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CPR Exam 4 > Arfoosh: Asthma > Flashcards

Arfoosh: Asthma Flashcards

1
Q

What are 5 common triggers of asthma?

A 
Allergens
Exercise
Cold Air
SO2
Particulates
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2
Q

What are the 4 things that occur in airway remodeling due to asthma?

A 
FIBER, MUSCLE, BLOOD, and BOOGERS
Sub-epithelial fibrosis
Increased muscle mass
Angiogeness
Mucus gland hyperplasia
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3
Q

In asthmatic patients, is peak air flow (FEF) higher or lower in the morning compared to the evening?

A

Lower in the AM

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4
Q

What will be common physical exam findings of an asthmatic patient?

A
  • Increase in RR, HR
  • Pulsus Paradosux (systemic drops by 10 or more on inhalation)
  • Hypoxia
  • accessory ventilation muscle use
  • hyper-inflated chest
  • prolonged inspiratory phase with ronchi and wheezing
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5
Q

What is the standard workup for an asthmatic patient to assess their level?

A 
CBC with diff
IgE
Peak Expiratory flow or Spirometry
CXR
Allergy skin test (not routine)
ABG (in severe cases)
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6
Q

What are some complaints your patient may have that will clue you in on a dx of asthma?

A
  • frequent wheezing
  • cough at night
  • cough/wheeze after exercise
  • colds “go to chest” or take >10d to clear
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7
Q

If your patient has a normal FEV or FEV/FVC, does that rule out asthma?

A

Nnnnnope.

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8
Q

To see if your patient is asthmatic, what test can you perform to trigger its effects?

A

Metacholine test: positive will show a 20% drop in FEV and will be reversed with bronchodilator.
(this is a somewhat weak positive predictor and a strong negative predictor. if there’s a 20% drop after the first or second dose = asthma. if there’s a 20% drop or less after 3,4,ot5th dose, you might have asthma but probably not.)

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9
Q

Ipratropium is a (short or long-acting?) reliever that acts on which receptors?

A

Muscarinic

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10
Q

What is the response of inhaled corticosteroids?

A 
Anti-inflammatory
Upregulate B Agonist receptors
Decrease airway hyper-responsiveness
reduce exacerbation
reduce asthma-related mortality
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11
Q

What are salmeterol and formoterol?

A

Long-acting B2 agonists (meter/motor)

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12
Q

How long does bronchodilation last with long-lasting B2 agonists?

A

12 h

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13
Q

Can you use B2 agonists as a rescue medication?

A

No

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14
Q

What should always be used together with a long-acting B2 agonist?

A

ICS

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15
Q

In order to treat asthma in aspirin-sensitive patients or patients with virus-induced-wheezing, what can you use?

A

Leukotriene modifiers

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16
Q

How does Theophyline work and why must you be careful with dosage?

A

Phosphodiesterase Inhibitor; narrow therapeutic window (GI and cardiac SE)

17
Q

How can you treat your patient that is already on a higher corticosteroid dose and continues to have attacks, and is showing elevated IgE?

A

Omizulab: binds IgE

18
Q

What can you use in your patient (hospitalized, non-hospitalized) that has severe, persistent uncontrolled asthma?

A

Prednisone (non-hospital)

Methylprednisone (hospital)

19
Q

Your patient has daytime sx and need for rescue inhaler less than twice a week, normal lung function, and no limitations of activities or sleep disturbance. Is this patient’s asthma controlled, partly controlled, or uncontrolled?

A

Controlled

20
Q

Your patient has daytime sx and need for rescue inhaler more than twice a week, less than 80 of personal best lung function, and occasional limitations of activities and/or sleep disturbance. Is this patient’s asthma controlled, partly controlled, or uncontrolled?

A

Partly controlled; 3 or more of these factors is uncontrolled

21
Q

List the 5 characteristics that describe the level of control in an asthma patient.

A

Daytime sx, activity limitation, sleep disturbance, need for rescue inhaler, and lung function (3 or more in any week is considered uncontrolled)

22
Q

***Treatment options for asthma in steps 1-5.

A

Step 1, select one: rapid-acting B2 agonist as needed
Step 2, select one: low-dose ICS or Leukotriene modifier (cheaper)
Step 3, select one: Low-dose ICS plus LABA, OR med or high-dose ICS OR low-dose ICS plus leuko OR low-dose ICS plus sustained release theophylline
Step 4, select one or more: med or high-dose ICS plus LABA OR leuko OR sustained release theophylline
Step 5, add either to step 4 tx: oral glucocorticosteroid (lowest dose) OR anti-IgE tx

23
Q

ED asthma management, initial assessment shows FEV or PEF >40%. What is your treatment and follow-up?

A
  • O2 (need >90%)
  • SABA (inhaled, nebulizer or MDI with valved holding chamber, up to 3 doses in first hour)
  • oral systemic corticosteroids if no response (or if patient recently took that already)
    F/U: repeat assessment
24
Q

ED asthma management, initial assessment shows FEV or PEF

A
  • O2 (need >90%)
  • high-dose SABA plus ipratropium (inhaled, nebulizer or MDI with valved holding chamber, every 20 mins continuously for 1 hour)
  • oral systemic corticosteroids
    F/U: repeat assessment
25
Q

ED asthma management, initial assessment shows impending or actual respiratory arrest. What is your treatment and follow-up?

A
  • intubation and mechanical ventilation (100% o2)
  • nebulized SABA and ipratropium
  • IV corticosteroids
  • consider adjunct therapies
    F/U: admit to ICU
26
Q

ED asthma management, repeat assessment shows FEV or PEF 40-69% (moderate exacerbation). What is your treatment and follow-up?

A
  • inhaled SABA every 60m
  • oral systemic corticosteroid
    F/U: continue tx for 1-3h; make an admit decision in
27
Q

ED asthma management, repeat assessment shows FEV or PEF

A
  • O2
  • nebulized SABA
  • oral systemic corticosteroids
  • consider adjunct therapies
28
Q

ED asthma management, after your repeat assessment, what is your follow-up?

A
  • If good response (>70% and sustained 60m after last tx, no distress, normal PE): D/C home, con’t with SABA, corticosteroid, consider ICS initiation, patient education
  • If incomplete response (40-69%): Hospital Ward, O2, inhaled SABA, corticosteroid (oral or IV), monitor (once they improve, step down to D/C home with the above tx)
  • If poor response (

CPR Exam 4 (23 decks)

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