12 Questions
What zone is indicated when a patient's peak expiratory flow is between 80-100%?
Green zone
Which drug, when taken with meals, has decreased bioavailability?
Zafirlukast
What is the main purpose of standing while using a peak flow meter?
To get an accurate reading
Which drug interactions may increase the effect of warfarin?
Clarithromycin
Which type of corticosteroid is preferred for chronic asthma therapy?
Inhaled corticosteroids
What is the main reason for monitoring refill records for daily controller medication and quick relief medications?
To ensure compliance with medication regimens
Which of the following is a significant interaction of corticosteroids to be aware of?
Hypokalemia with hepatic enzyme inducers
What is a known side effect associated with Zileuton?
Hepatic dysfunction
Which type of corticosteroid shows the most rapid improvement in pulmonary function tests (PFT) within 1-3 hours?
Methylprednisolone
Which medication is a LOX inhibitor and requires special precautions in patients with hepatic diseases?
Zileuton
What is the main mechanism of action of Cromolyn in asthma management?
Anti-inflammatory through mast cell stabilization
When would Theophylline compounds be considered in asthma management?
When beta agonists and corticosteroids fail to control acute asthma exacerbation
Study Notes
Monitoring and Peak Expiratory Flow
- Optimal management of patients can reduce symptoms, including nocturnal and early morning onsets
- Peak expiratory flow (PEF) measurement has a green zone (80-100%) and a yellow zone (50-79%)
- Proper use of PEF meter: stand while using, position indicator at the bottom of the scale, hold meter without blocking the opening, inhale deeply, place mouthpiece in mouth, and blow out as fast and as hard as possible
Drug-Drug and Drug-Disease Interactions
- Zafirlukast administration with meals decreases bioavailability; take 1 or 2 hours before meals
- Zileuton and zafirlukast may increase warfarin's effect and theophylline levels
- Inducers of CYP450: erythromycin, clarithromycin, itraconazole, oral contraceptives, and conjugated estrogen
Parameters to Monitor
- Refill record for daily controller medication and quick relief medications
- Reduction in symptoms
- Emergency department visits and hospitalizations
- Need for “bursts” of systemic corticosteroids
- PEF monitoring
Corticosteroids
- Suppress inflammation and decrease airway hyper responsiveness
- Systemic corticosteroids: improvement in PFT in 1-3 hours, maximum effect in 6-9 hours
- Examples: prednisone, prednisolone, methylprednisolone, beclomethasone, betamethasone, dexamethasone, hydrocortisone, triamcinolone
- IV corticosteroids: given to patients who cannot take oral medications
- Oral corticosteroids: prednisone and prednisolone
- Inhaled corticosteroids: preferred anti-inflammatory therapy for chronic asthma
- Examples: beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone
- May affect: child growth, vitamin D, fungal infection
Leukotriene Inhibitors
- Zafirlukast, montelukast, pranlukast, and zileuton: considered as second-line agents
- Precautions and monitoring effects: Churg-Strauss Syndrome associated with zafirlukast, montelukast, pranlukast
- Zileuton: LOX inhibitor, C/I with severe hepatic function
Cromolyn
- Stabilizing mast cells and inhibiting mast cell degranulation
- Nedocromil and cromolyn MDI has been removed from the market
- Cromolyn is less effective in its anti-inflammatory properties than inhaled steroids
Theophylline Compounds
- Used if beta agonists and corticosteroids fail to control asthma
- Induced phosphodiesterase inhibition results in increased levels of cAMP
- Contraindicated to patients with hypersensitivity, special precautions for hepatic diseases, hypoxemia, hypertension, CHF, alcoholism, and elderly
Anticholinergics
- Ipratropium bromide: treatment for acute asthma exacerbation in the emergency department or hospital setting
- Should not be used alone to treat an asthma exacerbation
Other Drugs Used for Asthma Management
- Antihistamines
- Antibiotics
- Magnesium sulfate
- Immunotherapy
- Omalizumab
Test your knowledge on monitoring asthma and using a peak flow meter to manage symptoms. Learn about the green zone (80-100%) and yellow zone (50-79%) for peak expiratory flow. Practice proper techniques like standing while using the meter, positioning the indicator, and ensuring a tight seal around the mouthpiece.
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