Asthma Flashcards
1
Q
Asthma vs COPD:
Which one is REVERSIBLE?
A
ASTHMA
2
Q
What is Asthma?
A
A chronic lung disease characterized by inflammation of the bronchiole tubes and variable episodes of AIRFLOW OBSTRUCTION.
3
Q
What 5 factors can cause an Asthma attack?
A
- Positive family history (genetics)
- High pollen counts, mold, pet dander
- Climate changes
- Air pollution
- Occupational factors (Chemicals, foods, compounds)
4
Q
Is airflow obstruction in asthma usually reversible?
A
Yes, it is usually reversible with treatment or spontaneously.
5
Q
What are the 3 HALLMARK signs of an asthma attack?
A
- Cough
- Dyspnea: hard getting air OUT- not in
- Wheezing: turbulent airflow in narrowed tubes
6
Q
What are 5 LATE SIGNS of Asthma
A
- Chest tightness
- Diaphoresis: excessive sweating
- Tachycardia: HR >100
- Widened PULSE pressure: Syst - Dyast = __
- Hypoxemia: very severe stages
7
Q
Q: What 2 things must we determine FIRST in order to DIAGNOSE asthma?
A
Determine an airflow obstruction is present and if it is at least partially reversible
- What “at least partially reversible” means: the obstruction in the airways can improve significantly after administering a bronchodilator, but it might not return to completely normal function. This characteristic helps differentiate asthma from other respiratory conditions.
8
Q
4 common accompanying conditions in Asthma
(Occur with asthma)
A
- Viral infections
- GERD
- Eczema- KNOW
- rashes
9
Q
Sputum & Blood Test for Asthma
List the 2 main ones
A
- Elevated Eosinophils (WBC)
- Elevated IgE: causes inflammation
10
Q
Stages of ABG’s in Asthma:
Q: At FIRST, what do arterial blood gas (ABG) results typically show in asthma?
A
hypocapnia and respiratory alkalosis.
- hypocapnia: Low levels of PaCO2 (below 35 mmHg)
11
Q
ABG’s in Asthma:
What shows LATER in ABGs during an asthma attack?
A
Increased PaCO2 (partial pressure of carbon dioxide) & respiratory acidosis
- CO2 is acid to the body
12
Q
Q: What does a NORMAL PaCO2 level indicate during an asthma attack?
A
A: It may signal impending respiratory failure.
- It suggests that the patient may NOT be effectively ventilating and could be losing the ability to breathe adequately.
13
Q
Which assessment finding would be MOST CONCERNING in a patient having an asthma attack?
a. Inspiratory wheezing
b. Productive cough
c. Tachycardia
d. Expiratory wheezing
A
a. Inspiratory wheezing
(high-pitched, musical sound that occurs during INHALATION)
- It suggests a more severe degree of airway obstruction and may indicate impending respiratory failure or significant respiratory distress.
14
Q
ASTHMA:
What tests do you anticipate the HCP ordering?
List 5 tests
A
- Pulmonary function tests (spirometry)
- Methacholine challenge **
- Peak flow monitoring
- Chest x-ray: rules out other dx
- Allergy testing
15
Q
What is the Methacholine challenge?
A
- test is performed to evaluate how “reactive” or “responsive” your lungs are- INDUCES asthma attack
- inhale doses of methacholine, a drug that can cause narrowing of the airways.
- A breathing test will be repeated after each dose of methacholine to measure the degree of narrowing or constriction of the airways
16
Q
What does chest tightening indicate in asthma?
A
the bronchioles are constricting, making it harder for air to move through the lungs.
17
Q
2 ways to prevent Asthma attack?
A
- Eliminate asthma triggers if possible
- Take meds as prescribed!
18
Q
What are some serious complications of asthma?
List 3
A
- Status asthmaticus
- Respiratory failure
- Pneumonia
19
Q
Define:
severe, prolonged asthma attack that does not respond to standard treatments like bronchodilators.
A
Status asthmaticus
20
Q
Define:
During asthma attack, lungs can no longer provide adequate oxygen or remove enough carbon dioxide, resulting in life-threatening hypoxia or hypercapnia
A
Respiratory Failure
21
Q
Define:
A lung bacterial infection that can develop due to increased mucus production during asthma attack and impaired airway clearance.
A
pneumonia
22
Q
2 types of RELIEF medicatiins for asthma
(not cure it)
A
- Quick Relief Medications: Immediate RELIEF
- Long Acting Medications: MAINTAINS control of presistent asthma: used only if #1 doesnt work
KNOW RELIEF & MAINTAIN
23
Q
Asthma/COPD:
List the 3 CLASSES of INHALED meds
A
- Beta Adrenergic Agonists
- Anticholinergics (muscarinic antagonists)
- ICS – Inhaled Corticosteroids
24
Q
There are 2 TYPES of Beta Adrenergic Agonist
A
- SABA – Short Acting B2-Adrenergic Agonists
- LABA – Long Acting B2-Adrenergic Agonists
25
Both SABA's and LABA's end in
"ol"
26
*Asthma Inhaled Meds*:
Name the **2 Inhaled SABA** meds (short acting)
1. **Albuterol** (Ventolin, ProAir)
2. **Levalbuterol** (Xopenex)
27
*Asthma Inhaled Meds*:
List the **3 Inhaled LABA** meds (long acting)
1. **Salmeterol** (Serevent)
2. **Formoterol** (Foradil)
3. **Arformoterol** (Brovana)
28
*2nd Class of Inhalers for Asthma/COPD*:
There are 2 **TYPES** of **Anticholinergics** (muscarinic antagonists)
1. SA**M**A – Short Acting Muscarinic Antagonist
2. LA**M**A – Long Acting Muscarinic Antagonist
* *block the action of acetylcholine, which leads to broncho**dilation***.
29
SA**M**As and LA**M**As end in
"ium"
30
One medication that falls under **SAMA**
Ipratropium (Atrovent)
31
2 Meds that fall under **LAMA**
1. Tiotropium (Spiriva)
2. Umeclidinium (Incruse Ellipta)
32
*3rd Class of Inhalers for Asthma/COPD*:
2 **MEDS** that fall under **ICS**
(no types)
1. Fluticasone (Flovent, Arnuity Ellipta)
2. Budesonide (Pulmacort)
33
If **Inhaled** Meds DONT work we use **SECOND meds in line**
Name the **2 classes** NEXT in line:
1. Corticosteroids: *non-inhaled*
2. Monoclonal Antibodies
34
*Non-inhaled* Corticosteroids end in
"one"
35
List the 3 **Corticosteroid** meds used for Asthma/COPD
1. **Hydrocortisone** (Solu-Cortef)
2. **Methylprednisolone** (Solu-Medrol)
3. **Prednisone** (Medrol)
36
**Hydrocortisone** is **administered** via
IV
37
**Methylprednisolone** is **administered** via
* IV
* IM
38
**Prednisone** is **administered** via
Oral
39
Monoclonal Antibodies end in
"mab"
40
There are 2 **TYPES** of meds that fall under **Monoclonal Antibodies**
1. Anti-IgE
2. Anti-Interleukin 5
41
Which Monoclonal Antibodies **med TYPE** is used for **MODERATE- SEVERE** asthma
Anti- IgE
42
What is the **ONE** med that falls under **Anti-IgE**
Omalizumab (Xolair)
43
How is Omalizumab (Xolair) administered?
subQ
44
Which Monoclonal Antibodies **med TYPE** is used for **SEVERE** asthma
Anti-Interleukin 5
45
2 Meds that fall under the Anti-Interleukin 5 type
1. Mepolizumab (Nucala)
2. Reslizumab (Cinqair)
46
**Mepolizumab** (Nucala) is **administered** by
subQ
47
**Reslizumab** (Cinqair) is **administered** by
IV
48
3 Med **Classes** used in Asthma/COPD for **ANTI-INFLAMMATION**
1. **Leukotriene Modifiers**
2. **PDE-4 Inhibitor** (*Targeting PDE-4 decreases inflammation*)
3. **Methylxanthines**
49
**Leukotriene Modifiers** have what abbreviations in their name?
"lu" or "leu"
50
2 **TYPES** of meds that fall under **Leukotriene Modifiers**
1. Leukotriene Receptor (Blocker) Antagonists (LTRA)
2. Leukotriene Inhibitor
51
Leukotriene Receptor (Blocker) Antagonists (LTRA) meds end in
-lukast
52
**2 meds** that fall under **Leukotriene Receptor (Blocker) Antagonists (LTRA)**
* Zafirlukast
* Montelukast
53
Zafirlukast and Montelukast are administered by
oral
54
**ONE** med falls under **Leukotriene Inhibitor**.
Zileuton (Zyflo)
55
Zileuton (Zyflo) is administered via
oral
56
While **Leukotriene Modifiers are used for Asthma**, **PDE-4 inhibitors are mostly used** for
COPD
57
**PDE-4 Inhibitor** has **ONE** med only.
**Roflumilast** (Daliresp)
*(reduces inflammation)*
58
When is **Roflumilast (Daliresp)** prescribed in **COPD** management?
**ONLY** for **SEVERE COPD** to reduce the frequency of exacerbations
59
What drug **SHOULD NOT** be used with PDE-4 inhibitors?
Theophylline - *a methylxanthines med*
60
*Anti-inflammatory asthma/COPD*:
The NEWER, MORE EFFECTIVE drugs right now.
Methylxantines
61
Drugs for Methylxanthines end in
"ophylline"
62
*Anti-inflammatory asthma/COPD*:
2 drugs that fall under **Methylxanthines** class
1. Aminophylline
2. Theophylline
63
**Aminophylline** is administered via
IV
64
**Theophylline** is administerd via
oral
65
Why is **Theophylline** is considered a dangerous drug?
* Has a **narrow** therapeutic level
* Even small increases in dose can result in toxicity, leading to severe side effects.
66
*Methylxanthines Class:*
Therapeutic level for Theophylline
10-20 ng/mL
67
*Methylxanthines Class:*
4 Signs of **Theophylline Toxicity**
1. N/V
2. Seizures
3. insomnia
4. changes in mental status
68
*Daily Medication chart*:
What med is used for QUICK-RELIEF on ALL PATIENTS.
SABA
69
*Daily Medication chart*:
SABA is used as ___.
needed for symptoms
70
*Daily Medication chart*:
SABA: intensity of treatement depends on
SEVERITY of symptoms.
71
*Daily Medication chart*:
Administration of SABA treatments
up to 3 treatments at 20 minute intervals as needed.
72
*Daily Medication chart*:
What other medication may be given with SABA quick relief?
Corticosteroids may be needed.
73
Q: What frequency of SABA use (for symptom relief) suggests **INADEQUATE asthma control?**
Using a SABA **> 2 days a week** indicates the need for improved treatment management.
74
Step 1: Prefereed medication for Asthma management
SABA (as needed)
75
STEP 2: Preferred med & its Alternative
Preferred: **Low dose ICS**
Alternative: **LTRA or Theophylline**
76
4 main S/S of asthma
1. Tripod posture
2. Cough
3. Accessory muscle use
4. Increased respiratory rate
5. Hypoxemia: *low O2 levels*
77
2 **assessments** that are **VITAL** to perform for Asthma patients.
1. Listening to Breath Sounds Matters!
2. Counting Respirations matters (it is a VITAL sign)
**KNOW**
78
*Asthma:*
What does a "**silent chest**" indicate in a Asthma patient?
* Indicates that the patient may be in **status asthmaticus**- a medical emergency requiring immediate intervention.
* is **dangerous and an ominous sign** indicating **severe airway obstruction** and impending **respiratory failure.**
79
6 steps to **Manage & Teach** patients with Asthma.
* Managed by EARLY treatment and education
* Written asthma action plan
* Quick-acting beta adrenergic agonist medications (SABA)- **FIRST**
* Systemic corticosteroids if do not respond to SABA medications- **SECOND**
* Supplemental oxygen if hypoxic
* Peak flow monitoring
80
What is Status Asthmaticus
* Now its called "Severe life-threatening asthma attack"
* **Rapid onset, severe, persistent asthma attack** that **does NOT respond to usual treatment**
* High risk for respiratory failure
* Pt usually ends up on ventilator
81
S/S of Status Asthmaticus
Same as sever Asthma with:
* PROLONGED exhalation
* Distended Neck Veins
* Wheezing -as obstruction worsens, wheezing may disappear = impending resp. Failure!!! **
82
Assessments & Dx findingsfor **Status Asthmaticus**
1. Ability to talk
2. LOC
3. Positioning
4. **ABGs**: LOW PaCO2 in beginning due to increased breathing
83
**Most common diagnostic** findings for Status Asthmaticus
ABGs: **LOW PaCO2** (in beginning)
(*plus increased PH= respiratory ALKALOSIS*)
84
As Asthma gets **worse** ABGs change.
**HIGH** PoCO2 (can become normal levels)
and
**DECREASED** PH
* increased PaCO2 bc they can’t breath it out.
* Both of these reflecting **Respiratory ACIDOSIS = signals IMPENDING RESP. FAILURE**.
85
*Medical mgmt of Status Asthmaticus*:
After administering SABAs (inhaled), systemic corticosteroids, and supplemental oxygen for hypoxia in **status asthmaticus**, what additional medication may be given, and at what dosage **if did NOT respond to the initial tx.**
* **Magnesium sulfate**: *help relax bronchial smooth muscle and reduce airway resistance*
* **Single dose over 20 minutes**
-all of this can cause flushing, tingling, CNS depression, respiratory depression, hypotension
86
*Medical mgmt of Status Asthmaticus*:
Adverse effect of Magnesium sulfate
* flushing
* tingling
* CNS depression
* respiratory depression
* hypotension
87
Complications of **severe asthma** can be caused by
the **increased** pressures within the pulmonary system
