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Asthma Flashcards

(129 cards)

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1
Q

what is the atopic triad

A

asthma, allergic rhinitis, atopic dermatitis (eczema)

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2
Q

describe the allergic asthma phenotype in terms of treatment

A

usually responds well to ICS

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3
Q

describe the non-allergic asthma phenotype in terms of treatment

A

usually less response to ICS

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4
Q

when does allergic asthma usually present

A

childhood, associated with PMH or FH of allergic disease such as eczema, allergic rhinitis, or food and drug allergy

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5
Q

when does non-allergic asthma usually present

A

adults, occupational asthma, asthma with obesity

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6
Q

what does the biodiversity hypothesis suggest

A

exposure to microbe-rich environments protects against allergic and autoimmune diseases

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7
Q

TH1 is what type of immunity

A

cell-mediated protective immunity (no allergies)

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8
Q

TH2 is what type of immunity

A

antibody mediated immunity (allergies, asthma)

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9
Q

who is likely to differentiate to TH1 immunity

A

older siblings, early daycare exposure, rural, childhood infections, microbial exposure

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10
Q

who is likely to differentiate to TH2 immunity

A

only child, widespread use of antibiotics, urban environment

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11
Q

describe TH1/TH2 shift

A

at birth, predominant TH2. As exposure to bacterial/viral infections occur, shifts towards TH1. If TH1 doesn’t mature, TH2 predominates which favors allergy, allergic rhinitis, and eczema

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12
Q

T2 inflammation/eosinophilic/allergic asthma is present when

A

at an early age

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13
Q

T2 asthma is associated with

A

atopy, allergy, elevated IgE, eosinophilia, elevated FeNO

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14
Q

non-TH2/non-eosinophilic asthma is present

A

later in life

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15
Q

describe some protective factors for developing asthma

A

being the younger sibling, natural birth, breastfeeding, higher socioeconomic status, healthy diet, low pollution rates, exercise, microbial exposures, farm living

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16
Q

describe some risk factors for developing asthma

A

asthma family history, c-section, formula feeding, sheep/hay farming, urban living, respiratory viral infections, lower socioeconomic status, obesity, use of antibiotics

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17
Q

what medications can be asthma triggers

A

ASA/NSAIDs, non selective beta blockers

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18
Q

which beta blockers are asthma triggers

A

propranolol and carvedilol

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19
Q

what is samter’s triad

A

asthma, nasal polyps, aspirin/NSAID sensitivity

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20
Q

how does aspirin/NSAID exacerbated respiratory disease occur

A

the arachidonic pathway changes: NSAIDs block COX so PGE2 not available to keep 5 lipoxygenase in check= more leukotrienes (bronchospasm, increase permeability, mucus)

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21
Q

3 major characteristics of asthma

A

chronic airway inflammation, variable degree of airflow obstruction and narrowing, bronchial hyperresponsiveness

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22
Q

FEV1/FVC ratio of ___ demonstrates obstruction

A

<70%

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23
Q

what will demonstrate airway reversibility after beta2 agonist inhalation

A

FEV1 increases by more than 12% and 200 mL

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24
Q

what does airway reversibility demonstrate

A

asthma

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25
what does a peak flow meter measure
peak expiratory flow rate (PEFR): the fastest speed a person can blow air out of lungs after taking as big of a breath as possible
26
what type of inhale for MDIs and soft mist inhalers
slow and deep
27
what type of inhale for DPI
deep and forceful
28
ICS place in therapy for asthma
primary maintenance therapy, best outcomes
29
corticosteroids mechanism
glucocorticoid receptor agonist in the lungs to provide anti-inflammatory, immunosuppressive, and antiproliferative effects to mitigate responses to various stimuli
30
ICS onset of action
variable, up to 2-4 weeks for max effect
31
ICS side effects
oral candidiasis, URTI, sinusitis, hoarseness, cough, pneumonia
32
which class may slow bone growth in children
ICS
33
systemic corticosteroids place in therapy
reserved for poorly controlled, in the setting of an acute exacerbation not relieved by rescue agents
34
OCS drug interactions
CYP3A
35
OCS side effects
HTN, fluid retention, hyperglycemia, GI upset, insomnia, infection, adrenal axis suppression, glaucoma, pulmonary TB
36
OCS cautions
immunosuppressed, HTN, DM
37
OCS counseling
take with food
38
name the ICS agents
fluticasone, budesonide, mometasone, beclomethasone
39
name the OCS agents
prednisone, dexamethasone, methylprednisolone
40
name the SABAs
albuterol, levoalbuterol
41
SABA place in therapy
drug of choice for acute asthma exacerbations, most effective for relieving acute bronchospasm
42
SABA mechanism
selective B2 adrenergic agonist: binds to B2 receptors in the lungs, resulting in bronchial smooth muscle relaxation, increase cAMP
43
SABA onset
1-2 minutes neb, 2-5 minutes MDI/DPI
44
SABA duration
3-4 hours neb, <6 hours MDI
45
SABA side effects
tremor, tachycardia (less with levo), chest pain, hypokalemia, hypomagnesemia, hyperglycemia
46
SABA risk?
regular use= poor asthma control. RISK WITH SABA ONLY THERAPY
47
regular or overuse of SABA causes
beta receptor downregulation, lack of response, increased use
48
counseling: if giving albuterol with ICS in a separate inhaler
albuterol FIRST, then ICS
49
LABA agents
formoterol, olodaterol, salmeterol, vilanterol
50
LABA place in therapy
chronic therapy for asthma IN COMBINATION with ICS. monotherapy for mild COPD, combo with LAMA for persistent COPD
51
LABA onset
1-2 minutes formoterol olodaterol. >10 minutes salmaterol vilanterol
52
LABA duration
>12-24 hours
53
black box warning LABA
never monotherapy for asthma!!!!!!!! LABA monotherapy is for COPD only.
54
important point for LABA
do not take two different LABAs. use same combination for reliever and maintenance.
55
SAMA agent
ipratropium
56
SAMA place in therapy
mainly COPD and acute asthma exacerbations (emergency)
57
SAMA mechanism
competitive inhibitor of cholinergic (muscarinic) receptors in the bronchial smooth muscle leading to bronchodilation
58
SAMA onset
15-30 minutes
59
SAMA duration
4-8 hours
60
SAMA side effects
headache, flushing, blurred vision, tachycardia, palpitations
61
LAMA agents
aclidinium, glycopyrrolate, tiotropium, umeclidinium
62
LAMA place in therapy
mainly for COPD. tiotropium for sever asthma >12 after ICS/LABA`
63
tiotropium duration
>24 hours
64
LAMA side effects
headache, blurred vision, flushed skin, tachycardia, palpitations, acute urinary retention, cough
65
general cons of biologics
increased infection risk, high cost, need to avoid live vaccines
66
biologics place in therapy
not first line or monotherapy. decrease exacerbations. add on to standard therapy for severe asthma step 4-5 in patients with T2 phenotype. may decrease OCS dose
67
LTRA agents
montelukast, zafirlukast
68
5-lipoxygenase inhibitor
zileuton
69
LTRA mechanism
interfere with pathway that allows mast cells and eosinophils to release leukotriene mediators. reduce symptoms associated with allergic component of asthma: swelling and smooth muscle contraction
70
LTRA onset
3-4 hours
71
LTRA duration
up to 24 hours
72
LTRA side effects
URI, fever, headache, pharyngitis, cough.
73
FDA boxed warning for montelukast
neuropsychiatric effects
74
risk with zafirlukast
hepatotoxicity
75
methylxanthine agents
theophylline, theophylline ER
76
theophylline place in therapy
adjunct
77
theophylline mechanism
inducing smooth muscle relaxation to result in bronchodilation
78
theophylline side effects
caffeine-like effects at therapeutic levels: n/v, headache, insomnia. toxic level effects: persistent vomiting, arrhythmias, seizures
79
theophylline monitoring
narrow therapeutic window requiring blood monitoring. normal level <20 mcg/mL
80
chromone agent
cromolyn sodium
81
cromolyn place in therapy
adjunct; EIB or add on for allergic asthma
82
cromolyn mechanism
mast cell stabilizer: inhibits release of histamines and leukotrienes from mast cells during allergic response
83
anti-IgE mAb
omalizumab
84
omalizumab mech
inhibits binding of IgE to mast cells and basophils: thus decreases mediators of allergic response
85
omalizumab side effects
anaphylaxis, urticaria, thrombocytopenia, malignancy, CV
86
omalizumab monitoring
weight, IgE levels, platelets
87
IL-5 antagonists
mepolizumab, relizumab, benralizumab
88
IL-5 antagonist mechanism
inhibit IL-5 signaling, reducing the production and survival of eosinophils
89
IL-5 antagonist side effects
hypersensitivity, headache, fatigue, herpes zoster (mepolizumab), malignancy
90
IgG4 antibody
dupilumab
91
IgG4 antibody mechanism
inhibits IL-4 and IL-13 signaling/ inflammatory response by binding to IL-4Ra subunit
92
IgG4 antibody side effects
favorable tolerability: injection site reaction, oropharyngeal pain, eosinophilia
93
thymic stromal lymphopoietin blocker
tezepelumab
94
tezepelumab side effects
pharyngitis, arthralgia, back pain
95
what are some medication-related asthma risks
high SABA use >1 canister per month, not prescribed ICS, poor adherence, incorrect inhaler technique
96
what are some comorbidities than increase risk of asthma symptom
obesity, chronic rhinosinusitis, GERD, food allergy, pregnancy and hormonal changes
97
asthma control test score?
>19/25 is well controlled. 19 or less is not controlled.
98
mild asthma by GINA definition
symptoms <4-5 days per week
99
moderate asthma by GINA definition
symptoms most days or waking with asthma >1 time per week
100
severe asthma by GINA definition
daily symptoms or waking with asthma >1 time per week AND low lung function
101
what are options for reliever treatment asthma
SABA, low dose ICS-formoterol. (alt: SAMA for acute exacerbation)
102
what are options for controller or maintenance asthma treatment
ICS, LABA, LAMA, LTRA, biologics
103
treatment for mild or moderate acute asthma exacerbation
albuterol 4-10 puffs q20min for 1 hour, continue hourly x1-3. Likely take oral corticosteroids at home.
104
treatment for severe acute asthma exacerbation
albuterol + ipratropium MDI or neb q20min or continuously for 1 hour, then q1-4h prn. + oral corticosteroids. adjunct (magnesium, ketamine, heliox) helpful.
105
treatment for life threatening acute asthma exacerbation
IV corticosteroids
106
treatment for green zone
take long term control agent only. uses reliever before exercise, avoid triggers.
107
treatment for yellow zone
increase usual reliever, contact clinician, OCS burst
108
role of TH2 in pathophysiology of asthma
releases IL-4 and IL-5
109
role of IL-4 in pathophysiology of asthma
differentiation of CD4 to plasma cells: producing IgE antibodies
110
role of IL-5 in pathophysiology of asthma
proliferation, activation, and survival of eosinophils
111
role of IgE in pathophysiology of asthma
bind to and activate mast cells
112
role of leukotrienes in pathophysiology of asthma
bronchoconstriction
113
role of TSLP in pathophysiology of asthma
inflammatory mediator in response to allergens
114
role of dendritic cells in pathophysiology of asthma
stimulate TH2
115
role of mast cells in pathophysiology of asthma
release histamine and leukotrienes
116
mediators of early phase allergen reaction?
histamine, prostaglandins, leukotrienes
117
mediators of late phase allergen reaction?
eosinophils, neutrophils, macrophages, T lymphocytes, prostaglandins, leukotrienes, thromboxones, PAF
118
what does airway remodeling include
fibrosis, epithelial cell injury, mucus hypersecretion, smooth muscle hypertrophy, angiogenesis
119
bronchoprovocation testing
patient is given methacholine, positive test is fall in FEV1 by 20%
120
exercise challenge test
positive if FEV1 falls 10% for adults or 12% for children
121
baseline eosinophil count of ____ is a predictor for T2 asthma
>150
122
which DPIs could be mistaken for a MDI
respiclick, redihaler, digihaler
123
how to load the dose for ellipta
sliding cover down
124
how to load the dose for diskus and inhub
sliding lever
125
how to load the dose for respiclick, digihaler, redihaler
opening the cap
126
how to load the dose for twisthaler
twist counterclockwise
127
how to load the dose for flexhaler
twist as far as it goes in any direction, then back in the other direction until it clicks
128
how to load the dose for pressair
press the button, control window will turn green. it will then turn red if you inhaled correctly
129
how to load the dose for handihaler
SINGLE USE: you have to put a capsule in and puncture it. don't swallow the capsule idiot

Pulmonology (2 decks)

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