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Flashcards in Pulmonary Deck (19)
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1
Q

Components of the atopic triad?

A

Allergic rhinitis, atopic dermatitis, asthma

2
Q

Definition of asthma for official dx purposes and when do we do Dx testing? (from peds lecture way back, maybe FYI?)

A

Only do spirometry on kids >5 y/o though! Don’t do it during acute attack!

12% increase in FEV1 or FCV post bronchodilator OR >20% decline in pearl flow w/sx OR >20% increase post bronchodilator. I dunno if that’s important. Who knows?!?! Usu asthmatics get sx before age 5 and it’s usu misdiagnosed!!!

3
Q

Key points about LABAs and differences btw Salmeterol and Fometerol

A
  • Both reduce the am’t of steroids you need to take
  • Never use LABA’s w/o access to SABA rescue inhaler too of course
  • Salmeterol is slower onset, Fomoterol is rapid onset
4
Q

Definition of asthma?

A

Intermittent, reversible airway obstruction, chronic airway inflamm, bronchial hyper-responsiveness (+/- mucus build up )

5
Q

Sx of asthma?

A

Coughing, usu nocturnal. Usu seasonal or response to specific exposures or duration

6
Q

Common triggers of pediatric asthma?

A

URI, exercise, weather, stress, irritants (tobacco, pets, cockroaches!?!?!, mold, etc), meds (BB, ASA, NSAIDS)

7
Q

What to give kiddo w/asthma first? know doses!!

A

SVN w/Albuterol (salbumamol): -0.083%, .15mg/kg
–min dos: 2.5 mg.
–max dose: 5mg)
–Q 20-30mins, up to 3 doses
(monitor vitals to assess efficacy and watch SE’s like tachycardia)
+/- Ipratropium (Anticholinergic) for second round of administration PRN

8
Q

What do you do after administering SABA to patient?

A

Do it again unless Sx completely resolve! (up to 3x)

9
Q

How do you begin management of a little wee tot with asthma? (Remember doses!)

A

-SABA:
Either: Albuterol HFA inhaler w/spacer 90mcg/spray dosed 1-2 puffs q 4-6hrs
OR: Albuterol Sulfate sol’n for nebulizer
SE’s: tachycardia, shakiness, HA, dizziness

AND Glucocorticoid: Prednisolone 15mg/5ml or Prednisone oral 5mg/5ml dosed 1-2 mg/kg/d in divided doses for 3-5d. SE’s: anxiety, agitation, insomnia, hunger, etc.

10
Q

Now the child has nighttime symptoms and his business is not being dealt with by the SABA and steroid. What next? (remember doses)

A

-Now you move to the low dose inhaled glucocorticoid OR (leukotriene R antagonist) Montelukast or Chromolyn
(More on leukotriene R antagonists on next card)

11
Q

Everything about Leukotriene R antagonists

A
  • Indications: asthma, allergic rhinitis, exercise induced bronchospasm
  • -Dosing for 1-6 y/o: 4mg QD
  • -Dosing for 6-15 y/o: 5mg QD
  • -Dosing for >15 y/o: 10mg QD
  • -SE’s: URI, F, HA, MOOD CHANGE/DEPRESSION, VASCULITIS
12
Q

What to do if current tx no longer working?

A

D/C and go to recommended tx for that level of asthma (if doing an alternative to 1st line, like using Monoleukast instead of inhaled low dose glucocorticoid) before going up a level.

13
Q

Everything about low dose ICS

A

Fluticasone HFA (Flovent)

  • -44mcg/inhalation, 2 puffs BID
  • -Don’t use the Diskus for kids
14
Q

What does COPD looks like?

A

inc AP diameter, thin, wheezing, crackles, rhonci, sputum, cough, you get the idea. Can have an exacerbation…

15
Q

Tx for ACUTE COPD exacerbation?

A
  1. Bronchodilator (SABA and +/- SAMA)
  2. Glucocorticoids–Prednisone 40mg PO d for 5d
  3. ABX, Macrolide or Fluoroquinolone 1st. (b/d usu H. flu, S. penuemo, M. catt, Pseudomonas involved. )
    - -She also said give the old guy: Albuterol/Ipratroprium combo SVH (then recheck vitals, PE)
  4. F/U in 2-3d if not improving. F/U in 2 wks to check PFT’s and recheck BP.
16
Q

Everything about Albuterol

A
  • SABA (B2)
  • For RESCUE
  • “buterol”
  • onset in 20 mins, works for 4-6hrs
  • SE: nervousness, shaky, inc HR, upset stomach, insomnia
17
Q

Salmeterol/fluticasone

A

LABA+ICS
-For CONTROL
-lasts up to 12hr
SE: same as SABA plus thrush and hoarseness d/t steroid

18
Q

Tiotroptrium & Ipratroprium

A

-Anticholinergics (antimuscarinic/muscrarinic R antagonists)
-For relief/bronchodilator
-Ipratroprium bromide is short acting and cab be a rescue too. 4x/d
-Tiotroprium bromide is long acting. Not for rescue. Once daily
SE’s for both: HA, DRY MOUTH, HOARSNESS, cough, N, blurred vision, dizziness

19
Q

Criteria for O2 therapy for COPD

A

indicated if pO2