RxPrep Asthma

bronchoconstriction, inflammation

What 2 characteristics of asthma cause expiratory airflow limitation?

SOB, chest tightness, coughing, wheezing

What are the 4 classic symptoms of asthma?

reversible

The inflammation and bronchoconstriction in asthma are (irreversible/reversible).

exacerbations; asthma attacks

The most common asthma complication is ________, also called ________.

cigarettes,

cold air/weather changes,

drugs, dust/pollen,

perfume/cosmetics,

pets,

pollution

What are 7 common asthma triggers?

aspirin,

NSAIDs

non-selective beta blockers

What 3 drugs/classes are common asthma triggers?

allergic rhinitis,

anxiety,

depression,

GERD,

infections,

obesity,

obstructive sleep apnea,

stress

What 8 conditions are common asthma triggers?

spirometry

What is used to confirm an asthma diagnosis?

FEV1,

FEV1/FVC

What are the 2 main pulmonary function tests looked at for asthma?

FEV1

pulmonary function test that shows how much air can be forcefully exhaled in one second

FEV1/FVC

pulmonary function test that shows the percentage of total air capacity ("vital capacity") that can be forcefully exhaled in one second (the speed of the exhale)

short-acting bronchodilator; reversibility

To diagnose asthma, pulmonary function tests should be measured at baseline and after use of a(n) ________ to test for ________.

increase; >12

An FEV1 (decrease/increase) of ________% post-bronchodilator is consistent with an asthma diagnosis (considered "reversible").

Global Initiative for Asthma

What does GINA stand for?

GINA

What is the gold standard asthma guidelines?

daytime symptom frequency, nighttime awakenings

What 2 things is initial asthma treatment primarily based on?

<2x/month

How many daytime symptoms characterize asthma Step 1 initial treatment?

none

How many nighttime awakenings characterize asthma Step 1 initial treatment?

≥2x/month

but ≤4-5 days/week

How many daytime symptoms characterize asthma Step 2 initial treatment?

most days

How many daytime symptoms characterize asthma Step 3 initial treatment?

daily

How many daytime symptoms characterize asthma Step 4 initial treatment?

none

How many nighttime awakenings characterize asthma Step 2 initial treatment?

≥1x/week

How many nighttime awakenings characterize asthma Step 3 initial treatment?

≥1x/week

How many nighttime awakenings characterize asthma Step 4 initial treatment?

tobacco smoke

Patients with asthma should avoid exposure to ________.

flu

What vaccine is recommended in all patients with asthma who are ≥6 months old?

inhaled, injectable, oral

What 3 formulations do asthma drugs come in?

inhaled

What drug formulation is preferred for asthma and has reduced toxicity?

relievers

(Controllers/Relievers) rapidly open airways to treat acute symptoms.

exercise-induced bronchospasm

In addition to treating acute asthma symptoms, relievers can be used preventively for ________.

rescue inhalers

What's another term for relievers?

maintenance inhalers

What's another term for controllers?

controllers

(Controllers/Relievers) are taken on a daily basis to reduce inflammation.

inhaled corticosteroid

What does ICS stand for?

ICS

What drug class is the mainstay of treatment for controllers and is considered first-line?

low dose ICS + formoterol

What is the preferred reliever regimen for asthma?

short-acting beta-2 agonist

What does SABA stand for?

SABA

What is an alternative reliever regimen for asthma?

ICS + formoterol reduces risk of exacerbations

What does the low dose ICS + formoterol combination do compared to a SABA alone as a reliever?

SABA

What asthma reliever drug class quickly reverses bronchoconstriction?

ICS

SABAs don't treat underlying inflammation, so they should always be used in combination with a(n) ________.

systemic steroids

Oral ________ are used during asthma exacerbations or for severe asthma that's difficult to control with other drug combinations.

LABA, LAMA, LTRA, monoclonal antibodies

What are 4 controller alternatives?

long-acting beta-2 agonist

What does LABA stand for?

leukotriene receptor antagonist

What does LTRA stand for?

long-acting muscarinic antagonist

What does LAMA stand for?

LABA

What asthma controller drug class should always be used with an ICS and never alone due to increased risk of serious adverse outcomes?

LABA

What drug class is the preferred add-on agent to an ICS?

children

What patient population are LTRAs most commonly used in?

serum drug concentration monitoring

What's a reason why theophylline is the least desirable option for asthma add-on treatment?

omalizumab

What monoclonal antibody is used as an add-on treatment for severe allergic asthma?

a

What Step is asthma treatment initiated at if a patient is having symptoms <2x/month?

a) Step 1

b) Step 2

c) Step 3

d) Step 4

b

What Step is asthma treatment initiated at if a patient is having symptoms or need for SABA ≥2x/month?

a) Step 1

b) Step 2

c) Step 3

d) Step 4

c

What Step is asthma treatment initiated at if a patient is having symptoms on most days or waking at night ≥1x/week?

a) Step 1

b) Step 2

c) Step 3

d) Step 4

d

What Step is asthma treatment initiated at if a patient is having symptoms daily, waking at night ≥1x/week, or initial presentation is with an exacerbation?

a) Step 1

b) Step 2

c) Step 3

d) Step 4

PRN low dose ICS + formoterol rescue

no maintenance

What is the preferred Step 1 regimen for asthma?

low dose ICS + SABA rescue

no maintenance

What is the alternative Step 1 regimen for asthma?

PRN low dose ICS + formoterol rescue

no maintenance

What's the preferred Step 2 regimen for asthma?

SABA rescue

low dose ICS maintenance,

What's the alternative Step 2 regimen for asthma?

low dose ICS + formoterol rescue

low dose ICS + formoterol maintenance,

What's the preferred Step 3 regimen for asthma?

SABA rescue

low dose ICS + LABA maintenance,

What's the alternative Step 3 regimen for asthma?

low dose ICS + formoterol rescue

medium dose ICS + formoterol maintenance,

What's the preferred Step 4 regimen for asthma?

SABA rescue

medium dose ICS + LABA maintenance

What's the alternative Step 4 regimen for asthma?

injectable treatment (mabs),

oral steroid,

tiotropium

What 3 add-ons should be considered for Step 5 asthma treatment?

low dose ICS + formoterol rescue

high dose ICS + formoterol maintenance,

What's the preferred Step 5 regimen for asthma?

SABA rescue

high dose ICS + LABA maintenance,

What's the alternative Step 5 regimen for asthma?

Are daytime asthma symptoms occurring >twice/week?

What's the main question that should be asked at each visit to assess asthma control?

0

Asthma patients are considered "well-controlled" if ________ control question(s) is/are answered "yes."

maintain current step

What's the course of action for an asthma patient who is deemed "well-controlled" at their follow-up?

≥3 months

Asthma patients may step down their treatment if controlled for ________.

1-2

Asthma patients are considered "partly controlled" if ________ control question(s) is/are answered "yes."

step up 1 step

What's the course of action for an asthma patient who is deemed "partly controlled" at their follow-up?

3-4

Asthma patients are considered "uncontrolled" if ________ control question(s) is/are answered "yes."

step up 1-2 steps and

consider short course of oral steroids

What's the course of action for an asthma patient who is deemed "uncontrolled" at their follow-up?

beta-2 agonist

drug class that causes relaxation of bronchial smooth muscle, which leads to bronchodilation

used as needed

SABAs are (scheduled/used as needed) for acute asthma symptoms.

LABA

What drug class is used as part of asthma rescue therapy or as maintenance therapy beginning in Step 3 of treatment?

albuterol

What's an example of a SABA used in asthma?

ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA

What are 4 brand names for inhaled albuterol?

90

Albuterol inhalers come in doses of ________ mcg/inhalation.

1-2 inhalations Q4-6H PRN

How are albuterol MDIs/DPIs typically dosed for asthma?

multi-dose inhaler

What does MDI stand for?

dry powder inhaler

What does DPI stand for?

true

True or False: Oral forms of albuterol are available but not recommended for asthma.

it's non-selective

Why shouldn't OTC epinephrine be used for asthma?

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

What are 7 side effects of SABAs?

levalbuterol

________ contains the R-isomer of albuterol.

200

Most albuterol inhalers contain ________ inhalation(s)/canister.

Ventolin HFA

What albuterol inhaler is available in both 200 inhalations / canister and 60 inhalations/canister?

2 inhalations prior to exercise

How are SABAs dosed for exercise induced bronchospasm?

salmeterol

What's an example of a LABA used in asthma?

Serevent Diskus

What's the brand name for inhaled salmeterol?

increased risk of asthma-related deaths when not adequately controlled on ICS,

increased risk of asthma-related hospitalizations in pediatric/adolescent patients

What are 2 boxed warnings associated with salmeterol inhalers?

salmeterol

________ should be used in an asthma maintenance inhaler only, not for acute bronchospasm.

ICS

drug class that inhibits the inflammatory response

formoterol; SABA

ICSs are used as needed in combination with ________ or a(n) ________ for acute symptoms (rescue treatment).

LABA

ICSs are used as monotherapy or in combination therapy (with a(n) ________) to control symptoms (maintenance treatment).

beclomethasone, budesonide, fluticasone

What are 3 examples of ICSs used for asthma?

QVAR RediHaler

What's the brand name for inhaled beclomethasone?

Pulmicort Flexhaler, Pulmicort Respules

What are 2 brand names for inhaled budesonide?