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asthma
NEED to know drugs
| Question | Answer |
|---|---|
| beclomethasone Dipropinate MDI | QVAR |
| Budesonide turbuhaler and ampules | Pulmicort Flexhaler |
| Flunisolide MDI | Aerobid |
| Fluticasone Propionate MDI | Flovent |
| Mometasone DPI and Twisthaler | Asmanex |
| triamcinolone acetonide | Asmocort |
| Spirometry devise do what | determine reversibility, demostrate obstruction in patient greater than 5, is an objective measure to establish diagnosis, |
| ways to diagnosis asthma | detailed medical history, physical exam and spirometry. (peak flow meteres are monitoring tools not diagnostic) ALWAYS look for differential diagnosis before dx asthma |
| key symptoms for asthma | exercise induced, viral infection, inhalant allergens, irritants, changes in weather, strong emotional expression (laughing or cyring hard), stress, & mentrual cycles, symptoms at night , wheezing, chest tightness, diffcult breathing, cough |
| to determine treatment failure and success | frequency of using short acting beta 2 agonist and need for oral corticosteroids and frequency of use |
| Severity: the intrinsic intensity of the disease process. Severity is most easily and directly measured in a patient who | is not receiving long-term control therapy. |
| control is oftern messure in | patients already on medication for treament. Severity can also be measured, once asthma control is achieved, by the step of care (i.e., the amount of medication) required tomaintain control. |
| what is responsiveness | the ease with which asthma control is achieved by therapy |
| asthma severity and astham control include the domains of | current impairment and furture risk |
| what is impairment | the frequency and intensity of symptoms and function limitations the patient is currently experiencing or has recently experience |
| what is risk 3 things: | the likelihood of either asthma exacerbation, progressive decline in lung function (children reduced lung growth), or risk of Adverce effects from medication |
| what are the signs of deterioration and need to reevaluate therapy | waking at night or early morning with asthma, increase medication use, and decrease activity tolerance |
| what are some foods that contain sulfites | beer wine shirmp dried fruit, processed potatoes |
| what is the role of corticosteroids in the treatment of asthma | they reduce airway hyperresposivenes, inhibit inflammatory cell migration and block late phase reaction to allergen. They don't alter the progreesion or underlying severity in children |
| what is the role or oral systemic corticosteroids and their role in asthma therapy | they are used short course booster treatment to gain prompt control and used long term to treat patient who require step 6 care (severe persisten asthma) |
| what are alternative treats for asthmas | cromoly sodium and nedocromil (mast cells stabilizer) alternative for mild persistent asthma or EIA. Omalizumab (anti-IgE) immunomodulators that prevents bind of IgE (step 5 and 6 adjunctive therapy >12 yo) |
| what are some more alternative to treat asthma | leukotriene modifiers interfere with the pathway , they are an alternative but preferred for step 2 mild persistent asthma |
| what are methylxanthines used for like theophylline and what limits its use | mild to moderate bronchodilator as alternative, low Therapeutic window, also as adjuct (second line) with ICS in patients over 5 years of age |
| what are the preffered quick relief medications and what are alternatives | SABA such as albuterol, levalbuterol, and pirbuterol |
| pitrakinra is generic for what drug, what is the dosage and mechanism of action | Aerovant 25 mg subq it decrease hyperresponsivenes by antagonizing IL4 adn IL13 |
| If a patient is to be on long term oral or high dose ICS what should you recomend they take | calcium supplementation |
| what ICS is ok to take while pregnant | budesonide |
| what drugs could be prescibe to improve adherence | once daily budesonide (pulmicort Flexhaler) or (Asmonex mometasone) |
| the only therapy shown to reduce to the risk of death from asthma | inhaled corticosteroids |
| how should a patient be started on steroids and why | patients should be started on higher and more frequent doses and then tapered down once control has been achieved because the the inflammatory of sthmas inhibits steroid receptor binding. |
| when can you expect symptoms to improve with ICS | 1 to 2 weeks adn reach max in 4 to 8 |
| long acting agents are ineffective for acute severe asthma because it takes how long | 20 minutes for onset and 1 to 4 hours for maximum branchodilation after inhalation |
| in acute severe asthma, when is continous nebulization of short acting B2 agonist recommended | after patient has unsatisfactory response to three doses q 20 mins of aerosolized beta 2 agonist or when PEF or FEV1 are below 30% of predicted normal |
| what is the preferred treatmetn choice for EIB or EIA | inhaled B2 agnonist 15 mins before a 2 to 3 hour work out long acting can be used if duration is longer |
| in nocturnal asthma, what is preffered | long acting inhaled B2 agonist are preferred over oral sustained release B2 or theophylline. however nocturnal astham may be an indicator of inadequate antiinflammatory treatment |
| which is more indicative of severe exacerbation (A) degree of cough, breathlessness, wheezing, and chest tightnees or (B) use of accessory muscles and suprasternal retractions | A doesn't correlate with with severity of exacerbation but B does and suggest severe exacerbation |
| a PEF value below 50% of personla best or predicted suggests what | severe exacerbation and patient should use SABA and call doctor this would be in the red zone patient should take oral corticosteroid |
| A PEF reading in the yellow zone would be what % of best | 50-80%. this is a moderate exacerbation and patient should continue to use B 2 agonist SABA and can add oral corticosteroid if no response |
| what is the initial treatment for asthma attack | inhale SABA up to three threatments of 2-4 puffs by MDI at 20 min intervals or a single nebulizer treatment and then measure responce again |
| what must be assessed to step up therapy | adherence, environment control and comorbind conditions |
| When is step down therapy recommened | when asthma is well controlled for at least 3 months |
| what is step 1 therapy for children and adults, what classification is this | intermittent asthma with SABA prn for therapy and patient education and environment control and every step |
| if patient has a mild exacerbation (>80% of predicted norm after intial treatment what is the recommendation for the next week | patient may continue SABA q 3 to 4 h for 24 to 48 hrs and patient my double dose on inhaled corticosteroids for 7-10 days |
| what is the preferred treatment at step 2 for children and adults | SABA + low-dose ICS |
| what is the preferred treatment at step 3(consider consultation at step 3) | SABA + Low-dose ICS + LABA or Medium-dose ICS |
| what is the preferred treatment at step 4 (need to see asthma specialist) | SABA + Medium-dose ICS + LABA |
| what is the preferred treatment at step 5 | SABA + High-dose ICS + LABA |
| what is the preferred treatment at step 6 | SABA + High-dose ICS + LABA + oral corticosteroid |
| nonpharmacologic therapy in acute severe asthma | oxygen supplementation, patient education, treatment program |
| to be considered an acute severe asthma attack what must peak expiratroy flow and FEV be | bellow 50% of normal predicated values. |
| to be classified as intermittent asthma what is the impairment, risk, and step for initiating treatment | symptoms < 2 days/week, night time awakening < 2X/ month and use of SABA < 2 days/week, no interference with normal activity, lung function >85% with risk of exacerbations less than 2 per year proceed to step 1 |
| to be classified as mild persistent asthma what is the impairment, risk, and step for initiating treatment | Symptoms >2 X WK not QD, night time awakenings 3-4X months, use of SABA >2XWK not QD, minor limitation, Lung function >80% (normal for adults), exacerbations >2 times per year proceed to step 2 |
| to be considered Moderate persistent | symptoms occur daily, night time awakenings are > 1XWK but not nightly, SABA use is Daily, some limitation, lung function is reduced to 75-80% (reduced by 5% in adults)>2 times per year proceed to step 3 or 4 |
| when is asthma considered to be severe persistent | symptoms occur throughout the day, nighttime awakenings happen often like 7 X wkly, normal activity is extremely limited, and lung function is less than 75% (greater than 5% in adults) |
| What % does lung fxn decrease each decade | 5% decrease (<20 yrs old= 85%; 20-39= 80%; 40-59=75% ; 60-80= 70% |
| what is the preferred drug for aspirin induced asthma | leukotriene modifiers like zafirlukast(Accolate) and motelukast(Singulair) zileuton (Zyflo) |
| Singulair | Montelukast |
| zafirlukast | Accolate |
| Zileuton | Zyflo |
| Omalizumab (BRAND?) anti-IgE given subq in step 5 and 6 alternate therapy | Xolair |
| Advair contains | fluticasone and salmeterol |
| Symbicort contains | budesonide and formoterol |
| we access control in patients | who are on medication |
| we access severity in patient who are | not currently taking long term control medication |
| medication approved in pregnancy | albuterol and budesonide |
Created by:
lainylaina