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EOR Family med > Asthma > Flashcards

Asthma Flashcards

1
Q

asthma

A

reversible, often intermittent, obstructive disease or the small airways

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2
Q

pathophysiology of asthma

A

airway inflammation, airway hyperactivity, bronchoconstriction

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3
Q

what type of hypersensitivity reaction is asthma

A

type 1 hypersensitivity rxn

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4
Q

RF for asthma

A

atopy strongest risk factor
FHx
pollution
obesity
environmental tobacco smoke
male

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5
Q

sx asthma

A

episodic dyspnea
wheezing
cough (especially at night)
may have chest tightness or fatigue

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6
Q

PE for asthma

A

wheezing and/or prolonged expiratory phase during normal breathing due to presence of airflow obstruction, hyper resonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles

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7
Q

when is wheezing most prominent in asthma

A

during expiration

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8
Q

severe asthma and status asthmaticus

A

inability to speak ion full sentences, “tripod” positioning, silent chest, altered mental status, pulses paradoxes (inspiratory BP drop > 10

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9
Q

what is the best and most objective way to assess acute exacerbation severity and patient response to tx in asthma

A

peak expiratory flow rate

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10
Q

what percent for peak expiroatry flow rate indicates tx response in asthma

A

PEFR > 15%

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11
Q

what PEFR value indicates respiratory distress in asthma

A

PEFR < 200 L/min

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12
Q

what might ABG show during mild exacerbation

A

respiratory alkalosis from tachypnea

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13
Q

what indicates need for mechanical ventilation in asthma

A

pseudo normalization of the PaCO2 or the combination of an increased PaCO2 and respiratory acidosis may indicate impending respiratory failure

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14
Q

are chest radiographs helpful in the diagnosis of asthma

A

no

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15
Q

airflow obstruction in asthma

A

decreased FEV1
Decreased FEV1/FVC <0.7
increased lung volumes due to hyperinflation: increased residual volume (RV), total lung capacity (TLC), and RV/TLC

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16
Q

significant reversibility in asthma

A

increase in 12% or more and 200 mL in FEV1 or FVC after inhaling a short-acting bronchodilator

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17
Q

what test can you do for asthma when asthma is suspected but baseline spirometry is normal or non diagnostic

A

bronchial provocation with Methacholine or Histamine

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18
Q

what will bronchial provocation testing show for asthma

A

a decrease in FEV1 20% or greater after exposure to methacholine

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19
Q

intermittent asthma

A

sx 2 or fewer times per week
2 or fewer awakenings due to sx per month
use of SABA two or fewer times per week
no interference with normal activity

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20
Q

tx for intermittent asthma

A

short-acting beta-agonist as needed

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21
Q

mild persistent asthma

A

sx > 2 times per week (but not daily)
3-4 episodes of night awakenings due to sx per month
use of SABA more than 2 times per week (but not daily and not more than once per day)
minor limitations to daily activity

22
Q

tx for mild persistent asthma

A

low dose inhaled corticosteroids
short acting beta agonist as needed

23
Q

moderate persistent asthma

A

sx daily
night awakenings due to sx at least once per week (but not nightly)
use of SABA on daily basis
some limitations in daily activity

24
Q

tx moderate persistent asthma

A

low dose inhaled corticosteroids plus long acting beta agonist or a medium dose inhaled corticosteroid plus a long acting beta agonist
short acting beta agonist as needed

25
Q

severe persistant asthma

A

sx daily
night awakenings every night
use of SABA multiple times per day
extreme limitations in daily activity

26
Q

tx severe persistent asthma

A

medium or high dose inhaled corticosteroid and a long-acting beta agonist plus LAMA and oral system corticosteroids

27
Q

short acting beta agonists

A

albuterol
levalbuterol
Terbutaline
Epinephrine

28
Q

ADE short acting beta agonists

A

tachycardia
arrhythmias
muscle tremors
CNS stimulation
hypokalemia

29
Q

anticholinergics (SAMA/LAMA)

A

Ipratropium
Aclidinium
Glycopyrrolate
Revefenacin
Tiotropium
Umeclidinium

30
Q

anticholinergics ADE

A

thirst
blurred vision (pupil dilation)
dry mouth
urinary retention
dysphagia
glaucoma
BPH

31
Q

corticosteroids

A

Prednisone
Methylprednisolone
Prednisolone

32
Q

ADE corticosteroids

A

immunosuppression
catabolic
hyperglycemia
fluid retention
osteoporosis
growth delays

33
Q

inhaled corticosteroids

A

beclomethasone
Flunisolide
Triamcinolone

34
Q

ADE inhaled corticosteroids

A

oral candidiasis
dysphonia

35
Q

long acting beta agonists

A

Salmeterol
ICS/LABA: Budesonide/Formoterol, Fluticasone/Salmeterol

36
Q

mast cell modifiers

A

Cromolyn
Nedocromil

minimal side effects

37
Q

Leukotriene modifiers/receptor antagonists

A

Montelukast
Zafirlukast
Zileuton

minimal side effects

38
Q

ADE Theophylline

A

nervousness
N/V
Anorexia
HA
Narrow TI: toxicity causes arrhythmias and seizures

39
Q

acute bronchitis

A

self-limited lower respiratory tract infection causing inflammation of the large airways

40
Q

most common cause of acute bronchitis

A

respiratory virus - Influenza A and B, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, rhinovirus

41
Q

bacterial causes of acute bronchitis

A

s pneumonia
h influenza
m catarrhalis
mycoplasma pneumoniae
chalmydia pneumoniae
bordetella pertussis

42
Q

when does acute bronchitis commonly occur

A

during winter months

43
Q

sx acute bronchitis

A

cough is hallmark - acute and persistent (1-3 weeks); initially nonproductive but later a productive cough with sputum may develop. presence of sputum is nonspecific.

URI sx - runny nose, sore throat, low grade fever, malaise, sore throat, HA, myalgias, fever — fever is rare in acute bronchitis

wheezing or mild dyspnea

44
Q

PE for acute bronchitis

A

often normal but both wheezing and honcho may be auscultated on PE
honcho usually clear with coughing

45
Q

dx acute bronchitis

A

clinical - acute onset of persistent cough (1-3 weeks) + no findings suggestive of pneumonia (fever, tachypnea, rales, hypoxia, or signs of parenchymal consolidation, such as dullness to percussion, decreased or bronchial breath sounds, rales, ego phony)

46
Q

chest radiographs for acute bronchitis

A

not needed - usually normal or nonspecific.
indicated when acute bronchitis cannot be distinguished from pneumonia

47
Q

tx acute bronchitis

A

self limited

48
Q

tx for cough in bronchitis

A

guaifenasin
dextromethorphan
benzonatate
codeine

49
Q

FEV1 and FCV for intermittent asthma

A

FEV1 > 80% of predicted
normal FEV1/FVC

50
Q

FEV1 and FVC in mild persistent asthma

A

FEV1 > 80% predicted
normal FEV1/FVC

51
Q

FEV1 and FVC in moderate persistent asthma

A

FEV1 60-80% predicted
FEV1/FVC reduced by < 5%

52
Q

FEV1 and FVC in severe persistent asthma

A

FEV1 < 60
FEV1/FVC reduced by > 5%

EOR Family med (25 decks)

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