Inhaler Medication Guide PDF

Glucocorticoid -- beclomethas***one*** (Qvar) - MOA: Suppresses inflammation by reducing bronchial hyperactivity and decreasing airway mucous production; most effective drug available for long term control of airway inflammation o USE: Asthma - CI: candida albicans - Monitors: basel...

Glucocorticoid -- beclomethas***one*** (Qvar) - MOA: Suppresses inflammation by reducing bronchial hyperactivity and decreasing airway mucous production; most effective drug available for long term control of airway inflammation o USE: Asthma - CI: candida albicans - Monitors: baseline height in kids, PFTs, eye exam, bone density in adults - Pt ed: preventative therapy; not for acute attack in asthma, pts with chronic asthma to monitor and record PEF, Advise patients to rinse their mouth and gargle after dosing to minimize dysphonia and oropharyngeal candidiasis, if on SABA, take 5 min before - AE: URI, candida, dysphonia (voice probs) - Dosing: initial high dose followed by a taper to minimize adrenal suppression - Mast Cell stabilizer -- Cromolyn (used if intolerant to glucocorticoid) o MOA: stabilize cytoplasmic membrane of mast cells which prevents release of histamines and other mediators. Also inhibits inflammatory cells such as eosinophils o USE: suppresses bronchial inflammation, **prophylaxis** of mild to mod asthma, seasonal allergies and pre exposure to allergens or pre exercise - Dose: given via nebulizer 4x/day 20 mg - Pt ed: take 15 min before exercise, proper use of nebulizer, takes weeks to achieve therapeutic effect - Leukotriene modifier -- Montelukast (Singulair) -- best for kids \> 1yr o Phenytoin use can decrease levels - AE: neuropsychiatric events, HA, URI, mood changes - Given as adjunct to glucocorticoids to prevent inflammation daily basis (granules) - Long acting muscarinic antagonist **(LAMA)** -- Tiotrop***ium*** (Spiriva) o Same as SAA below but lasts for 24 hrs instead of 6 and better scheduling - Monitor for anticholinergic effects: constipation, retention, tachy, blurred vision - AE: HA, cough, nasopharyngitis - Short acting anticholinergic **(SAA)** -- ipratrop***ium*** (Atrovent) o MOA: blocks muscarinic receptors in the bronchi, reducing bronchoconstriction +-----------------------+-----------------------+-----------------------+ | | | - Both long & short | | | | (SABAs & LABAs) | | | | activate B2 | | | | receptors which = | | | | bronchodilation | | | | to reduce | | | | bronchospasm o | | | | AE: tremor, | | | | tachy, angina | | | | | | | | - Pt ed: using | | | | spacer with one | | | | way valve may | | | | improve results | | | | | | | | | | | | | | | | - Methylxanthine -- | | | | theophylline o | | | | Bronchodilation | | | | but only used | | | | when other drugs | | | | are too expensive | | | | | | | | - How is COPD and | | | | asthma diagnosed? | | | | o **COPD: | | | | Spirometry values | | | | are not | | | | considered in the | | | | initiation of | | | | therapy though | | | | play a role in | | | | the diagnosis and | | | | severity | | | | assessment of | | | | COPD. In addition | | | | to considerations | | | | of history and | | | | signs and | | | | symptoms of COPD, | | | | diagnosis of COPD | | | | requires | | | | spirometry | | | | testing. Patients | | | | who have signs | | | | and symptoms of | | | | COPD should be | | | | tested to measure | | | | the degree of | | | | airway | | | | obstruction. A | | | | postbronchodilato | | | | r | | | | forced expiratory | | | | volume in 1 | | | | second | | | | (FEV1)/forced | | | | vital capacity | | | | (FVC) of less | | | | than 0.7 is | | | | needed to confirm | | | | the COPD | | | | diagnosis.** | | | | | | | | - Lung function | | | | tests -- | | | | spirometry o | | | | In asthma may | | | | also check | | | | eosinophils | | | | and IgE (if | | | | high = | | | | asthma) | | | | | | | | - What are the | | | | classic | | | | characteristics | | | | of COPD and | | | | asthma? What | | | | differentiates | | | | them and what | | | | similarities do | | | | they have? | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Asthma | | | | Similarities | | | | COPD | | | | | | | | | | | | | | | | | | | | | | | | Breathlessness | | | | | | | | Chest tighteni | | | | ng | | | | Cough | | | | Drug therapy h | | | | elpful | | | | Cause: binding | | | | of allergens (not pr | | | | eventable) | | | | | | | | | | | | Wheezing | | | | Dyspnea | | | | | | | | | | | | Airway restric | | | | tion | | | | Inflammation | | | | Chronic cough< | | | | /p> | | | | Excessive sput | | | | um production | | | | Poor exercise | | | | tolerance | | | | Drug therapy n | | | | ot very helpful | | | | Cause preventa | | | | ble (smoking) | | | | | | | | | | | | | | | | | | | | | | | | - Know the | | | | **initial** | | | | treatment | | | | recommendations | | | | for COPD and | | | | asthma o Inhaled | | | | glucocorticoids | | | | are first-line | | | | therapy for | | | | management of the | | | | inflammatory | | | | component of | | | | asthma. There is | | | | conflicting | | | | evidence to | | | | support routine | | | | glucocorticoid | | | | use in COPD. | | | | Their primary use | | | | in COPD is in | | | | management of | | | | exacerbations. | | | | | | | | - SABA PRN FOR | | | | INT ASTHMA | | | | (STEP 1), | | | | STEP 2 -- ICS | | | | (most | | | | effective for | | | | long term | | | | control | | | | therapy) | | | | | | | | - What medication | | | | would you | | | | prescribe if a | | | | patient falls | | | | into Group A, | | | | Group B, etc. for | | | | the management of | | | | COPD? o 0-1 mod | | | | exacerbations not | | | | requiring | | | | hospitalization | | | | | | | | - Group A: | | | | bronchodilato | | | | r | | | | | | | | - Group B: | | | | LABA + LAMA o | | | | 2+ mod | | | | exacerbation | | | | with 1 | | | | leading to | | | | hospitalizati | | | | on | | | | | | | | - Group A: | | | | LABA + LAMA | | | | (preferred to | | | | short acting | | | | agents) | | | | | | | | - Group B: | | | | LABA + LAMA + | | | | ICS if | | | | eosinophil | | | | count \>300 | +-----------------------+-----------------------+-----------------------+ +-----------------+-----------------+-----------------+-----------------+ | | | | How is asthma | | | | | classified and | | | | | how does that | | | | | affect the | | | | | medication | | | | | management? | | | | | STEPS AND AGE | +-----------------+-----------------+-----------------+-----------------+ | | | | Discuss the | | | | | affects of ICS | | | | | to growth in | | | | | children -- may | | | | | slow growth in | | | | | children but so | | | | | does poorly | | | | | controlled | | | | | asthma | +-----------------+-----------------+-----------------+-----------------+ | | | | What | | | | | medications | | | | | should not be | | | | | used as | | | | | monotherapy in | | | | | COPD and | | | | | asthma? | +-----------------+-----------------+-----------------+-----------------+ | | | | What | | | | | medications | | | | | affect | | | | | theophylline | | | | | levels? | | | | | | | | | | - Interacts | | | | | with | | | | | caffeine by | | | | | decreasing | | | | | theophyllin | | | | | e | | | | | breakdown o | | | | | Tobacco and | | | | | marijuana | | | | | increase | | | | | theophyllin | | | | | e | | | | | clearance o | | | | | Phenobarbit | | | | | al, | | | | | phenytoin | | | | | and | | | | | rifampin | | | | | lower | | | | | theophyllin | | | | | e | | | | | levels | | | | | | | | | | - Cimetidine | | | | | and | | | | | fluroquinol | | | | | one | | | | | antibiotics | | | | | (such as | | | | | ciprofloxac | | | | | in) | | | | | elevate | | | | | theophyllin | | | | | e | | | | | levels | +-----------------+-----------------+-----------------+-----------------+