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RxPrep
Asthma
| Question | Answer |
|---|---|
| What is the first-line controller for asthma? | Inhaled corticosteroids (ICS) |
| What is the preferred reliever in the updated asthma approach? | ICS-formoterol |
| Which oral asthma controller is most commonly used in children? | Montelukast |
| Which add-on inhaler can be used in patients with a history of exacerbations despite ICS/LABA? | LAMA |
| Which biologic can be used for severe asthma regardless of eosinophil count or biomarkers? | Tezepelumab |
| Which biologic is for severe allergic asthma? | Omalizumab |
| Which biologics are for severe eosinophilic asthma? | Mepolizumab, reslizumab, benralizumab, dupilumab |
| What is the preferred ICS/LABA for maintenance and reliever therapy (MART/AIR)? | ICS-formoterol (Breyna, Symbacort, or Dulera) |
| Can LABA be used alone in asthma? | No, LABA monotherapy should not be used in asthma |
| Why should LABA not be used alone in asthma? | Increased risk of asthma-related death |
| When can step-down in treatment be considered? | If controlled for 3 months |
| What are the 4 symptom/control assessment questions? | 1) Daytime symptoms >2x/week 2) any nighttime awakenings 3) SABA reliever >2x/week 4) any activity limitation |
| What defines well-controlled asthma? | No questions answered “yes” |
| What defines partly controlled asthma? | 1–2 questions answered “yes” |
| What defines uncontrolled asthma? | 3–4 questions answered “yes” |
| Step 1 symptom frequency (when to start at step 1)? | Symptoms < 2 times/month |
| Step 2 symptom frequency (when to start at step 2)? | Symptoms ≥ 2 times/month but < 4–5 days/week |
| Step 3 symptom frequency (when to start at step 3)? | Symptoms most days |
| Step 4/5 symptom frequency? | Symptoms daily |
| When do we start using daily, low-dose ICS? | At step 2, along with low dose ICS-laba as needed |
| When do we start using medium dose ICS-LABA for asthma? | Step 4 |
| When do we start using HIGH dose ICE-formoterol (or other LABA) for asthma? | Step 5 |
| Step 1 regimens? | *PRN low-dose ICS-formoterol or Take low-dose ICS whenever SABA is used |
| Step 2 regimens? | As-needed low-dose ICS-formoterol (just like step 1) or PRN SABA/ICS (airsupra)+ maintenance ICS |
| Step 3 regimens? | Low or medium ICS-LABA or ICS-SABA with maintenance ICS formoterol May add LTRA |
| Step 4 regimens? | Low dose ICS-LABA rescue and maintenance medium ICS-laba May add LTRA or tiotropium if needed |
| Step 5 regimens? | Same as step 5, tiotropium now recommended, consider adding oral steroid therapy. |
| When should biologics be considered? | Step 5 / persistent severe asthma |
| Which drug can be used for exercise-induced bronchospasm prevention 5–15 minutes before exercise? | SABA or low-dose ICS-formoterol |
| If a patient is already taking daily LABA for asthma, should they take extra LABA before exercise? | No |
| Main side effects of ICS? | Thrush and dysphonia, rinse mouth after use |
| Major warning with high-dose/long-term ICS? | Systemic corticosteroid effects (includes Osteoporosis, glaucoma, adrenal suppression, hypertension, hyperglycemia, headache, tremor, weight gain) |
| Which ICS is preferred in pregnancy? | Budesonide |
| Which ICS is commonly used in young children? | Budesonide |
| Brand name of Budesonide | Pulmicort and Respules |
| Fluticasone brand name? | Flovent |
| Brand name fluticasone furoate? | Arnuity Ellipta |
| Ciclesonide brand name? | Cicelsonide |
| Which ICS/LABA combinations contain formoterol? | Symbicort, Dulera, Breyna |
| Generic name of Dulera? | mometasone/formoterol |
| fluticasone/salmeterol brand name? | Advair, Airduo, Wixela |
| Which ICS/LABA is fluticasone/vilanterol? | Breo Ellipta |
| Why is formoterol special among LABAs? | Rapid onset, so it can be used as reliever with ICS. No other LABA can be used for rescue |
| Which LABAs formulations can be used for rescue? | Any formulations with formoterol. |
| Which SABA is also available OTC and is not recommended routinely? | Epinephrine (Asthmanefrin) |
| Main SABA warnings? | Diabetes, glaucoma, hyperthyroidism, seizures, cardiac disease |
| Which electrolyte should be monitored with SABAs? | Potassium |
| Zafirlukast brand name? | Accolate |
| Zileuton brand name? | Zyflo / Zyflo CR |
| Zafirlukast contraindication? | Hepatic impairment |
| Zileuton major warning? | Hepatotoxicity |
| Which leukotriene modifiers require LFT monitoring? | Zafirlukast and zileuton (all of them except montelukast) |
| Common leukotriene modifier side effects? | Headache, dyspepsia, abdominal pain, LFT increase |
| Why is theophylline rarely used now? | Significant adverse effects, many interactions, and drug level monitoring required (narrow TI) |
| Theophylline therapeutic range? | 5-15 mcg/mL |
| Major theophylline toxicities/ADRs? | Persistent vomiting, arrhthmias, seizures |
| Common theophylline side effects? | Nausea, vomiting, headache, insomnia, tachycardia, tremor |
| Theophylline mainly metabolized by? | CYP1A2 |
| Name common things that increase theophylline levels | Cimetidine, ciprofloxacin, fluvoxamine, propranolol, erythromycin, clarithromycin |
| Name common things that decrease theophylline levels | Smoking, carbamazepine, rifampin, phenytoin, phenobarbital, St. John’s wort |
Created by:
cdaughtry