presented by : abdulhadi burzangi. pharm.d 1. i.background of asthma. ii.clinical presentation....
Post on 20-Dec-2015
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I. Background of Asthma.II. Clinical presentation.III. Drug used in asthma.IV. Stepwise approach for managing asthma. V. Steps for using inhaler.VI. Case.
Key Point..
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I- BackgroundI- Background
•Definition :
- Asthma is a chronic inflammatory disease
of airway associated with inflammation,
obstruction and increase airway hyper-
responsiveness.4
• Types of asthma :
Intermittent Persistent Mild Moderate Severe
symptoms< 2 days/week < 2 days/week
but not daily
Daily Through out the day
Night time awakening
< 2 days/month3-4 days/month >1 day/weekOften 7 days/w
SABA use for symptoms
control> 2 days/week >2 days/weekDaily Several time
per day
Interference with normal
activityNone Minor limitation Some limitation Extremely
limited
• Asthma triggers : 1- Allergens.
2- Occupational exposure. 3- Disease. 4- Environmental changes. 5- Emotions. 6- Exercise. 7- Drugs and preservatives.
11- Clinical presentation
- In case of chronic ambulatory asthma : 1- Episode of dyspnea.
2- Chest tightness. 3- Coughing ( particularly at night ). 4- Wheezing or a whistling sound when breathing.
- In case of severe acute asthma : 1- Severe dyspnea.
2- Chest tightness. 3- S.O.B 4- The patient is able only to say a few words with
each breath.
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111111 - -Drugs used in asthmaDrugs used in asthma
A. Beta 2 agonist.
1- Short acting beta agonist (SABA).
2- Long acting beta agonist (LABA).
B. Corticosteroids (CS).
1- Inhaled.
2- Oral.
C. Leukotrine receptor antagonist.D. Mast cell stabilizer.E. Phosphodiestrease inhibitor.F. Anti IgE.G. Anticholinergic.
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A. Beta 2 agonistA. Beta 2 agonist
• SABA : - e.g : Albuterol .
- Uses
• LABA : - e.g : 1-Salmetrol 2-Formetrol .
- Uses
- Side effect of both : 1- Tachycardia. 2- Palpitation. 3- Tremor. 4- Hypokalemia. 7
B. CorticosteroidB. Corticosteroid
• Inhaled CS :
- e.g : 1- Beclomethasone. 2- Budesonide. 3- Flunisolide. 4- Fluticasone. 5- Trimcinolone.
- Uses
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• Oral CS :
-e.g : 1-predinsone , 2-predinsolone
3-methylpredinsolone
-Uses
• Short term and long term side Short term and long term side effect :effect :
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Short term S.E Long term S.E
-Facial flushing.-Appetite stimulant. -GIT irritation.-Mood change.-Acne.-Weight gain.-Hyperglycemia.-Leukocytosis.-Hypocalsemia.
-HPA axis suppression.-Growth retardation.-HTN.-Osteoporosis.-Hirsutism. -Myopathy.
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C. Leukotriene receptor antagonist - e.g : ( Montelukast, Zafirlukast and
Zileuton ).
- Uses D. Mast cell stabilizer
- e.g : ( Cromolyn Na+ and Nedocromil ).
- Uses
E. Phosphodiestrase inhibitors E. Phosphodiestrase inhibitors
- e.g : ( Theophylline ).
- use - Factors affecting serum theophylline concentration :
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Decrease Theophylline conc.Increase Theophylline conc.
-High protein diet. -Smoking.-Rifampin.-Phenytoin.-Phenobarbital.-Carbamazepine.
-High carbohydrate diet.-Systemic viral infection.-Cimetidine.-Erythromycin.-Ciprofloxacin.-Ticlopidine.
V. Steps for using inhaler.
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1 .Remove the cap and hold inhaler upright.
2 .Shake the inhaler.
3 .Tilt your head back slightly and breathe out slowly.
4 .Position the inhaler in one of the following ways
5 .Press down on the inhaler to release medication as
you start to breathe in slowly.
6 .Breathe in slowly (3 to 5 seconds).
7 .Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.
8 .Repeat puff as directed. Waiting 1 minute between
puffs may permit second puff to penetrate your
lungs better.
VI. CaseVI. Case
K.M is 33years old female , she came to ambulatory care department at last Saturday . She had been bronchial asthma X 13 years . She was complaining of cough, wheezing , chest tightness and drowsiness. The patient said ( sometimes my family want to take me to ED when i had asthmatic attack but i didn’t want to visit ED). She on seretid (Flutacasone/Salmetrol) for her asthma.
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Subjective :
• Chief complaint: - wheezing.
- cough. - chest tightness. - drowsiness.
• Problem list : - bronchial asthma X 13 years.
- iron deficiency anemia.
• Social history : - single.
• Allergy : - Food > banana … shrimp.
- Drugs > no known drug allergy.
- Others > dust and costs.
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ObjectiveObjective : :
• Vital sings : R.R : 20 rate/min Temp. : 36.8 ْc
B.P : 130/61 Pulse : 81 beat/min
• Weight : 68.6 kg Height : 150cm.
• Past medication : - Inhaled beclomethasone 100 mcg puff bid.
- Ventolin (Albuterol).
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Current medication: - Seretid ( Fluctasone 250mcg + Salmetrol
50mcg )BID. - Ferrose (100 mg iron as iron III hydroxide polymaltose
complex).
Assessment : -The patient diagnosed with mild persistent
asthma. - She doesn’t response to her medication.
Plan : -Ventolin solution + Ventolin neublizer.
- Ferrose.
RecommendationRecommendation
-Check the patient compliance…..-Stop gradually…..-General measure for treating asthma.
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