PHRD5985 Pharmacotherapy Lecture 9 - Asthma

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daynuhmay
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269721
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PHRD5985 Pharmacotherapy Lecture 9 - Asthma
Updated:
2014-04-08 05:49:05
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asthma
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asthma
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  1. what plays the biggest role in the occurrence of asthma?
    genetics
  2. 3 criteria necessary to diagnose asthma
    • 1) episodic sx of airflow obstruction
    • 2) airflow obstruction is at least partially reversible (12% & at least 200mL after SABA)
    • 3) alternative diagnoses are excluded
  3. goals of asthma therapy
    • 1) reduce impairment (require 2 days/week of SABA)
    • 2) reduce risk (prevent recurrence, loss of lung fcn)
  4. 4 components of asthma care
    • 1) assessment & monitoring
    • 2) patient education
    • 3) control environmental factors & comorbid conditions
    • 4) medications
  5. 4 important concepts in (1) assessment & monitoring
    • severity - used to initiate tx
    • control - used to monitor/adjust tx
    • impairment
    • risk
  6. how often to monitor well-controlled asthma
    every 1-6mos
  7. how often to monitor asthma if step down therapy initiated
    every 3 mos
  8. Step 1 treatment
    SABA prn
  9. Step 2 preferred treatment
    low-dose ICS 

    (+SABA prn)
  10. Step 3 preferred treatment
    low-dose ICS + LABA OR medium-dose ICS

    (+SABA prn)
  11. Step 4 preferred treatment
    medium-dose ICS + LABA

    (+SABA prn)
  12. Step 5 preferred treatment
    high-dose ICS + LABA AND consider omalizumab (for pts w/ allergies)

    (+SABA prn)
  13. Step 6 preferred treatment
    high-dose ICD + LABA + oral CCS AND consider omalizumab (for pts w/ allergies)

    (+SABA prn)
  14. how long should short burst of systemic CCS be used in asthma treatment?
    until pt continues 80% PEF personal best or sx resolve (usually 3-10 days)
  15. list quick relief medication (used prn) for prompt reversal of asthma sx (3)
    • 1) SABA
    • 2) CCS (oral, IV)
    • 3) anticholinergics (ONLY if SABA not working in emergency setting)
  16. list long-term control medications (taken daily) for control of persistent asthma (6)
    • 1) CCS (inhaled, oral)
    • 2) cromolyn/nedocromil
    • 3) immunomodulators
    • 4) leukotriene modifiers
    • 5) LABA 
    • 6) methyxanthines (theophylline)
  17. -one's & -ide's
    corticosteroids
  18. most effective therapy for mild/moderate/severe persistent asthma
    ICS
  19. mainstay of therapy for any pt w/ persistent asthma
    ICS
  20. how long should it take to see improvement when treating with ICS?
    1-2 weeks
  21. daily use should not exceed ____ salmeterol
    100mcg
  22. daily use should not exceed ___ formoterol
    24mcg
  23. consider step down in asthma tx if well controlled for how long?
    at least 3 months
  24. most important thing to remember about theophylline
    increased levels can cause DDIs & Cl changes => MUST MONITOR THEOPHYLLINE SERUM LEVELS
  25. dosing of omalizumab
    based on body weight and IgE levels (must be 30-700 IU/mL)
  26. when are oral CCS used?
    acute exacerbations or severe (Step 6) asthma
  27. ideal candidate for theophylline
    on Medicare & has nocturnal sx
  28. what step does a pt >4yo need to be on to be referred to an asthma specialist?
    Step 4

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