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Flashcards in Dubin Asthma Deck (45)
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1

Asthma relievers - immediate

SABA, Ipratroprium (anticholinergics), Oral or injected steroids.

2

Asthma controllers - long term

ICS, LTRAntag, LAB2A, Methlxanthines (Theophylline), Omalizumab (anti ige)

3

Classifications for intermittent asthma

- Symptoms less than once per week
- Brief exacerbations
- Nocturnal s/s 2 or less per month
- FEV1 greater than 80% predicted

4

Classifications for mild Persistent asthma

- Symptoms MORE than 1/week, but LESS than 1/day
- Exacerbations may affect activity/sleep
- Nocturnal s/s 2 or MORE per month
- FEV1 greater than 80% predicted

5

Classifications for Moderate Persistent asthma

- Symptoms DAILY
- Exacerbations may affect activity/sleep
- Nocturnal s/s MORE than 1/per week
- FEV1 60-80% predicted

6

Classifications for Persistent asthma

- Symptoms DAILY
- FREQUENT exacterbaations
- FREQUENT nocturnal asthma symptoms
- LIMITATION of physical activity
- FEV1 less than 60% predicted

7

Short Acting Beta 2 Agonists (SABA) MOA

SAB2A relax bronchial smooth muscle by activating Adenylate Cyclase and STIMULATION cAMP PRODUCTION.

8

Preferential SAB2A for tx of asthma bronchospasm.. If this doesn't work, try what?

Albuterol.
If albuterol doesn't work, the try isomer Levalbuterol.

9

Name 5 SAB2A

Albuterol, Pirbiterol, Terbutaline, Metaproterenol, Levalbuterol

10

Name 3 LAB2A.
Use these when?

- Use as CONTROLLERS for DAILY SYMPTOMS (moderate persistent/Severe Persistent)
- Salmeterol, Formoterol, Fluticasone/Salmeterol (Advair)

11

What is the PREFERRED controller LAB2A?

Advair = Solmeterol (LAB2A) + Fluticasone (ICS)

12

What is an extremely potent inhaled B1 and B2 agonist? Used frequently?

Isoproterenol
- Dangerous SE if used too much (Death)

13

Name 2 Mast Cell stabilizers

- CROMOLYN (use with albuterol)
- Nedocromil

14

Name 2 Leukotriene Modifiers

- MONTELUKAST
- Zafirlukast

15

Name the most common methylxanthine and its MOA.

THEOPHYLLINE (IV)
- MOA: phosphodiesterate inhiitor that PREVENTS cAMP BREAKDOWN

16

Therapeutic blood range for theophylline.
If blood level too high, what happens?

10-20
SE - seizures.

17

When should theophylline be added to therapy regimen?

When person has difficulty breaking asthma with LABA (especially night time asthma).
- To achieve maximal bronchodilation and diaphragm contraction.

18

Name of anticholinergic and MOA.

Ipratroprium.
- Anticholinergic that decreases ACh release to decrease PSNS vagal stimulation to airway smooth muscle.

19

Name of 5 inhaled steroids

Beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone acetonide.

20

Uses of inhaled steroids.

- ONLY IN ASTHMATICS. as relievers.
- Never in hospitals - only use oral or IV steroids.

21

Use for IV steroids.

Steroid burst for status asthmaticus.

22

Adverse effects of long term use or oral steroids.

Adrenal suppression, buffalo hump, moon facies, purple stria, posterior capsule cataracts, necrosis of femoral head, thin skin, blood sugar elevation.

23

When is immunotherapy used?

- When ALLERGIES ARE THE MAIN TRIGGER of asthma
- In patients with severe anaphylaxis.
- Indicated in kids with SEVERE persistent asthma exacerbated by allergies.

24

Name and MOA of immunotherapy.

Omalizumab - monoclonal antibody developed against IgE to decrease total serum IgE levels.

25

In 85% of deaths due to asthma, what is the duration of the final episode?

12 hours or longer

26

Four main causes of death in asthmatics.

1. Asphyxia
2. Barotrauma/Ventilator
3. Nosocomial Infection
4. Unexpected

27

Three components of "Sudden Asphyxic Asthma"

1. Rapid decomposition
2. Extreme hypercapnia (CO2 in blood) with metabolic and respiratory acidosis.
3. Silent chest on auscultation.
(also, airway devoid of inspissated mucus; more neuts than eosino in submucosa @ autopsy)

28

Do previous admissions in the past year and life threatening attacks in the past increase risk of asthmatic death?
What are other risk factors?

Yes
- 3+ meds, marked circadian cariation in lung function, physiological abnormalities)

29

Important physical findings to identify High-Risk asthmatics for unexprected deaths.

1. Tachycardia (120+)
2. Tachypnea (20-30bpm)
3. RONCHI/WHEEZING (or COT to lack of wheeze)
4. Hyperinflation of chest
5. ACCESSORY MUSCLE USE.
6. PULSUS PARADOXUS
7. Cyanosis

30

What condition can wheezing and then lack of wheezing indicate?

STATUS ASTHMATICUS - air exchange gets so bad that no air is moving and you have a silent chest.