Therapeutics: Asthma 2

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Therapeutics: Asthma 2
2014-04-12 21:24:09
Therapeutics Asthma
Therapeutics: Asthma 2
Therapeutics: Asthma 2
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  1. What Education should you provide to an asthma patient?
    Med roles, use (Fast acting vs long term use)and skills, Enviro/Trigger Control
  2. Describe the Approach to therapy for asthma:
    Stepwise = step up based on severity, step down after control is established
  3. What are the Quick relief drugs for asthma?
    SABA (sympathomymetics) or systemic corticosteroids
  4. What are the SABAs?
    Albuterol (preferred), Pirbuterol, Levabuterol
  5. What are the Systemic corticosteroids for rescue relief?
    Cortisone, Hydrocortisone, Prednisone, Prednisolone, Methylprednisone, Traimcinolone
  6. What is the Role/mechanism of corticosteroids in asthma?
    Restore B-receotr density in the lungs post tachyphylaxis
  7. What are the Long term control therapies for asthma?
    • Anti-inflammatories(ICS, Mast CS, LM) = preferred
    • Bronchodilators (LABA, Theo)
  8. When should you not use long term control drugs for asthma?
    Never used for Short term control
  9. What are the Anti-inflammatory drugs for asthma?
    ICS, Mast cell stabilizers and Leukotriene modifiers
  10. What are the ICSs?
    Beclomethasone, Fluticasone, Budesonide, Mometasone, Ciclesonide
  11. What are the Mast CSs?
  12. What are the Leukotriene modifiers?
    Zafirlukast, montelukast, Zileuton
  13. What are the long term control Bronchodilators?
    LABA, Theophylline and maybe long acting anticholinergics
  14. What are theLABAs?
    Salmeterol, formoterol, indacaterol, arformoterol
  15. What are the potential Causes of asthma exacerbations?
    • Viral
    • Enviromental
    • Sinusitis or rhinitis
    • GERD
    • Phsychological
  16. When you Obtain history & PE for a patient having an exacerbation, what information should you gather?
    • Onset time
    • precipitating factors
    • current medications
    • past exacerbations
    • concurrent diseases
  17. How do you Perform a functional assessment of a patient having an exacerbation?
    • Look at PEFR diary
    • O2 sat
    • Obtain PEFR pre/post SABA
  18. What labs should you look at with a patient who is having an exacerbation?
    • ABG
    • CBC (infection screen)
    • Chest x-ray (maybe)
    • Theophilline conc. (if on)
  19. What groups are at theGreatest risk of mortality from an asthma exacerbation?
    • Infants under a year
    • History of life-threatening events
    • <10% improvement in PEFR
    • PCO2 > 40 mmHg
  20. What are th General Txs for a patient undergoing an exacerbation?
    • B2 agonist for all
    • Systemic Corticosteroid pulse for most
    • O2 therapy
    • Anticholinergics n COPD patients
  21. What characteristics does a mild exacerbation have?
    Dyspnea only w/ activity + PEF > 70%
  22. How do you treat a mild exacerbation?
    HOME Tx = increase frequency of SABA or maybe PO systemic corticosteroids
  23. What characteristics does a moderate exacerbation have?
    Dyspnea limits ADL + PEF 40-69%
  24. How do you treat a moderate exacerbation?
    Requires office visit, increase frequency of SABA (=only get mod relief), probably will get Oral systemic corticosteroids
  25. What characteristics does a severe exacerbation have?
    Interferes with conversation + PEF <40%
  26. How do you treat a severe exacerbation?
    Requires ED visit, only partial or less relief from SABA, NEED oral systemic corticosteroids
  27. What characteristics does a life-theatening exacerbation have?
    Life threatening = Can’t speak, perspiring + PEF <25%
  28. How do you treat a life-threatening exacerbation?
    Requires ED visit/ICU, No relief from SABA, NEED IV corticosteroids
  29. What means do we have of Monitoring asthma on a regular basis (at home)?
    Peak expiratory Flow Rate
  30. What are the Requirements for use of PEFR?
    maximal effort
  31. How does PEFR compare to FEV1?
    • PEFR = Flow velocity/s
    • FEV1 = Volume of air/s
    • Use is similar
  32. How do you use a PEFR?
    • Indicator at bottom
    • Breathe deeply as can
    • Exhale as fast as can
    • 3x= highest = best
  33. What is PEFR used for?
    • Detect subtle changes early in Exacerbation
    • Monitor therapy
    • Use zones to choose therapy
  34. When should youEstablish Personal best with a PEFR?
    Day when asthma is well controlled
  35. What is PEFR Green zone?
    >80% = Fine
  36. What is PEFR Yellow zone?
    50-80% = Treat exacerbation early
  37. What is a PEFR Red zone?
    <50% = Get ED help
  38. After using a rescue inhaler, what improvement should you expect in PEFR?
    Should improve with treatment = 15% or greater increase (if not see PCP)
  39. What is a Component of Control rating of “Well controlled”?
    • Same as Mild persistent:
    • Symptoms > 2D/wk, Night wakening 3-4x/mo, SABA use > 2D/wk, Minor interference ADL, FEV1 >80% during attacks, FEV1/FVC = Normal, 0-1 exacerbations/year
  40. What is a Component of Control rating of “Not Well controlled”?
    • Same as Moderate persistent:
    • Symptoms QD, Night wakening > 1x/wk, SABA use QD, Some interference ADL, FEV1 60-80% during attacks, FEV1/FVC = Reduced by 5%, > 2 exacerbations/year
  41. What is a Component of Control rating of “Very Poorly Controlled”?
    • Same as Severe persistent:
    • Symptoms multiple x day, Night wakening > 7D/wk, SABA use multiple x day, Extreme interference ADL, FEV1 <60% during attacks, FEV1/FVC = Reduced by 5%, > 2 exacerbations/year
  42. How should you treat a patient with a Component of control rating of “Well controlled”?
    no step ∆, Check up 1-6mo, Controlled for 3mo = step down
  43. How should you treat a patient with a Component of control rating of “Not Well controlled”?
    step up 1, Check up 2-6 wks, consider alt Tx for SE
  44. How should you treat a patient with a Component of control rating of “Very Poorly controlled”?
    Short course oral steroids (use pulse dosing), step up 1-2, check up 2 wks, consider alternate treatments
  45. After stepping up an asthma treatment, what should you do?
    • Step back whenever possible = target fewest/least intense med possible
    • Don’t step down if change in environment (moved, etc.)
  46. If a patient needs to be stepped up, what questions should you ask that are not on the components of control chart?
    Ask open ended questions about compliance