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Naplex
Asthma - Clinical pearl
| Question | Answer |
|---|---|
| What is the only LABA is used for both relieve and maintenance in asthma | Formoterol. It is the only LABA which has onset 3 min, peak 15 min |
| is Salbuterol used for both relieve and maintenance in asthma | NOOOOO. Salbuterol onset 30-45mins, peak 3 hrs --> maintenance only All LABA (except formoterol) have box warning for increased risk of asthma-related deaths when used as monotherapy in asthma |
| can LABA be used as monotherapy in asthma | NOOOO, except formoterole All other LABA have box warning for for increased risk of asthma-related deaths when used as monotherapy in asthma |
| Step 1 asthma | - PRN low-dose ICS-formoterol (Symbicort) - PRN low-dose ICS + PRN SABA (Take at the SAME TIME, SABA first) |
| Step 1 asthma definition | |
| Asthma Step 2 | - PRN low-dose ICS-formoterol (Symbicort) (same as step 1) - Daily low-dose ICS + PRN SABA |
| Step 2 asthma definition | Infrequent symptoms (ie, < 5x/week) |
| Step 3 | - Daily low-dose ICS-formoterol + PRN low-dose ICS-formoterol - Daily low-dose ICS-LABA + PRN SABA |
| Step 3 asthma definition | Symptoms most days, night awakening at least once/week, or reduced lung function |
| Step 4 | - Daily medium-dose ICS-formoterol + PRN low-dose ICS-formoterol - Daily medium-dose ICS-LABA + PRN SABA |
| Step 4 asthma definition | Daily symptoms or night awakening at least once/week. + reduced lung function or recent exacerbation |
| Step 5 | - Daily high-dose ICS-formoterol + PRN low-dose ICS-formoterol - Daily high-dose ICS-LABA + PRN SABA - w or w/o tiotropium, oral steroid, or injectable monoclonal antibody |
| Step 5 asthma definition | |
| Dose of Symbicort for asthma rescue | low-dose (always, regardless of asthma severity) |
| Medium dose of Symbicort for asthma | Step 4 maintenance |
| High dose of Symbicort for asthma | Step 5 maintenance |
| Asthma step 4 vs step 5 maintenance | - Step 4: medium dose - Step 5: high dose - Maintenance is either Symbicort or ICS + another LABA |
| Albuterol adverse effects: | The major side effects of inhaled beta-2 agonists include nervousness, tremor, shakiness, cough, tachycardia, hyperglycemia and hypokalemia. |
| INHALED CORTICOSTEROIDS | • Must rinse mouth with water and spit out after each use to prevent thrush |
| Zafirlukast | It is a leukotriene receptor antagonist (LTRA) that reduces airway inflammation, not for rescuse |
| zileuton | it reduces airway inflammation by inhibiting leukotriene synthesis |
| Xolair (Omalizumab) | is injectable monoclonal antibody, treat moderate-to-severe persistent allergic asthma |
| TRUE or FALSE: use maintenance for step 1 asthma | FALSE. Only SABA or Symbicort PRN |
| Asthma Action Plan - Green Zone (Safety) | 80 - 100% of personal best |
| Asthma Action Plan - Yellow Zone (Caution) | 50-＜80% of personal best Take rescuce and monitor peak flow |
| Asthma Action Plan - Red Zone (Danger) | < 50 % of personal best Seek medical attention |
| Asthma symptoms | • Wheezing • Breathlessness • Chest tightness • Cough |
| Maintenance of step 2 vs step 3 | • Step 2: Daily low-dose ICS • Step 3: Daily low-dose ICS-LABA |
| Albuterol causes hyper or hypoglycemia | Albuterol can raise blood sugar levels |
| Albuterol causes hyper or hypokalemia | Albuterol can raise potassium level; it is a used to treat hyperkalemia |
| Drugs trigger asthma symptoms | Aspirin, NSAIDs, non-selective beta blockers |
| COMORBID CONDITIONS trigger asthma symptoms | Infections (Colds and Viruses), Allergic Rhinitis, GERD, Obesity, Obstructive Sleep Apneo, Anxiety, Stress and Depression |
| Environmental Triggers of asthma symptoms | pollution, cigarettes, cold air/changes in weather, pets, dust,, pollen & cockroaches, perfume and cosmetics |
| When to use Oral Prednisone for asthma | In asthma, oral steroids are used for exacerbations and severe, persistent asthma (step 5); they should always be used for the shortest duration and lowest dose possible. |
| SEs of oral prednisone / steroids | incrase blood pressure, increase appetite, causing weight gain. |
| Theophylline dosing | • Dosed using IBW. • If TBW < IBW, use TBW |
| Theophylline SEs: | • Nausea, headache, tachycardia, insomnia, tremor/nervousness • Toxicity: arrhythmias, seizures |
| Theophylline Therapeutic range | 5-15 mcg/mL |
| Theophylline conversion to aminophylline | 0.8 A - 100; T - 80 AT 100: 80 |
| Theophylline MoA | Theophylline is a nonselective phosphodiesterase inhibitor. It causes an increase in cyclic adenosine monophosphate (cAMP), which promotes the release of epinephrine from adrenal cells. This causes bronchodilation. |
| diagnosis of asthma | A post-bronchodilator increase in FEV, or FVC ≥ 12% and ≥ 200 mL indicates significant bronchodilator responsiveness (ie, reversibility), confirming the diagnosis of asthma. |
| FEV1/FVC < 0.7 | confirms the diagnosis of COPD, not asthma. |
| zileuton is indicated for | patients 12 years and older. |
| Montelukast is indicated for | patients at least one year of age |
| zafirlukast is indicated for | patients 5 years and older |
| Theophylline toxicity due to meds: | Ciprofloxacin, clarithromycin and zafirlukast can all increase levels of theophylline. |
| Pulmicort Respules are | nebulizer suspensions indicated for children. |
| Meds decrease levels of theophylline. | Carbamazepine and primidone can increase the metabolism of theophylline, therefore, decreasing levels of theophylline. |
| Singulair boxed warning | neuropsychiatric events; behavior and mood-related changes have been reported. This warning was added in 2009 and applies to all the leukotriene modifiers. |
| Levalbuterol | a short-acting beta-2 agonist, is a rescue inhaler that contains only the R-isomer of albuterol. It may be considered in patients who experience adverse effects (eg, palpitations) with albuterol. |
| Using a peak flow meter | requires the patient to be in a standing (or at least in an upright) position forthe best measurement. Patients should blow out as hard and as fast as possible. |
| A peak flow reading of less than 150 L/min (liters per minute) indicates | a medical emergency because it signifies severe, potentially life- threatening narrowing of the airways, often signaling an acute, severe |
| An asthma diagnosis requires | the presence of intermittent respiratory symptoms and objective evidence of variable airflow limitation, demonstrated by a post-bronchodilator increase in FEV, or FVC ≥ 12% and ≥ 200 mL on spirometry. |
| QVAR RediHaler | is a metered-dose inhaler that is NOT compatible with a spacer |
| The risk of thrush with ICS can be decreased by | - rinsing the mouth after each use of an ICS - using a spacer |
| Omalizumab is a monoclonal antibody that prevents IgE binding to the high-affinity receptors on basophils and mast cells. | - Is used as adjunctive therapy for patients 6 years and older with allergies and severe, persistent asthma. - The first 3 doses must be given in a healthcare setting |
| Meds can increase the metabolism of theophylline, therefore, decreasing levels of theophylline. | Carbamazepine and primidone |
| montelukast granules | is mixed with must be cold or at room temperature |
| Diskus | Is a DPI, contains medication in dry powder form. Correct cleaning: • Wipe the mouthpiece with a dry tissue or dry cloth • Keep the device dry |
| Breztri Aerosphere is | MDI, tripple therapy (budesonide/glycopyrrolate/formoterol fumarate) indicated for COPD |
| Which meds increase, decrease or neutral impact on theophylline level: Allopurinol Citalopram Carbamazepine Primidone Quinidine | - Increase: Allopurinol, Quinidine - Decrease: Carbamazepine, Primidone - Neutral impact: Citalopram |
| Interleukin receptor antagonists • Indicated for severe asthma with an eosinophilic phenotype | • Mepolizumab (Nucala): SC every 4 weeks • Reslizumab (Cinqair): IV every 4 weeks • Benralizumab (Fasenra): SC every 8 weeks • Dupilumab (Dupixent): SC every 2 weeks |
| Pregnancy Asthma | Preferred controllers: ICS (typically budesonide) |
Created by:
dao.vo11017