Asthma (exam 2) Flashcards
(110 cards)
1
Q
causes of asthma
A
genetic disposition
environmental risk factors
2
Q
what accounts for the most risk of asthma?
A
genetics
3
Q
early phase reaction of asthma
A
triggered by activation of IgE
4
Q
late phase reaction of asthma
A
6-9 hours post allergen inhalation
release of pro inflammatory mediators
5
Q
characteristic symptom of asthma
A
wheezing - high pitched whistle sound
6
Q
auscultation
A
listening to sounds from organs with a stethoscope
7
Q
ronchi
A
expiratory wheezing heard on auscultation
8
Q
signs of asthma
A
ronchi
dry hacking cough
signs of atopy (allergic rhinitis/atopic demraitits)
eosinophils and IgE in the blood
9
Q
symptoms of asthma
A
SOB
chest tightness
coughing
wheezing
10
Q
spirometry
A
tests lung function
measures FEV1 and FVC
11
Q
FVC
A
forced vital capacity
max amount of air exhaled after max inspiration
12
Q
FEV1
A
forced expiratory volume after 1 second
amount of air exhaled during the first second after max inhalation
13
Q
FEV1/FVC
A
measures lung obstruction
75-80% depending on age group
14
Q
peak expiratory flow
A
measures how fast a patient exhales during a forceful breath
correlates with FEV1
15
Q
goal of peak expiratory flow
A
at least 80% of patients best
16
Q
green zone of PEFR
A
80-100% of personal best
17
Q
yellow zone of PEFR
A
50-80% of personal best
18
Q
red zone of PEFR
A
less than 50% of personal best
19
Q
variable symptoms of asthma
A
worse at night and awakening
worsened by triggers
20
Q
history features associated with asthma diagnosis
A
family history
allergic rhinitis
atopic dermatitis
21
Q
an exam may be
A
normal or bronchi may be heard
22
Q
spirometry testing for asthma
A
reduced FEV1/FVC
reversibility of airflow obstruction
23
Q
reversibility of airflow obstruction is measured by
A
12% improvement of FEV1 after bronchodilator
10% change in PEF when measured bid for 1-2 weeks
24
Q
inhalation drug therapy
A
delivers at site of action
more rapid effect
reduces side effects
some only effective this way
25
oral and parenteral drug therapy
used for treatment of asthma exacerbations
26
metered dose inhaler (MDI)
canister filled with drug
shaken before use
primed on first use
releases drug as forcible spray
27
soft mist inhaler (SMI)
mist that leaves inhaler slowly
inhaled via a slow deep breath
28
dry powder inhaler (DPI)
drug as a powder
activated when patient breathes in
29
Jet/ultrasonic nebulizers
produces aerosol for inhalation
30
spacer devices
used with MDIs
decreases need for good hand-lung coordination
31
how long should you wait to do the second dose (if 2 puffs needed) in an MDI inhaler?
1 minute after first puff so second can penetrate the lungs better
32
difference between MDI and DPI inhalers
DPI you breath quick and deeply
MDI you breathe slow
33
short acting beta 2 agonists
albuterol
levalbuterol
34
indications for SABAs
rescue inhaler (reliever)
exercise induces bronchospasms
35
side effects of SABAs/LABAs
tachycardia
tremor
anxiety
increase gluconeogenesis
increase insulin secretion
mild drop in K
36
short acting cholinergic antagonists (SAMAs)
ipratropium
ipratropium/albuterol
37
indication for SAMAs
COPD
asthma exacerbation in those who cannot tolerate albuterol
38
side effects of SAMAs/LAMAs
dry mouth
nausea
constipation
metalic taste
urinary retention
39
inhaled corticosteroids (ICS)
fluticasone propionate
fluticasone furoate
beclomethasone
ciclesonide
budesonide
mometasone
40
inhaled corticosteroids are used for
maintenance/controller therapy
41
which is the drug of choice for asthma?
inhaled corticosteroids!
every patient with asthma should receive one of these!
42
exception of everyone with asthma receiving an ICS
children 5 and under with very mild asthma
43
ICS are dosed based on
potency
44
when are inhaled corticosteroids fully effective?
within 4-8 weeks
45
local adverse effects of ICS
dysphonia
oral thrush
46
systemic adverse effects of ICS
osteoporosis
growth suppression (children)
cataracts
dermal thinning
adrenal insufficiency
47
systemic adverse effects of inhaled corticosteroids only occur at
high doses
48
how to manage dysphonia
decrease dose of ICS
use spacer
49
how to manage oral thrush
use spacer
rinse and spit after inhaler use
treat with clotrimazole or nystatin
50
how to manage osteoporosis
monitor bone density
add calcium and vitamin D
51
in order to reduce side effect of ICS,
decrease ICS dose and add a LABA
52
Long acting beta agonists (LABAs)
salmeterol
formoterol
vilanterol
53
LABA approved for COPD
indacaterol
olodaterol
54
what drugs should be avoided when on a LABA?
non selective beta blockers (carvedilol, labetalol, nadolol, propanolol)
55
LABAs help reduce ICS dose by
50%
56
should LABAs be used as a mono therapy?
why?
NO! always with ICS
there is increased risk of deaths when LABAs are used alone
57
combination ICS/LABAs
Advair diskus (fluticasone/salmeterol)
Symbicort (budesonie/formoterol)
dulera (mometasone/formoterol)
breo (fluticasone/vilanterol)
58
why can Symbicort be used as needed?
formoterol has a quick onset of action (3 minutes)
59
Max dosing of 12+ for Symbicort?
for ages 6-11?
12 inhalations/day
8 inhalations/day
60
ICS/SABA combination inhaler
airspura
as needed treatment/prevention of bronchospasm ages 18 and up
moderate asthma only
61
Long acting muscarinic antagonists (LAMAs)
tiotropium (Spiriva)
fluticasone/umexlidinium/vilanterol (trelegy)
62
indications for LAMAs
COPD
second line therapy for asthma
63
systemic corticosteroids
short bursts decrease toxicity
used for severe persistent asthma and acute exacerbations
64
theophylline has a
narrow therapeutic index
65
theophylline
potent bronchodilator
mild anti inflammatory agent
66
drug interactions with theophylline
CYP1A2 inhibitors increase theophylline levels
CYP1A2 induces decrease theophylline levels
67
why is theophylline not recommended
less effective than inhaled bronchodilators
slow onset of action
more adverse drug reactions
doesn't treat airway inflammation
68
adverse effects of theophylline
caffeine like side effects
cardiac tachyarrhythmias
seizures
69
effects of leukotriene antagonists
improve FEV1 and PEF
reduce nocturnal awakenings
reduce B2 agonist use
70
cisternal leukotrienes are correlated with
airway edema
smooth muscle contraction
altered cellular activity —> inflammatory process
symptoms of allergic rhinitis
71
leukotriene inhibitors
Singulair - montelukast
accolate - zafirlukast
zyflo - zileuton
72
which leukotriene inhibitors do you need to monitor neuropsychological events?
all of them!
montelukast, zafirlukast, zileuton
73
which leukotriene inhibitors do you need to monitor liver function tests?
zafirlukast and zileuton
74
Xolair (omalizumab)
anti IgE antibody
used for allergic asthma not controlled by ICS (6 and up)
75
which biologics have a boxed warning for anaphylaxis?
omalizumab
reslizumab
76
which biologics are approved for ages 6 and up
mepolizumab
omalizumab
dupilumab
brenralizumab
77
which biologics are approved for ages 12 and up?
tezepelumab
78
which biologics are approved for only adults
reslizumab
79
recombinant IgE antibody
omalizumab
80
IL4 antagonist
dupilumab
81
IL5 antagonist
reslizumab
benralizumab
mepolizumab
82
anti-Thymic stromal lymphopoietin (anti-TSLP)
tesepelumab
83
goals for asthma treatment
achieve good control of symptoms
maintain normal activity levels
decrease risk of exacerbations
decrease risk of fixed airflow limitation
decrease risk of medication side effects
84
GINAs 3 step cycle
assess the patient
adjust treatment
review response
(continuously repeated)
85
non pharmacological treatment for asthma
avoid triggers
advice about exercise induced bronchospasm
avoid medications that worsen asthma
address dampness and mold
86
which medications worsen asthma
NSAIDs
non-selective beta blockers
87
controller
maintenance therapy use to prevent worsening symptoms
ICS, LABA, LTRA
88
reliever
used PRN for shortness of breath and for exercise/allergen exposure
SABA, ICS-formoterol, ICS-SABA
89
anti-inflammatory reliever (AIR)
reliever containing an ICS component
budenonide/formoterol
budesonide/albuterol
90
maintenance and deliver therapy (MART)
use of ICS-formoterol as both controller and reliever
91
patients ages _____ and older require an ______ inhaler
6
ICS
92
when should step down therapy be considered?
if asthma is controlled for at least 3 months
93
when should step up therapy be considered?
if asthma remains uncontrolled
94
assessment of asthma control
symptoms
future risk of adverse outcomes
95
treatment issues regarding asthma
inhaler technique
adherence to therapy
96
risk factors for exacerbation
exposures
comorbidities
medications
lung function
97
sustained step up therapy
step up therapy to the next level
98
short term step up therapy
step up for 1-2 weeks if reversible risk factor
99
day to day adjustment therapy
adjust number of PRN doses
100
goal of step down is to
find the minimum effective treatment
101
guidelines for stepping down therapy
reduce therapy 1 step
decrease ICS dosing by 25-50%
102
mild asthma classification
well controlled on steps 1 or 2
103
moderate asthma classification
well controlled on steps 3-4
104
severe asthma
remains uncontrolled despite optimized treatment
or
asthma requiring high dose ICS-LABA to remain controlled
105
why should nebulizers be avoided?
increases viral transmission
106
indoor allergen mitigation
remove possible allergens
ex: pillow cover for dust mite allergy, air purifier, etc.
107
immunotherapy
SQ as adjunct treatment of asthma in patients above 5
SCIT only started when asthma is controlled
SLIT not recommended
108
role of fractional exhaled nitric oxide (FeNO) testing
measure of airway inflammation
only for ages 5 and up
109
bronchial thermoplasty
uses heat to remove muscle tissue from airways
not recommended for most patients
110
difference between GINA guidelines and NAEPP 2020 guidelines
NAEPP - step 1 is only a prn SABA, no ICS like GINA; ages 5-11 categorized together, GINA was ages 6-11
