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Pharmo Drugs Kim > Chapter 13 Patho > Flashcards

Chapter 13 Patho Flashcards

1
Q
  1. what is the NAEPP?
A

national asthma education and prevention program

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2
Q
  1. first evidence based asthma guidelines were published in
A

1991

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3
Q
  1. Today the NAEPP guideline are structured around the following four components
A
  1. assessment and monitoring of asthma
  2. PT education
  3. control of factors contributing to asthma severity
  4. the pharmacologic treatments
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4
Q
  1. GINA
A

global initiative for asthma launched in 1993

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5
Q
  1. Some of GINA’s goals
A

awareness of asthma, research, reduce asthma morbidity and mortality, improve management of asthma, improve availability and accessibility of effective asthma therapy.

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6
Q
  1. Anatomic alterations of the lungs w/ asthma
A
  1. smooth muscle constriction of bronchial airways
  2. excessive production of thick white bronchial secretions
  3. mucous plugging
  4. hyperinflation of alveoli
  5. atelectasis caused by mucous plug
  6. bronchial wall inflammation leading to fibrosis
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7
Q
  1. also w/ asthma
A

inside of airway swells and mast cells release histamine

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8
Q
  1. asthma was first recognized
A

by Hippocrates more than 2000 years ago

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9
Q
  1. according to CDC/NCHS
A

prevalence of asthma in the US has increase from 7.3% to 8.4%, 1 in 11 children have asthma and 1 in 12 adults have asthma, its estimated that 25.7 million people suffer from asthma

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10
Q
  1. number of americans hospitalized annually for severe asthma
A

500,000

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11
Q
  1. number of people in US who die annually due to asthma
A

3200

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12
Q
  1. The WHO estimates that about
A

235 million people suffer from asthma world wide

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13
Q
  1. asthma is about two times more prevalent in boys than girls during
A

childhood

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14
Q
  1. approx. 50% of people w/ asthma develop it before
A

age 10

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15
Q
  1. two types of asthma
A

extrinsic and intrinsic , significant overlap exists

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16
Q
  1. extrinsic asthma
A

allergic or atopic asthma, asthma episode clearly linked to the exposure of a specific allergen (antigen)

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17
Q
  1. ex of extrinsic asthma allergens
A

dust, mites, fur, cockroach, fungi, molds, yeast, pollen

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18
Q
  1. extrinsic asthma is
A

an immediate type 1 anaphylactic hypersensitivity reaction, it is family related and usually appears before 30, it often disappears after puberty

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19
Q
  1. Because extrinsic asthma is associated w/ an antigen -antibody induced bronchospasm
A

an immunologic mechanism plans an important role. (IgE) immunoglobulin-E

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20
Q
  1. PT w/ extrinsic asthma may demonstrate
A
  1. early asthmatic response , within minutes after exposure and resolves with in an hour.
  2. late asthmatic response , begins several hours after exposure and last much longer.
  3. biphasic response, begin early but does not resolve
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21
Q
  1. Intrinsic asthma
A

nonallergic or nonatopic asthma, episode cannot be directly linked to a specific antigen or extrinsic factor. these PT have normal serum IgE levels. onset usually occurs after the age of 40.

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22
Q
  1. Risk factors
A
  1. host: genetics, obesity, sex

2. enviromental: allergens, infections, occupational sensitizers, tobacco smoke, diet

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23
Q
  1. other risk factors
A

drugs, food additive and preservatives , exercise, gerd, sleep, emotional stress, perimenstrual, allergic bronchopulmonary aspergillosis

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24
Q
  1. Indicators for asthma
A

wheezing, recurrent cough, difficult breathing, chest tightness

25
Q
  1. asthma symptoms occur or worsen
A

at night, awakening the PT, in a seasonal pattern, if PT has eczema, hay fever, or family history of asthma or atopic diseases. also if PT has a cold that goes to the chest for takes longer than 10 days to clear up.

26
Q
  1. asthma symptoms worsen in the presence of
A

fur, aerosol chemicals, change in temp, dust mites, drugs, aspirin or beta blockers, exercise, pollen, resp infections, smoke, strong emotions

27
Q
  1. Tests for asthma
A

FEV1, FEV1/FVC , PEFR

28
Q
  1. ***An increase in FEV1 greater than or equal to
A

12% AND greater than or equal to 200 ml after administration of a bronchodilator suggests reversible airflow limitation consistent w/ asthma.

29
Q
  1. Normal FEV1/FVC
A

greater than .75-.80. anything less than this indicates airflow limitation and asthma should be suspected. ( most hospital use .70 as normal)

30
Q
  1. An improvement of 60 L/min
A

or greater than or equal to 20% of the prebronchodilator PEFR after inhalation of a bronchodilator,

31
Q
  1. Also a diurnal variation in PEFR of more than 20% w/ twice daily readings, more than 10%
A

suggest a diagnosis of asthma.

32
Q
  1. other diagnostic test for asthma
A

inhaled methacholine or histamine
inhaled mannitol
exercise or cold air challenge
positive skin test allergen increases probability of dx of asthma
FeNO-increases w/ airway inflammation. normall 25 ppb in adults

33
Q
  1. Challenges in the differential diagnosis of asthma
A 
kids younger than 5
older children and adults
elderly
cough variant asthma
sick building syndrome
distinguishing asthma from COPD
34
Q
  1. clinical manifestations of asthma
A

bronchoconstriction

excessive bronchial secretions

35
Q
  1. Vitals seen w/ asthma
A

increased RR, HR, and BP.

pulsus paradoxus: decreased blood pressure during insp. increase blood pressure during exp.

36
Q
  1. Physical exam finding w/ asthma
A 
accessory muscle use, insp and exp
pursed lip breathing
substernal intercostal retractions
barrel chest
cyanosis
cough and sputum production
37
Q
  1. Chest assessment finding w/ asthma
A 
expiratory prolongation I:E ratio > 1:3
decreased tactile fremitus and vocal fremitus
hyperresonant percussion note
diminished BS and heart sounds
wheezing and crackles
38
Q
  1. sputum examination
A

eosinophilia
charcot-leyden crystals
cast of mucus from small airways ( kirschman spirals)
IgE level (elevated w/ extrinsic asthma)

39
Q
  1. Chest radiograph
A

increased anteroposterior diameter
translucent or dark lung fields
depressed or flattened diaphragm
could appear normal

40
Q
  1. Primary management of asthma
A

attain and maintain control of clinical manifestations
maintain normal activity levels
maintain pulmonary function as close to normal as possible
prevent asthma exacerbations
avoid adverse effects from asthma medication
prevent asthma mortality

41
Q
  1. Components of asthma management
A

component 1: develop PT/DR relationship
component 2: identify and reduce exposure to risk factors
component 3: assess, treat, monitor asthma
component 4: manage asthma exacerbations
component 5: special considerations

42
Q
  1. treating to achieve control
A

notion of step therapy

43
Q
  1. Primary therapies for asthma exacerbations
A

repetitive administration of rapid acting inhaled bronchodilators
early introduction of systemic glucocorticosteroids
oxygen therapy
continuous neb of short acting beta 2 agnosit in status asthmaticus

44
Q
  1. primary goal of treatments is to
A

relieve airflow obstruction and hypoxemia as quickly as possible, and to plan the prevention of future exacerbations

45
Q
  1. component 5 special considerations
A

pregnancy, obesity, surgery, rhinitis, sinusitis, nasal polyps, occupation, resp infection, gerd, aspirin induced asthma, anaphylaxis and asthma

46
Q
  1. ultra short acting bronchodilator agents
A

epinephrine/ adrenalin

racemic epinephrine

47
Q
  1. short acting beta 2 agents or SABA’s
A

albuterol , metaproterenol, levalbuterol

48
Q
  1. systemic corticosteroids
A

methylprednisolone and hydrocortisone

49
Q
  1. Long acting beta 2 agents or LABA’s
A

Salmeterol

50
Q
  1. leukotriene inhibitors
A

zafirlukast, montelukast, zilueton

51
Q
  1. monocional antibody
A

omalizumab

52
Q
  1. xanthine derivatives
A

theophylline, oxtriphylline, aminophylline, dyphlline

53
Q
  1. status asthmaticus
A

severe asthma unresponsive to repeated courses of beta-agonist therapy, ie inhaled albuterol, levalbuterol, or SQ epinephrine, MEDICAL EMERGENCY

54
Q

% of acute severe asthma (SA) PT’s that also have a resp tract infection

A

50%

55
Q

stage one SA

A

resp alkalosis, decrease PaCO2, normal PaO2,

asthma exacerbation

56
Q

stage two SA

A

resp alkalosis,even more decrease In PCO2,decrease O2 common ED finding

57
Q

stage three SA

A

normal PH, normal PaCO2, even more decreased PaO2 impending failure

58
Q

stage four SA
resp acidosis, increase PaCO2, extreme decrease PaO2
impending resp arrest

A

resp acidosis, increase PaCO2, extreme decrease PaO2

impending resp arrest

Pharmo Drugs Kim (23 decks)

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