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318 CH 75
Drugs for Asthma
Question | Answer |
---|---|
What is Asthma? | Chronic inflammatory disorder. Immune mediated inflammation. |
what are the s/s of Asthma? | breathlessness, tightness in chest, wheezing, dyspnea and cough |
what are the 2 goals of the treatment of Asthma? | Bronchodilate [Beta 2] and Decrease inflammation [Steriods] |
what are the 3 anti-inflammatory drugs used for asthma? | (1) Glucocorticoids, (2) Leukotreien modifiers [Singulair, (3) Chromolyn [Chromolyn(Intal)] |
what are the most effective anti-inflammatory drugs for asthma? | glucocorticoids |
what is the mechanism of action for glucocorticoids? | Suppress inflammation, decrease action of inflammatory cells (Eosinophils), decrease edema in airway |
what is them primary administration method of glucocorticoids for asthma? | inhalation (can be administered orally) |
what are the side effects of glucocorticoids (steroids in general)? | bone loss, dry mouth/thrush, adrenal fatigue |
what can a pt do to prevent bone loss while on glucocorticoids? | calcium/Vitamin D supplements |
who is at increased risk for bone loss? | asian, white women who smoke and don't perform weight baring exercises |
what can a pt do to reduce dry mouth/thrush in a pt on inhaled glucocorticoids? | rinse with water after inhalation |
what will be necessary in times of stress in a pt who's adrenal glands are fatigued? | more steroids |
glucocorticoids: are they used for acute asthma attacks or are they used long term for prophylaxis? | long term |
who takes oral glucocorticoids? | it is reserved for pts with severe asthma. the risk for toxicity is increased with duration of use, so should be as brief as possible. |
what are the most common adverse effects (that are different from inhaled) in oral glucocorticoids? | orthopharyngeal candidas and dysphonia (hoarseness and speaking difficulty) |
What is the mechanism of action for Singulair? | promote bronchodilation and decrease inflammation/edema |
Is singulair more or less effective compared to glucocorticoids? | less |
what is singulair used for? | exercise induced asthma (pt 15+ years), in conjunction for allergic rhinitis |
what is the dosing schedule for Singulair? PRN or long term? | NOT PRN! takes at least 24 hours to see max effect. 1x/day |
what is the major side effect of Singulair? | increase in suicide |
what is the SAFEST of all anti-asthma drugs? | Chromolyn [Intal] |
what is Chromolyn [Intal]? prophylactic med or PRN? | prophylactic anti-inflammatory med used for asthma |
how is chromolyn [Intal] administered for asthma? | inhalation |
what is chromolyn [Intal] used for? | exercise induced asthma (age 15+) and chronic asthma |
What bronchodilators used for (in asthma)? | symptomatic relief. acute attack. |
What bronchodilators are used for asthma pts? | Beta 2 adrenergic agonists, Methylxanthines (Theophyllin), Glucocorticoid/LABA combo (Advair) |
are beta 2 adrenergic agonsts used acute or prophylactically? | both. short acting - PRN. Long acting - prophylactically[ONLY IN CONJUNCTION with glucocorticoids] |
what are the adverse effects of Beta2 agonists? (Asthma) | Tachycardia, TREMOR, angina |
adverse effects of long acting Beta 2 agonists (asthma)? | may increase the risk of severe asthma and asthma-related deaths |
what is the mechanism of action for Theophyllin? | relaxes smooth muscle and promotes bronchodilation |
administration route for Theophyllin | ORAL or in emergencies IV. NOT INHALED! |
therapeutic index for Theophyllin: | 5-15 |
s/s mild theophyllin toxicity: (therapeutic level of this) | n/v/d, restlessness. 20-25 |
s/ssevere theophyllin toxicity. what is the therapeutic level of this? | dysrhythmias and convulsions >30 |
what is the antidote of Theophyllin? | none!! use activated charcoal, cathartic for OD. if administered IV, these things will not help. |
what is teh glucocorticoid/LABA combo drug? | Advair |
what is the mechanism of action for Advair? | anti-inflammatory / bronchodilator |
how is Advair administered? | dry powder inhaler (NOT A RESCUE inhaler) |
administration schedule for Advair | 2x/day |
side effects of Advair | those of Glucocorticoid and LABA |