Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHM 702: Pulm and ToXXX > Ass-thma (Chronic) > Flashcards

Ass-thma (Chronic) Flashcards

1
Q

SABA agents for asthma

A
  • albuterol
  • levalbuterol - more potent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ICS agents for asthma

A
  • Ciclesonide
  • Fluticasone - higher risk of sore throat/hoarseness
  • Beclomethasone - smaller particles → better lung penetration
  • Mometasone
  • Budesonide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LABA agents for asthma

A
  • Salmeterol
  • Formoterol
  • Vilanterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

LAMA agents for asthma

A
  • Tiotropium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Leukotriene modifiers for asthma

A

Leukotriene D4 antags
- Montelukast
- Zafirlukast - DDI warfarn, theophylline

5-lipooxygenase inhibitor
- Zileuton - DDI theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Biologics for asthma

A
  • Omalizumab
  • Mepolizumab
  • Reslizumab
  • Benralizumab
  • Dupilumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SABA application in asthma therapy

A
  • short acting beta agonists
  • Rescue therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inhaled corticosteroid application in asthma therapy

A

First line maintenance - dosed BID (except for Arnuity QD and mometasone QD OR BID)

AVOID in aute bronchospasm and status asthmaticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LABA application in asthma therapy

A
  • long acting beta agoists

Maintenance therapy - must be used in COMBO with ICS ← has a BBW of asthma-related death if used as monotherapy

ICS/formoterol (speficially, budesonide/formoterol), can be used as a rescue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

LAMA application in asthma therapy

A

Maitenance therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Leukotriene modifier application in asthma therapy

A

Maintenance for persistent asthma

If using montelukast for exercise, take 2hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Theophylline application in asthma therapy

A

Not frequetly used d/t high risk of AE, DDI (CYP3A4), and narrow window (5-15mcg/mL)
- also less effective than ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Biologics application in asthma therapy

A
  • In pts with severe allergic or eosinphilic asthma
  • Admined in healthcare setting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SABA MOA

A

stimulate beta 2 receptor in lungs → relaxation of bronchial smooth muscle → bronchodilation (does NOT address inflammation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Inhaled corticosteroid MOA (asthma)

A
  • Reduce chronic airway inflammation; decrease airway hypersensitivity
  • Reduce risk of exacerbations → reduced hospital admissions and death
  • Improve lung function → peak expiratory flow rate increases
  • Reduce symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LABA MOA

A

stimulate beta 2 receptor in lungs → relaxation of bronchial smooth muscle → bronchodilation (does NOT address inflammation)

  • same as SABA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LAMA MOA

A

Inhibit the action of ACh at the M3 muscarinic receptor in bronchial smooth muscle → bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Leukotriene modifiers MOA (asthma)

A

Block pro-inlammatory leukotrienes at receptor sites → reduce airway constriction and mucus secretion

19
Q

Theophylline MOA

A

Block phosphodiesterase, increase cAMP → release of epinephrine from adrenal medulla cells → brochodilation, CNS and cardiac stimualtion, diuresis, gastric acid secretion

Caffeine is an active metabolite

20
Q

Biologics for asthma MOA

A

Targets
- IgE: allergic response
- IL-4: inflammation
- IL-5: eosinophils

21
Q

SABA AE

A
  • Tremor, shakiness
  • Lightheadedness
  • Cough
  • Palptations
  • Hypokalemia
  • Tachycardia
  • Hyperglycemia
22
Q

Inhaled corticosteroids for asthma AE

A

USE LOWEST DOSE POSSIBLE
- step down when asthma is well controlled, decrease dose 25-50% after 3 months of stability

Oropharyngeal candidiasis
Dysphonia

Growth concerns in children (not clinically significant)

Hyperglycemia
Increased risk of fractures

23
Q

Leukotriene modifiers for asthma AE

A
  • HA
  • URI
  • GI
  • Psych - montelukast only
    • aggressive behavior
    • AMS
24
Q

Theophylline AE

A

Nausea
Loose stools
HA
Tachycardia
Insomnia
Tremor, Nervousness

AVOID in: CV hx, hyperthyroid, PUD, seizures

25
Q

Clinical pearls regarding inhaler types

A
  • Avoid DPIs in children <4
  • Shake MDIs
  • Do NOT shake DPI
  • Avoid DPI in milk protein allergies (except budesonide)
    • DPI may contain lactose
26
Q

Systemic corticosteroids use in assthma

A

Can be used for management of exacerbation ← short course that does NOT need to be tapered off

27
Q

Epinephrine inhlaer in asthma

A

OTC epinephrine inhaler is nonselective → AE for tachycardia, HTN → DO NOT USE

28
Q

Cromolyn in asthma

A

Neb exists but is not preferred

29
Q

Asthma

A

characterized by intermittent or persistent presence of highly variable degrees of airflow obstruction from airway wall inflammation and bronchial smooth muscle constriction

30
Q

Asthma signs/symptoms

A
  • dyspenea
  • wheezing
  • SOB
  • chest tightness
  • dry, hacking cough
  • variable expiratory airflow
  • signs of atopy
  • reduced O2 saturation

s/s tend to worsen at night and early morning and vary over time in intensity

31
Q

Asthma triggers

A
  • viral infections
  • allergens
  • tobacco smoke/enviroment
  • exercise
  • stress/emotions
    - drugs/preservatives (asa, nsaids, sulfites, non-selective beta blockers, bezalkonium chloride)
  • occupational stimuli
32
Q

Asthma risk factors

A
  • higher exposure to residential allergens
  • socioeconomic disparities(shortage of PCPs in minority communities; language and literacy barriers)
  • underuse of asthma medications
  • second hand tobacco somke
  • allergen exposure
  • urbanization
  • RSV
  • family size (smaller family, higher risk)
  • decreased exposure to common childhood infectious agents
33
Q

Atopy risk factors

A
  1. eczema
  2. allergic rhinitis
  3. allergic asthma
34
Q

Mild asthma

A

Asthma that is controlled by step 1 or 2

35
Q

Moderate asthma

A

Asthma that is controlled by step 3 or 4

36
Q

Severe asthma

A

Asthma that is controlled by step 5

37
Q

Asthma symptom assessment (the checklist)

A

In the past 4 weeks, has the patient had:
- daytime asthma s/s more than 2x a week
- any night waking d/t asthma
- SABA use for s/s more than 2x a week (EXCLUDE if using before exercise)
- activity limitation d/t asthma

38
Q

Asthma comorbidities

A
  • obesity
  • chronic rhinusinusitis
  • GERD
  • confirmed food allergy
  • anx
  • depression
  • preggers
39
Q

Risk factors for developing fixed airflow limitation

A
  • low birth weight
  • lack of ICS treatment
  • exposure to tobacco smoke, etc.
  • low FEV1
  • chronic mucus hypersecretion
  • sputum or blood eosinophilia
40
Q

Long term goals of astha management care

A
  • symptom control
  • risk reduction for future exacerbations
41
Q

Why ICS instead of SABA alone?

A
  • pts with mild asthma can have severe exacerbations - ICS is preventative
  • SABA only increases risk for exacerbations
  • Low dose ICS reduces asthma related hospitalzations and death
  • Patients who experience severe exacerbations have better long-term lung function if on an ICS
42
Q

What is the first thing we do when a patient comes in with partly controlled or uncontrolled asthma

A

CHECK INHALER TECHNIQUE and adherence

43
Q

Stepping down asthma therapy

A
  • Appropriate time for step down: >3 months of good asthma control
  • Reduce CIS dose by 25-50% at 2-3 month intervals (can go all the way down to PRN ICS/formoterol)
  • Do NOT completely stop ICS unless needed to temporarily confirm dxx
44
Q

Non-pharm interventions for asthma

A
  • smoking cessation
  • physical activity
  • remove sensitizers
  • avoid medications that may worsen asthma (NSAIDs or beta blockers)
  • Remediation of dampness or mold in homes
  • sulingual immunotherapy

PHM 702: Pulm and ToXXX (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions