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What are MDIs and how should they be used?`
Metered-dose inhalers. Small, hand-held, pressurized devices. Begin slow inhalation before activation, hold medicine in lungs for 10 seconds, and wait 1 minute between activations.
What are SMIs and how should they be used?
Soft mist inhalers. Begin slow inhalation, hold medicine in lungs for 10 seconds, and wait 1 minute between activations.
What is the advantage of DPIs? Disadvantages? How fast should the patient inhale?
No hand-lung coordination needed, breath-activated. Must have adequate inspiratory flow to inhale powder. Inhale rapidly.
What are SVNs and how are they used? What are the advantages?
Small volume nebulizers. Converts a solution into a mist. Does not require timing of dose with inhalation, rapid deep inspiration, or hand strength.
List 3 ways glucocorticoids treat asthma.
Suppress inflammation and bronchial reactivity, decrease mucus production, increase number and responsiveness of beta-adrenergic receptors.
What is the first-line treatment for moderate to severe persistent asthma?
Discuss the proper way to administer inhaled glucocorticoids. Why?
Gargle & spit after use. Use the beta-adrenergic inhaler first if one is used. The beta-adrenergic inhaler opens the airways so that the glucocorticoid can penetrate deeper into the lungs. Gargling and spitting decreases the chance of an oropharyngeal infection.
Why might oral glucocorticoids be necessary during stress even if asthma symptoms are controlled?
May need to supplement because stressful events require bursts of steroids. The patient may develop adrenal crisis without supplementation.
How does montelukast (Singular), a leukotriene modifier, work?
Blocks leukotriene receptors.
What are the four mechanisms of actions for leukotriene modifiers?
Bronchodilation, decreased mucus, decreased edema, and decreased eosinophilic infiltration
How does Cromolyn, a mast cell stabilizer, work?
Prevents mast cells from lysing and releasing histamine and other mediators.
How long must mast cell stabilizers be used to obtain a therapeutic effect?
May take several weeks
How does omalizumab (Xolair) work? Why are patients asked to stay in the clinic after injections?
Myoclonal antibody binds free IgE so that it cannot bind to mast cells and cause their lysis. Risk for anaphylaxis.
Why are beta2-adrenergic agonists used?
Relieve bronchospasm and prevent exercise-induced bronchospasm.
What are the three mechanisms of action for beta2-adrenergic agonists?
Bronchodilation, suppression of histamine release, increased ciliary motility.
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