Pharmo Drugs Kim > Chapter 13 Patho > Flashcards

Chapter 13 Patho Flashcards

(58 cards)

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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
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A

wheezing, recurrent cough, difficult breathing, chest tightness

25
25. asthma symptoms occur or worsen
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
26. asthma symptoms worsen in the presence of
fur, aerosol chemicals, change in temp, dust mites, drugs, aspirin or beta blockers, exercise, pollen, resp infections, smoke, strong emotions
27
27. Tests for asthma
FEV1, FEV1/FVC , PEFR
28
28. ***An increase in FEV1 greater than or equal to
12% AND greater than or equal to 200 ml after administration of a bronchodilator suggests reversible airflow limitation consistent w/ asthma.
29
29. Normal FEV1/FVC
greater than .75-.80. anything less than this indicates airflow limitation and asthma should be suspected. ( most hospital use .70 as normal)
30
30. An improvement of 60 L/min
or greater than or equal to 20% of the prebronchodilator PEFR after inhalation of a bronchodilator,
31
31. Also a diurnal variation in PEFR of more than 20% w/ twice daily readings, more than 10%
suggest a diagnosis of asthma.
32
32. other diagnostic test for asthma
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
33. Challenges in the differential diagnosis of asthma
``` kids younger than 5 older children and adults elderly cough variant asthma sick building syndrome distinguishing asthma from COPD ```
34
34. clinical manifestations of asthma
bronchoconstriction | excessive bronchial secretions
35
35. Vitals seen w/ asthma
increased RR, HR, and BP. | pulsus paradoxus: decreased blood pressure during insp. increase blood pressure during exp.
36
36. Physical exam finding w/ asthma
``` accessory muscle use, insp and exp pursed lip breathing substernal intercostal retractions barrel chest cyanosis cough and sputum production ```
37
37. Chest assessment finding w/ asthma
``` 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
38. sputum examination
eosinophilia charcot-leyden crystals cast of mucus from small airways ( kirschman spirals) IgE level (elevated w/ extrinsic asthma)
39
39. Chest radiograph
increased anteroposterior diameter translucent or dark lung fields depressed or flattened diaphragm could appear normal
40
40. Primary management of asthma
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
41. Components of asthma management
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
42. treating to achieve control
notion of step therapy
43
43. Primary therapies for asthma exacerbations
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
44. primary goal of treatments is to
relieve airflow obstruction and hypoxemia as quickly as possible, and to plan the prevention of future exacerbations
45
45. component 5 special considerations
pregnancy, obesity, surgery, rhinitis, sinusitis, nasal polyps, occupation, resp infection, gerd, aspirin induced asthma, anaphylaxis and asthma
46
46. ultra short acting bronchodilator agents
epinephrine/ adrenalin | racemic epinephrine
47
47. short acting beta 2 agents or SABA's
albuterol , metaproterenol, levalbuterol
48
48. systemic corticosteroids
methylprednisolone and hydrocortisone
49
49. Long acting beta 2 agents or LABA's
Salmeterol
50
51. leukotriene inhibitors
zafirlukast, montelukast, zilueton
51
52. monocional antibody
omalizumab
52
53. xanthine derivatives
theophylline, oxtriphylline, aminophylline, dyphlline
53
54. status asthmaticus
severe asthma unresponsive to repeated courses of beta-agonist therapy, ie inhaled albuterol, levalbuterol, or SQ epinephrine, MEDICAL EMERGENCY
54
% of acute severe asthma (SA) PT's that also have a resp tract infection
50%
55
stage one SA
resp alkalosis, decrease PaCO2, normal PaO2, | asthma exacerbation
56
stage two SA
resp alkalosis,even more decrease In PCO2,decrease O2 common ED finding
57
stage three SA
normal PH, normal PaCO2, even more decreased PaO2 impending failure
58
stage four SA resp acidosis, increase PaCO2, extreme decrease PaO2 impending resp arrest
resp acidosis, increase PaCO2, extreme decrease PaO2 | impending resp arrest
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