exam 1 - asthma therapeutics - background and drugs

in children (under 18) is asthma more common in men or women

men

in adults 18 and over, is asthma more common in men or women

women

what time of day can asthma symptoms worsen and why

at night, lower cortisol released at night

spirometry is used in patients over ______years of age before and after the inhalation of a ________

5, SABA

what pulmonary function testing technique is the gold standard in diagnosing asthma

spirometry

what four measurements are collected in a spirometry test

FVC, FEV1 and FEV6, FEV1/FEV and FEV1/FEV6

what is FVC

forced vital capacity, the point of maximal inhalation, how much air the lungs can hold

what is FEV

the maximal volume of air forcibly exhaled from the point of FVC in 1 second (FEV1) and 6 seconds (FEV6)

if there is an obstructive defect, what will happen to the FEV1

decrease

if there is an obstructive defect, what will happen to the FVC

normal

If there is an obstructive defect, what will happen to the FEV1/FVC and FEV1/FEV6

decrease

what is exhales nitric oxide recommended

as adjunct to evaluation process for individuals over 5 years if diagnosis is uncertain

can exhales nitric oxide be used alone

no

what can exhales nitric oxide be helpful

determining which individuals have eosinophilic asthma and are likely to respond to ICS

the most effective long term control medications are those that attenuate the _____________characteristic of asthma

underlying inflammation

name the 5 medications classified as ICS for long term maintenance

beclomethasone dipropionate, budesonide, fluticasone, mometasone, cuclesonide

brand name for beclomethasone dipropionate

Qvar

brand name for inhaler budesonide

pulmicort flexhaler

brand name for budesonide nebulizer

pulmicort respules

brand name for fluticasone inhaler

annuity ellipta

brand name for mometasone furoate

asmanex HFA/twisthaler

brand name for ciclesonide

alvesco

ICS are long term use to prevent symptoms for patients with __________________asthma

mild, moderate and severe persistent asthma

what dose ICS should be taken whenever a SABA is taken PRN

low dose

local adverse effects of ICS

candidiasis, dysphonia, cough, suppression of growth velocity (low to medium doses), systemic affects (high doses)

what supplements should adults consider who are on inhaled ICS

calcium and vitamin D

what ICS MDIs do not need to be shaken before use

QVAR, alvesco, Respimat products

what is considered an immunosuppressive dose of a systemic corticosteroid

2 mg/kg or 20 mg/day or more of a prednisone equivalent for greater than 1 month

what should systemic corticosteroids be taken with

food

what vaccine can not be administered while a patient is on an immunosuppressive dose of a systemic corticosteroid

varicella

what are the two LTRAs

montelukast and zafirlukast

brand for montelukast

Singulair

brand for zafirlukast

accolate

when do the guidelines recommend LTRAs

with concomitant allergic rhinitis, those who cannot take ICS, in combination with ICS in moderate/severe persistent asthma

adverse effects of LTRAs

headache, dizziness, abdominal pain

adverse effects of zafirlukast

reversal hepatitis, irreversible hepatic failure

what is montelukast BBW

neurophysiatric events

when should zafirlukast be taken

1 hour before or 2 hours after food

what should be monitored when taking zafirlukast

LFTs

what is a LAMA used in maintenance asthma therapy

tiotropium

brand of tiotropium

Spiriva Respimat

when is a LABA used in therapy

an add on treatment in moderate/severe persistent asthma

LABA adverse effects

anticholinergic adverse effects, upper respiratory tract infections, pharyngitis, sinusitis

the max benefit of a LAMA may take up to __________ weeks of dosing

4-8

what LABA is used in chronic asthma treatment

salmeterol

brand name of salmeterol

serevent

what should LABAs be added to for asthma therapy

ICS

adverse effects of LABAs

tachycardia, skeletal muscle tremor, hypokalemia, potential severe exacerbations

list the monoclonal antibodies used for asthma treatments

omalizumab, mepolizumab, reslizumab, benralizumab

brand of omalizumab

Xolair

brand of mepolizumab

nucala

brand of reslizumab

cinqair

brand of benralizumab

fasenra

brand of dupliumab

dupixent

when can omalizumab be used for asthma treatment

moderate or severe IgE asthma that is inadequately controlled with ICS

when can mepolizumab, reslizumab, benralizumab and dupilumab be used in therapy

add on maintenance treatment of severe asthma with an eosinophilic phenotype

route and frequency of omalizumab

SC once every 2-4 weeks depending on body weight and IgE serum levels

route and frequency of mepolizumab

SC once every 4 weeks

route and frequency of reslizumab

IV every 4 weeks

route and frequency of benralizumab

SC every 4 weeks for first 3 doses, then every 8 weeks

name the two SABAs used in asthma

albuterol, levabluterol

adverse effects of SABAs

nervousness, tachycardia, muscle tremor, hypokalemia, increased lactic acid, headache, hyperglycemia, cough

what's the drug of choice for acute bronchospasm

SABA

what are the low dose ICS and LABA combination inhalers

Symbicort, dulera

what LABA and ICS combination inhaler is preferred in asthma guidelines

Symbicort

what is the SABA and ICS combination inhaler for asthma

airsupra

what is a SAMA for asthma

ipratopium bromide

Brand name for ipratropium bromide

atrovent

when is SAMA used in asthma treatment

add on to SABA for moderate to severe asthma exacerbations

side effects of a SAMA

dry mouth, increased wheezing

systemic corticosteroid dosing for adults and children 12 years and older

40-60 mg/day for 3-10 days

systemic corticosteroids dosing for infants and children under 12 years

1-2 mg/kg/day for 3-10 days