vitohuxo's version from 2016-02-28 22:09


Question Answer
preferred route of medicineinhalers
theophyllinecan be useful some cases but significant drug interactions and side effects
step down possible ifwell controlled and at least 3 months
albuterol moabeta 2 agonist- relaxation of bronchial smooth muscle leading to bronchodilation
proair, proventil, ventolinalbuterol. 90mcg/inh and 0.5% and 0.083% nebulizer soln, syrup, and tablet. 0.5% must be diluted with normal saline before use!!!!!
SE albuterolnervousness, tremor, tachycardia, cough, hyperglycemia, decreased potassium (drives into cell)
Advair diskus and advair HFAsalmeterol (LABA) and fluticasone. diskus 1 BID and HFA 2BID
symbicortbudesonide and formoterol (LABA). 2 BID
boxed warning for LABAsincreased risk death asthma patients.
QVARbeclomethasone HFA ICS. does not need to be shaken before use. 1-2 BID
flovent HFAfluticasone ICS. 2BID
side effects ICSdifficulty speaking, thrush, cough
montelukast MOAleukotriene receptor antagonists. decrease airway edema, constriction, and inflammation
montelukast dose10mg daily in the evening over 14 years of age. 5mg for 6-14 years of age. and 4mg 1-5 years
SE montelukastheadache
theophylline moablocks phosphodiestrase causing release of epinephrine and bronchodilation, mild-anti inflamm effect. may help as add on therapy.
theophylline active metabolitescaffeine and 3 methylxanthine
theophylline therapeuitc range5-15 mcg/ml. measure peak level 3 days after oral dosing.
theophylline SEdiarrhea and nausea
theophylline dosingbased on IBW. none in last 24 give LD 5mg/kg. using IV then multiple by 0.8
theophylline DIsmall increase in dose can result in large increase in theophylline concentration. drugs that may increase theophylline levels due to 1a2 are cipro, fluvoxamine, propranolol, zafirlukast, ziluteon. 3a4= clarithromycin, erthyromcin,
theophylline will decrease level oflithium
september 2015 spiriva approved foruse in asthma patients 12 years of age and older. bronchodilation
omalizumab (xolair) moainhibits IgE binding on mast cells and basophils. used mod to severe persistent allergic asthma 12 years and older with + skin test.
xolair should always be givenin healthcare setting. boxed warning anaphylaxis. given SC every 2-4 weeks
mepolizumab (Nucala) moainterluekin 5 receptor antagonist monoclonal antibody that inhibits IgE binding to igE receptor on mast cells and basophils. add on treatment severe asthma 12 years and older those with eosinophilic phenotype asthma
in pregnancy what is preferred?albuterol and budesonide (due to more data)
use a peak flow meterevery morning upon wakening and before any asthma medications
green zone on peak flow meter80-100% of personal best
yellow zone peak flow meter50-80% personal best
nebulizers are covered by medicare partB
MDIsuse a propellant HFA, require slow and deep breathe, need to be shaken except qvar and alvesco, can be used with spacers
DPIsdo not have propellants so require quick and forceful breath, cannot be used with spacers,
symbicort dont put in water to clean. just wipe with clean dry cloth to prime spray 2 times
flovent and ventolin to primespray 4 times
proair primingnone needed
singulair oral granules never store mixed with anything. do not mix with any drink other than baby formula or breast milk. can also be given with applesauce, ice cream, mashed carrots, rice or directly in the mouth.
serevent diskusLABA by itself.