NR 566 / NR566 Advanced Pharmacology Care of the Family Midterm Exam | Already graded A | Latest, 2020 / 2021| Chamberlain College
1. Mild intermittent
... [Show More] asthma
- Symptoms occur less often than twice a week and the patient is asymptomatic between exacerbations; nighttime symptoms occur less than twice a month; and peak expiratory flow (PEF) is greater than 80% predicted. The use of short-acting beta2 agonists (SABA) should be less than twice a week, unless used for exercise-induced bronchospasm (EIB).
2. Mild persistent asthma
- Symptoms occur more often than twice a week but less often than once a day and exacerbations may affect activity; nighttime symptoms occur 3 to 4 times a month; and PEF is greater than 80% predicted. Patients with mild persistent asthma may use their short-acting beta2 agonists more than twice a week but not daily, and not more than once daily.
3. Moderate persistent asthma
- The patient is having daily symptoms; requires daily use of a beta2 agonist; exacerbations affect normal activity; nighttime symptoms occur more often than once a week; and PEF is greater than 60% to less than 80%.
4. Severe persistent asthma
- The patient has some degree of symptoms all the time; extremely limited physical activity and frequent exacerbations; frequent nighttime symptoms, often 7 days a week; and decreased lung function (PEF less than 60% predicted). Table 30-1 outlines the classifications of asthma severity in patients aged 12 years or older.
5. Risk factors for fatal asthma attacks
- Previous severe exacerbations requiring intubation or ICU.
- Two or more hospitalizations.
- More than 3 ED visits in the past year.
- Use of more than 2 SABA canisters per month.
- Difficulty perceiving airway obstruction or worsening asthma.
- Low socioeconomic status or inner-city residence.
6. Asthma step therapy
- The Expert Panel Report 3: Guidelines (NAEPP, 2007) recommends a stepwise approach to the pharmacological management of asthma. Management can begin at a higher level and gradually step down or start low and move up, depending on the patient's status when beginning treatment.
o Step 1: SABA PRN
o Step 2: Low dose ICS
o Step 3: Medium dose ICS
o Step 4: Medium dose ICS + LABA or Montelukast
o Step 5: High dose ICS + LABA or Mentelukast
o Step 6: High dose ICS + LABA or Montelukast + oral corticosteroids
7. COPD therapy and goals of treatment
- Slow the disease process
- Maintain quality of life
- Medications
- Quit smoking
- Nutrition
- Infection protection
- Exercise -pulmonary rehabilitation improve function and quality of life
8. Respiratory drug interactions with digoxin
- Albuterol can lower digoxin levels in body
9. Patient education for treatment of asthma
- Basic facts about asthma.
- Medication skills.
- Self-monitoring skills.
- Specific to drug therapy.
- Reasons for the drug.
- Drugs as part of the total treatment regimen.
10. Use of oral corticosteroids in the treatment of COPD
- Corticosteroids have nonspecific anti-inflammatory activity at multiple points in the inflammatory process. Because of the cellular-level airway changes that define COPD, corticosteroids' effects are less dramatic in COPD than those seen in asthma. Yet corticosteroids are key components in the management of stable COPD and COPD exacerbations.
- The use of daily inhaled corticosteroids (ICS) in the COPD patient has mixed results in clinical studies.
- inhaled corticosteroids do not modify the long-term decline in FEV1 seen in COPD, but as both monotherapy and in combination with inhaled bronchodilators they decrease exacerbations and improve health status in patients with symptomatic COPD
- Therefore, the current ACP and GOLD guidelines recommend starting a patient on moderate- to high-dose inhaled corticosteroids
- Combination therapy of ICS and a long-acting beta agonist, such as Advair (salmeterol/fluticasone), is more effective in decreasing exacerbations than either agent alone [Show Less]