L2: asthma Flashcards
1
Q
this is the chronic inflammation in the airways that are caused by allergens/pollutants causing narrowing of airways anf airflow obstruction
A
asthma
2
Q
inflammation of Nasal mucus membrane, mainly caused by allergens
A
allergic rhinitis
3
Q
the bronchooles are inflamed, caused by allergens and pollutants
A
asthma
4
Q
the two pathways in the pathophysiology of asthma
A
allergic and nonallergic eosinophilic airway inflammation
5
Q
interleukin responsible for the proliferation of mast cells
A
IL-9
6
Q
IL responsible for the class switchingnif B cells to produce IgE
A
IL 4 and 13
7
Q
IL that increases govlet cell jyperplasia jn the epithelial cells of the airways causing hypersecretjon of mucus. it also causes the constriction of bronchial smooth muscles
A
IL 13
8
Q
primary inflammatory regulator
A
histamine
9
Q
examples of eicosanoids
A
leukotrienes and prostaglandins
10
Q
cytokines released in non allergic eosinophilic airway inflammation
A
epithelial-derived cytokines
11
Q
epithelial-derived cytokines activates ___ releasing ___
A
innate lymphoma cells
releasing IL 5 and 13
12
Q
airway hyperresponsiveness involves:
A
repair
fibrosis
remodelling
13
Q
structural changes in the airways which makes asthma irreversible
A
remodelling
14
Q
asthma becomes irreversible when ____ _____ occurs
A
airway hyperresponsiveness
15
Q
A
16
Q
t or f: chronic asthma occur with exercise, or spontaneously, or with known allergen
A
t
17
Q
t or f: in chronic asthma, there js wheezing on auscultation wherein it is typically heard on inspiration
A
f
typically found on expiration causing prolonged expiratory phase
18
Q
chronic asthma includes signs of __
A
atopy
19
Q
acute severe asthma is also known as
A
status asthmaticus
20
Q
inflammation, airway edema, excessive mucus accumulation, and severe bronchispasm result in a profound airway narrowing that is poorly responsive to usual bronchodilator therapy
A
acute severe asthma
21
Q
expiratory and inspiratory wheezing on auscultation
A
acute severe asthma
22
Q
in EIB, there is a drop of more than or equal to __% from baseline value
A
10%
23
Q
refractory period after EIB
A
lasts up to 4 hrs after exercise
24
Q
nighttime asthma
A
nocturnal asthma
25
lung fx at midnight ___
lowers
26
histamine and eosinphils levels are ___ at midnight
higher
27
___ happens during this time because endogenous cortisol is low
adrenal suppression
28
cortisol has ___ properties
anti inflammatory properties
29
used to assess how well your lungs work by measuring how much air you jngale, how much tou exhale and how quickly you exhale
spirometry
30
FEV1
forced expiratory volume in 1 sec
31
FVC
forced vital capacity
32
normal ratio of FEV1/FVC
>0.7
33
a fev1/fvc ratio of less than 0.7 means ?
there is airway obstruction
34
performed when the facility does not have a spirometer, because it is less accurate. the vaues obtained from the PEF depends on the effort and muscular strength of the patient
peak expiratory flow
35
uses to determine improvement in lung function as demonstrated by change in FEV 1 or PEFR
reversibility test
36
bronchodilators used in reversibility test
salbutamol or ipratropium
37
in reversibility test, a difference if more 200mL or 400mL means thag the patient is ____ to bronchodilators
responsive
38
This test is used as a basis for deciding whether a patient can be given bronchodilators
reversibility test
39
this test measures variable airflow limitation reflecting the increased sensitivity of the airways to inhaled stimuli even when spirometric results are normal
airway hyper-responsiveness
40
A. bronchoconstrictors
B. bronchodilators
1.reversibility test
2. airway hyper-responsiveness
1. B
2. A
41
this test involves giving bronchoconstrictors tthat acts directly on the bronchioles
direct challenge test
42
this test involves giving bronchoconstrictors that has stimulates the release of inflammatory mediators
indirect challange test
43
drugs used in direct challenge test
methacholine and histamine
44
drugs used in indirect challenge test
exercise, mannitol, hyperventilation, AMP
45
high conc of this means that there is airway inflammation
Nitric oxide (Fraction of exhaled nitric oxide FeNO)
46
used to determine the specific allergen causing the reaction
skin-prick testing
47
asthma can be classified into ?
intermittent or persistent
48
persistent asthma can be further classified as?
milk, moderate, or severe
49
symptoms occur less than or equal to 2 days per week
intermittent asthma
50
lung function is still relatively high (FEV1 >80%)
intermittent asthma
51
are there nocturnal asthma symptoms experienced in intermittent asthma?
no.
but there are nighttime awakenings in adults
52
mild, moderate, severe
symptoms occur more thann 2 days a week but not daily
mild
53
mild, moderate, severe
symptoms occur daily
moderate
54
mild, moderate, severe
symptoms occur throughout the day
severe
55
mild, moderate, severe
nocturnal symptoms 1-2x amonth in children and 3-4x a month in adults
mild
56
mild, moderate, severe
nocturnal symptoms 3-4x a month in children, more than 1x a week but not nightly in adults
moderate
57
mild, moderate, severe
nocturnal symptoms is more than 1x a week but not nightly in children and 7x a week for adults
severe
58
mild, moderate, severe
lung functions
1. FEV1>80%
2. FEV1=60-80%
3. FEV1<60%
1. mild
2. moderate
3. severe
59
patient is usually reassessed ___ months after initial therapy
2-3x
60
used as prophylaxis to prevent future exacerbations. taken as a maintenance drug daily to lessen asthma attacks.
controller
61
to provide rapid relief of asthma symptoms during attacks
reliever
62
the dose or frequency should be ___ if after 1-3 months of therapy, the patient's symptoms are already controlled
decreased
63
preferred controller
ICS-formoterol
ICS - beclomethasone/budesonide
64
preferred reliever
as needed, low-dose ICS-formoterol
65
the patient uses the same inhaler as reliever and controller
maintenance and reliever therapy (MART)
66
GINA track 1
1. steps 1-2
2. step 3
3. step 4
4. step 5
1. as-needed-only low dose ICS-formeterol
2. low dose maintenance ICS-formoterol
3. low dose maintenance ICS-formoterol
4. medium-dose maintenance ICS-formoterol
5 add LAMA - ICS + formoterol + LAMA
67
alternative controller
ICS whenever SABA is taken
ICS - beclomethasonne or budesonide
68
alternative reliever
as-needed ICS-SABA, ot as needed SABA
69
GINA track 2
1. step 1
2. step 2
3. step 3
4. step 4
5. step 5
1. take ICS whenever SABA is taken
2. low dose maintenance ICS
3. low dose maintenance ICS-LABA
4. medium or high dose maintenance ICS-LABA
5. add LAMA
70
intervention for px with EIB
give SABA or patient's reliever meds before doing exercise
71
inhalation technique of DPI vs MDI
DPI - fast and swift inhalation
MDI - slow and steady inhalation
72
pharmacologic drugs used for asthma (3)
1. bronchodilators
2. anti-inflammatory
3. biologic agents
73
bronchodilator drugs
1 b2 agonists
2. anticholinergics
3. methylxanthines
74
anti-inflammatory
1. corticosteroids
2. leukotriene modifiers
75
stimulating b2-rececptors in bronchial smooth muscles activates __
activated adenylyl cyclase stimulating atp then cAMP
76
bronchodilators effects (3)
bronchodilation
improve mucociliary clearance
mast cell membrane stabilization
77
more bronchoselective (fast-acting)
aerosol route
78
chronic administration of bronchodilators causes ?
tolerance (prone to side effects)
79
SE of b2 agonists (4)
hypokalemia
inc hr
hyperglycemia
hyperlactermia
80
SABA
terbutaline
pirbuterol
albuterol (or salbutamol)
levav\lbuterol
metaproterenol
81
LABA
formoterol
salmeterol (slow onset)
bambuterol (PO)
82
Ultra-LABA
indacaterol
Vilanterol
Olodaterol
83
first treatment of choice for acute severe asthma and EIB
SABA
84
SABA that is not indicated for acute severe asthma exacerbations
SABA DPI
85
for patients with unsatisfactory response following initial 3 doses every 20 mins. of aerosolized B2 agonist
PEF or FEV1 of <30% than normal
continuous nebulization
86
duration of SABA vs LABA
SABA - 2hrs 12 hours
LABA - more than or equal to 12 hrs (2x daily)
87
recommended for chronic therapy only in combination with ICS
LABA
88
LABAs provide a bronchodilatory effect but cannot treat the root cause of asthma which is ___ thus ___ should be given
inflammation - ICS
89
monotherapy LABA is given when px has _
COPD
90
ultraa-LABA duration
>24 hrs (once a day dosing)
91
competitively blocks the muscarinic receptors that prevents the binding of acetylcholine leading to bronchodilation
anticholinergiics
92
anticholinergic MOA (2)
reduce secretion of mucus
stabilize immune cells, prevent degranulation
93
alternative reliever for BA
anticholinergics
94
ROA of anticholinergics
inhalation
95
short acting anticholinergic that has a DOA of 4-8 hrs
ipratropium bromide
96
long-acting anticholinergic with a DOA of 24 hrs
tiotropium bromide
97
adjunctive therapy in acute severe asthma, not completely responsive to B2-agonists alone
ipratropium bromide
98
add-on therapy in patients >= 12 yo whose asthma is not well controlled with a medium-to-high dose of ICS and LABA combi
tiotropium bromide
99
methylxanthines drugs
theophylline (PO, IV) and aminophylline (IV)
100
weak non-selective inhibitory of PDE causing inc in cAMP and cGMP (prevent degradation of cAMP and cGMP causing bronchodilator and anti-inflamm)
methylxanthines
101
last resort treatment as bronchodilating agent
methylxanthines
102
theophylline requires ___
TDM
103
SE of methylxanthines
N&V
tachycardia
jitteriness
difficulty sleeping
cardiac tachyarrhythmia
seizure
104
anti-inflammatory proteins
annexin-1
secretory leukoprotease inhibitor
IL-10
IkBa
105
pro-inflammatory cytokines
IL-1, 4, 5, 6, 8
GM-CSF
106
corticosteroids binds to NFkB and AP-1 which prevents ___
action of pro-inflammatory cytokines
107
this is given if acute severe asthma exacerbation does not respond to inhaled b2 agonists
systemic corticosteroids
108
duration of therapy of SCS in
adults
children
adults: 5-7 days
children: 3-5 days
109
ideal administration of SCS
short burst of SCS -> maintain appropriate long-term control with ICS
110
in px requres chronic use of scs....
lowest possible dose should be used
alternate day therapy
use short acting corticosteroids
111
long-acting scs
dexamethasone
112
short-acting scs
prednisone, hydrocortisone, methylprednisolone
113
scs has causes sodium and water retension posing a tisk for_
hypertension
114
preferred long-term controller for persistent asthma
inhaled corticosteroids
115
inhaled corticostereoids
improvement is seen in ___
max improvement in ___
first 1 to 2 weeks
4 to 8 weeks
116
adverse effects of inhaled corticosteroids
dysphonia
oropharyngeal candidiasis/thrush
117
5-lipoxygenase inhibitor
zileuton
118
cysteinyl leuktriene receptor antagonist
zafirlukast
montelukast
118
leukotriene modifiers decreases _ _
nocturnal awakening and b2 agonist use
119
indication of leukotriene modifiers
mild to moderate persistent asthma
119
inidication of montelukast
EIB
120
zileuton dosing
- 600 mg QID with meals and at bedtime
- 2 ER tabs, 600 mg BID, within 1hr after morning or evening meals
121
SE of zileuton
elevated hepatic enzymes (1st 3 mos. of therapy)
122
zileuton CI
active liver disease
hepatic enzymes 3x higher the upper limit of normal
123
DI of zileuton
warfarin
theophylline
124
zafirlukast dosing
adult: 20mg BID, 1hr before or 2 hrs after meals
children (5-11 yo) 10 mg BID
125
montelukast dosing
adult: 10mg OD in the evening
children (6-14 yo) 5mg OD in the evening
126
SE of monetlukast
unmasks the symptioms of churg strauss syndrome (blood vessel inflammation)
127
montelukast DI
warfarin
128
indicatin of biologic agents
moderate to severe asthma
129
t or f: biologic agents are used if asthma is uncontrolled with dual therapy of ICS/LABA or triple therapy ICS/LABA/LAMA
t
130
inhalational anesthetics
halothane
isoflurane
enflurane
131
used when acute sever asthma on mechanical ventilation that is unresponsive to standard medical therapy
inhalational anesthetics
132
moa of inhalational anesthtics
b2 adrenergic receptor stimulation
direct relaxation on bronchial smooth muscle
attenuate of histamine-induced bronchospasm
alteration of the NO pathway in epithelial cells
