Asthma Maintenance Therapy Flashcards Preview

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Flashcards in Asthma Maintenance Therapy Deck (41)
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1

"Older" ICS that are more commonly used

-Budesonide (comes in a nebulized suspension*)
-Fluticasone

2

"Older" ICS that are less commonly used

-Beclomethasone
-Mometasone

3

Newer ICS

Ciclesonide

-"ones" and "-ides"
-Prodrug that is activated in the lung so it causes less ADRs
-Smaller particle size to allow more to reach the lung

4

ICS mechanism of action

-same as systemic steroids
-topical deposition minimizes systemic ADRs

5

ICS indications

-1st line agent for persistent asthma
-Give lowest dose that maintains asthma control -->may need to change seasonally

-most benefits acheived at LOW doses

6

What should you do if a low dose ICS is not enough for adults?

-Increase to a medium dose or add a LABA

-Definitely add a LABA +/- leukotriene modifier before going to high dose ICS

7

ICS pearls

-Most potent long-term controller of asthma symptoms

8

ICS pt education

-Use a spacer
-Rinse your mouth after use and spit it out
-Takes 1-2 wks for full effect

9

ICS CYP3A4 substrates

-Budesonide
-Fluticasone
-Ciclesonide

-minimal clinical implications

10

ICS local ADRs

-dysphonia
-OP candidiasis (thrush)

11

ICS systemic effects

-Increased intraocular pressure --> open angle glaucoma (monitor for in patients with FH of glaucoma)
-Increased risk for skin bruising or purpura

12

LABA in Brigitte Schaefer's Pronunciation

-Salmeterol
-Formeterol

13

LABA MOA

-Long duration of action (>12 hrs), highly lipid soluble
-Formeterol is a full ag, salmeterol is a partial ag

14

LABA indications

Add-on therapy for persistent asthma

15

LABA Black box warning

Monotherapy is medical negligence, increases risk of severe asthma attacks and death

16

Salmeterol Cyp interactions

-Sub of 3A4
-Strong inhibitors can cause ADRs (tachy, paplitations) esp in heart disease

17

LABA ADRs

-Same as SABAs
-Tachy, palpitations, tremor possible

18

LAMA

Tiotropium

19

LAMA MOA

Long-acting muscarinic antagonist

20

LAMA Indications

Use as an add-on to high dose ICS plus LABA if asthma still not controlled

21

LAMA Interactions and ADRs

-Other anticholinergics -> increase ADRs
-Dry mouth most common, pharyngeal irritation

22

Leukotriene Modifiers MOA

action of 5-liopoxygenase on arachidonic acid

23

Leukotriene 5-lipoxygenase inhibitor

Zileuton (DO NOT USE, hepatotoxicity)

24

Leukotirene Cysteinyl LTRA

-Montelukastorres
-Zafirlukast (DO NOT USE, hepatotoxicity)

25

ADRs of Montelukastorres

-HA
-Rare neuropsych effects, monitor with pts and family

26

Cromoglycates and include MOA

-Cromolyn
-Alter Cl channels and prevent mast cell degranulation

27

Cromoglycates Indications

-Prophylactic only
-No effect on airway smooth muscle tone, ineffective in reversing bronchospasm

28

Methylxanthines and include MOA

-Theophylline
-Non specific inhibition of PDE
-Bronchodilator at high serum conc, but anti-inflammatory effect at lower serum conc.

29

Methylxanthines interactions

1A2 and 3A4, main 1A2 inhibitors = ciprofloxacin, amiodarone, OCPs, cimetidine

30

RF for decrease theophylline clearance

- <1yo or >60yo
-Concurrent dz (CHF, fever >102, hypothyroid, liver dz)