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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
what percent of childhood asthma is associated with prior viral exposure?
80-95%
26
what 4 pathogens were found in >50% of children ages 7-9 who later had asthma?
pneumonia RSV mycoplasma chlamydia
27
high risk occupations to develop asthma?
farming painting janitorial work plastic manufacturing
28
what does exercise induce?
bronchospasm
29
can exercise induced asthma be found in patients with normal spirometry?
YES | atopy or CF
30
why is exercised induced asthma a neglected diagnosis?
silent in 50% of patients except during exercise
31
when is weight gain associated with increased risk of asthma symptoms?
early infancy
32
what kind of predisposition does atopy increase risk of asthma?
genetic predisposition
33
types of atopic diseases
allergic rhinitis atopic dermatitis (eczema) urticaria + allergen skin tests
34
what family histories increase risk of asthma
``` asthma allergies sinusitis rhinitis eczema nasal polyps ```
35
3 important social history questions for asthma
smoking workplace school
36
how do nocturnal symptoms of asthma occur
bronchospasm between 4-6am
37
important Hx quetsions regarding exacerbations
``` 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 ```
38
goals of initial visit? (5)
1. diagnose asthma 2. assess asthma severity 3. initiate medications and demonstrate use 4. develop written asthma action plan 5. schedule follow-up appointment
39
what value indicates obstruction
low FEV1/FVC
40
what is the best indicator of severity?
FEV1
41
what is change of FEV1 from personal best (in terms of percentages and stable --> severe)
50% severe
42
what does CXR appear like with asthma?
normal
43
pH and CO2 of ABG?
pH down | CO2 up
44
are obstructions reversible?
partially
45
wheezing Ddx
``` upper airway obstruction (tumor or edema) endobronchial foreign body or CA acute LV failure recurrent PE chronic bronchitis ```
46
goals of asthma treatment
``` 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 ```
47
meds used for exacerbations or emergencies
rescue meds
48
meds used to prevent exacerbations
controller meds
49
what is important for determining which medication to use?
classification of asthma
50
6 criterion for asthma classification
``` symptoms nighttime awakenings short-acting beta2 agonist use interference with normal activity lung function exacerbations requiring oral systemic corticosteriods ```
51
four classifications of asthma
``` intermittent persistent mild moderate severe ```
52
MOA of SABAs
beta agonist | relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells
53
indications for SABAs
adults and kids acute asthma exacerbations exercise-induced asthma prophylaxis
54
what drug shouldn't you use with beta blockers?
SABAs
55
adverse effects of SABAs
``` tachycardia URI pharyngitis nausea **a fib **hypokalemia ```
56
generic SABA
albuterol
57
brand name SABA
ventolin | proventil
58
pregancy category of SABAs
C
59
clinical teaching for SABAs
``` adverse effects proper inhalation rinsing wash mouthpiece controller therapy if needed >2x/week ```
60
3 doses that inhaled corticosteroids (ICS) are available in
low- dose medium-dose high-dose
61
MOA of ICS
potent anti-inflammatory effect inhibits mast cells, eosinophils, etc inhibits production/secretion of cell mediators (cytokines, histamine, leukotrienes)
62
indications of ICS
adults and kids asthma allergic rhinitis atopic dermatitis
63
adverse effects of ICS
``` candiasis HA bronchitis cough epistaxis sinusitis URI **pneumonia **COPD **glaucoma ```
64
generics of ICS
fluticasone budesonide beclomethasone triamcinolone
65
brands of ICS
flonase/flovent pulmicort QVAR azmacort
66
brand of fluticasone
flonase/flovent
67
brand of budesonide
pulmicort
68
brand of beclomethasone
QVAR
69
brand of triamcinolone
azmacort
70
pregnancy category for ICS
C
71
clinical teachings for ICS
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
LABA MOA
beta2 agonist | relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells
73
indications for LABAs
adults and kids >4 asthma COPD exercise indiced asthma prophylaxis
74
LABA black box warning
increased risk for asthma related death, intubation, or hospitalization (greatest in ages 4-11) No risk if paired with inhaled steroid
75
adverse effect of LABAs
``` HA musculoskeletal pain **death **prolonged QT ** exacerbation of severe asthma ```
76
generics of LABAs
salmeterol | formoterol
77
brands of LABAs
serevent | foradil
78
brand of salmeterol
serevent
79
brand of formoterol
foradil
80
pregnancy category of LABAs
C
81
clinical teachings for LABAs
not for acute exacerbation warn of adverse effects show proper inhalation technique
82
MOA of LTRAs
``` leukotriene antagonist prevents airway edema smooth muscle contraction respiratory inflammation nasal mucosa rxn after allergen exposure ```
83
indications of LTRAs
adults and children > 12 months asthma treatment and prophylaxis exercise induced asthma prophylaxis allergic rhinitis
84
adverse effects of LTRAs
HA steven-johnson syndrome aggressive/altered behavior suicidal thoughts
85
what does LTRA stand for?
leukotriene receptor antagonist
86
generics of LTRAs
montelukast, zafirlukast
87
brand of LTRA
singulair
88
pregnancy category of LTRAs
B
89
clinical teaching for LTRA
not for acute exacerbation | behavior side effects (agitation, dream disorder, hallucination)
90
LABA + ICS MOA
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
indications for LABA + ICS
adults and kids >12 years asthma COPD
92
adverse effects
``` oral candidiasis GI upset HA nasopharyngitis URI **hypokalemia **glaucoma **cataracts **death ```
93
LABA + ICS generics
formoterol/budenoside salmetrol/fluticasone formoterol/mometasone
94
LABA + ICS brands
symbicort advair dulera
95
formoterol/budesonide brand
symbicort
96
salmeterol/fluticasone brand
advair
97
formoterol/mometasone brand
dulera
98
pregnancy category of LABA + ICS
C
99
clinical teaching for LABA + ICS
not for acute exacerbations reduced growth rate in kds watch for adrenal suppression rinse mouth after each use to prevent oral infection
100
oral corticosteroid MOA
mimics cortisol with salt-retaining properties | used for anti-inflammatory effects of many organ systems
101
oral corticosteroid indications
adults and kinds asthma: moderate --> severe exacerbation asthma: long-term therapy
102
adverse effects of oral corticosteroids
``` 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
generic oral corticosteroids
prednisone methylprednisone prednisolone
104
brand oral corticosteroids
deltasone medrol prelone
105
pregnancy category of oral corticosteroids
D
106
clincial teaching for oral corticosteroids
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
MOA of theophylline
bronchodilation through smooth muscle relaxation | suppression of airway stimuli
108
indications of theophylline
``` adults and kids asthma exacerbation asthma COPD Newborn apnea ```
109
adverse effects of theophylline
``` nausea and vomiting HA insomnia restlessness irritability **a-fib **Steven-johnson **seizures ```
110
brand for theophylline
theo-dur
111
pregnancy category of theophylline
C
112
clinical teachings of theophylline
not for acute exacerbations | theophylline toxicity
113
symptoms of theophylline toxicity
vomiting arrhythmia seizures
114
cromolyn MOA
anti-inflammatory prevents bronchoconstriction blocks histamine
115
indications for cromolyn
adults and children >2 asthma prophylaxis allergic rhinitis vernal (spring) conjunctivitis
116
adverse effects of cromolyn
``` bad taste cough throat irritation burning sensation in the eye **anaphylaxis **bronchospasm ```
117
brands for cromolyn
cromlon intal nasalcrom
118
pregnancy category for cromolyn
B
119
clinical teaching for cromolyn
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
MOA of monoclonal Ab
inhibits binding of IgE to receptors of mast cells and basophils
121
indications of monoclonal Ab
adults and kids >12 IgE mediated allergic asthma off label: allergic rhinitis, peanut allergy, idiopathic urticaria, latex allergy
122
black box warning for monoclonal Ab
anaphylaxis
123
adverse effects for monoclonal Ab
``` injection site rxn HA viral dz URI sinusitis pharyngitis **thrombocytopenia **anaphylaxis ```
124
generic monoclonal Ab
omalizumab
125
brand monoclonal Ab
Xolair
126
pregnancy category for monoclonal Ab
B
127
who should avoid NSAIDS
adults with severe persistent asthma or nasal polyps
128
what other medication should asthmatics avoid?
beta blockers
129
what vaccination is it important for asthmatics to get?
flu
130
what foods should asthmatics avoid?
dried fruit processed potatoes shrimp beer or wine associated with sulfites
131
when should exercised-induced asthmatics dose short acting beta2 agonists?
15-30 minutes prior to activity
132
when should exercised-induced asthmatics dose long acting beta2 agonists?
30-60 minutes
133
how long do short-acting beta2 agonists last?
2 hours
134
how long do long-acting beta2 agonists last?
12 hours
135
short acting beta2 agonist generics
albuterol pirbuterol levalbuterol
136
albuterol brand
ventolin
137
purbuterol brand
maxair
138
levalbuterol brand
xopenex
139
long acting beta2 agonist generics
salmeterol | formoterol
140
salmeterol brand
serevent
141
formoterol
foradil
142
mild episode of exacerbation
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
moderate episode of exacerbation
``` 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
severe episode of exacerbation
``` 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
exacerbation treatment
``` 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
short acting anti-cholinergic MOA
anti-cholinergic effects suppress tightening of bronchial smooth muscle anti-secretory properties
147
anti-cholinergic indications
adults and kids (inh >12, spray >5) asthma exacerbation allergic rhinitis COPD
148
adverse effects of short acting anti-cholinergics
``` bitter taste xerostomia bronchitis dry nasal mucosa sinusitis constipation **bowel obstruction **death **MI **CVA ```
149
anti-cholinergic generic
ipratropium
150
anticholinergic brand
atrovent
151
pregnancy category for anti-cholinergic
B
152
clinical teaching for anti-cholinergics
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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