asthma Flashcards
what is asthma
chronic lung disease that inflames and narrows the airways
pathophys of asthma (4)
- bronchial inflammation and bronchoconstriction that affects all levels of the airway
- increases mucus secretion
- loss of barrier increases susceptibility to eosinophils, etc
- loss of enzymes that typicaly breakdown inflammatory mediators
what does PFT measure
amount and speed of air
- Test for airflow limitation & severity
- Assess for obstruction reversibility
- Identify restrictive airway pattern
what test does this
PFT
you should not use a bronchodilator within ____ of their PFT
48hrs
normal FEV1 to FVC ratio
at least 80%
FEV1/FVC of obstructive vs restrictive
- obstructive it is reduced
- restrictive it is normal
give examples of extrinsic/atopic triggers
pollen
mold
eggs and berries
give examples of intrinsic/nonatopic triggers
- nonallergic (leukotrienes, etc)
- environmental
give examples of EIB triggers
related to activity
* chlorine
* pollution
* hot/cold dry air
tx of EIB
- SABA 10 to 15mins before exercise
- controller meds
a way to self-monitor asthma
peak flow meter
what is the rule of two used for
- to decide if controller med is needed
state the rule of twos! (4)
- Using a rescue inhaler >2x/week?
- Wake up w/ sx >2x/month?
- Refill rescue inhaler > 2x/year?
- Peak blow at 20% below baseline w/ asthma sx?
what is the pulmonary index score (PIS)?
assessment tool for kids with acute asthma exacerbation
what is the pulmonary index score (PIS)?
assessment tool for kids with acute asthma exacerbation
- Used w/ MDI to minimize systemic absorption and limit local SE
- all ICS MDI should be used w/ this device in all patients
what device does this describe?
holding chambers
what three medications can be a trigger for asthma
NSAIDs
BB
Aspirin
decreases cellular migration and inhibits fluid release and accumulation of leukocytes –> reduction of inflammatory cells
what medications
inhaled ICS
inhibits the action of leukotrienes, which are a family of products generated from the metabolism of arachidonic acid in leukocytes
leukotriene antagonists (montelukast, zafirlukast)
stimulate B-2 receptors in airway cells to produce smooth muscle relaxation and bronchodilation caused by adenylyl cyclase activation to produce cyclic 3’5’ AMP
what medication
SABA
if you see patient presenting with asthma sx and they also have a nasal polyp, what should you be suspecting
aka Sampters triad?
aspirin induced asthma
how fast do SABAs work
5-10 minutes
if a patient with asthma develops influenza A, which flu medication would you want to avoid giving them? why?
Zanamivir bc increases risk of bronchospasm
green zone corresponds with ____ % of the best peak flow
80%
yellow zone corresponds with ____ % of the best peak flow
50-79%
bronchodilator that prevents sx (esp. Nocturnal asthma)
LABA (salmeterol, formoterol)
anti-inflammatory; All but the mildest exacerbations should be discharged on a short course of this
oral steroids
Hits B1 and B2→ long term use increases risk of cardiomyopathies!!!!
EPI
which class is always used in combo with ICS, only if persistent asthma is not controlled w/ ICS
LABA
Meds for pt w/ asthma + allergic rhinitis. Prophylaxis only
leukotriene antagonists
side effects of this class includes
- HA
- Mild-flu sx
- Aggressive behav., agitation
- hepatic issues (which specific med?)
Leukotriene antagonist
hepatic– zafirlukast
these are SE for?
- Euphoria, energetic
- Insomnia
- hunger
- cataracts
- moon face
first 3 are short term SE of Oral steroids
which med requires serum monitoring to avoid toxicities (5-15 mcg/ml) and multiple drug interactions
theophylline
- bronchodilator that improves resp. muscle endurance, PPD inhibitor which inhibits lekotriene synthesis and inflammation
- nonselective adenosine receptor antagonist
- requires higher doses in smokers
- used as long-term prophylaxis in select ppl
theophylline
