate or severe hepatic impairment |
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Definition
|
|
Term
| antibiotic if COPD pt has infection |
|
Definition
| azithromycin or erythromycin |
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|
Term
| signs and symptoms of cold |
|
Definition
| mild upper respiratory viral illness symptoms, sneezing, nasal congestion, rhinnorhea (runny nose), cough, sore throat, low grade fever, headache, malaise. but can be different depending on the virus, usually up to 10 days |
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|
Term
|
Definition
| treat the symptoms. intranasal ipratropium bromide (relieve rhinorrhea and sneezing, reduces volume of nasal discharge but doesn't affect nasal congestion), antihistamines, antitussives (for coughs, inhibits cough centers in the brain), expectorants (makes cough), decongestants, intranasal glucocorticoids. debate about whether these agents are effective in treating a cold or not |
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|
Term
| has side effects of nasal dryness, blood-tinged mucus, epistaxis |
|
Definition
| intranasal ipratropium bromide |
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|
Term
|
Definition
dextromethorphan (Delsym)-dec's sensitivity of the cough receptors and depresses the medullary cough centers in the brain
codeine- only works on CNS cough centers in the brain |
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|
Term
| can cause the side effects at high dose of confusion, excitement, irritability, nervousness, serotonin syndrome w monoamine oxidase inhibitors |
|
Definition
|
|
Term
| cases side effects at high dose of altered mental status, visual disturbances, respiratory depression, constipation |
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Definition
|
|
Term
| has black box warning that it can cause respiratory depression and death in some children who receive it following tonsillectomy or adenoidectomy |
|
Definition
| Codeine, if child is an ultra-rapid metabolizer (produce morphine when metabolized by CYP enzyme). not recommended to give codeine to children |
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|
Term
| expectorant agent and how it works |
|
Definition
| guaifenesin- increases the effective hydration of the respiratory tract. reduces the mucus viscosity making it easier for pt to cough out. can be found in combo w codeine, dextromethorphan, phenylephrine, pseudoephedrine |
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|
Term
| decongestant agents and how they work |
|
Definition
| pseudoephedrine (Sudafed)(weak stimulant to CNS), phenylephrine (Sudafed PE) (not as strong, less reaches systemic circulation), work by directly stimulating the alpha adrenergic receptors of the respiratory mucosa leading to vasoconstriction and dec blood flow to mucosa layer which helps in relieving congestion and directly stimulate beta adrenergic receptors causing bronchial dilation (only pseudoephedrine does this). both work on alpha-1 receptors but only pseudoephedrine also works on beta-2 receptors |
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|
Term
| how intranasal itrapropium bromide works |
|
Definition
| relieve rhinorrhea and sneezing, reduces volume of nasal discharge but doesn't affect nasal congestion |
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|
Term
| restrictions are placed on the sale of |
|
Definition
| pseudoephedrine becasue of illicit production of methamphetamine |
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|
Term
| causes side effects of hypertension and bradycardia |
|
Definition
| pseudoephedrine and phenylephrine |
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|
Term
| inhaled or intranasal glucocorticod agents and how they work |
|
Definition
| beneficial for allergic rhinitis but not helpful for cough or cold. beclomethasone and fluticasone. |
|
|
Term
| what is allergic rhinitis |
|
Definition
| allergies, most common chronic disease in pediatrics, inflammatory process that is IgE mediated and usually presents with symptoms such as nasal congestion, rhinorrhea, sneezing, nasal itching, lacrimation. can be seasonal, perennial (year-round), intermittent, persistent , or episodic |
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|
Term
| allergic rhinitis vs asthma |
|
Definition
| allergic rhinitis affects upper respiratory tract, asthma affects lower respiratory tract, can have both together |
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|
Term
| main therapy for allergic rhinitis |
|
Definition
| oral antihistamines, usually indicated for sneezing and itching. 1st gen- more sedating and more anticholinergic SEs (diphenhydramine/Benadryl), 2nd gen- less sedating (loratadine/Claritin, desloratadine/Clarinex, fexofenadine/Allegra (least sedating), Cetrizene (Zyrtec), Levocetirizene (xyzal) |
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|
Term
| Intranasal antihistamines good for, agents |
|
Definition
| for allergic rhinitis, faster onset, high efficacy for nasal congestion but more expensive than oral antihistamines. olopatadine, azelastine, azelastine + fluticasone, indicated when symptoms affect quality of life |
|
|
Term
| SE of bitter taste, epistaxis, headache |
|
Definition
| intranasal antihistamines, olopatadine, azelastine, azelastine + fluticasone |
|
|
Term
| intranasal corticosteroids used for, agents |
|
Definition
| allergic rhinitis. triamcinolone, budesonide, flunisolide, fluticasone, mometasone, ciclesonide |
|
|
Term
| cause side effects of pharyngitis, epistaxis, cough, can affect taste, cause nasal burning or headache |
|
Definition
| intranasal corticosteroids, triamcinolone, budesonide, flunisolide, fluticasone, mometasone, ciclesonide |
|
|
Term
| intranasal decongestant, agent, MOA |
|
Definition
| oxymetazoline (Afrin), for allergic rhinitis, alpha adrenergic agonist -> nasal arteriolar vasoconstriction, most effective when given in combo w intranasal corticosteroids, do not use >3 days (rebound congestion) |
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|
Term
| Treatment for increased lacrimation in allergic rhinitis, pt counselling |
|
Definition
| naphazoline (Clear Eyes)- vasoconstrictor, antihistamine eye drops- Zaditor, NSAID eye drops- Acular, corticosteroid eye drops- Alrex. All OTC. instruct pt to remove contact lenses before using |
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|
Term
| causes SEs of ophthalmic irritation, mydiasis, photophobia |
|
Definition
| ophthalmic agents- naphazoline (Clear Eyes)- vasoconstrictor, antihistamine eye drops- Zaditor, NSAID eye drops- Acular, corticosteroid eye drops- Alrex |
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