Asthma Exacerbations (exam 2)

Question 1

asthma exacerbation

Answer 1

episode of progressive increase in asthma symptoms

Question 2

asthma exacerbation occurs as a result of

Answer 2

exposure to external agents
poor adherence to controller medication

Question 3

preferred term to tell patients for asthma exacerbation

Answer 3

flare up

Question 4

all patients should have a

Answer 4

written asthma action plan

Question 5

how does an asthma action plan help a patient with self management?

Answer 5

how to identify worsening asthma
changes to reliever and controller if symptoms worsen
when to use OCS
when to seek medical care

Question 6

green zone of asthma action plan

Answer 6

no limitation of activities
no nighttime awakenings
reliever use less than 3 times/week
no cough, wheezing, SOB, tightness of chest
PEF greater than 80%

Question 7

yellow zone of asthma action plan

Answer 7

some limitation, but still can do some activities
nighttime awakenings
increased symptoms and reliever use
PEF 50-79%

Question 8

red zone of asthma action plan

Answer 8

cannot do usual activities
very SOB
reliever needed more than 3-4 hours
no improvement/worsening after less than 24 hours in yellow zone
PEF less than 50%

Question 9

Reliever changes for exacerbations

Answer 9

increase frequency of low dose budesonide/formoterol, SABA or ICS-SABA

Question 10

MART controller changes for exacerbations

Answer 10

continue usual maintenance dose
increase reliever

Question 11

maintenance ICS with SABA as reliever controller changes for exacerbations

Answer 11

quadruple ICS dose

Question 12

maintenance ICS-formoterol with SABA as reliever controller changes for exacerbations

Answer 12

quadruple maintenance ICS-formoterol

Question 13

maintenance ICS plus other LABA with SABA as reliever controller changes for exacerbations

Answer 13

step up to higher dose formulation of ICS plus LABA

consider adding separate ICS inhaler to quadruple ICS dose

Question 14

when to give oral corticosteroid therapy for exacerbations

Answer 14

patient doesn’t respond to increase reliever and controller medication after 2-3 days
deteriorates rapidly
PEF/FEV1 less than 60%
history of sudden severe exacerbations

Question 15

course of therapy for OCS in adults?

children?

Answer 15

adults 5-7 days

3-5 days

Question 16

mild-moderate exacerbation

Answer 16

not agitated
talks in phrases
prefers sitting to lying
accessory muscles not used
RR less than 30 breaths/min
plus rate 100-120 bpm
O2 90-95%
PEF over 50%

Question 17

severe exacerbation

Answer 17

agitated
talks in words
hunched
RR over 30 breaths/min
accessory muscles used
pulse rate over 120 bpm
O2 under 90%
PEF less than 50%

Question 18

treatment for mild-moderate exacerbation in primary care setting

Answer 18

SABA
OCS
oxygen

Question 19

treatment for severe exacerbation in primary care setting

Answer 19

transfer to acute care facility
start with SABA, SAMA, oxygen and systemic steroid

Question 20

initial assessment in the ED for asthma exacerbations

Answer 20

ABCs
a - airway
b- breathing
c - circulation

Question 21

when would someone go to the ICU for an asthma exacerbation?

Answer 21

drowsiness
confusion
silent chest

Question 22

treatment for mild-moderate asthma exacerbation in the ED

Answer 22

SABAs
consider ipatropium bromide
oral corticosteroids
oxygen

Question 23

treatment for severe asthma exacerbation in the ED

Answer 23

SABAs
ipatropium bromide
oxygen
oral or IV corticosteroids
consider IV magnesium, high dose ICS

Question 24

discharge planning for asthma exacerbation

Answer 24

reliever PRN
continue course of oral corticosteroid
continue on ICS at inc step
follow up appointment with primary care 2-7 days after discharge

Question 25

what is the preferred regimen post discharge from ED?

Answer 25

budesonide-formoterol MART

Question 26

systemic corticosteroids

Answer 26

most effective anti-inflammatory improvement observed in 4 hours

Question 27

oral corticosteroids MOA in treatment of asthma exacerbations

Answer 27

reduces mucus production reduces airway edema reduces bronchial hyperresponsiveness increases number of B2 receptors and improves responsiveness

Question 28

is IV or oral corticosteroids better for asthma exacerbations?

Answer 28

both are equal! IV given to those who cannot take by mouth

Question 29

dose and effect of systemic corticosteroids

Answer 29

minimize dose and duration to minimize adverse effects 5-7 days of OCS

Question 30

if corticosteroid therapy is long, there is risk for

Answer 30

the body producing less cortisol

Question 31

when should corticosteroids be tapered

Answer 31

for therapy over 2 weeks and long term of high doses

Question 32

why do we taper corticosteroids?

Answer 32

prevents cortisol deficiency prevents sudden worsening of symptoms

Question 33

do we have to taper steroids for asthma exacerbations?

Answer 33

no! regimen is only 5-7 days

Question 34

when should magnesium sulfate be used for asthma exacerbations?

Answer 34

severe exacerbations not responding to initial treatment

Question 35

adverse effects of magnesium sulfate

Answer 35

hypotension facial flushing sweating depressed deep tendon reflexes hypothermia cardiac, CNS and respiratory depression

Question 36

MOA of magnesium sulfate

Answer 36

blocks calcium ion influx into smooth muscle which results in bronchodilation and anti inflammatory effects