- Chronic airway inflammation & bronchoconstriction that causes obstruction (coughing, SOB, chest tightness, wheezing)

Asthma Flashcards by Emily Byford

What is Asthma?

Chronic airway inflammation & bronchoconstriction that causes obstruction (coughing, SOB, chest tightness, wheezing)

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What are some of the triggers & comorbid condition of asthma?

Triggers: Pollution, Cigs, Weather changes, Pets, Dust, Pollen, Drugs (Aspirin. or NSAIDs)
Comorbid: Infections, Allergic Rhinitis, GERD, Obesity, OSA, Anxiety, Stress…

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What is the way that asthma is diagnosed?

SPIROMETRY, which looks at;
FEV1: exhaled in 1 sec
FVC: max volume exhaled after deep breath
FEV1/FVC: total air that can be exhaled in 1 sec

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What are some of the things to do to help control risk factors for asthma?

AVOID exposure or perfoming smoking
Annual FLU shot (maybe Pneumonia or COVID)
Allergen Sensitivity Test if asthma is related to it

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What are relivers (rescue) drugs that are used for Asthma and what are some of the drug classes?

Work within minutes to open airways for the acute symptoms
ICS + Fomoterol or SABA (Steroids, SAMA, Epi)

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What are controller (maintenance) drugs that are used for Asthma and what are some of the drug classes?

used daily to help with reducing inflammation & control symptoms
ICS (1st line), SAMA, SABA, LTRAs, Monoclonal antibodes

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Per the GINA Guidelines what do the individual steps mean for the asthma treatment algorithem?

step 1 - 5

Step 1: symptoms < 2x / months
Step 2: symptoms or SABA for > 2x / months
Step 3: symtpoms of most days or waking at night > 1x / week
Step 4/5: symptoms daily, waking at night > 1x / week, or exacerbations

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What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 1?

“symptoms < 2x / month”

Low dose ICS + Fomoterol (PRN) [Rescue] OR
SABA + Low odse ICS (taken together) [Rescue]

BOTH are rescue

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What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 2?

“symptoms or SABA usage . 2x / month”

Low dose ICS + Fomoterol (PRN) [Rescue] OR
SABA or ICS-SABA + Low dose ICS [Rescue + Maintenance]

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What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 3?

‘“symptoms mose days or waking at night > 1x / week”

Low dose ICS-Fomoterol + Low dose ICS-Fomoterol [Rescue + Maintenance] OR
SABA or ICS-SABA + Low dose ICS-LABA [Rescue + Maintenance]

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What is the asthma treatment (rescue and maintenance) recommended for someone with GINA Step 4/5?

Low dose ICS-Fomoterol + Med-High dose ICS-Fomoterol [Rescue + Maintenance] OR
SABA or ICS-SABA + Med-High dose ICS-LABA [Resuce + Maintenance]

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What is the MOA for the Beta 2 agonists that are used for asthma?

Bind to the beta 2 receptor which causes relaxation of smooth muscle = bronchodilation
SABA or LABA

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What are the Short Acting (SABAs) Beta 2 Agonist that are used for Asthma?

Albuterol (ProAir HFA or RespiClick, Ventilin HFA, Proventil HFA) 90 mcg/inhalation
Levalbuterol (Xopenex)

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What are some of the side effects for the SABAs that are used in asthma?

Nervousness
Tremor
Tachycardia
Palpitations
Cough
Hyperglycemia
Decrease Potassium

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What are some addtional notes for the SABAs that are used for asthma?

MDIs: need shaken well before use
Most albuterol is 200 inhal/canister BUT Ventolin has 200 and 60

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What are the Long Acting (LABA) Beta 2 Agonist that are used for Asthma?

Salmeterol (Serevent Diskus)

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What are some boxed warnings for Salmeterol used in asthma?

Increased risk of asthma related deaths (ONLY in combo with ICS)

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What is the MOA for the Inhaled Corticosteroids (ICS) used for asthma?

Reduce inflamationin airways = reduce asthma symptoms

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What are some of the ICSs that are used for asthma?

Beclomethasone (QVAR)
Budesonide (Pulmicort, Arunity Ellipta) + Fomoterol (Symbicort)
Fluticasone (Flovent) + Samleterol (Advair); + Vilanerol (Breo Ellipta)

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What are some of the warnings for the ICS used in Asthma?

Increased risk of fractures, Growth Retardation in kids, immunosuppression

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What are some of the side effects for the ICS used in asthma

Difficulty speaking, Thrush, Cough

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What are some of the Additional Notes for the ICS used for asthma?

Rinse out mouth with water to prevent thrush
Budesonide is ONLY ICS with Nebs (Repsules)
QVAR = DO NOT SHAKE

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What ICS is approved for asthma?

Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent, Arunity)

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What ICS is approved for COPD?

Covered in COPD section

NO single agent

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What **LABA** is approved for **Asthma**?

- Salmeterol (Serevent Diskus)

What **LABA** is approved for **COPD**? ## Footnote Covered in the COPD section

- **Salmeterol (Serevent Diskus)** - Formoterol - Arformoterol - Olodaterol

What **LAMA** is approved for **Asthma**?

- Tiotropium (Spiriva)

What **LAMA** is approved for **COPD**? ## Footnote Covered in the COPD section

- **Trotropium (Spiriva)** - Aclidinium (Tudorze) - Revefenacin - Umeclidinium (Incurse Ellipta)

What **ICS/LABA** is approved for **Asthma**?

- Budenoside/Formoterol (**Symbicort**) - Fluticasone/Salmeterol (**Advair**) - Mometasone/Formoterol (**Dulera**) - Fluticasone/Vilanerol (**Breo**)

What **ICS/LABA** is approved for **COPD**?

- Budenoside/Formoterol (**Symbicort**) - Fluticasone/Salmeterol (**Advair**) - Fluticasone/Vilanerol (**Breo**)

What **LABA/LAMA** is approved for **asthma**?

- **NONE**

What **LABA/LAMA** is approved for **COPD**?

- Aclidinium/Fomoterol (Duaklir) - Glycopyrrolate/Fomoterol (Bevespi) - Tiotropium/Olodaterol (**Stiolto**) - Umeclidinium/Vilanterol (**Anoro**)

What **ICS/LABA/LAMA** is approved for **Asthma**?

- Umeclidinium/Valanterol/Fluticasone (**Trelegy**)

What **ICE/LABA/LAMA** is approved for **COPD**?

- Umeclidinium/Valanterol/Fluticasone (**Trelegy**) - Glycopyrrolate/Formoterol/Budesonide (**Breztri**)

What are some of the **key features** for **MDIs**?

- i.e.; HFAs or Repimats or NO suffix - **SLOW, DEEP** inhalation while pressing - Spacer can be used - Shake before use & prime first dose

what are some **key features** for **DPIs**?

- i.e.; Diskus, Ellipta, Pressair, Handihaler, RespiClick, Flexhaler - **Dry Powder** - **QUICK, FORCEFUL** inhalation - NO Spacer; DO NOT shake and NO Priming

What is the **MOA** for the **Leukotriene Modifying Agents (LTRAs)** used for **Asthma**

- Mediators for airway inflammation = reduce airway edema, constrictions and inflammation

What are the **LTRAs** that are used for **asthma**?

- **Montelukast (Singular)** - Zafirlukast - Zileuton

What are some of the **boxed warnings/warnings** for **montelukast** used for **asthma**?

- Neuropsychiatric Events (increase mood changes and suicidal thoughts)

What are some of the **side effects** for **montelukast** used in **asthma**?

- Headache, Dizziness, ab pain, Increase LFTs, URTis

What are some **additional notes** for **montelukast** used in **asthma**?

- Take in the **Evening** - Monte Granules: Can be taken directly into mouth or with Breast Milk/formula, Applesaue, carrots, rice or ice cream (NOTING ELSE) - 1 - 5 yo = 4 mg & 6 - 14 yo = 5 mg

What is the **MOA** for **Theophylline** used for **asthma**?

- Blocks phosphodiesterase = increse in cAMP & Epi = bronchodilation (limited by decreased effectiveness and drug interactions)

What are some of the **side effects** for **Theophylline** used for **asthma**?

- N/V, Headache, Insomia, Increase HR, Tremor, Nervousness - **Toxicity**: Presistant vomiting, Arrhythmias, seizures

what are some **additional notes** for **Theophylline** used for **asthma**?

- Amino to Theo = **x 0.8** & Theo to Amino = **/ 0.8** - Theraputic Range for Theo: **5 - 15** - use **IBW** when dosing; if **< IBW use TBW** ## Footnote **ATM** --> **A**mino to **T**heo is **M**ulltiply

What are some **medications** that could **increase theophylline** levels? ## Footnote 1A2 Substrate

- **Cipro**, Fluvoxamine, Propranolol, **Zileuton** (1A2 Inhibitors) - **Clarithormycin**, Erythromycin (3A4 inhibitors) - **Zafirlukast, alcohol**, allopurinol disulfiram, estrogen OC, MTX, Verapamil... (other agents)

What are some **medications** that could **decrease theophylline** levels?

- Carbamzaepine, Fosphenytoin, Phenobarb, Phenytoin, Primidone, Rifampin, Ritonavir

What is the **MOA** for the **IgG monoclonal antibodies** used for **asthma**? ## Footnote -

- **Inhibits IgE binding** to the IgE receptor on Mast Cells and Basophils

What are the **different monoclonal antibody** class that are used for **Asthma**?

- IgG - Interleukin Receptor Antagonist - Human Thymic Stromal Lymphopoietin Blocker

What is the **IgG Monoclonal Antibodies** that is used for **asthma**?

- Omalizumab (Xolair)

What is the **Administration and notes** for **xolair**?

- Given **SubQ** IN the healtcare setting - For **severe asthma**, those with positive skin test - Boxed warning: **Anaphylaxis**

What are some of the **Interleukin Receptor antagonsts** that are used for **asthma**?

- Mepolizumab (Nucala) **SubQ** - Reslizumab (Cinqair) **IV** - Benralizumab (Fasenra) **SubQ** - **Dupilumab (Dupixent) SubQ**

What is the best way to **prevent exercise-induced bronchospasm** within **asthma**?

- SABA or Low dose ICS-Fomoteral **5 - 15 mins** before exercise ## Footnote **Salmeterol** could be used BUT it HAS to be in combo with ICS

What is the way to **Keep control** of the **asthma** during **pregnancy**/

- ICS (daily or PRN)

What is the **proper timing** and **order** of inhalers if given multiple for **asthma**?

- SABA (bronchodilator 1st) - WAIT 60 secs - LAMA or LAB (other bronchodilator) - WAIT 60 secs - ICS ## Footnote **bronchodilators** help the ICS get deeper into the lungs

What is a **spacer** and what is the importance of using one?

- Helps with drug deliverly - Best used for **Kids** or those with **Dexterity issues** - Can help **reduce thrush** risk

What are the **proper steps** to take when using a **MDI**? ## Footnote i.e.; Albuterol, Symbicort, Flovent HFA, Dulera...

- Step 1: **Shake** inhaler for **5 secs** before each spray and **prime** 2 - 4 times (away from faces) - Step 2: Breathe **out fully** through mouth then place the piece in mouth fully closing lips around it - Step 3: Breathe in **SLOW, DEEP** while pressing the top of the cantiser down. **Hold breathe** for **10 secs** then breathe normally (rinse mouth out if ICS)

What are the **proper steps** to take when using a **DPI**? ## Footnote i.e.; Advair

- Step 1: Push thumb grip away to prime it (Snaps into spot) - Step 2: hold diskus **flat** with mouthpiece toward you - Step 3: Breath out **away** from diskus - Step 4: place mouth around mouthpiece closing completly. **QUICK, DEEP, FAST** breathe in holding for 10 secs - Step 5: Breath normally, closes the diskus (slide back to you) and rinse month out with water --> spit

What are the **proper steps** to take when using a **Flexhaler** ## Footnote i.e.; budesonide flexhaler

- Step 1: Twist off white cover - Step 2: Twist brown base until **click** is heard = dose loaded - Step 3: Turn head away from inhalar and breath out - Step 4: Place mouth arounf mouthpiece tightly and breath **DEEP, FAST** - Step 5: Replace cap and **rinse mouth** with water --> spit

What is the **brand name** for **Beclomethasone** ## Footnote ICS; Asthma

- QVAR RediHaler

what is the **brand name** for **budesonide**? ## Footnote ICS; Asthma

- Pulmicort Flexhaler

what is the **brand name** for **Fluticasone**? ## Footnote ICS; Asthma

- Flovent HFA or Arnuity Ellipta (dry powder)

what is the **brand name** for **Salmeterol**? ## Footnote LABA; Asthma or COPD

- Serevent Diskus

what is the **brand name** for **tiotropium**? ## Footnote LAMA; Asthma or COPD

- Spiriva Respimat (Only in asthma) - Spiriva HandiHaler

what is the **brand name** for **Budesonide/Formoterol**? ## Footnote ICS/LABA; Asthma or COPD

- Symbicort or Breyna

what is the **brand name** for **Fluticasone/Salmeterol**? ## Footnote ICS/LABA; Asthma or COPD

- Advair Diskus (dry powder) or HFA

what is the **brand name** for **Mometasone/Formoterol**? ## Footnote ICS/LABA; Asthma only

- Dulera

what is the **brand name** for **Fluticasone/Vilanterol**? ## Footnote ICS/LABA; Asthma or COPD

- Bero Ellipta (dry powder)

what is the **brand name** for **Umeclidinum/Vilanterol/Fluticasone**? ## Footnote ICS/LABA/LAMA; Asthma or COPD

- Trelegy Ellipta (dry powder)

What is important to know about the **Green, Yellow and Red** zones of a asthma action plan (peak flow meter care)?

- **Green**: **> 80 - 100%** of personal best = **all good** continue plan - **Yellow**: **50 - 80%** of personal best = **"Caution"**, may increase rescue usage - **Red**: **< 50%** of personal best = **MEDICAL ALART** go to **ER**

Asthma Flashcards

(69 cards)