Asthma Management and Medications

Asthma Management

• Mild Intermittent Asthma:
  • Short-Acting: SABA (like albuterol) as needed.
  • Long-Acting: None.
• Mild Persistent Asthma:
  • Short-Acting: SABA as needed.
  • Long-Acting: Low-dose ICS (like budesonide); LTRAs (like montelukast) as an alternative.
• Moderate Persistent Asthma:
  • Short-Acting: SABA as needed.
  • Long-Acting: Medium-dose ICS or Low-dose ICS + LABA (like formoterol).
• Severe Persistent Asthma:
  • Short-Acting: SABA as needed.
  • Long-Acting: High-dose ICS + LABA; add biologics (like omalizumab) if needed.
• Acute Asthma Exacerbation:
  • Short-Acting Focus: High-dose SABA (often nebulized) + ipratropium; add oral steroids (like prednisone) for severe cases.

Patient Education for Asthma Medications

• Inhaled Corticosteroids (ICS):
  • Daily use is important even without symptoms, preventing inflammation.
  • Not for immediate relief, use SABAs for acute attacks.
  • Rinse mouth with water after use to prevent oral thrush.
• Short-Acting Beta-Agonists (SABAs):
  • "Rescue" inhalers for rapid relief during asthma attacks.
  • Use only when needed, overuse can lead to decreased effectiveness.
  • Can cause tremors and palpitations.
• Long-Acting Beta-Agonists (LABAs):
  • Maintenance medications, not for immediate relief.
  • Typically prescribed alongside ICS to enhance control.
  • Example: Formoterol or Salmeterol.

Smoking Cessation Medication Options and Dosing

• Nicotine Replacement Therapy (NRT):
  • Patches, gum/lozenges, nasal spray, inhalers, all deliver controlled doses of nicotine.
  • Dosing varies based on smoking habits.
• Bupropion SR (Zyban):
  • Non-nicotine aid for smoking cessation.
  • Typical dosage: 150 mg once daily for 3 days, then 150 mg twice daily.
  • Treatment lasts 7-12 weeks.
• Varenicline (Chantix):
  • Partial agonist for nicotine receptors, reducing cravings and withdrawal.
  • Gradual dosing increase over several days.
  • Treatment lasts 12 weeks, add-on 12 weeks available.

Smoking Cessation Education: The 5 As

• Ask: Assess if the patient is a smoker.
• Advise: Counsel the patient to quit.
• Assess: Determine the patient's willingness to quit.
• Assist: Provide counseling and pharmacotherapy.
• Arrange: Plan follow-up appointments.

Oxygen Therapy

• Primarily used for chronic lung diseases with low oxygen saturation.
• May prolong survival when used for over 15 hours per day in severe cases.
• Recommended for patients with:
  • PaO₂ ≤ 55 mmHg or SaO₂ ≤ 88% at rest.
  • PaO₂ between 56-59 mmHg with complications like pulmonary hypertension, right-sided heart failure, or elevated hematocrit.
• Oxygen concentrators for home use, portable cylinders for transport (D-cylinder: small, E-cylinder: larger).

Safety Considerations with Theophylline

• Narrow therapeutic window, regular monitoring is crucial.
• Side effects include nausea, vomiting, insomnia, tremors, headaches, restlessness.
• Toxicity can cause arrhythmias, seizures.
• Metabolism affected by liver enzymes and interactions with various drugs.
• Conditions like smoking, heart failure, and liver disease can alter levels.

Acetylcholinesterase Inhibitors

• Block the enzyme acetylcholinesterase, increasing acetylcholine levels.
• Used in Alzheimer's disease and myasthenia gravis.
• Side effects:
  • Gastrointestinal distress: Nausea, vomiting, diarrhea, abdominal cramps.
  • Bradycardia and heart block.
  • Increased salivation and sweating.
  • Muscle cramps and weakness.
  • CNS effects: Dizziness, headache, confusion.

Anti-Seizure Medications

• Discontinuation guidelines:
  • Seizure-free period of 2-5 years.
  • Consider seizure type, control stability, and risks.
  • Normal neurological exam and neuroimaging.
  • Normal EEG findings.

Dilantin (phenytoin)

• Mechanism of action: Blocks sodium channels, increasing membrane stability.
  • Side effects:
    • Gingival hyperplasia.
    • Hirsutism.
    • Facial coarsening.
    • Hyperglycemia.
    • Hematologic effects (anemia).
    • Osteoporosis.
    • Rash including DRESS.
    • Megaloblastic anemia.
    • Teratogenicity.

Indications for Anticonvulsant Medications

• Keppra: Partial seizures.
• Lacosamide: Large, whole-body seizures (tonic-clonic).
• Lacosamide: Myoclonic seizures (muscle-jerk seizures).
• Lacosamide (off-label): Continuous seizure emergencies.
• Gabapentin: Nerve-related pain.

Mechanisms of Action for Seizure Medications

• Inhibiting Sodium Channels:
  • Phenytoin, Carbamazepine, Lamotrigine.
• Increasing GABA Activity:
  • Benzodiazepines (diazepam), Valproic Acid.

This quiz covers key concepts in asthma management, focusing on the treatment strategies for mild, moderate, and severe persistent asthma. It will also address the role of inhaled corticosteroids and the management of acute asthma exacerbations. Test your knowledge on the medications and their appropriate use.