Asthma Flashcards by Sara Bojarski

disease characterized by chronic airway inflammation and bronchoconstriction resulting in expiratory airflow limitation

symptoms of wheezing, breathlessness, chest tightness, coughing

asthma

How well did you know this?

Not at all

Perfectly

diagnosis of asthma is confirmed with

spirometry

How well did you know this?

Not at all

Perfectly

percentage of total air capacity that can be forcefully exhaled in 1 second

FEV1/FVC

How well did you know this?

Not at all

Perfectly

to diagnose asthma, PFTs should be measured at baseline and after using a short acting bronchodilator to test for

reversibility

How well did you know this?

Not at all

Perfectly

major asthma guideline

GINA - global initiative for asthma

How well did you know this?

Not at all

Perfectly

at each visit for asthma, do what

check inhaler technique
check priming and cleaning
step up, maintain, step down therapy

How well did you know this?

Not at all

Perfectly

vaccines to be given in asthma or kept up to date

flu, pneumo

How well did you know this?

Not at all

Perfectly

preferred form of asthma med that delivers directly to the lung and reduces toxicity

inhaled

How well did you know this?

Not at all

Perfectly

rapidly open airways to treat acute symptoms?

relievers/rescue

How well did you know this?

Not at all

Perfectly

inhaler taken daily to reduce inflammation

controllers/maintenance

How well did you know this?

Not at all

Perfectly

3 formulations of asthma drug

oral, inhale, inject

How well did you know this?

Not at all

Perfectly

preferred reliever used as needed for asthma symptoms to reduce risk of exacerbation

ICS + formoterol

How well did you know this?

Not at all

Perfectly

alternative asthma reliever option used as needed for symptoms with an ICS to reverse bronchoconstriction

SABA

How well did you know this?

Not at all

Perfectly

oral used for severe asthma exacerbations

systemic steroids

How well did you know this?

Not at all

Perfectly

first line asthma controller therapy

ICS

How well did you know this?

Not at all

Perfectly

preferred add on option for asthma used with ICS but NEVER USE ALONE?

alternative add on?

LABA

alt- LAMA

How well did you know this?

Not at all

Perfectly

MoAb for severe allergic asthma

omalizumab

How well did you know this?

Not at all

Perfectly

MoAb for severe eosinophilic asthma

mepolizumab

How well did you know this?

Not at all

Perfectly

MoAb for severe asthma

tezepelumab

How well did you know this?

Not at all

Perfectly

step of asthma therapy if symptoms <2x month

step 1

How well did you know this?

Not at all

Perfectly

step of asthma therapy if symptoms or need SABA >2x month

step 2

How well did you know this?

Not at all

Perfectly

step of asthma therapy if symptoms on most days or waking at night >=1x week

step 3

How well did you know this?

Not at all

Perfectly

step of asthma therapy if symptoms daily, waking at night >=1x week, or initial presentation is with exacerbation

step 4

How well did you know this?

Not at all

Perfectly

preferred regimen for step 1 asthma treatment?
alternative?

PRN ICS + formoterol

alt- SABA + ICS

How well did you know this?

Not at all

Perfectly

preferred regimen for step 2 asthma treatment? alternative?

rescue: PRN ICS + formo alt rescue SABA or ICS/SABA + LD ICS maintenance

preferred regimen for step 3 asthma treatment? alternative?

resc LD ICS/formo + maint ICS/formo alt resc SABA or ICS/SABA + LD maint ICS/LABA

preferred regimen for step 4 asthma treatment? alternative?

resc LD ICS/formo + maint MD ICS/formo alt resc SABA or ICS/SABA + MD maint ICS/LABA

4 yes/no questions to assess asthma control

1. daytime asthma sx >2x week 2. any nighttime awakenings 3. SABA used >2xweek 4. is activity limited due to asthma

bind to beta 2 receptors and cause relaxation of bronchial smooth muscle causing bronchodilation

beta 2 agonists

in asthma, LABAs are used as

maintenance starting step 3

SABA examples

albuterol, levalbuterol

brand names of albuterol (4)

Proair HFA Proair respiclick Ventolin HFA Proventil HFA

dosing of albuterol

90mcg/inh 1-2 puffs Q4-6H PRN for MDI/DPI

PO forms of albuterol are available but

not recommended

epinephrine should _____ be used since it is ____

not be used nonselective

AEs of SABAs

nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, low K

before use of MDIs, do what

shake well

levalbuterol contains the ____ of albuterol

R-isomer

most albuterol contain ____ inhalations/canister, except _____ which contains ___ inhalations/canister

200inh/can ventolin 60 inh/can

when using SABAs for exercise induced bronchospasm, use _____ prior to exercise

5 minutes

LABA example

salmeterol

brand name of salmeterol

Serevent Diskus

BBW salmeterol

inc risk of asthma-related death - only use in patients receiving ICS inc risk asthma hospitalization in children/adolescents

LABAs are not used for

acute bronchospasm

inhibit the inflammatory response of asthma used as needed in combo with formoterol or a SABA for rescue or monotherapy or w/ LABA for maintenance

inhaled corticosteroids

3 main inhaled steroids

beclomethasone budesonide fluticasone

brand name of beclomethasone inhaler

QVAR RediHaler

brand name of budesonide inhaler

Pulmicort Flexhaler Pulmicort Respules

brand names of budesonide + formoterol

Symbicort, Breyna

brand name of fluticasone inhaler

Arnuity Ellipta

brand name of fluticasone + salmeterol

Advair DIskus, Advair HFA

brand name of fluticasone + vilanterol

Breo Ellipta

brand name of mometasone + formoterol

Dulera

warning of ICS

inc risk fractures, growth retardation

AEs of ICS

dysphonia, oral candidiasis, cough

what should be done to decrease risk of thrush with ICS

rinse with water and spit after using use spacer

Ciclesonide (Alvesco) is an ICS MDI than does not

need to be shaken

only ICS available as nebulized solution (jet nebulizer only)

budesonide Pulmicort respules with jet

do not do what to QVAR Redihaler

do not shake

ICS and ICS/LABA are preferred for ___ wherase LABA, LAMA, or LAMA/LABA are preferred for___

asthma COPD

LAMA example

tiotropium

brand name of tiotropium for asthma

Spiriva respimat

LAMA/LABA/ICS option that may be used in asthma

umeclidinium/vilanterol/fluticasone

brand name of umeclidinium/vilanterol/fluticasone

Trelegy Ellipta

generic products in Trelegy

umeclidinium/vilanterol/fluticasone

brand name identifiers for MDIs

HFA, respimat, or no suffix

brand name identifiers for DPIs

Diskus, Ellipta, Pressair, HandiHaler, Respiclick, FlexHaler

dose delivery of MDIs

aerosolized liquid

dose delivery of DPIs

fine powder

are there propellants in MDIs or DPIs?

MDIs- some (HFA) DPIs - no

administration of MDIs

slow, deep inhalation while pressing canister (hand breath coordination)

administration of DPIs

quick, forceful inhalations (breath activated dose delivery)

can spacers be used for MDIs?

most not QVAR RediHaler or Respimat products

can spacers be used for DPIs

is shaking before use required for MDIs

yes for all except QVAR Redihaler, Alvesco, Respimat products, and Atrovent HFA

is shaking before use required for DPIs

do not shake

is priming required for MDIs

before first use and if not used for certain time

is priming required for DPIs

not needed except Flexhaler

examples of leukotriene modifying agents

montelukast, zafirlukast, zileuton

med that inhibits leukotriene D4

montelukast

med that inhibits leukotriene formation

zileuton

brand name of montelukast

Singulair

montelukast formulations include

tablet, chewable tablet, packet

montelukast is approved for

allergic rhinitis, asthma, EIB

when should montelukast be taken

in the evening

dose of montelukast in age 1-5

4mg

dose of montelukast in age 6-14

5mg

BBW montelukast (& the warning for all in class)

neuropsychiatric events

how are montelukast granules/packets taken

directly in mouth or dissolved in breastmilk/formula or applesauce/carrots/rice/ice cream use within 15 minutes of opening

dispense zafirlukast in

original container

zafirlukast is a 2C9 substrate and can increase levels of zileuton is a minor substrate and can also ^^

theophylline

blocks phosphodiesterase causing an increase in cAMP and bronchodilation

theophylline

limitations of theophylline use

low effectiveness, DDIs

active metabolite of theophylline

caffeine

weight used to dose theophylline

IBW

therapeutic range of theophylline? measure the?

5-15 mcg/ml peak

signs of theophylline toxicity

vomiting, arrythmias, seizures

to convert aminophylline to theophylline, do what? ATM *** and to go theophylline to aminophylline

A > T multiply by 0.8 (ATM) T > A divide by 0.8

small theophylline dose increases can result in

large concentration increases

theophylline is a major substrate of ___ inhibitors of ^ can increase theophylline levels such as ___&___

1A2 ciprofloxacin, zileuton other drug that inc levels - zafirlukast

drugs that decrease theophylline levels (7)

carbamazepine fosphenytoin phenobarbital phenytoin primidone rifampin ritonavir

class that inhibits muscarinic cholinergic receptors causing bronchodilation used as an add on treatment with ICS if hx of exacerbations despite standard tx

anticholinergics (LAMA, tiotropium)

class used for severe asthma that remains uncontrolled despite max treatment usually with unique indications

MoAbs

IgG MoAb which inhibits IgE binding

omalizumab

brand name of omalizumab

Xolair

generic for Xolair

omalizumab

admin of omalizumab

SC in healthcare setting

indication of omalizumab? how to document?

severe allergic asthma document with positive skin test

BBW omalizumab

anaphylaxis

which MoAb class is used only for severe eosinophilic asthma

interleukin receptor antagonists

resilizumab BBW

anaphylaxis

interleukin antagonists for eosinophilic asthma mepolizumab, benralizumab, and dupilumab are given ____ and reslizumab is given __

3- SC 1- IV

preferred and alternative option to treat EIB

pred - SABA or LD ICS/formoterol 5-15 minsfore exercise alt- LABA (salmeterol) if need longer, but should not use alone in persistent asthma

effects of SABA for EIB with last

2-3 hours

patient counseling and assessing ___&___ is essential

inhaler technique and adherence

for a patient with good asthma control, an albuterol inhaler should last

12 months

if prescribed >1 inhalation at a time, wait

60 seconds between each

what should be used first among multiple inhalers

bronchodilators (SABA) to open airways quickly then other bronchodilators (LABA, LAMA) then ICS

device that turns liquid medication into a fine mist

nebulizer

good option for children or anyone with dexterity issues who struggle with hand-breath coordination

spacers

spacers cannot be used with

DPI

clean spacers at least

once a week

3 common spacer names

Aerochamber, optihaler, optichamber

device that measures peak expiratory flow rate (PEFR)

peak flow meter

the best PEFR is called ____which can be measured by ___ measurement accounts for __,__, &__

personal best spirometry height, sex, age

plan for managing symptoms at home

asthma action plan

technique for peak flow meter

use every morning before meds with proper technique and best effort blow out hard and fast, write down PEFR record highest value

clean peak flow meter at least

once a week

green zone of action plan __ % of PB and what it indicates?

>80-100% all clear, follow routine maintenance

YELLOW zone of action plan __ % of PB and what it indicates?

50-80% o caution - follow action plan

RED zone of action plan __ % of PB and what it indicates?

<50% medical alert- go to ED

counseling for admin of MDI (albuterol HFA**, symbicort, fluticasone, Dulera)

shake for 5 secs before each spray breathe out fully breath in slow and deep pressing canister hold breath up to 10 secs rinse mouth if ICS

how to clean Ventolin and ProAir HFA

rinse mouthpiece only under warm running water and let air dry at least weekly

how to clean Symbicort, Breyna, Dulera

wipe with clean dry cloth, do not put into water

how to admin Advair Diskus (fluticasone/salmeterol)

push thumb grip away hold flat exhale with mouthpiece away breath in quickly and deep- do not breath through nose hold breath 10 seconds close diskus rinse and spit with water

how to admin budesonide (Pulmicort Flexhaler)

take off cover, twist brown base turn head away and exhale breath in deeply for forcefully replace cover, rinse mouth

how to prime budesonide (Pulmicort Flexhaler)

twist brown based fully then back and hear click, repeat now primed and does not need to be primed again

how to clean budesonide (Pulmicort Flexhaler)

wipe mouthpiece with dry tissue

how to admin Respiclick (ProAir/albuterol, fluticasone/salmeterol//AirDuo)

open cap (open & closing without inhaling will waste med and damage) breathe quick and deep hold breath 10 seconds rinse with water for airduo

how to clean Respiclick (ProAir/albuterol, fluticasone/salmeterol//AirDuo)

do not wash

Asthma Flashcards

(140 cards)