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Unit 3- Asthma Flashcards

(58 cards)

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1
Q

Asthma definition

A

bronchoconstriction, airway inflammation, reversible airflow limitation

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2
Q

Asthma essentials of dx

A

episodic or chronic sx wheezing/dyspnea or cough

sx worse HS or early AM

prolong expiration and diffusse wheezing

limited airflow on PFT or positive bronchoprovacation challenge

reversibly airflow obstruction

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3
Q

Asthma more common in

A

males <14

blacks

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4
Q

asthma triggers

A

dust mites
cockroaches
cat dander
seasonal pollens

URI, rhinosinusitis, postnasal drip, aspiration, GERD, cold air, stress

tobacco, crack, coke, meth (increase sx and need for meds, decrease lung function)

air pollution

ASA/NSAID/tartazine dyes

workplace agents

catamenial- women during menses

exercise- during or 3 min after ends, peak 10-15 min, resolves by 60

cardiac- d/t HF

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5
Q

Cells present in asthma attack

A 
eosinophils
neutrophils
lymphocytes (t-cells)
IgE- central role in allergic asthma
IL-5: promotes eosinophilic inflammation

goblet cell hyperplasia> plugs airway c mucus> collagen deposit under basement membrane, hypertrophy of bronchial SM> airways edena, mast cell activation

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6
Q

Asthma predisposing factors

A 
genetics
obsetiy 
atopy-strongest predictor
tobacco exposure
RSV or viruses
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7
Q

Lifestyle modifiatons for asthma

A 
NO SMOKING
pets
humidity (keep indoor <50%)
eliminate carpet
limited stuffed toys (Wash weekly)
encase pillow and mattress in dust-mite proof
control cockroaches
avoid outdoor activity when pollution index high
avoid BB and sulfite- foods
get annual FLU
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8
Q

Asthma s/sx

A 
episodic wheezing
difficulty breathing
chest tightness
cough
excess sputum
attacks variable
occur spontaneously or triggers
worse at night
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9
Q

Physical exam for asthma

A 
nasal polyps
nasal mucosal swelling
increased secretion
eczema
atopic dermatitis
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10
Q

T or F: asthama has a prolonged inspiratory phase

A

FALSE

asthma has a wheezing or prolonged expiratory phase

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11
Q

Sign of severe asthma attack

A

globally diminished lung sounds
absent wheeze
use of accessory muscles (flaring and retractions)

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12
Q

asthma management steps

A
  1. eval severity (new dx, not on LABA)
    a. assess pt recall of
    previous 2-4wk and
    spirometry> assign
    severity
    b. more frequent and
    intense
    exacerbation=greater
    underlying disease
    severity
  2. iniate tx using stepwise approach
    a. tx purpose: pt has
    >=2 exacer. requiring
    PO steroids in past
    year> considered
    same at pt w/
    persistent asthma
  3. assess asthma control and adjust tx PRN
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13
Q

T or F: 0-4yr can not do lung function test

A

TRUE

d/t not being old enough to cooperate

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14
Q

NAEPP asthma dx and management

A
  1. Assess and monitor asthma severity and asthma control
  2. Pt education to poster partnership for care
  3. control environment factors and comorbid conditions affecting asthma
  4. pharm agents (2 categories)
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15
Q

NAEPP asthma dx and management - pt education

A

all pt should have written action plan that includes instructions for daily management and measures to take in response to change in status

be taught to reconize sx and control need for therapy

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16
Q

NAEPP asthma dx and management - control environmental factors

A

reduce exposure to irritants and allergens= may reduce med need

comorbid conditions = rhinisinusitis, GERD, obseity , OSA

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17
Q

NAEPP asthma dx and management - pharm agents

A

quick relievers= act directly to relax SM

long term (controllers)= act to attenuate airway inflamm. and taken daily to achieve and maintain control

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18
Q

T or F: NAEPP recommend using weekly anti-inflammatory therpy w inhaled corticosteroids for persistent asthma

A

FALSE

they recommend DAILY

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19
Q

SABA medications

A 
albuterol
levalbuterol
bitolrerol
pirbuterol
terbutaline

1-2 puffs
severe=6-12 q30-60min

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20
Q

SABA MOA:

A

relax SM> increase airflow and decrease sx

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21
Q

T or F: nebulized SABA are more effective

A

FALSE

DOES NOT offer more effective but DOES provide higher dose

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22
Q

What does repetitive ABA admin do

A

produces incremental bronchodilation

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23
Q

Alternative if SABA not working

A

Anticholinergics
corticosteroids
antimicrobials

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24
Q

Anticholinergic MOA

Study These Flashcards
A

reverse bronchospasm but NOT allergen or exercise induced.
Decrease mucus gland secretions

IPORATROPIUM BROMIDE

25
With intolerance to Beta 2 agonist of bronchospasms d/t BB what do you give
ANTICHOLINERGICS Iporatropium bromide
26
Corticosteroid MOA
systemic steroids are PRIMARY for pt w mod-severe exacer who dont respond promptly and completely to SABA reduce rate of relapse and speed resolution of obstruction Prednisone, methylprednisone
27
Antimicrobial MOA
consider likihood of acute bacterial RTI
28
Long term controllers examples
anti-inflammatory | long term bronchodilators
29
Inhaled corticosteroids
PREFERRED 1st LINE for persistent asthma use twice daily max response not usually observed for months dry powder inhales:not used w/ inhalation chamber systemic effects may be seen w/ high dose of steroids
30
Systemic corticosteroids
most effective in achieving prompt control of asthma during exacerbation in child and adult alternating days is preferred than daily tx requires concurrent tx w/ Ca and Vit D to prevent bone mineral loss avoid rapid discontinuation to prevent adrenal insufficiency
31
When do bone density test need to be done with systemic steroids
after 3 months
32
Mediator inhibitors (long term broncho)
Cromolyn sodium and nedocromil prevent sx, improve function with mild persistent or exercise induced effective before allergen exposure, dont relieve sx once present
33
Long acting beta 2 agonists (LABA)
Salmetrol and Formoterol Delivery: dry powder device MOA: bronchodilate up to 12 hr after single dose prevent sx, nocturnal sx, and prevent exercise induced SHOULD NOT BE used as monotherapy
34
T or F: LABA should be used as monotherapy
FALSE They have no anti-inflammatory effects need to be used with steroids
35
Anticholinergics, short acting muscarinic agents, long acting muscarinic agents
reverse vagally mediated spasms but not allergen or exercise 1. Ipratroprium bromide (SAMA): less effective than SABA 2. Tiotropium add on therapy: improve lungs and reduce frequency of exacerbation
36
Phosphodiesterase inhibitor
Theophylline use for mild dilation MOA: anti-inflammatory and immunodilator properties>enhances mucociliary clearance and strengthens diaphragmatic contracions MONITOR serum concentractions d/t narrow therapeutic range
37
Leukotriene modifiers
Zileutonn or Zafirlukast or montelukast Alt to low-dose inhaled steroids in pt with mild persistent, but as monotherapy are less effective than inhaled steroids
38
Omalizumab and Reslizumab
recombinant antibody that binds IgE without activating mast cells: TREATS severe asthma in 18 or older
39
Vaccinations for asthma
pneumovac and flu
40
Oral sustained release beta 2 agonists
reserved for pt with nocturnal asthma or persistent mod-severe who DO NOT respond to other therapies
41
Mild exacerbation
minor changes in airway function PEF>80% pt respond quick and full to inhaled SABA Can initiate inhaled steroid if not one one
42
T or F: doubling the dose of steroids is helpful in mild asthma
FALSE is not effective or recommended
43
Moderate asthma exacerbation
goal: correct HYPOXEMIA, reverse obstruction and reduce reoccurrence
44
T or F: systemic steroids should be given if peak flow if <50% baseline
FALSE should be given if <70% baseline or pt doesnt respond to several SABA tx
45
The improvement of ___ after ___ minutes correlates to the severity of asthma
FEV1 30 minutes
46
Acute (severe) asthma exacerbation
all pt should IMMEDIATELY get O2, high dose of inhaled SABA and systemic corticosteroids Albuterol repeat in 20 minutes x3 Ipratropium bromide:: reduce rate of hospitalization when added to inhaled SABA Short course PO steroids IV mag FEV1<25
47
When can you D/C pt home with severe asthma
when PEF or FEV1 has returned to 60% or more
48
What is contraindicated in severe asthma
``` mucolytic agents (may worsen cough and airflow) Hypnotics (d/t resp depression) ```
49
Tx for all asthma
SABA Albuterol as MDI 1 puff repeat q20 x3
50
How to dx <5 with PFT/spirometry
clinical judgement and assessment of sx
51
How to determine is obstruction is reversible
test before and after short acting dilator FEV1 FVC FEV1/FVC
52
FEV1
forced expiratory volume in 1 sec
53
FVC
forced vital capacity
54
FEV1/FVC
compared to reference norms for age, weight and gender Airflow indicated by reduced
55
A positive or negative response to bronchodilators confirms asthma
positive
56
Peak expiratory flow meters
handheld devised for personal manageent usually lowest when awakening highest several hours before midpoint of day measures in the AM before taking dilator and in afternoon after taking dilator 20% change in PEF suggest inadequate control
57
When to refer for asthma
atypical presentation or uncertain dx comorbid conditions: rhinosinusitis, tobacco, environmental allergies, bronchopulm mycosis suboptimal response to therapy not meeting goads after 306 months requires high dose steroids for control >2 course of prednisone in past 12 months life-threatening exacerbation require hospitalization in last 12 mo social or psych issues interfering with asthma
58
When to admit asthma to hospital
Poor response to SABA after 2 tx 20 min apart O2 <95 on RA inability to speak in sentences accessory muscles change in alertness PEF <50%

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