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Flashcards in Asthma Pharm Deck (44)
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1

Step Up Therapy

Start treatment at step appropriate to asthma severity at time of evaluation
Goal not achieved- gradually step up therapy until successful

2

Step Down Therapy

Treat exacerbation symptoms with aggressive management
Gradual reduction of long-term-control meds to lowest level possible

3

Types of Long-Term Control

Anticholinergics
Corticosteroids
Mast cell-stabilizing agents
Leukotriene modifiers
Methylxanthines
LABA

4

Administration Techniques

MDI
Nebulizer
Inhaled powder
Systemic administration

5

Beta-2 agonists

Produce airway dilation
Stimulation of beta-adrenergic receptors
Decrease release of mediators

6

Short-acting Beta 2 Agonists

Acute attack
Prevention of exercise-induced bronchospasm

7

Long-acting Beta 2 Agonists

Prevention
Maintenance therapy

8

Examples of Short Acting B2 Agonist

Albuterol
Proventil
Ventolin
Terbutaline (Brethine)
Bitolterol (Tornalate)
Pirbuterol (Maxair)

9

Adverse Effects of Beta-2 Agonists

Tachycardia
Tremor
Hypokalemia
Headache
Hyperglycemia
Increased lactic acid

10

Examples of Long Acting Beta-2 Agonists

Salmeterol (Serevent)
Formoterol (Foradil)
Levalbuterol (Xopenex)
Fenoterol (Berotec)

11

What are LABA's used for?

Maintenance therapy
Slower onset, long-lasting

12

Anticholinergics Antimuscarinic Agents

Ipratropium bromide (Atrovent)
Tiotropium (Spiriva)

13

What can Ipratropium bromide enhance?

Bronchodilation achieved by beta-agonists

14

Types of Methylxanthines

Theophylline
Aminophylline

15

What is Theophylline for?

Maintenance therapy

16

Theophylline SE

Insomnia
Nervousness
N/V
Anorexia
Headache
Tachycardia
Seizures
Cardiac arrhythmias

17

Theophylline Immediate Release Products

Slo-Phyllin
Theolair
Quibron-T
Elixophillin
Bronkodyl
Theophylline generics

18

Theophylline Sustained Release Products

Slo-bid Gyrocaps
Theo-24
Theobid
Theo-Dur
THeospan-SR
Theophylline SR generics

19

MOA of Corticosteroids

Reduce airway inflammation

20

Inhaled Steroids

Reduce airway reactivity

21

SE of Corticosteroids

Thrush
Dysphonia
Adrenal suppression (LD)
Cataract formation (LD)
Decreased growth in children (LD)
Interference with bone metabolism (LD)
Purpura (LD)

22

Examples of Corticosteroids

Fluticasone (Flovent)
Budesonide (Pulmicort)
Beclomethasone (Vanceril, Beclovent, QVAR)
Triamcinolone (Azmacort)
Flunisolide (Aerobid, Aerobid-M)

23

Budesonide (Pulmicort)

First nebulizer steroid
Greater number symptom free days
Decreased B-agonist need
Reduced hospitalization rates

24

Examples of PO Steroids for Acute Treatment

Methylprednisolone
Prednisone

25

Chronic Treatment with PO Steroids

Alternate-day schedule
Minimize SE
Interrupts growth
Long acting preparations should not be used

26

Newer Steroid Agents

Advair Diskus (fluticasone + salmeterol)
Combivent MDI (ipratropium + albuterol)

27

Examples of Mast Cell Stabilizers

Cromolyn (Intal)
Nedocromil (Tilade)

28

Action of Mast Cell Stabilizers

Don't influence airway tone
Inhibit degranulation of mast cells
Prevent release of chemical mediators

29

When are mast cell stabilizers most effective?

Seasonal disease

30

Examples of Leukotriene Inhibitors

Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Leutrol, Zyflow)