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Therapeutics > Respiratory (Asthma/COPD) > Flashcards

Respiratory (Asthma/COPD) Flashcards

1
Q

What is Tidal Volume

A

Air exhaled during normal respiration

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2
Q

What is inspiratory reserve volume

A

Maximum air inhaled above TV

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3
Q

What is expiratory reserve volume

A

Maximum air exhaled below the tidal volume

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4
Q

What is residual; volume

A

Volume of air remaining the in lungs after maximal expiration

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5
Q

What sum equates to the total lung capactiy

A

Tidal volume. inspiratory reserve volume, expiratory reserve volume, residual volume

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6
Q

What is the airflow measure FEV1

A

Patient inspires to Total lung capacity and exhales maximally.

This value is the volume of air exhaled in the first second FEV1

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7
Q

What is the FEV1/FVC ratio

A

This helps to differentiate the restrictive from obstructive lung disease (Its a percent of the total air that an individual can breath out from TLC)

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8
Q

What is FVC or forced vital capacity?

A

Total volume of air expired as rapidly as possible from TLC

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9
Q

What are the 3 main Pulmonary function tests?

A

Spirometry
Peak Expiratory Flow Meter
Carbon monoxide diffusing capacity (DLCO)

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10
Q

What is the best tool we have for testing lung funciton/

A

Spirometry

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11
Q

What are the results compared to for spirometry for asthma

A

Predicted normals OR
Patients Personal Best

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12
Q

What indices are measured during a spirometry test?

A

FVC
FEV1
FEV1/FVC ratio

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13
Q

What contraindicates exist with spirometry

A

Intracranial or intraocular pressure
Increase in intrathoracic and intra abdominal pressure
Increases in myocardial demand or changes in BP
Risk of Infection

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14
Q

What happens to the FEV1/FEVC ratio in obstructive lung disease

A

FEV1 is decreased as well FVC is also decreased, but not as much. Hence, the FEV1/FEVC ratio is decreased

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15
Q

What happens to the FEV1/FEVC ratio during restrictive lung disease?

A

The ratio either increases or remains the same

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16
Q

What are pulmonary function tests?

A

They are generally tests used to determine the effects of an inhaled 2 agonist or similar therapy.

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17
Q

What is the considered reversibility in FEV1?

A

12% (Usually >0.2L)

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18
Q

What is Peak Expiratory Flow Rate?

A

This is usually a patient device that i used for self monitoring and use a comparison against personal bests or predicted values

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19
Q

What is the carbon monoxide diffusing capacity used to measure?

A

Generally medication side effects

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20
Q

How do we interpret Acid-Base Disturbances (5 steps)

A

Check the pH

Determine the primary cause of the disturbance
- Check the PaCO2
- Check the Bicarbonate

Check for compensation/correction

Calculate the Anion Gap (AG)

Check PaO2 and O2S

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21
Q

What is the formula for Anion Gap

A

AG= Na+ - (Cl + HCO3)

Normal range 3-11 mmol/L

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22
Q

What is the range for normal physiological pH

A

7.35-7.45 (7.40)

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23
Q

What is the normal paO2

A

90-100mmhg

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24
Q

What is the normal PaCO2

A

35-45 mmHg

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25
Q

What is the normal HCO-

A

22-26mmol/L

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26
Q

In respiratory acidosis what happens to the PH, HCO3, PaCO2, Compensation

A

Decrease Ph, Normal HCO3, Increase PaCO2, Increased HCO3

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27
Q

In Respiratory alkalosis what happens to the PH, HCO3, PaCO2, Compensation

A

Increased Ph, Normal HCO3, Decreased PaCO2, Decreased HCO3

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28
Q

In Metabolic acidosis what happens to the PH, HCO3, PaCO2, Compensation

A

Decrease Ph, Decreased HCO3, Normal PaCO2, Decreased PaCO2

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29
Q

In Metabolic Alkalosis what happens to the PH, HCO3, PaCO2, Compensation

A

Increased Ph, Increased HCO3, Normal PaCO2, Increased PaCO2

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30
Q

What is the general Etiology of asthma?

A

Genetics
Sex (Male over female childhood)
Females in later life
Obesity

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31
Q

What is atopic asthma?

A

Allergy to antigens
Offending allergens are suspended in the air
1/2 children and young adults

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32
Q

What is non-atopic asthma

A

Secondary to chronic/recurrent infections
Hypersensitivity to bacterial/viruses

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33
Q

What is Type 2 Asthma

A

(Atopy)
Early onset allergic
Later onset eosinophillic asthma

Excersize induced asthma

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34
Q

Type 1 Asthma?

A

(Non-Atopic)
Obestiy
Late onset
Smoking related
Comorbidities

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35
Q

What is the adult criteria for asthma?

A

FEV1/FVC ratio <75-80%

Where it improves 12% and 0.2L imporvement post SABA or Beta 2 quick acting agonist

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36
Q

What are we looking for post treatment with a SABA for indicating asthma?

A

We are looking for an increase in FEV1 after a bronchodilator or after course of controller therapy

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37
Q

What are the number of daytime symptoms deemed acceptable for asthma control?

A

<2 days/week

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38
Q

What is the definition of controlled asthma for the need for a reliever (SAB or BUD/FORM)

A

<2 doses per week

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39
Q

What is the primary reliever medication that is utilized?

A

SABA (Shorta acting beta adrenergic agonists)

40
Q

What are the main SABA therapies?

A

Salbutamol
Terbutaline sulfate

41
Q

What are the main LABA therapies?

A

Sameterol (Partial agonist)
Formoterol (Full agonist)

(Vilanterol +Fluticasone)
(Indacterol+ mometasone)

42
Q

What is central to all pathogenesis of asthma?

A

Chronic Inflammation is central with ICS as the most effective anti-inflammatory management

43
Q

What are some examples of ICS? (6)

A

Fluticasone Proprionate
Fluticasone Furoate
Budesonide
Ciclesonide
Beclomethasone
Mometasone

44
Q

S/E of ICS

A

Dysphonia/throat irritation
URTI increase
Candidal oral infections
Growth retardation in kids

45
Q

What is the only available Leuokotriene Receptor antagonist?

A

Montelukast

46
Q

What are the side effects asociated with LRA?

A

Usually none it just must be taken regularly and do not abruptly substitute for inahled or oral steroid

47
Q

Who are LTRA therapy for?

A

Usually used for individuals who have suboptimal adherence to inhaled steroid or do not want to use an inhaled steroid

48
Q

What are the general combination products for asthma treatment?

A

This would be our LABA and ICS

49
Q

What are the 5 inhaled ICS and LABA combination products that we discussed in class?

A

Salmeterol+ Fluticasone (Advair)
Formoterol+ Budesonide (symbicort)
Formoterol + mometasone (Zenhale)
Vilanterol+Fluticasone (Breo)
Indacaterol+mometasone (Atectura)

50
Q

What is special about symbicort?

A

Symbicort is the combination product of formoterol and budesonide. (LABA + ICS) which can be used too as a resucue inhaler as opposed to using the SABA

SMART

51
Q

What are methylxanthines?

A

These are an add on in patients therapy who already require high dose CS.

Reserved for severe asthma

Requires consistent monitoring

52
Q

What is Omalizumab?

A

This is a S/C injection that is an anti- IgE antibody, hence reducing inflammation

53
Q

What are the current IL-5 inhibitors in the market?

A

Mepolizumab (Which is approved for asthma coverage in sask)

54
Q

What are some other therapies for severe asthma?

A

Tiotropium (LABA) and chronic use of macrolides

55
Q

What is considered overuse of SABA according to current guidelines?

A

2 inhalers of SABA in a year

56
Q

What is conisdered higher risk for an exacerbation is defined by (4)

A

History of severe asthma exacerbation
Poorly controlled asthma as per CTS
Overuse of SABA
Current smoker

57
Q

What is considered a severe asthma exacerbation?

A

Requires systemic steroid
an ED visit
Hospitalization

58
Q

What is considered a mild exacerbation?

A

an increase in asthma symptoms from baseline that does not require ED visit or hospitalizaton

59
Q

What is the severity classification treatment for very mild asthma? (Therapy)

A

PRN SABA only (Salbutamol or Terbutaline sulfate)

60
Q

What is severity classification treatment for mild asthma (Therapy)

A

SABA and ICS

if >12 they can use Symbicort PRN

61
Q

What is the severity classification for moderate controlled asthma (What therapy?)

A

Low dose ICS + second controller (LTA possibly) +prn SABA

OR

Moderate dose of ICS +- second controller medication and SABA prn

OR

Low moderate dose of Bud/form +prn bud/form

62
Q

How often should asthma be reviewd?

A

1-3 months after treatment started, then 3-12 months post

63
Q

How often during pregnancy should asthma be reviewed?

A

4-6 weeks

64
Q

What is a Peak expiratory flow meter used for?

A

Used in patients to monitor and measure their symptoms

Daily preventive management strategies

65
Q

How long after an exacerbation should asthma be reviewed?

A

Within 1 week

66
Q

When would we consider stepping up therapy for astham?

A

sustained step up for at least 2-3 months if asthma is poorly controlled

Short term for 1-2 weeks (Infection)

67
Q

What is short term step up?

A

When we increase therapy due to things like infections or increased presence of allergen

68
Q

What is sustained step-up?

A

When asthma is poorly controlled we will increase therapy for 2-3 months

69
Q

When should we consider stepping down therapy?

A

Only considered if >3 months of control and the goal is to find the lowest effective dose

70
Q

What steps/ general principles should be employed for stepping down controller treatment?

A

Record the level of symptom control and consider risk factors
Make sure patient has a written asthma action plan

Book a follow up appointment

71
Q

What can occur during ASA/NSAID induced asthma?

A

Chronic rhinitis, chronic nasal congestion
Inflammation in lower airway
Acute sensitization ot NSAIDS

72
Q

What is a Peak expiratory flow meter used for?

A

Used in patients to monitor and measure their symptoms

Daily preventive management strategies

73
Q

What medications should we avoid in patients with a severe asthma exacerbation?

A

Sedatives and hypnotics

74
Q

What is the treatment of acute severe asthma? (4)

A

SABA or Short Acting Anticholinergic agent every 20 minutes for 4-6 doses

Corticosteroids PO to improve symptoms within 2 hours. 7-10 day course

Oxygen

Maybe magnesium

75
Q

What is the peak expiratory flow for a mild to moderate exacerbation?

A

> 60% from person (PEF)

76
Q

What PEF should someone be admitted to hospital?

A

<60% personal best and is Deteriorating

77
Q

What are some none pharmacological asthma treatments we can utilize?

A

Scarf/Mask
Enhanced level of physical fitness

78
Q

In respiratory acidosis Ph ___ while paCO2 ___. In compensation HCO3 will ___

A

Decrease, Increase, Increase

79
Q

What can occur during ASA/NSAID induced asthma?

A

Chronic rhinitis, chronic nasal congestion
Inflammation in lower airway
Acute sensitization ot NSAIDS

80
Q

What is the management for ASA/NSAID induced asthma?

A

Leuokotriene antagonists

Low dose acetaminophen as tolerated

81
Q

Why are Beta blockers not generally warranted for asthamtics

A

Decreased response of beta agonists
Increased airway hyper responsiveness

82
Q

Is asthma control in pregnancy safe?

A

Yes. Basic therapies, with little evidence though for newer biologics

83
Q

What can uncontrolled asthma in pregnancy lead to?

A

Premature birth
Low birth weight
Maternal blood pressure changes

84
Q

What is Pulse Oximetry?

A

Utilizes light absorptive characteristics of hemoglobin to determin oxygenation levels

85
Q

In respiratory acidosis Ph ___ while paCO2 ___. In compensation HCO3 will ___

A

Decrease, Increase, Increase

86
Q

In respiratory alkylosis Ph ___ while paCO2 ___. In compensation HCO3 will ___

A

Increase, Decrease, Decrease

87
Q

In Metabolic acidosis Ph ___ while HCO3 ___. In compensation PaCO2 will ___

A

Decrease, Decrease, Decrease

88
Q

In Metabolic Alkylosis Ph ___ while HCO3 ___. In compensation PaCO2 will ___

A

Increase Increase Increase

89
Q

What are endogenous stimuli for asthma triggers?

A

Generated inside the body
Caused by stress gastroesophageal reflux disease (GERD), rhinitis

90
Q

What are Exogenous stimuli for asthma triggers?

A

those stimuli generated outside the body

91
Q

What are the side effects with inhaled corticosteroids

A

Dysphonia, hoarseness, throat irritation, cough

URTI increase

Candida oral infections

Growth retardation in kids

92
Q

What are the precautions of Inhaled corticosteroids

A

HPA-Axis suppression upon withdrawal

Long term steroid effects at high doses

Possible URTI increase risk

93
Q

When do we see an increase in asthma related hospitalization in children?

A

September. Back to school!

94
Q

Triggers of Asthma (Meds)

A

ASA/NSAIDS
Radiocontrast media
Beta blockers
Sulfites, benzalkonium, MSG

95
Q

Adult criteria for asthma diagnosis?

A

FEV1/FVC <75-80% predicted AND

12% improvement + 0.2L from baseline post quick acting 2 agonist

96
Q

children criteria for asthma diagnosis?

A

Reduced FEV1/FEV with a >12% increase in FEV1 post bronchodilator

97
Q
A

Therapeutics (10 decks)

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