1-2 weeks; 4-8 weeks
When will patients see initial improvement when starting an ICS?
When will they see the maximum improvement?
budesonide
________ is the only FDA approved ICS for children younger than 4 years.
LABA + ICS
Use of _________ combo is NOW recommended to treat acute symptoms or
exacerbations of asthma.
add on for step 4 & higher; patients w/ history of exacerbation >=12 yo
Spiriva Respimat is considered what type of medication and for who?
preventative treatment prior to exercise or exposure to known allergen
Cromolyn Sodium is used for what?
a,c
Which are used as alternative STEP 2 treatments
a) methylxanthines
b) spiriva respimat
c) cromolyn sodium
d) trelegy ellipta
d
Which is reserved for step 5 therapy?
a) methylxanthines
b) spiriva respimat
c) cromolyn sodium
d) trelegy ellipta
a
Which have a narrow therapeutic index?
a) methylxanthines
b) spiriva respimat
c) cromolyn sodium
d) trelegy ellipta
c
Which is available as a tablet and oral granules?
a) zafirlukast
b) Zileuton
c) Montelukast
a,b
Which inhibits CYP3A4?
a) zafirlukast
b) Zileuton
c) Montelukast
take at least 1 hour before or 2 hours after meals
How does Zafirlukast dosing work?
c
Which has to be taken at night?
a) zafirlukast
b) Zileuton
c) Montelukast
adults w/ chronic rhinosinusitis & nasal polyps + ASA sensitivity
Montelukast is a good option for patients with what condition?
moderate to severe
Immune modulators are for __________ asthma.
e
Which is the ONLY one that won't cause severe allergic reactions?
a) omalizumab
b) mepolizumab
c) reslizumab
d) benralizumab
e) dupilumab
f) tezepelumab
epinephrine autoinjector
Patients who have been prescribed immune modulators require what else
along with their medication?
a
Which requires initiation in a HC setting ?
a) omalizumab
b) mepolizumab
c) reslizumab
d) benralizumab
e) dupilumab
f) tezepelumab
no anaphylaxis after 3>= doses, can recognize & manage rx, use proper inj technique
What is the criteria for self-administration of Omalizumab? (3)
mepolizumab, reslizumab, benralizumab
Which is for severe eosinophilic asthma? (3)
moderate-severe asthma in patients 6>= yo w positive skin test or in vitro reactivity to perennial aeroallergen
Omalizumab indication?
f
Which is taken once every 4 weeks?
a) omalizumab
b) mepolizumab
c) reslizumab
d) benralizumab
e) dupilumab
f) tezepelumab
f
Which is approved for severe asthma in ages >=12 ?
a) omalizumab
b) mepolizumab
c) reslizumab
d) benralizumab
e) dupilumab
f) tezepelumab
Budesonide + albuterol
What is the preferred asthma treatment in pregnancy?
skin bruising, osteoporosis, cataracts
What AE's can occur in elderly patients when taking asthma medications? (3)
15% decrease in PEF or FEV1
How is Exercise-Induced Bronchospasm (EIB) diagnosed?
oxygen, continuous SABA use and inhaled ipatropium, systemic corticosteroids
What is the primary treatment for exacerbations? (3)
magnesium sulfate, epinephrine, terbutaline, ketamine, Heliox
What are the adjunctive therapies for exacerbation? (5)
>=1 exacerbation in previous year + SABA monotherapy, overuse of SABA (poor), poor adherence, incorrect inhaler technique, low FEV1, smoking, blood eosinophilia, no tools to assess risk
Risk factors of exacerbations? (8)
8 puffs; 36 mcg
Max daily dose of MART therapy in ages 4-11?
12 puffs; 54 mcg
Max daily dose of MART therapy in ages >=12 ?
LAMAs
Use of _____ should be used in caution with African American patients as it
can increase risk of death.
blurred vision, urinary retention, dry mouth, constipation
AE's of SAMAs? (4)
adrenal suppression, Cushing's syndrome, cataracts, impaired immune system
Long-term AE's of Systemic Corticosteroids? (4)
ICS
_______ are the ONLY therapy that reduces the risk of dying from asthma.
2 weeks
Budesonide nebules have ampules that should be used within _______ of opening the aluminum package.
add-on therapy for asthma not controlled on low-medium dose of ICS; prevention of exercised induced bronchospasm
LABA indication? (2)