Pediatric- HEENT and Pulm Flashcards
(171 cards)
1
Q
what s/s will Orbital cellulitis have
A
Fever proptosis (displacement of body part) Restriction of extraocular movements Swelling redness on eye lid
2
Q
Treatment for Orbital cellulitis
A
DONT WAIT
IV Vancomycin, Clindamycin, Cefotaxime
3
Q
What is the most common organism found in Orbital cellulitis
A
Secondary to sinus infection - Ethmoid *
* Strep pneumonia
H. influenza
Staph aureus
4
Q
If treatment is delayed with Orbital cellulitis what the most dangerous side effect?
A
**Optic nerve damage
spread of infection to sinuses, meninges and brain
5
Q
What care must be given if you suspect Orbital cellulitis?
A
Emergent referral to ophthalmologist
6
Q
What has decreased the incidence of Orbital Cellulitis
A
Pneumococcal vaccine
*Strep pneumoniae most common cause
7
Q
What are the most common causes of orbital cellulitis
A
- Sinus infection *
- dental infection
- bacteremia
- Dacrocystitis
- Facial infections
8
Q
What age group is orbital cellulitis most common in?
A
7-12 years old
9
Q
what is the best imaging for Orbital cellulitis?
what will it show?
A
CT - infection of the fat and ocular muscles
10
Q
What is the difference between Postseptal cellulitis and preseptal cellulitis
A
Postseptal- emergency- vision changes, pain when they move their eye
s. pneumo cause - child was sick with sinus then swollen eye
Preseptal- infection of the eyelid - periocular tissues
no vision changes and no ocular movement pain
11
Q
What is the most common organism is viral conjunctivitis?
A
Adenovirus
12
Q
What is the most common source someone obtained a viral conjunctivitis from?
A
most common swimming pool
direct contact
*highly contagious
13
Q
What are some physical exam findings of viral conjunctivitis
A
fever pharyngitis perauricular lymphadenopathy *often in both eyes copious watery discharge mucoid discharge punctate staining on slit lamp
14
Q
key symptoms of this diagnosis- punctuate staining on slit lamp, mucoid/water eye discharge
A
viral conjunctivitis
*Red eyes ! (ciliary injection)
15
Q
Treatment for viral conjunctivitis
A
cool compresses
artificial tears
antihistamines for itching/redness - olopatadine
16
Q
key terms for this diagnosis- red eyes, fever, pharyngitis, cobblestone mucosa on upper eyelid with itching tearing may have photophbia and vision loss
A
Allergic Conjunctivitis
17
Q
Treatment for Allergic Conjunctivitis
A
- ->Antihistamines
- ->H1 blockers
- ->topical steroid- long term
1. Olopatadine
2. Patanol- antihistamine/mast cell
3. pheniramine/naphazoline - Naphcon A - antihisamine
4. Emedastine
18
Q
What is the most common organism for Bacterial conjunctivitis ?
how is it transmitted?
A
Staph
Strep
Haemophilus
-Transmitted direct contact and autoinoculation
19
Q
What are the S/S of Bacterial conjunctivitis
A
purulent discharge
eyelid crusting
no visual changes * (viral can have visual changes)
mild eye pain
no ciliary injection** eye is not RED ** (viral is red)
20
Q
what is needed to detect corneal abrasions?
A
Fluorescein staining
rule out in conjunctivitis
21
Q
Treatment for Bacterial conjunctivitis
A
Topical Erythromycin
If contacts cover pseudomonas- fluroquine OR Tobrex
22
Q
What is the treatment for Gonoccoccal conjunctivitis
A
Admit - optho emergency
IV ceftriaxone for 5 days
can add a topical
23
Q
What is the treatment for Chlamydia conjunctivitis
A
Admit- optho emergency
IV Azithromycin for 5 days
can add topical
24
Q
How do you treat neonatorium bacterial conjunctivitis
A
AgNO3 - silver nitrate
day 2-5 gonococcal
day 5-7 chlamydia
7-11 HSV
25
What is Strabismus?
misalignment of eyes - 4% of population
26
What are all the types of Strabismus
1. Esotropia - IN horizontal
2. Exotropia - OUT horizontal
3. Hyoptropia - DOWN vertical
4. Hypertopia -UP vertical
27
What are the causes of Strabismus
1. cranial nerves - III, IV , VI (3, 4, 6)- weaken or palsy
2. eye muscles
3. brain- cerebral palsy, downs
4. Strokes
5. Trauma
28
What are some symptoms of Strabismus
Amblyopia - lazy eye
diplopia- double vision
cataracts
29
What will you find on physical exam with Strabismus
cover/uncover exam- eye can drift
30
What is Bruckner's test
Bruckner testing can be helpful in observing strabismus. When doing the Bruckner test, fundus reflex is one characteristic to pay close attention to. A patient with a strabismus may show an increased light reflex in the deviated eye. Using your occluder, occlude the non-deviated eye as if you were doing a unilateral cover test, and you may be able to observe a change in fundus reflex of the deviated eye. The reflex may change from a brighter white to a duller red. Why? The macula is usually the most heavily pigmented area of the retina; therefore, once the deviated eye takes up fixation upon unilateral occlusion, the reflex will assume a duller appearance
31
What is the diagnosis- loss of red light reflex in one eye
Retinal blastoma
32
Treatment for Strabismus
Glasses
Eye muscle exercises
ocular surgery
33
What is the most common infection of the middle respiratory tract?
Laryngotracheobrochitis - Croup
34
What is the most common cause of Laryngotracheobrochitis
aka croup
Parainfluenza
RSV
35
What causes the stridor?
| Describe stridor
Croup
| the walls of the subglottic airway are drawn together during INSPIRATION
36
what is the Patho behind Laryngotracheobrochitis
inflammation and edema of laryngotracheal airway
kids already have a smaller airway to being with
this will lead to increased airway resistance and increased work of breathing during INSPIRATION (Stridor)
37
Laryngotracheobrochitis is commonly seen in whom? what time of year?
6 months to 3 years
| Peaks in the Fall early winter time
38
Key symptoms should make you think what diagnosis-
Stridor- inspratory, barky seal-like cough, hoarseness, increase work of breathing, retractions +/-
nasal flaring, often starts out like cold symptoms (or out of the blew no pre-warning symptoms)
Laryngotracheobrochitis- CROUP !
39
What Physical exam findings will you see with CROUP?
| if diagnosis is unclear what is the next step?
lungs are usually clear *
usually clinical dx
AP neck x-ray- steeple sign narrowing of the subglottic region
40
What is the best imaging for Croup
| what are the best labs?
X-ray AP steeple sign narrowing of the subglottic region
| viral PCR or culture
41
What is the treatment for mild Croup
mild- no stridor at rest
symptomatic - humid air, fever reduction, fluids, cool mist humidifier
ONE dose Dexamethasone 0.6mg/kg in office
42
What is the treatment for moderate-severe Croup
Stridor at rest & retractions
try keeping the child calm to minimize labored breathing
Dexamethasone 0.6mg/kg - oral, IV or IM
If severe = Racemic aerosolized epinephrine by nebulizer (q 20 min)
*observe for 3-4 hours and decided to admit or not
*monitor for rebound effect
* worsening as drug clears
-Humidifed air
- antipyretics, fluids
43
How often can you give Racemic Epinephrine with Croup
If severe = Racemic aerosolized epinephrine by nebulizer - can repeat every 20min for 1-2 hours
peak effect- 10-30 minutes
fades within 60-90minutes
44
When should you admit a patient with Croup?
age < 6 months
if strior is still present at rest
if rebound effect after multiple treatments od Dexamethasone
oxygen requirments
oral intake
care giver understanding and abilty to return if needed
Recurrent Emergency Department visits in 24 hours
45
What part of the body does Croup occur?
Larynx
Sub-glottis
Trachea
that is why its called Laryngotracheitis
46
What part of the lungs does Bronchiolitis effect?
Lower respiratory tract infection affecting small airways (bronchioles)
47
What is the Patho of Bronchiolitis
small airways are inflamed and increase mucous production and occasionally bronchospasm leads to symptoms. can lead to airway obstruction or atelectasis
48
What is the most common cause of Bronchiolitis
```
Respiratory syncytial virus - RSV
rhinovirus
parainfluenza
influenza
adenovirus
*uncommon mycoplasma pneumonia
```
49
Bronchiolitis commonly infections whom?
| what time of year is common
first 2 years of life is common and peaks 2-6 months
| peaks December through march
50
Key symptoms for this diagnosis - history of 1-3 day is URI, low grade fever, cough, noisy breathing or wheezing, nasal flaring, hypoxia <95%, tachypnea >70,
lethargy +/- , dehydrated +/-
Bronchiolitis
51
X-ray is not usually indicated in Bronchiolitis
| but when do you need to order it?
1. infant < 3 months
2. fever > 38 (100.4)
3. suspect secondary infection
4. severe illness
5. hyperinflation
52
What is the best imaging for Bronchiolitis
| what will it show ?
x-ray
hyperinflated lungs due to air trapping peribronchial cuffing due to bronchial wall thickening and peribronchial opacification.
minimal focal areas of atelectasis
53
What is the treatment for Bronchiolitis
| when should you admit?
```
supportive care & monitoring
nasal suctioning
O2
IV fluids if needed
admit if- moderate to severe respiratory distress, hypoxemia, apnea, inability to tolerate oral feedings, inadequate care at home
```
54
What is the prognosis of Bronchiolitis
| what can you tell mom to expect?
most improve within a few days then gradually resolve in 1-2 weeks
can persist to have bronchial hyperactivity
55
Children who were hospitalized for RSV as an infant tend to have higher rates of what ?
Asthma
56
What vaccine can you give to prevent Bronchiolitis?
who do you give it to?
How much?
Synagis - Palivizumab
it is a RSV specific monoclonal Ab
-passive prophylasis
- one dose just prior to RSV season (nov)
- 15mg/kg IM once per month for max of 5 doses
max interval between doses if 35 days
- infants < 1 years old with chornic lung diesase, prematurity or hemodynamically significant congenital heart disease
57
What is prevention for Bronchiolitis?
Syngis - Palivizumab
| Influenza vaccine
58
What are two types of chronic Bronchiolitits
1. Bronchiolitis obliterans (constrictive)
| 2. Cryptogenic organizing pneumonia )COP
59
What is Bronchiolitis obliterans (constrictive)
Type of bronchiolitis that causes a crhonic inflammation and fibrosis of bronchioles causing collapse and obliteration of bronchioles. Granulation tissue in the bronchiole lumen causes obstrutive lung disease
60
If the CT scan shows Mosaic pattern on the chest what is the diangosis?
Bronchiolitis obliterans - constrictive
61
Bronchiolitis obliterans (constrictive) is common in whom?
```
Post lung transplant rejections
inhalation
injuries - silo filler's disease
drug reactions
RA
```
62
inital treatment for Bronchiolitis obliterans (constrictive)?
definitive?
High dose steroid and imunosuppression
| definitive- lung transplant
63
What is Crytogenic organizing pneumonia COP
| what is the treatment?
Common after pneumonia infection
persistent alveolar exudes causing inflammation and scarring *Fibrosis of the bronchioles and alveoli resembling pneumonia on a CXR but does not respond to antibiotics.
Steroids
64
Pathology of Acute epiglottis
inflammation of the epiglottis - thin flap at the base of the tongue which prevents food from going into the trachea. Swelling of the epiglottis can interfere with breathing
65
What is the most common cause of Acute Epiglottis
Haemophilus influenza type B - HiB
Streptococcua pneumonia
staphlococcus aureus
GABHS
66
What are s/s of Acute Epiglottis
```
3' D's
Dysphagia
Drooling
Distress
fevers, odynophagia, *inspiration stridor, *Tripoding, leaning forward with elbow on lap
```
67
How do you diagnosis Epiglottis ? What are the results?
if high suspicion- DO NOT ATTEMPT TO LOOK IN THEIR THROAT with tongue depressor !
Laparoscopy - Definitive = Cherry red epiglottis
68
Key terms for this diagnosis- Lateral cervical x-ray shows a thumb sign
what other common s/s
Acute epiglottis
| difficulty swallowing, drooling, distress and tripoding
69
Treatment for Acute Epiglottis
1. keep the child comfortable position and keep clam
2. dexamethason to reduce airway inflammation
3. tracheal intubations to protect airway
4. 2nd or 3rd gen cephalosporin + penicillin to cover staph
70
what is the most common organism that causes Pertussis
it is a highly contagious infection secondary to Gram neg bordetella pertussis
71
What phases will Pertussis go through?
1. Catarrhal - URI 1-2 weeks
2. Paroxysmal - Severe coughing fits, post cough emesis
3. Convalescent - resolving 6 weeks
72
This phase of pertussis- cold like symptoms for 1-2 weeks
Catarrhal
73
This phase of pertussis- severe coughing fits that come in paroxysms. Has an inspiratory whooping sound with cough fit
Paroxysmal phase
74
This phase of pertussis- cough and emesis is decreasing but cough still present up to 6 weeks
Convalescent phase
75
How do you diagnosis Pertussis
Nasopharyngeal swab - do in the first 3 weeks
| Severe Lymphocytosis* 60-80% lymphs
76
Treatment of Pertussis
1. supportive! antibiotics have no effect on duration or severity of illness
* decreaes contagiousness
2. Macrolides - Erythromycin or Bactrim
77
what is the most common complication of of pertussis
pneumonia
encephalopathy
otitis media
sinusitis
78
What is Hyaline membrane disease also know as
Infant respiratory Distress Syndrome
| IRDS
79
What is the diagnosis- present in premature infants secondary to insufficiency of surfactant production and lung structural immaturity
Hyaline membrane disease - Infant respiratory Distress Syndrome
IRDS
80
A decrease in surfacnt production can lead to what problems in the lungs?
Atelectasis and decrease in perfusion and ventilation
decrease lung compliance
-hyaline membrane disease or IRDS
81
What is the most common cause of death in the first month of life?
Hyaline membrane disease or IRDS
82
Hyaline membrane disease or IRDS
is most common in whom?
what are risk factors?
Common in white males * TWICE AS COMMON
c-section deliveries (under stress and release coristol)
perinatal infections
multiple births - especially premature
maternal diabetes- high insulin levels delays surfactant production
83
What are symptoms of Hyaline membrane disease?
IRDS
| Shortly after birth infant has respirator distress = tachypnea, nasal flaring, cyanosis, chest wall retractions, apnea
84
what is the best diagnostic test for Hyaline membrane disease. What will it show?
CXR- bilateral diffuse reticular ground glass opacities + air bronchograms from atelectasis
poor expansion
domed diaphragms
Histology- waxy appearing layers lining the collapsed alveoli
85
Treatment for Hyaline membrane disease - IRDS
Endotracheal tube: Exogenous surfactant given to open alveoli
CPAP
IV fluids
86
How do you prevent Hyaline membrane disease - IRDS
If you suspect a premature delivery- give steroids
| between 24-36 weeks
87
What re the most common types of Influenza outbreaks
| how does it spread?
A and B during the fall and winter
| Spreads via airborne respiratory secretions
88
Which type of influenza is associated with more severe
| extensive outbreaks
A
89
What are the most common symtoms of influenza
URI
Pharyngitis
pneumonia
abrupt onset of fever, headaches, chills, malaise, myalgias most common in legs and lumbosacral area
90
What are contraindications to Trivalent influenza vaccine
eggs
gelatin
thimerosal allergies
91
What are the two types of influenza vaccines
1. trivalent
| 2. live attenuate - healthy 5-49 years
92
What are contraindications to live attenuated influenza vaccine
>50 years old
| Pregnant
93
Treatment for Influenza
```
best if started with in 48 hours of onset (3-5 days)
Neuraminidase inhibitors
1. Oseltamivir (tamiflu)
Zanamivir (relenza)
2. Acetaminophen or salicylates
```
94
What medication is a diskhaler used for the treatment of influenza
Zanamivir (relenza)
95
What is this normal breath sound-
Loud high-pitched sounds heard over the trachea and larynx/manubrium
Expiration is longer than inspiration
Bronchial
96
What is this normal breath sound-
Medium pitched heard over the primary bronchus and posterioly between the scapula
Expiration is equal to inspiration
Bronchovesicular
97
What is this normal breath sound-
Soft gentle sounds over all the areas
Inspiration > expiration
Vesicular
98
What is normal pulmonary capillary wedge pressure
8-10mmHg
99
what type of breathing is this- deep, rapid, continuous respirations, as a results of metabolic acidosis, deep breaths and no expiratory pause and no expiratory between inhalation and exhalation
Kussmaul's Respiration
100
What type of breathing is- cyclic breathing in response to hypercapnia.. Smooth increases in respiratioins and the gradual decrease in respirations with a period of apnea 15-60 seconds. Due to decreased brain blood flow slowing impulses to the respiratory center
Cheyne Stokes
101
What type of inherited disorder is Cystic fibrosis ?
Autosomal recessive
102
What gene is the cause of cystic fibrosis
| What does it cause?
Cystic Fibrosis Trnsmembrane Receptor protein- CFTR
The defect prevents chloride transport and water movement leads to buildup of thick, viscous, mucous in lungs, pancrease, liver, intestines and reproductive tracts then leads to obstructive lung disease and exocrine gland dysfunction
103
Cystic fibrosis is most common in which race?
| what is the survival age?
white - caucasians
Northen europeans
1 in 3,000
median age of survival 36.8 years
104
What are the top s/s of Cystic Fibrosis
- Young with brochiectasis
- pancreatic insufficiency
- growth delays
- infertility
- full term infant with meconium ileus at birth (meconium is thicker than ususally and causes an obstruction)
- Pancreatic insufficiency - steatorrhea, bulky pale/foul smelling stool, *Vitamin deficiency A, D, E, K
- Recurrent pulmonary infections- Pseudomonas, Staph aureus, productive cough, dyspnea, chest pain, chronic sinusitis
105
What is the inital test done for Cystic Fibrosis
Sweat chloride test with pilocarpine >60mmol/L on TWO occasions
(pilocarpine is a cholinergic drug that increases sweat)
106
What is the most common cause of bronchiectasis in the untied states
Cystic Fibrosis
107
What will a CXR of Cystic Fibrosis show?
if infected with Bronchiectasis
hyperinflation of the lungs
CT- medial/proximal airway dilation lacking tapering and thick walls "tram-track" appearance
Signet ring sign* - pulmonary artery with dialted bronchus
108
What would be common to find on sputum cultures with cystic fibrosis
pseudomonas aeruginosa
Haemophilus influenza
staph aureus
109
what would a Pulmonary function test show with Cystic Fibrosis
Obstructive - irreversible
110
Treatment for Cystic Fibrosis
1. Airway clearance- bronchodilators, mucolytics, antibiotics, decongestants
2. pancreatic enzyme replacement- Vitamin A,D,E & K supplments
3. Lung and pancreatic transplantation
111
What will PFT's show with Obstructive disorders?
increased lung volumes
hyperinflation- High TLC, RV, FRC
obstruction- decrease FEV1, FVC As
112
Asthma
Bronchiectasis
Cystic fibrosis
All these are what type of lung disorder
Obstructive disorders
113
what is the patho of Bronchiectasis
Inflamed medium bronchi leads to dilation causing
1. destruction of muscular and elastic tissues of the bronchial wall
2. collapse of airways from inflammation
3. obstruction of airflow
4. impaired clearance of mucous = lung infections
114
What are common organisms that are present in Bronchiectasis
MC cause is Cystic fibrosis
H influenza
Pseudomonas* most common with CF
M. Catarrhalis
115
What are s/s of Bronchiectasis
Chronic cough that is daily with thick mucopurulent foul smelling sputum
hemoptysis (erosion of bronchial arteries) *massive amounts
Presistent crackles at the bases
clubbing, wheezing, rhonchi
116
What will a CT of Bronchiectasis show?
```
airway dilation
lack tapering of bronchi
bronchial wall thickening *tram-track
mucopurulent plugs
Signet ring sign
```
117
What are Signet rings?
Dilated pulmonary arteries
118
What pathogen is most commonly found in a cystic fibrosis patient with bronchiectasis
**** Pseudomonas
119
what is the treatment for Bronchiectasis with Aspergillus
* thick brown sputum
Corticosteroids + Itraconazole
if sxatic aspergilloma = Surgical
120
Treatment for Bronchiectasis
```
Antibiotics - empiric = ampicillin, amoxicillin
pseudomonal coverage = fluoroquinolone
*antibitic cycling may be used
Mucus managment
Chest physiotherapy
broncodilators
anti-inflammatory
surgery
embolization for bleeding
transplant
```
121
What is a reversible hyperirritability of the tracheobronchial tree resulting in broncoconstriction and inflammation
Asthma
122
What is the atopy most common predisposing factors
1. Asthma
2. Nasal polyps
3. ASA/NSAID allergy
4. Eczema
123
What does bronchoconstriction in asthma lead to?
airway narrows because of smooth muscle contrction, edema and thick mucous secretions.
the constrictions lead to air trapping causing obstructioin and decrease in expiratory air flow and increase airway resistance = increased work of breathing
124
What types of cells lead to inflammation responds in asthma?
```
T lymphocytes
Neutrophils
Eosinophils
Cytokines = leukotrines
Histamine releasing from mast cells * IgE mediated
```
125
What is causes the airway hyper-reactivity in asthma?
Early - IgE
later T-Cell
Extrinsic- allergic triggers pollen, mold, dust
Intrinsic- nonallergic triggers - infections, drugs, occupations, exercises, emotions, cold air
126
Key symptoms for this diagnosis- Dyspnea, wheezing and coughing at night*
Asthma
127
What are some clues to know how well the asthma is controlled?
1. Steroid use
2. previous intubations, ICU, hospital admissions
(>2 times a year or >3 times in one month)
3. How often waking up at night coughing
128
Is Asthma an inspirational or expirational wheeze ?
proonged expirational wheeze with hyperresonance
| decreased breath sounds
129
What is Status asthmaticus defined as?
1. inability to speak in full sentances
2. Peak expiratory flow <40% predicted
3. altered mental status
4. pulses paradoxus (inspration SBP drops >10
5. tripod position
6. silent chest ! no air exchange
130
What is the best way to objectively asses severity and patients response in the ED in Asthma ?
Pea kExpiratory Flow Rate- PEFR
| > 15% from inital response shows responding to treatment
131
What level of Po2 would indicative of respiratory distress in an infant or child?
<90%
132
What is the gold standard to diagnosis asthma ?
Pulmonary function test - RV, TLC, RV/TLC ratio
133
What will the pulmonary function test show with asthma
RV?
TLC?
RV/TLC?
Increase residual volume - RV
Increased Total lung capacity
Increased RV/TLC ratio
134
what if the PFT are normal ? what is the next step?
Induce bronchospasm/bronchodilator test using medication and measure the FEV1
135
What drugs are used in the Bronchoprovocation testing for asthma?
what is positive?
1. Metacholine
+ is >20 % drop in the FEV 1
2. bronchodilator
+ is an increase >12% in FEV1
136
Exercise induced asthma test is positive when?
>15% drop in FEV1
| while exercising of course
137
What would an ABG show in Asthma attack?
Respiratory Alkalosis
138
What peak expiration flow would you admit the patient with?
```
<50% predicted
= < 15% inital value
200cc
FEV < 1L
ER visit with in 3 days of exacerbation
altered mental status
```
139
What peak expiration flow can you discharge a patient with?
>70% predicted
>15% initial
clear lungs with good air movement
will follow up in 24-72 hours
140
What is first line asthma treatment for acute attack?
Albuterol - proventil
Terbutaline
Epinephrine
levalbuterol
141
What is the MOA for a Short acting beta agonist
```
Bronchodilator - especial peripheral
decreases bronchospasm
inhibits the release of bronchospastic mediators
increases ciliary movement
decreases edema
```
142
How are SABA's given
| how often?
Nebulizers most common in ED
| q 20 minutes x3 doses
143
What are side effects of SABA's
albuterol- tachycardia, arrhythmias, muscle tremor, CNA stimulation
144
What Anticholinergic is used for treatment of asthma?
Ipratropium- atrovent
145
MOA for what drug- Central bronchodilator that inhibits vagal medicated bronchoconstriction and inhibits nasal mucosal secretions
Anticholinergics- Ipratropium
146
What are side effects of Ipratropium
```
anticholinergic-
thirst, blurred vision
dry mouth
urinary retention
dysphagia
acute glaucoma
```
147
What anti-inflammatory is used in mod-severe asthma attacks?
Prednisone
Methprednisone
Prednisolone
148
What is the onset of action of oral and IV steroids in asthma?
4-8 hours
| will decrease relapse and reverses the late pathophysiology
149
What are side effects of systemic corticosteroids?
```
Immunosuppression
hyperglycemia
fluid retention
osteoprosis *
cataracts
Growth delay*
```
150
Becloethasone
flunisolide
triamcinolone
are all what class of medications?
Inhaled corticosteroids
151
Ipratropium is what class of medicaiton?
Anticholinergic
152
Albuterol
terbutaline
epinephrine
are all what class of medications
B2 agonists - short acting - SABA
153
What is the drug of choice for long term persistent asthma ?
Inhaled corticosteroids - ICS
Becloethasone
flunisolide
triamcinolone
154
What are side effects of of inhaled corticosteroids?
Thrush *
| use a spacer and rise the mouth
155
Salmeterol
symbicort
advair diskus
are all what class of meciations?
Inhaled corticosteroids
156
what do you add on to persistent asthma that is not controlled with ICS alone?
long acting B2 agonist - LABA
157
If a patient is on ICS and LABA what is the next step if controlled?
if controlled >3 months
| step down off LABA
158
Cromoly
Nedocromil
are all what class of medicaitons
-what are they used for?
Mast cell modifier
| used for inhibits acute phase response to cold air, exercise, sulfites
159
Montelukast
Zafirlukast
Zileuton
-are all what class of medications?
Leukotriene Modified
160
Leukotriene modifiers are used for what ?
asthmatics with allergic rhinitis
| aspirin induced asthma
161
What medication is used in asthma that is a bronchodilator that improves respiratory muscle endurance
Theopphylline
162
What are side effects of Theophylline?
nervousness, nausea, vomiting, anorexia, headache, numerous drug interactions
* Narrow TI- toxicity causes arrhythmia and seizures
* need higher dose in smokers
163
What medications are used in severe asthma?
IV magnesium
Ketamine
Heliox
Omalizumab - severe uncontrolled asthma
164
When are intermittent symptoms of asthma occurring?
- How often are they using a rescue inhaler
- How often are they waking up from coughing?
- How often does it effect activity?
- Lung function levels?
```
<2 times a day and <2 a week
using albuterol <2 times a day or <2 times a week
waking up at night less than 2 a month
Does not effect activity
FEV1 >80%
```
165
When are MILD symptoms of asthma occurring?
- How often are they using a rescue inhaler
- How often are they waking up from coughing?
- How often does it effect activity?
- Lung function levels?
```
> 2 days a week
but not daily
using albuterol >2 times a day or week
waking up at night 3-4 times a month
has minor effect in activity
FEV1 >80%
```
166
When are MODERATE symptoms of asthma occurring?
- How often are they using a rescue inhaler
- How often are they waking up from coughing?
- How often does it effect activity?
- Lung function levels?
Daily
using albuterol daily
waking up at night more than 1 a week - not every night
has some limitation in activity
167
When are SEVERE symptoms of asthma occurring?
- How often are they using a rescue inhaler
- How often are they waking up from coughing?
- How often does it effect activity?
- Lung function levels?
```
Throughout the day
Several times a day
using albuterol several times a day
waking up every night coughing
extremely limited in activity
FEV1 <60%
```
168
What is the treatment intermittent asthma
Albuterol as needed
169
what is the treatment for mild asthma
Albuterol
| ICS low dose
170
what is the treatment for moderate asthma
```
Abluterol
ICS low dose + long acting
OR
ICS bump up dose
OR
Leukotrine
```
171
what is the treatment for severe asthma
Albuterol
ICS high dose + long acting
can add Omalizumab
