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WI-18 Pulmonary > Asthma > Flashcards

Asthma Flashcards

1
Q

atopy

A

genetic tendency to develop an IgE response to common environmental proteins

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2
Q

atopy results in

A

wheezing
eczema
season rhinitis

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3
Q

triggers of asthma

A 
URI 
Allergens 
cold 
exercise
latex
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4
Q

mc chronic dz in childhood

A

asthma

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5
Q

asthma and gender

A

mc in boys in childhood, equals out in adolescence

boys “out grow”

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6
Q

characterization of asthma

A
  1. Airway obstruction (mucous)
  2. airway hyperactivity (bronchial spasm)
  3. chronic airway inflammation (edema)
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7
Q

fundamental issue in asthma

A

immunological inflammatory response

prolonged local airway inflammation and hyper-responsiveness

hypersensitivity to triggers = over production of IgE and blockage of Beta-2 receptors

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8
Q

normal reaction to allergens in pulmonary system

A

non specific still causes activation of local inflammatory cells

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9
Q

pathophysiology of asthma

A

immune system activation causes release of leukotrienes, histamine and prostaglandins

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10
Q

immune system activation of asthma causes:

A

smooth muscle contraction

mucous hyper secretion

vasodilation with endothelial leak and local edema

impairment of mucociliary elevator

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11
Q

smooth muscle contraction

A

narrows the airway lumen and limits expiratory flow

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12
Q

mucous hyper secretion

A

clogging smaller airways and narrowing airway lumen of larger bronchioles

causes cough

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13
Q

vasodilation with endothelial leak and local edema

A

decreased ability to exchange oxygen

loss of lung compliance

narrowing airway of lumen

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14
Q

impairment of mucociliary elevator

A

decreased ability to remove allergens and particulates from the lung

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15
Q

anatomic results of pathophysiologic process

A
  1. mucosal thickening and infiltration of airway wall with inflammatory cells
  2. hypertrophied and contracted airway smooth muscle
  3. damaged bronchiole cells, exposing nerves to stimulation
  4. increased number of mucus glands, hyper secretion and plugging of airways
  5. airway remodeling and fibrosis
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16
Q

hygiene hypothesis

A

extreme hygiene results in a weakened immune system unable to self regulate

HYPERSENSITIVITY

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17
Q

triggers of asthma

A 
atopy 
exercise
URI 
GERD
weather 
tobacco
pollution
ASA/NSAIDS
hormones, emotions
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18
Q

exercise induced asthma

A

bronchospasm following exercise in patients with underlying asthma

tx: SABA prophylactic
dx: exercise challenge test or document in pts with asthma

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19
Q

GERD asthma

A

cough secondary to GERD

susceptible to lifestyle modifications, acid reducing medications (PPI)

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20
Q

clinical features of asthma

A 
wheezing 
cough 
SOB 
chest tightness 
accessory muscle use 
short sentences 
anxiety
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21
Q

wheezing

A

loudest in chest

does NOT clear with cough

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22
Q

coughing asthma

A

common presenting symptom

nocturnal, seasonal recurrence lasts >3 weeks, likely due to asthma

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23
Q

increased likelihood of asthma

A
  1. episodic symptoms
  2. personal history of atopy
  3. history of asthmatic symptoms
  4. triggers: exercise, allergen exposure, ASA, viral URI
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24
Q

decreased likelihood of asthma

A

lack of improvement following anti-asthma medications

onset of symptoms after age 50

history of prolonged cig smoking

concomitant symptoms

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25
exam findings that support asthma diagnosis
play-bluish, swollen nasal mucosa lichenifield plaques nasal plus
26
diagnosis of asthma is based upon
clinical picture + pulmonary function testing spirometry is diagnostic test of choice
27
parameters of spirometry
FVC FEV1 FEV1/FVC ratio
28
peak flows
less accurate, can be done at home need to be confirmed in office allows us to measure progress
29
diagnostics used in asthma
``` pulse ox PEF ABG allergy test exercise challenge test ```
30
classic CXR findings in asthma
mc - normal hyperinflation, flat diapraghm
31
medications to use with caution
non-selective COX inhibitors non-selective BB ACE I
32
who gets spacers?
children and elderly
33
benefit of nebulizer
facemaske or mouthpiece long delivery without depending on patient use delivers medicine deep into the lungs
34
bronchodilators list (6)
``` SABA LABA Anticholinergic mg Combined alpha and beta Methylxanthines ```
35
immunomodulators list (4)
ICS leukotriene modifiers mast cell stabilizers systemic steroids
36
SABAs
beta 2 agonists rescue medicines
37
ADRs of SBA
``` hypokalemia palpitations tachycardia HTN angina ```
38
LABAs
controller medications that prevent bronchospasm by relaxing bronchial smooth muscle LONG lasting bronchodilator (>12 hrs)
39
SABAs drug
albuterol (proventil, ventolin, ProAir) Pirbuterol (maxair) Levalbuterol (Xopenex)
40
LABAs drug
Salmeterol (servant) formoterol (foradil)
41
LABA FDA
ALWAYS used with ICS NEVER as a mono therapy
42
ICS
controller medications that use local anti-inflammatory affect high inflammatory activity with LOW systemic response not for emergency use takes 1-2 weeks
43
adjusting ICS in asthma
when initiating therapy start low, go slow
44
ICS adr
local affects oropharyngeal candidiasis dysphonia low risk systemic adverse affects
45
leukotriene receptor antagonist
inhibits 5-lipoxygenase (zileuton) or competitive inhibition of leukotriene (montelukast, zafirlukast)
46
advantages of leukotriene receptor antagonist
improve FEV1 decrease asthma symptoms oral therapy
47
list of leukotriene receptor antagonist
Zilueton (Zyflo) Montelukast (Singular) Zarfirlukast
48
disadvantages of leukotriene receptor antagonist
not as effective of ICS linked to risk of suicidal thoughts and depression
49
Cromolyn
mast cell stabilizer only effective by inhalation minimal adverse effects but not as effective as ICS
50
Omalizumab (Xolair)
monoclonal Ab targeting Fc of IgE >12 yrs old SubQ infection, dosed 2-4 weeks, dose based on IgE Expensive!!
51
systemic corticosteroids
acute exacerbation or severe uncontrolled asthma Burst of anti-inflammatory activity (5-10 day) IV or PO can have ADR
52
consider systemic steroid if: (5)
1. decreasing lung fxn over days 2. lack of sustained relief from rescue medication 3. repeated drops in PEF over 1 or more days to below 60% 4. freq. night time symptoms 5. req. for emergency nebulizer or parenteral bronchodilator tx
53
anticholinergics
long history of use but NOT FDA approved reverse cholinergic mediated bronchoconstriction
54
ipratropium
anticholinergic atrovent or nebulizer solution used adjunct to SABA
55
how to triggers produce bronchospasm
vagal reflex mechanisms parasympathetic-ally innervated
56
metylxanthines
theophylline PDE5 inhibitor produced by bronchodilator
57
disadvantage of methylxanthines
little effect small therapeutic index many drug interactions
58
ADR of metylxanthines
HA, N/V, rumor, insomnia arrhythmia, seizures, hypoK
59
antihistamines
adjunct OTC medications for allergy mediated asthma no FDA asthma approval
60
asthma and pregnancy complication
low birth weight increased likelihood of prematurity neonate death try to avoid hypoxia in both mother and deaths
61
DOC of pregnancy
ICS albuterol, veclomethasone, budesonide, prednisone, theophylline are safe
62
perioperative pts and asthma complications
acute bronchospasm from intubation impaired cough hypoxemia atelecasis respiratory infection
63
perioperative pts and asthma management
pre-op: evaluate symptoms, med use, PFTs oral steroid to optimize before sx

WI-18 Pulmonary (11 decks)

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