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PHAR 253 > Asthma > Flashcards

Asthma Flashcards

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1
Q

how is asthma characterized?

A

paroxysmal or persistent symptoms
dypsnea, chest tightness, wheezing, sputum production & cough
airway hyper-responsiveness to a variety of stimuli

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2
Q

does asthma alter lifespan?

A

no

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3
Q

in children is there more males or females with asthma?

A

males

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4
Q

environmental factors contributing to asthma

A

tobacco smoke
allergen exposure
infections in infancy
environment
occupational sensitizers
exercise
drugs/preservatives
diet

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5
Q

atopic vs non-atopic asthma

A

atopic - extrinsic - allergy to antigens
non-atopic - intrinsic - secondary to chronic/recurrent infections

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6
Q

effect of age on asthma

A

most diagnosed by age 5

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7
Q

predictors of persistent adult asthma include:

A

atopy
onset during school age
presence of BHR

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8
Q

pathophysiology of asthma

A

bronchial hyper-reactivity of airways to physical, chemical & pharmacologic stimuli is the hallmark of asthma

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9
Q

bronchospasm

A

constriction of the muscles in the walls of the bronchioles

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10
Q

hyper-reactivity

A

an exaggerated response of bronchial smooth muscles to trigger stimuli

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11
Q

airway remodeling

A

refers to structural changes leading to airway obstruction, may eventually become only partially reversible

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12
Q

what causes airway inflammation?

A

CD4+, T lymphocytes, eosinophils, mast cells

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13
Q

types of asthma

A

early asthmatic response - minutes
late asthmatic response - hours
chronic asthma - days

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14
Q

asthma phenotype 1

A

obesity-related
very late onset
smoking related
comorbidities

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15
Q

asthma type 2

A

early onset allergic asthma
later onset eosinophilic asthma
aspirin exacerbated respiratory disease
exercise induced asthma

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16
Q

elements of asthma diagnosis

A

medical history
physical exam
pulmonary function test
other lab tests

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17
Q

symptoms of asthma

A

intermittent episodes of expiratory wheezing, coughing and dypsnea
chest tightness and chronic cough in some

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18
Q

triggers of asthma

A

exercise-induced bronchospasm
time of day
aero-allergens
irritants
respiratory tract infections
weather
psychological factors
hormonal fluctuations
GERD
medications
preservatives

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19
Q

why id a physical exam a poor indicator of asthma?

A

because asthma is a disease of exacerbation and remission, so the patient may not have any signs or symptoms at the time of the exam

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20
Q

what may be observed during a physical exam?

A

expiratory wheezing on ausculation
dry hacking cough
signs of atopy (allergic rhinitis and/or eczema)

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21
Q

why is a pulmonary function test necessary for asthma diagnosis?

A

to establish diagnosis, assess severity and treatment response

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22
Q

adult criteria of pulmonary function in asthma

A

FEV1/FVC < 75-80% predicted
12% improvement in FEV1 & at least 200ml from baseline 15 minutes post quick acting 2-agonist challenge or after a course of controller therapy

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23
Q

preferred criteria for a diagnosis of asthma

A

spirometry showing reversible airway obstruction

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24
Q

lab tests for asthma diagnosis

A

CBC, eosinophil count, IgE concentration, FeNO
allergy skin tests
sputum eosinophils

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25
what is the Canadian thoracic society? (CTS)
Canada professional organization which promotes lung health and provides best respiratory practices
26
what is global initiative for asthma? (GINA)
developed in collaboration with experts from many countries NOT a guidline, but a practical approach to managing asthma in clinical practice - updated yearly
27
what is the CTS definition of asthma control for each: daytime symptoms night symptoms physical activity exacerbations absence from work or school need for a reliever FEV1 or PEF PEF diurnal variation sputum eosinophils
daytime symptoms /= 90% of personal best PEF diurnal variation < 10-15% sputum eosinophils < 2-3%
28
asthma is well controlled when a patient can:
avoid symptoms during the day and night need little or no reliever mediaction have productive, physically active lives have normal or near-normal lung function avoid serious asthma flare-ups
29
goals of therapy for asthma
prevent asthma-related mortality maintain normal activity levels prevent daytime and nocturnal symptoms maintain normal spirometry prevent exacerbations provide optimal pharmacotherapy and avoid side effects
30
principles of asthma treatment
environmental control pharmacologic treatment appropriate use of inhalation therapy regular consultation with certified asthma educator graduated approach to therapy regular follow-up
31
types of asthma triggers
endogenous stimuli - stimuli generated inside the body exogenous stimuli - stimulie generated outside the body
32
what is the reliever?
short-acting beta-adrenergic agonists (SABA)
33
what is the controller?
long-acting beta-2 agonists (LABA)
34
MOA of SABAs
selective beta 2 adrenergic agonists - smooth muscle relaxation onset within 5 minutes peak effect on FEV within 30 minutes
35
indication of SABAs
prevention of exercise-induced or cold air induced bronchospasm treatment of intermittent episodes of bronchospasm
36
what does the structure of a SABA determine?
the selectivity, potency, duration of action and oral activity
37
what are the SABAs?
salbutamol terbutaline metaproterenol isoproterenol epinephrine
38
which two SABAs are preferred due to their selectivity for B2?
salbutamol and terbutaline
39
adverse effects of SABAs
tachycardia, palpitations skeletal muscle tremor nervousness, irritability, insomnia, headache BP changes cardiac arrhythmias increased BG hypokalemia at high doses tachyphylaxis
40
what drug interactions do SABAs have?
beta-blockers: oppose effect loop or thiazide diretics: increase risk of hypokalemia tricyclic antidepressants: may increase ADRs of SABA
41
how are SABAs usually dosed?
1-2 puffs every 4-6 hours as needed
42
how do LABAs work?
work slowly over a 12-hour period to keep airways open and muscles relaxed
43
what are the LABAs?
salmeterol - partial agonist formoterol - full agonist vilanterol - full agonist indacaterol - full agonist
44
which LABA is approved for rescue therapy?
formoterol
45
which LABAs are available in combo products only?
vilanterol indacaterol
46
what are the DOAs of the LABAs?
>12 hours: salmeterol, formoterol 24 hours: vilanterol, indacaterol
47
what are the most effective anti-inflammatory drugs available for asthma?
corticosteroids
48
what is the most common type of controller medication?
inhaled corticosteroids
49
how do ICSs work?
improve lung function decrease frequency /severity of attacks increase QOL decrease asthma mortality
50
MOA of ICSs
inhibit inflammatory response at all levels inhibits the late asthmatic response & decreases bronchial hyper-responsiveness in asthma
51
what are the ICS drugs?
fluticasone propionate fluticasone furoate budesonide ciclesonide beclomethasone mometasone
52
when are ICSs preferred?
in pregnancy
53
which ICSs are approved for use in all ages?
fluticasone propionate
54
which ICSs are approved for use in 6-11 years of age?
beclomethasone dipropionate (low) budesonide (low) ciclesonide (low) fluticasone propionate (low and meddium) mometasone furoate (low)
55
which ICS is only approved for adults 12 and older?
fluticasone furoate
56
side effects of ICSs
dysphonia, hoarseness, throat irritation, cough candida oral infections (thrush) growth retardation in kids adrenal axis suppression if high doses
57
education points for ICSs
regular, daily use; delayed onset rinse mouth & spit address steroid phobia wash face after use if using spacer with mask efficacy reduced in patients who smoke
58
what drug do ICSs interact with?
desmopressin: highly increased risk of hyponatremia
59
when would oral/IV CSs be used?
for short periods of time in ACUTE, SEVERE asthma
60
short term effects of oral/IV CS
insomnia increased activity mood changes water retention hyperactivity in children
61
long term effects of oral/IV CS
increased appetite weight gain stomach irritation cataracts osteoporosis HPA axis supression
62
MOA of leukotriene receptor antagonists (LTRA)
antagonizes the effects of leukotrienes, which are formed by the breakdown of arachidonic acid in mast cells, eosinophils and other inflammatory cells - reduces airway inflammation, small variable bronchodilator
63
side effects of LTRAs
headache dizziness heartburn nausea drowsiness
64
what drug is a LTRA
montelukast
65
when are LTRA given?
at night because their peak activity can occur at night
66
what are the advantages to combo products?
more convenient enhanced adherence ensures the patient receives their dose of inhaled corticosteroid avoids SABA dependence
67
can you use a LABA alone?
no must be used with a corticosteroid
68
what combo product is for maintenance or relief?
symbicort - formoterol + budesonide
69
MOA of methylxanthines (theophylline)
non-specific inhibition of phosphodiesterase, which causes mild bronchodilation increases diaphragmatic contractility and enhances mucociliary clearance
70
when is theophylline used?
as an 'add on' in patients that require high dose corticosteroid used only in severe asthma cases no role is rescue therapy
71
side effects of theophylline
diarrhea nausea heartburn anorexia headaches nervousness tachycardia upset stomach
72
what is omalizumab?
a biologic that is an anti-immunoglobulin E antibody it inhibits inflammatory response
73
when is omalizumab used?
when atopic asthma is poorly controlled despite high-dose inhaled steroids and appropriate add-on therapy, with or without oral prednisone
74
what are the new IL-5 inhibitors?
mepolizumab (>6) reslizumab (>18) benralizumab (>18)
75
what is the IL 4 and 13 inhibitor?
dupilumab (>12)
76
what are two other therapies for severe asthma?
tiotropium (>12) macrolides - azithromycin (>18)
77
a higher risk for an exacerbation is defined by any of the following:
history of a previous severe asthma exacerbation poorly-controlled asthma as per CTS criteria overuse of SABA current smoker
78
in what order are the drugs used to treat asthma?
start with SABA and ICS increase ICS add LABA add LTRA
79
very mild asthma is well controlled on:
PRN saba only
80
mild asthma is well controlled on:
low dose ICS (or LTRA) + prn SABA OR PRN bud/form (symbicort)
81
moderate asthma is well controlled on:
low dose ICS + second controller + prn SABA OR moderate doses of ICS +/- second controller and PRN SABA OR low-moderate dose bud/form + prn bud/form
82
severe asthma is well controlled on:
high doses of ICS + second controller for the previous year or systemic steroids for 50% of the previous year to prevent it from becoming uncontrolled, or is uncontrolled despite therapy
83
what is the difference between uncontrolled asthma and severe asthma?
anyone can have uncontrolled asthma and it is when a previously asymptomatic patient intermittently develops symptoms and can be addressed with self-management education and an action plan. severe asthma remains poorly controlled despite best practices.
84
how often should asthma be reviewed?
1-3 months after starting treatment and then every 3-12 months
85
when can you consider stepping down treatment?
in stable patients >3 months of control goal is to find the lowest effective dose
86
what should be included in an asthma action plan?
how to monitor and measure their symptoms daily preventative management strategies when and how to adjust medications when to seek urgent care
87
when is a peak expiratory flow meter used?
for moderate-severe asthmatics or asthmatics who are poor perceivers of airway obstruction
88
when following an action plan when should someone seek emergency medical care?
when their expiratory flow is <60% of best
89
risk factors of exacerbations
poor adherence suboptimal ICS use high SABA use obesity GERD pregnancy Low FEV
90
what is the first line treatment for ASA/NSAID induced asthma
leukotriene antagonists
91
if a b-blocker must be used which one should you choose?
a cardio-selective

PHAR 253 (8 decks)

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