Notes in asthma

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Status	Last Update	Fields
Published	09/08/2024	{{c2::salmeterol}} and {{c2::formoterol}} are {{c1::LABAS}}
Published	09/08/2024	LABAS should never used as monotherapy → always must be used in combo with an inhaled {{c1::corticosteroid}}
Published	09/08/2024	LABAS are used as {{c1::adjunctive}} therapy →“step {{c2::5}}” in combination with a controller medication
Published	09/08/2024	{{c2::LABAS}} binds to {{c1::beta2}}-receptors on {{c1::bronchial smooth}} muscle to cause airway {{c1::relaxation}}
Published	09/08/2024	LABAS onset is {{c1::QUICK}}, within 3 minutes
Published	09/08/2024	LABAS improved {{c1::FEV1}},  observed for 12 hours in most patients
Published	09/08/2024	side effects of {{c1::LABAS}} are {{c2::tachy}}cardia, hypo{{c2::kalemia}}, hyper{{c2::glycemia}}, cardiac {{c2::dysrhythmias}}
Published	09/08/2024	{{c1::respiratory symptoms}} and {{c1::heart rate}} must be monitored when giving LABAS
Published	09/08/2024	Inhaled corticosteroids are {{c1::first}}-line therapy for all steps of {{c3::persistent}} asthma; maintenance and prophylactic treatme…
Published	09/08/2024	{{c1::Inhaled corticosteroids}} reduce inflammation at the cellular level through inhibitory effects on {{c2::inflammatory mediators}}; reduce {{…
Published	09/08/2024	Local side effects of inhaled corticosteroids are (2) {{c1::oropharyngeal candidiasis, dysphonia}}
Published	09/08/2024	systemic side effects of {{c2::inhaled corticosteroids}} are hyper{{c1::glycemia}}, growth {{c1::suppression}}, {{c1::osteoporo}}sis, {{c1::catar…
Published	09/08/2024	monitor {{c1::respiratory}} symptoms, {{c1::PFTs}}, signs of {{c1::oral thrush}} with inhaled corticosteroids
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Published	09/08/2024	inhaled delivery methods are (4) {{c1::nebulizers, metered dose inhaler (MDI), dry powder inhalers (DPI),  and spacers }}
Published	09/08/2024	Nebulizers are for {{c1::all}} ages and used for patients with {{c1::poor inspiratory}} function
Published	09/08/2024	Metered dose inhaler (MDI) delivers medication from a pressurized canister using a {{c1::propellant}} but requires patient to coordinate {{c2::breath}…
Published	09/08/2024	Dry powder inhalers (DPI) is a {{c1::breath-actuated}} device that requires {{c2::sufficient airflow}} to inhale the medication from the device. …
Published	09/08/2024	counseling points for {{c1::SABAs}} are to {{c2::shake well}} before use, and ensure mouthpiece is {{c3::cleaned}} regularly
Published	09/08/2024	counseling points for {{c1::LABAs}} are that they are not for relief of {{c3::acute}} symptoms and are to only be used in combo with {{c2::ICS}}
Published	09/08/2024	counseling points for {{c1::ICS}} are that the patient may not {{c3::feel}} or {{c3::taste}} the medicine, they should {{c4::rinse…
Published	09/08/2024	Systemic corticosteroids are {{c1::prednisone, methylprednisolone, prednisolone (tastes the best), dexamethasone}}
Published	09/08/2024	Systemic corticosteroids are generally used to resolve {{c1::exacerbation}} symptoms
Published	09/08/2024	Systemic corticosteroids MOA is a reduction in {{c1::inflammation}} – same MOA as ICS
Published	09/08/2024	{{c2::Systemic corticosteroids}} side effects are hyper{{c1::glycemia}}, hyper{{c1::tension}}, {{c1::mood}} changes, {{c1::GI}} bleed, “{{c1::moon}} f…
Published	09/08/2024	systemic cortiocsteroids are generally given as a “{{c1::burst}}” over 3-10 days, depending on severity
Published	09/08/2024	{{c2::methylxanthines}} are (3) {{c1::theophylline, aminophylline, caffeine}}
Published	09/08/2024	{{c3::methylxanthines}} are alternative to {{c1::first}}-line therapies or as an {{c2::adjunct}} for {{c2::refractory}} status asthmaticus
Published	09/08/2024	{{c1::methylxanthines}} inhibit {{c2::phosphodiesterase}} to increase {{c3::cAMP}} and {{c3::cGMP}} concentrations →&nbs…
Published	09/08/2024	•Route of methylxanthines: •Oral: {{c1::theophylline}} preferred → sustained-release product available •IV: {{c1::aminophylline}} preferred …
Published	09/08/2024	•Monitoring parameters of methylxanthines: serum drug {{c1::concentrations}} (goal 5-15 µmol/L), signs of {{c1::toxicity}}
Published	09/08/2024	{{c1::Narrow}} therapeutic index of {{c2::methylxanthines}} significantly limits use → signs of toxicity include {{c4::nausea}}, {{c4::vomit…
Published	09/08/2024	{{c2::Leukotriene modifiers}} are {{c1::montelukast, zafrilukast, zileuton}}
Published	09/08/2024	{{c3::Leukotriene modifiers}} are used as {{c1::adjunctive}} therapy; may be particularly helpful in patients with {{c2::concomitant}} allergies
Published	09/08/2024	{{c1::Leukotriene modifiers}} MOA is inhibition of leukotrienes to reduce {{c2::airway}} {{c3::inflammation}} and {{c2::smooth}} muscle {{c3::contract…
Published	09/08/2024	•Side effects of {{c1::Leukotriene modifiers}} are generally well-tolerated but can be {{c2::fatigue}}, {{c2::dizziness}}, {{c2::m…
Published	09/08/2024	monitor {{c1::LFTs}} and {{c1::drug interactions}} with Leukotriene modifiers
Published	09/08/2024	•{{c1::Anticholinergics (i.e. ipratroprium bromide)}} MOA is {{c2::competitive}} inhibitors of {{c2::muscarinic}} receptors → reverse cholin…
Published	09/08/2024	•{{c2::Anticholinergics (i.e. ipratroprium bromide)}} has no FDA-labeled indication for asthma → not generally recommended •Often utilized i…
Published	09/08/2024	{{c1::Cromolyn Sodium}} MOA: {{c2::mast cell}} stabilizer → inhibits {{c3::early}} and {{c3::late}}-phase responses to allergens
Published	09/08/2024	{{c1::Cromolyn Sodium}} only effective when {{c2::nebulized}}; generally requires administration 4 times daily
Published	09/08/2024	•{{c2::Omalizumab}} MOA: recombinant anti-Ig{{c1::E}} antibody → prevents binding of Ig{{c1::E}} to receptors on {{c1::mast}} cells and {{c1…
Published	09/08/2024	•{{c1::Omalizumab}} is administered subcutaneously and should be given in clinic and monitored for signs of {{c2::anaphylaxis }}
Published	09/08/2024	•In 1/3 of women with asthma, symptoms will {{c1::worsen}} during pregnancy
Published	09/08/2024	the benefits of treating asthma in pregancy {{c1::outweigh}} the risks
Published	09/08/2024	{{c1::Albuterol }}as preferred rescue therapy in pregnancy
Published	09/08/2024	•{{c1::Budesonide}} most studied ICS with reassuring data (Category B) for pregnancy
Published	09/08/2024	Potentially modifiable risk factors for flare-ups of asthma: •(5) {{c1::Medications •Other medical conditions •Exposures •Context •Lung function}}
Published	09/08/2024	Independent risk factors for flare-ups of asthma: •{{c1::Intubation}} or {{c1::ICU}} for asthma •≥ {{c2::1}} severe exacerbation in last {{c2::12…
Published	09/08/2024	Having {{c1::uncontrolled}} asthma symptoms is an important risk factor for flare-ups (exacerbations)
Published	09/08/2024	Having any of these {{c1::risk factors}} for flare-ups increases the patient’s risk of exacerbations even if they have few asthma symptoms
Published	09/08/2024	management of asthma exacerbation:•{{c1::Adjustment}} of medications •Short course of oral {{c2::systemic corticosteroids}} •{{c3::Non-pharmacologic}}…
Published	09/08/2024	Prevention of asthma exacerbations:•{{c1::Adherence, adherence, adherence}}! •Avoidance of asthma {{c2::triggers}} •{{c3::Recognize}} acute severe ast…
Published	09/08/2024	Asthma {{c1::exacerbation}} is characterized by decrease in expiratory airflow → severity can be assessed using spirometry
Published	09/08/2024	{{c1::Status asthmaticus}} is an acute severe asthma {{c2::unresponsive}} to repeated therapy with {{c3::beta2-agonists}}
Published	09/08/2024	during a status asthmaticus you want oxygen to achieve SaO2 ≥ {{c1::90% }}
Published	09/08/2024	during status asthmaticus, saba administration protocol is: •Often give {{c1::albuterol}} as continuous or hourly nebulization •Appropriate to co…
Published	09/08/2024	{{c1::corticosteroids}} are administered IV or PO for status asthmaticus
Published	09/08/2024	•Additional agents if status asthmaticus is refractory:•{{c1::Magnesium sulfate}} IV → promotes {{c4::bronchial dilation}} •SC or IM {{c2::epinep…
Published	09/08/2024	{{c1::intermittent}} asthma symptoms happen less than or equal to 2 days per week
Published	09/08/2024	{{c1::intermittent}} nighttime awakenings happen less than or equal to 2 times a month
Published	09/08/2024	{{c1::intermittent}} SABA use for symptom control happens less than or equal to 2 times per week
Published	09/08/2024	{{c1::intermittent}} interference with normal activity happens 0 times
Published	09/08/2024	{{c1::intermittent}} classification has normal FEV1 between exacerbations, FEV1>80% predicted and FEV1//FVC normal
Published	09/08/2024	{{c1::intermittent}} classifications has 0-1 exacerbations per year requiring oral systemic corticosteroids
Published	09/08/2024	{{c1::persistent}} classification has more than 2 exacerbations per year requiring oral systemic corticosteroids
Published	09/08/2024	{{c1::mild persistent}} classification has  FEV1>80% predicted and FEV1//FVC normal
Published	09/08/2024	{{c1::moderate persistent}} classification has  FEV1>60% but less than 80% predicted and FEV1//FVC reduced by 5%
Published	09/08/2024	{{c1::severe persistent}} classification has  FEV1<60% predicted and FEV1//FVC reduced > 5%
Published	09/08/2024	{{c1::mild persistent}} classification has minor limitations of interference with normal activity
Published	09/08/2024	{{c1::moderate persistent}} classification has some limitations of interference with normal activity
Published	09/08/2024	{{c1::severe persistent}} classification has extremely limited of interference with normal activity
Published	09/08/2024	{{c1::mild persistent}} SABA use for symptom control happens more than 2 times per week but not more than once a day
Published	09/08/2024	{{c1::moderate persistent}} SABA use for symptom control happens daily
Published	09/08/2024	{{c1::severe persistent}} SABA use for symptom control happens several times per day
Published	09/08/2024	{{c1::mild persistent}} nighttime awakenings happen 3-4x a month
Published	09/08/2024	{{c1::moderate persistent}} nighttime awakenings happen >1x/week but not nightly
Published	09/08/2024	{{c1::severe persistent}} nighttime awakenings happen often 7x/week
Published	09/08/2024	{{c1::mild persistent}} asthma symptoms happen more than 2 days per week but not daily
Published	09/08/2024	{{c1::moderate persistent}} asthma symptoms happen daily
Published	09/08/2024	{{c1::severe persistent}} asthma symptoms happen throughout the day
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Published	09/08/2024	Goals of therapy: -{{c1::prevent}} chronic and troublesome symptoms-reduce use of {{c2::rescue}} inhaler-maintain normal {{c3…
Published	09/08/2024	Asthma: characterized by chronic airway {{c1::inflammation}}, airway {{c1::hyperresponsiveness}}, variable {{c1::expiratory}} airf…
Published	09/08/2024	Nonpharmacologic: {{c1::allergen/trigger}} avoidance avoidance of {{c1::environmental}} triggers (keep home air vents clean, …
Published	09/08/2024	beta 2 agonists MOA is that they stimulate {{c1::adenyl cyclase}} thereby increasing {{c2::cyclic adenosine monophosphate (cAMP)}} in smooth muscle ce…
Published	09/08/2024	Other mechanisms of beta2-agonist is prevention of {{c1::mediator}} release from {{c1::mast}} cellswhich enhances {{c2::mucociliary}} cleara…
Published	09/08/2024	{{c1::SABAs}} are used as a rescue inhaler
Published	09/08/2024	{{c1::respiratory}} symptoms, {{c1::HR}}, and serum {{c1::potassium}} with prolonged treatment should be monitored in SABAS
Published	09/08/2024	SABAs and LABAs have the same side effects of {{c1::tachycardia}}, {{c1::hypokalemia}}, {{c1::Hyperglycemia}}, {{c1::Cardiac dysrhythmi…
Published	09/08/2024	{{c1::Ciclesonide}}, {{c1::Mometasone}}, {{c1::Fluticasone}}, {{c1::Budesonide}}, {{c1::Beclomethasone}}, {{c1::Flunisolide}} are ICSs
Published	09/08/2024	{{c1::ICS}} are used as maintenance and prophylactic treatment of asthma
Published	09/08/2024	{{c2::Fluticasone}} + {{c3::Vilanterol}}{{c2::Fluticasone}} + {{c3::Salmeterol}}{{c1::Mometasone}} + {{c4::Formoterol}}{…
Published	09/08/2024	ICS + LABA combo inhalers are also considered {{c1::controller}} inhaler/medications
Published	09/08/2024	Other factors that impact concentration of methylxanthines are: {{c1::age (elederly or pediatric)}}, {{c1::CHF}}, {{c1::liver cirrhosis…
Published	09/08/2024	{{c1::Ipratropium Bromide}} is an anticholinergic used to treat asthma
Published	09/08/2024	the NHLBI guideline are for ages{{c1::12}}+
Published	09/08/2024	GINA guidelines use a preferred reliever for all stages of a PRN {{c1::low dose ICS-formotero}}l OR alternatively an PRN {{c1::SABA}}
Published	09/08/2024	components of severity for the GINA guidelines are:{{c1::Impairment}}: symptoms, nighttime awakenings, use of rescue inhaler, interference with normal…
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