Asthma Medication Therapy PDF

Classify Asthma Severity and Initiate Appropriate Medication Therapy: Asthma severity is classified based on symptom frequency, night awakenings, and rescue inhaler use. Initial therapy is determined by the frequency and severity of symptoms: o Step 1: For infrequent symptom...

Classify Asthma Severity and Initiate Appropriate Medication Therapy: Asthma severity is classified based on symptom frequency, night awakenings, and rescue inhaler use. Initial therapy is determined by the frequency and severity of symptoms: o Step 1: For infrequent symptoms, use low-dose ICS-formoterol PRN. o Step 2: Low-dose ICS maintenance with PRN SABA or ICS-formoterol. o Step 3: Low-dose ICS-LABA for persistent symptoms most days. o Step 4: Medium/high-dose ICS-LABA for daily symptoms or low lung function. o Step 5: Medium/high-dose ICS-formoterol with add-ons (LAMA or biologics like anti-IgE, anti-IL5)(Pharm Slide Deck Templa…). Adjust Medications Using a Stepwise Approach: Adjust therapy based on control level, increasing stepwise for inadequate control: o Step up for persistent symptoms or frequent exacerbations. o Step down once control is maintained for three months. Each step incorporates a combination of ICS and LABA, with additional options such as LAMA or biologics for severe cases(Pharm Slide Deck Templa…). Goals of Asthma Therapy: The primary goals are to control symptoms, maintain lung function, and prevent exacerbations. Chronic therapy emphasizes daily controller medications to prevent airway remodeling and achieve long-term control(Pharm Slide Deck Templa…). Proper Inhaler Technique for MDI and DPI:  MDI (Metered Dose Inhaler): Shake, exhale, press the inhaler while inhaling slowly, hold breath for 10 seconds, then exhale. DPI (Dry Powder Inhaler): Do not shake, inhale quickly and deeply, hold breath for 10 seconds, then exhale. Patient education includes watching videos on proper use and, if needed, using a spacer for MDIs(Pharm Slide Deck Templa…). Management for Acute Exacerbation and Continued Outpatient Management: Acute Exacerbation: o Administer SABA (e.g., albuterol) via MDI with a spacer or nebulizer every 20 minutes for the first hour. o Add systemic corticosteroids (e.g., prednisone) if moderate to severe symptoms persist. Outpatient Management: o Prescribe maintenance medications according to asthma control. o Educate patients on using a written asthma action plan and recognizing symptom worsening(Pharm Slide Deck Templa…). Beclomethasone (Qvar) Class: Inhaled Corticosteroid (ICS) Mechanism: Reduces airway inflammation by inhibiting inflammatory mediators Indications: Maintenance/controller therapy for asthma Adverse Effects: Oral thrush, headache, pharyngitis Contraindications: Hypersensitivity, not for acute asthma exacerbation Interactions: Desmopressin (caution in pediatric nocturia)  Monitoring: None generally needed Patient Education: Rinse mouth after use to prevent thrush, and use proper inhaler technique(Pharm Slide Deck Templa…). Fluticasone (Arnuity Ellipta) Class: Inhaled Corticosteroid (ICS) Mechanism: Anti-inflammatory effects reduce airway swelling and mucus production Indications: Maintenance therapy for asthma Adverse Effects: Oral thrush, arthralgia, headache Contraindications: Hypersensitivity Interactions: Desmopressin (monitor in children) Monitoring: Long-term use can warrant occasional monitoring for systemic effects Patient Education: Rinse mouth post-use to prevent thrush; effects may take up to a few weeks(Pharm Slide Deck Templa…). Prednisone Class: Oral Corticosteroid Mechanism: Broad anti-inflammatory action reduces immune response and inflammation Indications: Acute asthma exacerbations Adverse Effects: Hyperglycemia, insomnia, mood changes, adrenal suppression with long-term use Contraindications: Hypersensitivity, caution with live vaccines Interactions: Immunosuppressants, increases blood glucose levels Monitoring: Blood glucose and adrenal function with prolonged use  Patient Education: Take with food to avoid GI upset; adhere to prescribed taper if needed(Pharm Slide Deck Templa…). Montelukast (Singulair) Class: Leukotriene Receptor Antagonist (LTRA) Mechanism: Blocks leukotriene receptors to reduce inflammation and bronchoconstriction Indications: Asthma maintenance, particularly beneficial in children and patients with allergic asthma Adverse Effects: Rare but serious neuropsychiatric effects (e.g., mood changes) Contraindications: Hypersensitivity Interactions: Few; caution with certain psychiatric medications Monitoring: Observe for neuropsychiatric symptoms Patient Education: Typically taken in the evening; good option for children unable to use inhalers(Pharm Slide Deck Templa…). Omalizumab (Xolair) Class: Monoclonal Antibody Mechanism: Binds to IgE, preventing it from attaching to receptors on mast cells and basophils, reducing allergic inflammation Indications: Moderate to severe allergic asthma unresponsive to ICS therapy Adverse Effects: Injection site reactions, headache, possible anaphylaxis Contraindications: Hypersensitivity to any component of the formulation Interactions: May interact with certain immunosuppressants or antipsychotics Monitoring: Watch for allergic reactions post-administration  Patient Education: Requires regular injections; do not abruptly stop other asthma medications without consulting provider(Pharm Slide Deck Templa…). Albuterol (Ventolin) Class: Short-Acting Beta Agonist (SABA) Mechanism: Stimulates beta-2 receptors in bronchial smooth muscle, leading to bronchodilation Indications: Relief of acute bronchospasm; prevention of exercise-induced bronchospasm Adverse Effects: Tremor, tachycardia, CNS stimulation Contraindications: Hypersensitivity to albuterol or other ingredients Interactions: Beta-blockers may diminish effects; use caution with non-selective beta- blockers Monitoring: None typically needed Patient Education: Correct inhaler technique, can be used 15-30 minutes before exercise to prevent bronchospasm(Pharm Slide Deck Templa…). Salmeterol Class: Long-Acting Beta Agonist (LABA) Mechanism: Prolonged beta-2 receptor stimulation leading to extended bronchodilation Indications: Maintenance therapy for asthma when used with ICS Adverse Effects: Headache, muscle cramps, potential for tachycardia Contraindications: Not for monotherapy in asthma; hypersensitivity Interactions: Beta-blockers may counteract effects Monitoring: Watch for potential cardiovascular side effects in at-risk patients  Patient Education: Not for acute asthma symptoms; use in conjunction with ICS(Pharm Slide Deck Templa…). Ipratropium (Atrovent) Class: Short-Acting Muscarinic Antagonist (SAMA) Mechanism: Blocks muscarinic receptors, reducing bronchoconstriction and mucus secretion Indications: Moderate to severe asthma exacerbations, often as adjunct therapy Adverse Effects: Dry mouth, headache, blurred vision Contraindications: Hypersensitivity to atropine derivatives, caution in patients with glaucoma Interactions: Other anticholinergic agents Monitoring: None generally needed Patient Education: Slower onset than SABA; used as an adjunct in severe exacerbations (Pharm Slide Deck Templa…). Formoterol/Budesonide (Symbicort) Class: Combination ICS/LABA Mechanism: Budesonide reduces inflammation; formoterol provides long-acting bronchodilation Indications: Maintenance therapy for asthma; some formulations can be used for acute symptom relief Adverse Effects: Oral thrush, headache, tremor Contraindications: Not for acute asthma exacerbations if not specifically indicated  Interactions: Beta-blockers may reduce efficacy; caution with certain antivirals (e.g., ritonavir) Monitoring: Watch for signs of adrenal suppression with prolonged use Patient Education: Rinse mouth after use to avoid thrush; can be used as reliever therapy in some cases(Pharm Slide Deck Templa…).