Asthma Quiz Flashcards
(162 cards)
1
Q
What are some examples of obstructive airway disorders?
A
Asthma, COPD
2
Q
What type of disorder leads to a decrease in airflow?
A
Obstructive; Asthma and COPD
3
Q
Which type of airway disorder has no change in volume of air the lungs hold?
A
Obstructive disorders; Asthma and COPD
4
Q
What are examples of restrictive disorder?
A
Kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid
5
Q
What type of airway disorder has no change in airflow?
A
Restrictive disorders: kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid
6
Q
What type of airway disorder has a decrease in volume of air the lungs can hold?
A
Restrictive disorders; kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid
7
Q
How does asthma make it hard to breathe?
A
The muscles of bronchial tubes tighten and thicken, and the air passages become inflamed, and mucus-filled, making it difficult for air to move
8
Q
What is a normal bronchial tube like?
A
The muscles around the bronchial tubes are relaxed and the tissue is thin, allowing for easy airflow
9
Q
What type of airway disorder involves recurrent episodes of coughing (particularly at night or early am), wheezing, breathlessness and chest tightness?
A
Asthma
10
Q
Asthmatic episodes
A
Usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment
11
Q
How can you do an initial assessment for asthma?
A
FEV1 of >200mL AND >12% increase from baseline measure after SABA
12
Q
What else can be present in the initial assessment for asthma?
A
Increased bronchial hyperresponsiveness, presence of other risk factors (atopic conditions), wheezing, coughing, chest tightness
13
Q
What are some examples of atopic conditions?
A
Eczema, allergic rhinitis, etc.
14
Q
What are inhaled allergens?
A
Pollen, cockroaches, animal dander, house dust mites, damp rooms-mold
15
Q
What are inhaled irritants?
A
Perfumes, tobacco smoke, cleaning agents, airborne chemicals, wood burning stoves
16
Q
What are the interleukin-5 antagonists?
A
Cinqair (Reslizumab) and Nucala (Mepolizumab)
17
Q
What is the class of Xolair (Omalizumab)
A
Inhibits binding of IgE to the high-affinity IgE receptor on surface of mast cells and basophils
18
Q
Which monoclonal antibody is indicated for 6+ years, mod-severe asthma, not controlled on ICS + skin test or perennial allergies
A
Xolair (Omalizumab)
19
Q
Which two monoclonal antibodies have a boxed warning for anaphylaxis?
A
Xolair (Omalizumab) and Cinqair (Reslizumab)
20
Q
Which monoclonal antibody has hypersensitivity anaphylaxis as a boxed warning?
A
Nucala (Mepolizumab)
21
Q
Which monoclonal antibody is used for 18+ with severe asthma eosinophilia phenotype?
A
Cinqair (Reslizumab)
22
Q
Which monoclonal antibody is used for 12+ severe asthma with an eosinophilia phenotype?
A
Nucala (Mepolizumab)
23
Q
How do you reduce allergen exposure to animal dander?
A
Keep animals out of bedroom, seal (filter) air ducts leading to bedroom, HEPA filters
24
Q
How do you reduce exposure to dust mites?
A
Reduce humidity to <50%, remove carpets if possible, wash bedding weekly (>130F), encase mattress, pillow, and box springs in an allergen impermeable cover
25
How do you reduce exposure to cockroaches?
Use poison bait or traps, do not leave food or garbage exposed
26
How do you reduce exposure to pollens and outdoor molds?
Use air conditioning, stay indoors when pollen counts are high
27
How do you reduce exposure to indoor molds?
Fix all water leaks, clean moldy surfaces, reduce humidity to <50%
28
What are some important triggers/exacerbating factors for asthma?
GERD, rhinitis, sulfite sensitivity, ASA/NSAIDs, menstrual cycles, BBs
29
What is the staging of asthma for EPR 1?
Mild asthma, moderate asthma, severe asthma
30
What is the staging of asthma for EPR 2?
Mild intermittent asthma, mild persistent asthma, moderate persistent asthma, severe persistent asthma
31
What is the staging of asthma for EPR3?
Intermittent asthma, mild persistent asthma, moderate persistent asthma, severe persistent asthma
32
The staging severity for asthma is based on what two factors?
Impairment and risk
33
Impairment
Frequency and intensity of symptoms, functional limitations, effect on quality of life
34
Risk
Future exacerbations, loss of pulmonary function, risk of adverse effects from meds
35
What is a peak flow meter?
Measures how well lungs are able to expel air (peak expiratory flow rate or PEAFR -L/min)
36
What is the clinical utility for a peak flow meter?
Early indicator for loss of control, may help pts identify triggers, determine how well regimen is working, may help indicate when to seek emergency care
37
How does a pt record and establish the “personal best”
When asthma is under “good control” over a 2-3 week period, take 3 readings daily and record highest reading
38
When do you take the daily readings to establish a personal best?
3 readings daily and record highest reading (mid-morning or afternoon) and record the HIGHEST VALUE obtained during 2-3 week period
39
What do you do AFTER a personal best is established?
Use atleast every morning upon awakening, use before any asthma meds, may use after taking a rescue med to determine impact
40
What is the GREEN zone?
When pt is 80-100% of personal best, can continue with regular activities, follow maintenance med plan
41
What are the directions for pts when they are in the green zone?
Continue with regular activity, follow maintenance med plan
42
What is the yellow zone?
50-80% of personal best
43
What are the directions for a pt when they are in yellow zone?
May require med adjustment, contact health care provider
44
What is the red zone?
<50% of personal best
45
What are the directions for a pt if they are in the red zone?
Emergency! Dial 911, contact health care provider
46
If the peak flow reading is >20% or more after using a SABA
Consider adjusting controller therapy
47
How often should a follow-up appointment be scheduled while gaining control for asthma?
Every 2-6 weeks
48
How often should a follow-up be scheduled for someone with controlled asthma?
Every 1-6 months
49
If a reduction in therapy in anticipated, how often should a follow-up be scheduled for asthma?
3 month intervals
50
What should be assessed at every follow-up for asthma?
Asthma control, med technique, asthma action plan, medication adherence, pt related concerns
51
What are some risk factors for death?
Prior severe exacerbation (intubation of ICU admission)
2+ hospitalizations or 3+ ED visits in the past year
>2 canisters of SABA per month
52
When should an asthma specialist be contacted?
If hospitalized, difficulties achieving or maintaining control, if immunotherapy is considered, if additional testing is indicated, if >2 oral steroids burst in past year
53
What are some other risk factors for death?
Poor perceived of symptoms, low SE status, illicit drug use, psyc disease, complicating co-morbidities
54
When can stepping down therapy be considered?
Must be “well controlled” for atleast 3 months
55
Stepping down therapy
Reduction should be gradual, must monitor closely, consider history or prior exacerbations
56
How often do you monitor when stepping down therapy?
2-6 weeks
57
Remember to use the ____ amount of meds needed for control
Least
58
What is ACT?
Asthma control test
59
An ACT score of _ means your pts asthma may not be under control?
<19
60
What needs to be provided to ALL pts?
Daily management and managing worsening asthma
61
What is included in daily management for asthma?
Controlled medication, environmental control measures
62
What is included for managing worsening asthma?
How to adjust medication, when to see medical care
63
Which domains should be assessed when monitoring asthma severity and control?
Impairment and future risk
64
What are the maintenance regimens?
ICS, long acting B2-agonists, *long acting anticholinergics* leukotriene antagonists, theophylline
65
What are the rescue regimens?
Short acting B2 agonists, **short acting anticholinergics**
66
What are some therapeutic considerations?
Cost and coverage, produce availability, adverse effects, pt population, lifestyle, pt preference, ability to use device, lung fxn, cognitive fxn, dexterity and strength
67
What are some advantages of an MDI without a spacer?
Less time (<1min), small/portable, no drug preparation, mechanical ventilation
68
What are some disadvantages for an MDI without a spacer?
Technique/timing essential, Freon effect (
69
What are some advantages of DPI?
Less time (<1min), less technique/timing, small/portable, usually less $$ than MDI counterpart
70
What are the disadvantages of using a DPI?
Some dose preparation, requires breath hold, requires faster inhalation, oropharyngeal deposition, no mechanical ventilation
71
What are some advantages of nebulizers?
Minimal technique/timing, no breath hold required, mechanical ventilation
72
What are some disadvantages of nebulizers?
More expensive, drug prep required, admin time (5-15min), bulky and less portable, requires power source, must clean regularly!
73
What are valves holding chambers used for?
MDIs only!!!
74
VHC valve doodling chambers
Requires less coordination to use, improves drug deposition into lungs, decreases oropharyngeal deposition, use one actuation per inhalation!
75
When should a face mask be considered if using an MDI and VHC?
For children <4 years
76
What is the mechanism for the quick relief medication?
Increased adenyl cyclase -> increases CAMP which activates PKA -> Ca+ leaves the cell -> smooth muscle relaxes
77
When should the quick relief medication be used?
Acute symptoms and exacerbations
| Treatment of choice for exercise induced asthma
78
What are the take home points about quick relief medications?
SABAs are preferred
Weekly cleaning is recommended
Regularly scheduled, daily, chronic use is not recommended
79
What are some examples of quick relief medication?
Albuterol, Levalbuterol, Pirbuterol (discontinued)
80
Should all patients with asthma have an albuterol inhaler?
Yes
81
What are some indications for the RespiClick device?
Treatment or prevention of bronchospasms in 4 years+
| Prevention of exercise-induced bronchospasms in 4 years +
82
What are some features of the RespiClick device?
Dose counter, “click” open loads dose, expires 13 mos after opening, counts down by even numbers only
83
Does the RespiClick need to be primed or cleaned?
No
84
How is the RespiClick device activated?
Breath activated device (Dry Powder)
85
What are some examples of products that have a dose counter?
Proair HFA, Ventolin HFA
86
What are the two types of Albuterol for adults?
Albuterol Sulfate 0.5% solution 5mg/ml (concentrated)
| Albuterol Sulfate 2.5mg/3mL (0.083%) (pre-mixed)
87
Which Albuterol Rx for adults requires two prescriptions?
Albuterol Sulfate 0.5% solution 5mg/ml (concentrated)
88
What are the SABAs via nebulizer?
Albuterol for adults and children, Xopenex (Levalbuterol)
89
When is the nebulizer preferred?
When pt is unconscious
90
What are examples of oral beta-2 agonists?
Albuterol immediate release tablets and syrup, Vospire ER extended release tablets
91
When should you use inhaled corticosteroids?
Preferred long-term control therapy for all ages
92
How often should ICS be cleaned?
Weekly
93
What should be done after each use of ICS?
Rinse mouth and expectorate after using, wash around childs mouth if using a mask
94
What is mild-mod asthma most managed with?
Low-medium ICS doses
95
What do ICS do to lung function?
Improves lung function and reduced need for quick relief medications
96
What are some examples of ICS?
Beclomethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone proportionate and furoate, Mometasone
97
Oral candidiasis can be from ICS, how could you reduce it?
Spacer, rinse mouth, decrease dose/frequency if possible
98
What % of pts can get oral candidiasis?
34%
99
What % of pts can get dysphonia from ICS?
5-50%
100
What can dysphonia be reduced by?
Spacer, rinse mouth, decrease dose/frequency if possible
101
What can reflex cough and bronchospasms be reduced by from ICS?
Spacer, decreased rate or inspiration, pre-treat with albuterol
102
Low dose ICS has no significant effects on
Bone mineral density in children
Incidence of cataracts or glaucoma
HPA axis function
103
What is the preferred therapy for asthma?
ICS therapy
104
Implications of ICS
Minimal effects ICS dose is recommended be used in all children with asthma, trails should be required to monitor height
105
What is Arnuity or Ellipta?
Fluticasone Furoate
106
Clinical pearls fo Arnuity/Ellipta/Fluticasone Furoate
1st once daily ICS, cleaning NOT required, unable to double load dose, discard 6 weeks after opening tray
107
What are some potential drawbacks for Arnuity/Ellipta/Fluticasone Furoate
See DPI limitations, dosing may be less flexible
108
What is another name of ArmonAir or RespiClick?
Fluticaonse Propionate
109
What are some clinical pearls of ArmonAir/RespiClick/Fluticasone Proprionate
12+ asthma maintenance, not interchangeable with Flovent, unable to double load dose, discard 30 days after opening
110
A temporary increase in anti-inflammatory therapy may be indicated to reestablish asthma control
“Burst”
111
What MUST BE used concomitantly with anti-inflammatory medications for long-term control of asthma symptoms
Long acting B2 agonists
112
What can be used to prevent exercise-induced bronchospasm?
Long acting B2 agonists
113
Long acting B2 agonists do NOT eliminate the need for what?
An anti-inflammatory agent when used for asthma
114
What should not be used to treat acute symptoms or exacerbations?
Long acting B2 agonists
115
The use of LABAs is contraindicated without the use of what?
OF an asthma controlled medication such as an ICS
116
LABAs should be used for what?
The shortest duration of time required to achieve control of asthma symptoms and D/C, if possible, once asthma control is achieved
117
Pediatric and adolescent pts who required the addition of a LABA to an ICS should use what?
A combo product
118
What is another name for Breo/Ellipta
Fluticasone Furoate + Vilanterol
119
What are some clinical pearls for Breo/Ellipta/Fluticasone Furoate + vilanterol
1st once daily ICS/LABA combo, unable to double load dose, discard 6 weeks after opening tray, cleaning NOT required
120
What are some potential drawbacks for Breo/Ellipta/Fluticasone furoate +vilanterol
See DPI limitations
121
What is another name fo AidDuo/RespiClick
Fluticasone Propionate + Salmeterol
122
What are the clinical pearls for AirDuo/RespiClick/Fluticasone propionate + salmeterol
12+ asthma maintenance not controlled on ICS alone, not interchangeable with Adair, unable to double load dose, discard 30 days after opening
123
When should long acting antimuscarinics be used?
As an add-on for pts with a hx of exacerbations, once-daily, maintenances treatment of asthma in pts 6+ years
124
What are the long acting antimuscarinics?
Spiriva, Respimat (Tiotropium)
125
Clinical pearls for long acting antimuscarinics
Cost, expires 90 days after loading, dose = two half turns once daily, Respimat only LAMA approved for asthma
126
What are some potential drawbacks for the long acting antimuscarinics?
Initial load and priming, coordination between dose release and inhalation
127
When should Theophylline be used?
Alternative therapy for Step 2 care (not preferred), adjunctive therapy with ICS in patients >5 years old
128
Take home points for Theophylline
Monitor serum Theophylline concentration, consider adverse effect profile, DDIs
129
What should the serum Theophylline concentration be at?
5-15mcg
130
What are the adverse effects similar to for Theophylline
Caffeine
131
Smoking induces metabolism, so if a pt on Theophylline stops smoking,
The levels in serum will go very high
132
What are some dose-related acute toxicities from Theophylline?
Tachyarrhythmias, CNS stimulation, seizures, hyperglycemia and hypokalemia
133
What are the Theophylline drug inducers?
Smoking, Rifampin, Phenytoin, Omeprazole, Phenobarbital, Carbamazepine
134
What are the Theophylline drug inhibitors
ETOH, Zileuton, Cimetidine, Zafirlukast, Propranolol, Ciprofloxacin
135
Leukotrienes
Produced and release from multiple sources, contract smooth muscle, increase vascular permeability and mucus secretions
136
When to use leukotriene inhibitors
Alternative therapy for Step 2 care (not preferred), adjunctive therapy with ICS
137
What are some clinical pearls for leukotriene inhibitors
Montelukast and Zafirlukast block at recept level (LTRA)
| Zileuton blocks production
138
What needs to be taken on an empty stomach?
Zafirlukast
139
Which leukotriene inhibitor must liver function be monitored?
Zileuton
140
Which leukotriene must be administer once daily at bedtime?
Montelukast
141
Which leukotriene inhibitors must be taken atleast 2 hour before or 2 hours after meals?
Zafirlukast
142
What did the FDA find an association between in 2008?
Montelukast and behavior/mood changes, suicide
143
What is an example of a mast cell stabilizer?
Intal (Cromoly sodium)
144
Adverse effects of Intal (Cromolyn sodium)
Bad taste, cough/irritation
145
Clinical pearls fo mast cell stabilizers
Long-term prevention of symptoms in mild persistent asthma, presentation treatment prior to exercise or known allergies, dosed 3-4x/day
146
Mast cell stabilizers can be used for long term prevention fo what?
Symptoms in mild persistent asthma
147
How many times a day are mast cell stabilizers dose?
3-4x/day
148
Which vaccinations are required?
Influenza and pneumococcal
149
What can be used to assess and monitor asthma severity and control?
EPR-3 table and validated questionnaires to assess impairment and risk
150
Budesonide DPI
Pulmicort Flexhaler
151
Budesonide Neb
Pulmicort
152
Flunisolide HFA
Aerospan
153
Fluticasone HFA
Flovent HFA
154
Mometasone DPI
Asmanex, Twisthaler
155
Ciclesonide HFA
Alvesco
156
Albuterol
Proair HFA, Proair RespiClick, Proventil HFA, Ventolin HFA
157
Levalbuterol
Xopenex
158
Pirbuterol
Maxair Autohaler (Discontinued)
159
Advantages Diskus
Fluticasone + Salmeterol
160
Advair HFA
Fluticasone + Salmeterol
161
Symbicort HFA
Budesonide + Formoterol
162
Dulera HFA
Mometasone + Formoterol
