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Asthma - Coggle Diagram

- - - - PK/PD/PG
        
        hepatic metabolism, excreted 80%-100% in urine , t1/2 3.8-5 hours. 10% protein bound
      - H
        
        Acts on beta-2 adrenergic receptors and relaxes bronchial smooth muscle by increasing the actions of adenyl cyclase which increases cAMP levels and inhibits release of hypersensitivity mediators from mast cells.
      - A
        
        CNS- excitement, nervousness; Tremor; Respiratory: Upper respiratory tract infection; rhinitis; pharyngitis; exacerbation of asthma
        CVD: tachycardia, htn
        Metabolic: increased serum glucose
        GI: N&V
        Hematologic: decreased hematocrit
      - R
        
        dosage dependent on age, >12 YO 4-8 puffs every 30 minutes up to 4 hours and then every 1-4 hours PRN <12, 4-8 puffs every 20 minutes x 3 doses, then every 1-4 h PRN
      - M
        
        Measure efficacy by reduction in asthma symptoms
        
        Monitor pt with renal dysfunction, also in elderly patients
        
        Monitor BP, HR, serum glucose, serum K+
        
        Monitor forced expiratory volume, peak flow
        
        discontinue if symptoms worsen
      - D
        
        Take medication as long a doctor instructs or as long as sx persist
      - W
        
        Bronchospasm: Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents (may be fatal); this should be distinguished from inadequate response.
        
        Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm, oropharyngeal edema), including anaphylaxis, have been reported.
      - I
        
        Major: TCAs, atomoxetine, metacholine
      - S
        
        No adjustments needed for geriatric, organ dysfunction; risk in P&L not ruled out, so avoid if possible, but if using enroll in national study; pediatrics dose accordingly
      - E
        
        report sx of bronchospasm; report need to increase dosage for effectiveness; report sx of afib, hypokalemia; tachycardia; advice on proper inhalation and device technique; side effects may include palpitations, chest pain, tremors, headache, dizziness, nervousness.
      - D
        
        Out of pocket costs, housing situations
        
        Prevalence highest in lowest income, lower education
        
        Ebell, M., Marchello, C., & O'Connor, J. (2017). The burden and social determinants of asthma for adults in the state of Georgia. Journal of the Georgia Public Health Association, 6(4), 426–434. https://doi.org/10.21633/jgpha.6.406
    - - PK/PD/PG
        
        nonselective antagonist of M1, M2, and M3 receptors
        1.6h t1/2
        low protein binding
        hepatic metabolism
        low F
      - Blocks action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation; local application to nasal mucosa inhibits serous and seromucous gland secretions.
      - dry mouth, bitter taste, headaches, respiratory tract infections, nasal irritation, nausea, or sore throat
      - R
        
        (Metered-dose inhaler) Moderate/severe exacerbation, added to short-acting beta-2 agonist: 2 to 3 oral inhalations (17 mcg/inhalation) q6h
        (Nebulizer solution) Moderate/severe exacerbation, added to short-acting beta-2 agonist: 0.25 mg oral inhalation via nebulization q6h
      - sx improvement, improved QoL, FEV1, PEF >80%
      - D
        
        for the lifetime of asthma
      - W
        
        bronchospasm, CNS effects, hypersensitivity
      - I
        
        Anticholinergic agents
      - S
        
        Do dosage adjustment for renal/hepatic impairment or geriatrics. Systemic exposure/fetal risk is thought to be negligible in pregnant women. Breastfeeding risks are unknown
      - E
        
        Avoid activities requiring mental alertness or coordination; avoid contact with eyes; medication is not indicated for acute asthma attacks; symptomatic improvement may not be observed until after few weeks; instruct on proper inhalation technique
      - D
        
        SES
    - - PK/PD/PG
        
        metabolized via CYp3A4, excreted 60% feces, 25% urine, onset of action: 30-48 minutes, DOA: 12 hours 96% protein bound
      - H
        
        MOA:Relaxes bronchial SM by selective action on beta-2 receptors with little effect on heart rate;
        acts locally in the lung
      - A
        
        headache, pain, HTN, dizziness
      - R
        
        1 inhalation BID (~12 hours apart)
      - Monitoring:FEV1, peak flow, BP, HR, K, hypersensitivity, allergic rxn
      - D
        
        used for long term treatment, DOA: 12 hours
      - W
        
        asthma related death, hypersensitivity, bronchospasm, upper airway irritation
        
        increase the risk of asthma-related death when used as a monotherapy
      - I
        
        beta 2 agonists, non selective BBs, CYP3A4 inhibitors/substrates
      - S
        
        hepatic impairment may lead to accumulation
      - Education: Proper inhaler technique; not for acute exacerbations; report mod/severe exacerbations; avoid use of concomitant LABAs
      - D
        
        living conditions, low income, $$$, social economic status