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Asthma - Coggle Diagram

- - - - NSAIDs and some beta-blockers
  - - - SABA
      - Pharmacokinetics
        
        Onset of action: 5.7 minutes
        
        Duration of action: about 2 hours
        
        Half-life: 3.5-5 hours
        
        Metabolism: Hepatic to inactive metabolite
        
        Time to peak, FEV1: within 30 minutes
      - Adverse Events: tachycardia, nausea, pharyngitis, vomiting, feeling nervous,
      - Dosing: MDI- 2 inhalations every 4-6 hours or 1 inhalation every 4 hours
      - Special consideration: there's a 67% decline in albuterol clearance in patients w/ CrCl between 7-53 mL/min
      - Monitoring Parameters: FEV1, peak flow, and/or other pulmonary function tests; blood pressure, heart rate; CNS stimulation; serum glucose, serum potassium, serum creatinine; asthma symptoms; arterial or capillary blood gases; lactate
      - Special population: use a spacer for children < 5 years old and consider adding a face mask for children < 4 years old
      - Warning/Precautions: Bronchospasm (rare) and hypersensitivity reaction
      - Contraindications: hypersensitivity to albuterol; severe hypersensitivity to milk proteins
    - - LABAs
      - Dosing: 12 mcg via oral inhalation every 12 hours
      - Adverse Effects: Chest Pain, Palpitations, Diarrhea, Headache
      - Pharmacokinetics
        
        Protein Binding: 31% to 64%
        
        Metabolism: CYP2D6, CYP2C19, CYP2C9, CYP2A6; glucuronidation
        
        Half-life: powder: 10 hours, solution 7 hours
        
        Excretion: fecal and renal
        
        Onset: within 15 minutes
      - Monitoring: proper inhalation technique, reduced asthma symptoms, pulmonary function tests - FEV1, peak flow
      - DDIs: Atomoxetine, beta blockers, linezolid, loop diuretics, QT prolonging agents,
  - - - DPI, rinse your mouth
  - - - MOA: leukotriene receptor antagonist
      - Pharmacokinetics
        
        Vd: 8-11 L
        
        Metabolism: Extensively hepatic via CYP3A4, 2C8, and 2C9
        
        Excretion: Feces (86%); urine (<0.2%)
        
        Time to peak: Tablet: 10 mg: 3 to 4 hours (fasting)
        
        Protein binding: Plasma: >99%
        
        bioavailability: 64%
      - Adverse Events: dermatitis. diarrhea, headache, laryngitis, pharyngitis
        
        black box for serious neuropsychiatric (NP) events
      - Dosing: 10 mg once daily in the evening for adults, 4-5 mg in children
      - Monitoring Parameters: neuropsychiatric events, including suicidal thinking/behavior
  - - - Step 1-2: low dose as needed ICS-formoterol
      - Step 3: low dose maintenance ICS-formoterol
      - Step 4: medium dose maintenance ICS-formoterol
      - Step 5: Add on LAMA and consider high dose ICS-formoterol
    - - Step 1: Take ICS whenever SABA is taken
      - Step 2: Low dose maintenance ICS
      - Step 3: Low dose maintenance ICS-LABA
      - Step 4: Medium/high dose maintenance ICS-LABA
      - Step 5: Add on LAMa and consider high dose ICS-LABA
- - - - wheezing, chest tightness, SOB, cough
      - Can be exacerbated by allergens, weather, etc.
    - - At least once during diagnostic process, document that FEV1/FCV ratio is below the lower limit of normal
- - - - Well-controlled asthma is characterized by daytime symptoms no more than twice per week and nighttime awakening due to asthma no more than twice per month
- - - - Exposure to 2nd hand smoke in infancy and in utero
      - Family size
      - Socioeconomic status
      - viral respiratory infections
      - Air pollution
      - Allergen exposure
      - Decreased exposure to common childhood infectious agents