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CMPP > Asthma > Flashcards

Asthma Flashcards

1
Q

condition that makes it hard to exhale all of the air in the lungs

A

asthma

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2
Q

other obstructive lung diseases

A

COPD (emphysema and chronic bronchitis)
bronchiectasis
CF

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3
Q

is asthma acute or chronic

A

chronic

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4
Q

is asthma reviersible or irreversible?

A

reversible

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5
Q

what is the most chronic disease of childhood?

A

asthma

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6
Q

signs/symptoms of asthma

A 
wheezing
coughing 
SOB
chest tightness/pain
other non-specific symptoms in infants/young children
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7
Q

Hx of the following in young children with asthma

A 
recurrent bronchitis
pneumonia
recurrent croup
bronchiolitis
persistent cough/cold
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8
Q

the problem in asthma

A

airway remodeling after long term unresolved inflammation

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9
Q

airway remodeling in asthma

A

increased airway wall thickness that involves both smooth muscle and collagen tissue
increase mucous glands and mucus production
increased vascularity or blood blood supply in the airways

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10
Q

pathophys of asthma

A

airway inflammation –> bronchial hyperresponsive –> persistent airflow obstruction

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11
Q

step 1 airway inflammation

A

mast cell, eosinophil, and T-lymphocyte infiltration
mucus hypersecretion
desquamation of epithelium
smooth muscle hyperplasia

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12
Q

main inflammatory cells of asthma

A 
mast cells
eosinophils
T lymphocytes
>100 inflammatory mediators
chemokines
cytokines
histamines
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13
Q

how does mediator release occur

A

Chemically-rich mast cells that line the bronchial mucus membranes release histamine or other mediators which causes bronchospasm and bronchial inflammation

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14
Q

step 2: bronchial hyperresponsiveness

A

hyperinflation compensates for inflammation

result is alveolar hypeventilation and air trapping

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15
Q

step 3: persistent airflow obstruction

A 
chronic mucous plug formation (exudate of serum proteins and cell debris)
airway remodeling (structural changes due to long-standing inflammation)
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16
Q

risk factors for asthma

A 
males
childhood asthma
evironmental allergens/pollutants (dust mites, cat & dog, fungi, tobacco smoke)
viral respiratory tract infections
exercise, hyperventilation
GERD
chronic sinusitis/rhinitis
African American
ASA/NSAID hypersensitivity
medication use (tylenol, abx, beta blockers)
obesity
emotional factors/stress
irritants
perinatal factors (prematurity and prenatal exposure to maternal smoking)
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17
Q

ASA induced asthma

A

triad: atopy, nasal polyps, ASA sensitivity

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18
Q

when is ASA induced asthma experienced?

A

30s-40s

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19
Q

signs/symptoms of ASA asthma

A

rhinorrhea
conjunctival irritation
flushing of head/neck

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20
Q

treatment of ASA asthma

A

avoidance

leukotriene antagonist

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21
Q

why does GERD induce asthma

A

presence of acid in distal esophagus

mediated via vagal nerve increases airway resistance and reactivity

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22
Q

how much more likely are pts who have asthma to have gerd?

A

3x

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23
Q

how to treat gerd induced asthma?

A

treat GERD

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24
Q

when is rhinovirus a risk factor for wheezing?

A

infancy

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25
Q

what percent of childhood asthma is associated with prior viral exposure?

A

80-95%

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26
Q

what 4 pathogens were found in >50% of children ages 7-9 who later had asthma?

A

pneumonia
RSV
mycoplasma
chlamydia

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27
Q

high risk occupations to develop asthma?

A

farming
painting
janitorial work
plastic manufacturing

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28
Q

what does exercise induce?

A

bronchospasm

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29
Q

can exercise induced asthma be found in patients with normal spirometry?

A

YES

atopy or CF

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30
Q

why is exercised induced asthma a neglected diagnosis?

A

silent in 50% of patients except during exercise

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31
Q

when is weight gain associated with increased risk of asthma symptoms?

A

early infancy

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32
Q

what kind of predisposition does atopy increase risk of asthma?

A

genetic predisposition

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33
Q

types of atopic diseases

A

allergic rhinitis
atopic dermatitis (eczema)
urticaria
+ allergen skin tests

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34
Q

what family histories increase risk of asthma

A 
asthma
allergies
sinusitis
rhinitis
eczema
nasal polyps
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35
Q

3 important social history questions for asthma

A

smoking
workplace
school

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36
Q

how do nocturnal symptoms of asthma occur

A

bronchospasm between 4-6am

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37
Q

important Hx quetsions regarding exacerbations

A 
prodrome signs/symptoms
rapidity of onset
associated illnesses
# of exacerbations within the last year
need for ED visits, hospitalizations, ICU admissions, intubations
missed days from work or school
activity limitation
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38
Q

goals of initial visit? (5)

A
  1. diagnose asthma
  2. assess asthma severity
  3. initiate medications and demonstrate use
  4. develop written asthma action plan
  5. schedule follow-up appointment
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39
Q

what value indicates obstruction

A

low FEV1/FVC

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40
Q

what is the best indicator of severity?

A

FEV1

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41
Q

what is change of FEV1 from personal best (in terms of percentages and stable –> severe)

A

50% severe

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42
Q

what does CXR appear like with asthma?

A

normal

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43
Q

pH and CO2 of ABG?

A

pH down

CO2 up

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44
Q

are obstructions reversible?

A

partially

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45
Q

wheezing Ddx

A 
upper airway obstruction (tumor or edema)
endobronchial foreign body or CA
acute LV failure
recurrent PE
chronic bronchitis
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46
Q

goals of asthma treatment

A 
prevent of chronic symptoms
daily controller agent for persistent dz
maintain normal activity levels
prevent recurrent exacerbations
initiate therapy at aggressive level and step down drugs when control is achieved
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47
Q

meds used for exacerbations or emergencies

A

rescue meds

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48
Q

meds used to prevent exacerbations

A

controller meds

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49
Q

what is important for determining which medication to use?

A

classification of asthma

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50
Q

6 criterion for asthma classification

A 
symptoms
nighttime awakenings
short-acting beta2 agonist use
interference with normal activity
lung function
exacerbations requiring oral systemic corticosteriods
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51
Q

four classifications of asthma

A 
intermittent 
persistent
   mild
   moderate
   severe
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52
Q

MOA of SABAs

A

beta agonist

relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells

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53
Q

indications for SABAs

A

adults and kids
acute asthma exacerbations
exercise-induced asthma prophylaxis

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54
Q

what drug shouldn’t you use with beta blockers?

A

SABAs

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55
Q

adverse effects of SABAs

A 
tachycardia
URI
pharyngitis
nausea
**a fib
**hypokalemia
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56
Q

generic SABA

A

albuterol

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57
Q

brand name SABA

A

ventolin

proventil

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58
Q

pregancy category of SABAs

A

C

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59
Q

clinical teaching for SABAs

A 
adverse effects
proper inhalation
rinsing
wash mouthpiece
controller therapy if needed >2x/week
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60
Q

3 doses that inhaled corticosteroids (ICS) are available in

A

low- dose
medium-dose
high-dose

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61
Q

MOA of ICS

A

potent anti-inflammatory effect
inhibits mast cells, eosinophils, etc
inhibits production/secretion of cell mediators (cytokines, histamine, leukotrienes)

62
Q

indications of ICS

A

adults and kids
asthma
allergic rhinitis
atopic dermatitis

63
Q

adverse effects of ICS

A 
candiasis
HA
bronchitis
cough
epistaxis
sinusitis
URI
**pneumonia
**COPD
**glaucoma
64
Q

generics of ICS

A

fluticasone
budesonide
beclomethasone
triamcinolone

65
Q

brands of ICS

A

flonase/flovent
pulmicort
QVAR
azmacort

66
Q

brand of fluticasone

A

flonase/flovent

67
Q

brand of budesonide

A

pulmicort

68
Q

brand of beclomethasone

A

QVAR

69
Q

brand of triamcinolone

A

azmacort

70
Q

pregnancy category for ICS

A

C

71
Q

clinical teachings for ICS

A

not for acute exacerbations
rinse mouth with water & spit
watch for adrenal suppression
do not apply topical to face, underarms, groin, or diaper area

72
Q

LABA MOA

A

beta2 agonist

relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells

73
Q

indications for LABAs

A

adults and kids >4
asthma
COPD
exercise indiced asthma prophylaxis

74
Q

LABA black box warning

A

increased risk for asthma related death, intubation, or hospitalization (greatest in ages 4-11)

No risk if paired with inhaled steroid

75
Q

adverse effect of LABAs

A 
HA
musculoskeletal pain
**death
**prolonged QT
** exacerbation of severe asthma
76
Q

generics of LABAs

A

salmeterol

formoterol

77
Q

brands of LABAs

A

serevent

foradil

78
Q

brand of salmeterol

A

serevent

79
Q

brand of formoterol

A

foradil

80
Q

pregnancy category of LABAs

A

C

81
Q

clinical teachings for LABAs

A

not for acute exacerbation
warn of adverse effects
show proper inhalation technique

82
Q

MOA of LTRAs

A 
leukotriene antagonist
prevents airway edema
smooth muscle contraction
respiratory inflammation
nasal mucosa rxn after allergen exposure
83
Q

indications of LTRAs

A

adults and children > 12 months
asthma treatment and prophylaxis
exercise induced asthma prophylaxis
allergic rhinitis

84
Q

adverse effects of LTRAs

A

HA
steven-johnson syndrome
aggressive/altered behavior
suicidal thoughts

85
Q

what does LTRA stand for?

A

leukotriene receptor antagonist

86
Q

generics of LTRAs

A

montelukast, zafirlukast

87
Q

brand of LTRA

A

singulair

88
Q

pregnancy category of LTRAs

A

B

89
Q

clinical teaching for LTRA

A

not for acute exacerbation

behavior side effects (agitation, dream disorder, hallucination)

90
Q

LABA + ICS MOA

A

beta 2 agonist
relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells
mimics cortisol with salt-retaining properties
used for anti-inflammatory effects on many organ systems

91
Q

indications for LABA + ICS

A

adults and kids >12 years
asthma
COPD

92
Q

adverse effects

A 
oral candidiasis
GI upset
HA
nasopharyngitis
URI
**hypokalemia
**glaucoma
**cataracts
**death
93
Q

LABA + ICS generics

A

formoterol/budenoside
salmetrol/fluticasone
formoterol/mometasone

94
Q

LABA + ICS brands

A

symbicort
advair
dulera

95
Q

formoterol/budesonide brand

A

symbicort

96
Q

salmeterol/fluticasone brand

A

advair

97
Q

formoterol/mometasone brand

A

dulera

98
Q

pregnancy category of LABA + ICS

A

C

99
Q

clinical teaching for LABA + ICS

A

not for acute exacerbations
reduced growth rate in kds
watch for adrenal suppression
rinse mouth after each use to prevent oral infection

100
Q

oral corticosteroid MOA

A

mimics cortisol with salt-retaining properties

used for anti-inflammatory effects of many organ systems

101
Q

oral corticosteroid indications

A

adults and kinds

asthma: moderate –> severe exacerbation
asthma: long-term therapy

102
Q

adverse effects of oral corticosteroids

A 
HTN
body fluid retention
impaired glucose tolerance
increased appetite/weight gain
osteoporosis
nausea/vomiting
glossitis
sore throat
oral candidiasis
dysphonia
reduced growth rate (kids)
impaired skin healing
**cushing/s
**CHF
**tendon rupture
**cardiac arrest
103
Q

generic oral corticosteroids

A

prednisone
methylprednisone
prednisolone

104
Q

brand oral corticosteroids

A

deltasone
medrol
prelone

105
Q

pregnancy category of oral corticosteroids

A

D

106
Q

clincial teaching for oral corticosteroids

A

careful for drug-induced immuinosuppression (vaccine caution)
report symptoms of infx
avoid sudden discontinuation
take with food or milk to minimize GI symptoms
avoid taking with alcohol or tobacco
can increase osteoporosis

107
Q

MOA of theophylline

A

bronchodilation through smooth muscle relaxation

suppression of airway stimuli

108
Q

indications of theophylline

A 
adults and kids
asthma exacerbation
asthma
COPD
Newborn apnea
109
Q

adverse effects of theophylline

A 
nausea and vomiting
HA
insomnia
restlessness
irritability
**a-fib
**Steven-johnson
**seizures
110
Q

brand for theophylline

A

theo-dur

111
Q

pregnancy category of theophylline

A

C

112
Q

clinical teachings of theophylline

A

not for acute exacerbations

theophylline toxicity

113
Q

symptoms of theophylline toxicity

A

vomiting
arrhythmia
seizures

114
Q

cromolyn MOA

A

anti-inflammatory
prevents bronchoconstriction
blocks histamine

115
Q

indications for cromolyn

A

adults and children >2
asthma prophylaxis
allergic rhinitis
vernal (spring) conjunctivitis

116
Q

adverse effects of cromolyn

A 
bad taste
cough
throat irritation
burning sensation in the eye
**anaphylaxis
**bronchospasm
117
Q

brands for cromolyn

A

cromlon
intal
nasalcrom

118
Q

pregnancy category for cromolyn

A

B

119
Q

clinical teaching for cromolyn

A

not for indicated for acute exacerbation
nasal form: may not see symptomatic improvement for 1-2 weeks
inhaled form: may not see improvement for 4 weeks
do not wear contacts (especially not with eye solution)
take oral solution 30 minutes before meals and bedtime

120
Q

MOA of monoclonal Ab

A

inhibits binding of IgE to receptors of mast cells and basophils

121
Q

indications of monoclonal Ab

A

adults and kids >12
IgE mediated allergic asthma
off label: allergic rhinitis, peanut allergy, idiopathic urticaria, latex allergy

122
Q

black box warning for monoclonal Ab

A

anaphylaxis

123
Q

adverse effects for monoclonal Ab

A 
injection site rxn
HA
viral dz
URI
sinusitis
pharyngitis
**thrombocytopenia
**anaphylaxis
124
Q

generic monoclonal Ab

A

omalizumab

125
Q

brand monoclonal Ab

A

Xolair

126
Q

pregnancy category for monoclonal Ab

A

B

127
Q

who should avoid NSAIDS

A

adults with severe persistent asthma or nasal polyps

128
Q

what other medication should asthmatics avoid?

A

beta blockers

129
Q

what vaccination is it important for asthmatics to get?

A

flu

130
Q

what foods should asthmatics avoid?

A

dried fruit
processed potatoes
shrimp
beer or wine associated with sulfites

131
Q

when should exercised-induced asthmatics dose short acting beta2 agonists?

A

15-30 minutes prior to activity

132
Q

when should exercised-induced asthmatics dose long acting beta2 agonists?

A

30-60 minutes

133
Q

how long do short-acting beta2 agonists last?

A

2 hours

134
Q

how long do long-acting beta2 agonists last?

A

12 hours

135
Q

short acting beta2 agonist generics

A

albuterol
pirbuterol
levalbuterol

136
Q

albuterol brand

A

ventolin

137
Q

purbuterol brand

A

maxair

138
Q

levalbuterol brand

A

xopenex

139
Q

long acting beta2 agonist generics

A

salmeterol

formoterol

140
Q

salmeterol brand

A

serevent

141
Q

formoterol

A

foradil

142
Q

mild episode of exacerbation

A

breathless after activity
talk in sentences and lie down
agitated
increased respiratory rate without accessory muscle use
HR < 100
auscultation moderate expiratory wheezing
O2 sat >95%

143
Q

moderate episode of exacerbation

A 
breathlessness when talking
increased respiratory rate
accessory muscle use
HR = 100-120
asucultation: loud expiratory wheezing
infants have feeding difficulties and softer, shorter cry
assume sitting position
O2 sat: 91-95%
144
Q

severe episode of exacerbation

A 
breathlessness at rest
increased respiration rate >30
accessory muscle use
HR >120
loud expiratory/inspiratory wheezing
agitated
anorexia
tripod
2-3 word dyspnea
sitting
O2 sat <91%
145
Q

exacerbation treatment

A 
supplemental O2
nebulized albuterol or duoneb
inhaler with spacer if pt can hold breath for 4 seconds
prednisone (discharge with short course)
peak flow (before & after)
ABGs if severe or low peak flow
146
Q

short acting anti-cholinergic MOA

A

anti-cholinergic effects
suppress tightening of bronchial smooth muscle
anti-secretory properties

147
Q

anti-cholinergic indications

A

adults and kids (inh >12, spray >5)
asthma exacerbation
allergic rhinitis
COPD

148
Q

adverse effects of short acting anti-cholinergics

A 
bitter taste
xerostomia
bronchitis
dry nasal mucosa
sinusitis
constipation
**bowel obstruction
**death
**MI
**CVA
149
Q

anti-cholinergic generic

A

ipratropium

150
Q

anticholinergic brand

A

atrovent

151
Q

pregnancy category for anti-cholinergic

A

B

152
Q

clinical teaching for anti-cholinergics

A

avoid activities requiring mental alertness or coordination
improvements from nasal spray may not be seen for a few weeks
proper inhalation technique

CMPP (17 decks)

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