Asthma Flashcards
a chronic, obstructive, inflammatory lung disease characterized by increased airway responsiveness to stimuli that leads to bronchospasms and airway narrowing that is partially-completely reversible
asthma
pathophysiology in which inflammatory cells infiltrate the submucosa, smooth muscles around airways hypertrophy, or basement membrane thickens leads to ….
airway narrowing
pathophysiology in which there is increased intraluminal mucus accumulation that leads to resistance to air flow and occlusion to airways
goblet cell hyperplasia
pathophysiology in which there is an increased sensitivity to allergens and airway reactivity
denudation of airway epithelium
what 2 medication types can trigger asthma?
beta blockers
NSAIDs (aspirin)
pharmacotherapy that works on beta2 receptors and causes airway smooth muscles to relax, causing bronchodilation
beta-adrenergic agonists
what are 4 examples of short acting b2 agonists? (SABA)
albuterol
levalbuterol
metaproterenol
terbutaline
what are 3 examples of long acting b2 agonists? (LABA)
formoterol
arformoterol
salmeterol
why is formoterol so special? (LABA)
long acting with a quick onset of 3 minutes
what can repeated use of SABAs or LABAs lead to?
downregulation of pulmonary B2 adrenoreceptors
what would have a faster onset: nebulized albuterol or albuterol MDI with spacer?
nebulized albuterol
what do anticholinergics do? (2)
airway dilation
reduce mucous secretions
(block parasympathetic system)
what is an example of a short acting muscarinic agent? (SAMA)
ipratropium bromide
what are 2 examples of long acting muscarinic agents?
tiotropium
umeclidinium
what is used to reverse inflammation, may take months for maximum effect, and is given to all patients with persistent symptoms?
inhaled corticosteroids
what are 3 examples of inhaled corticosteroids?
fluticasone
mometasone
budesonide
what 2 combinations of corticosteroids with a LABA?
budesonide-formoterol
mometasone-formoterol
what type of corticosteroids are used to control exacerbations (burst therapy), and speeds recover and reduces relapses?
oral / injectable corticosteroids
what are 2 examples of corticosteroids that can be used for burst therapy?
prednisone
methylprednisolone
a pharmacotherapy that does not provide immediate effects but long-term use helps prevent chronic airway inflammation
leukotriene receptor antagonists
what is an example of a leukotriene receptor antagonist?
montelukast
a medication that is used in moderate-severe asthma that is not controlled by inhaled corticosteroids, but has a narrow TI
theophylline (PDI)
a medication that prevents mast cells from releasing histamine and leukotrienes, but is only effective if it is taken regularly and prior to exposure to trigger
cromolyn sodium
what cannot be done during an asthma exacerbation?
PFT
what would FEV1 prediction on PFT be to confirm airway obstruction/asthma?
less than 80%
what can be done to show a decrease in FEV1 by 20% or more to lend a positive result?
Only done if spirometry is inconclusive.
bronchoprovocation using methacholine
a monitor that shows quick measurement of forced expiration following full inspiration
peak expiratory flow measurement (PEF)
a patient presents with wheezing and increased difficulty breathing, chest tightness, cough +/- sputum, and symptoms often get worse at night. There is visible dyspnea, prolonged expiration, accessory muscle use, tripod position, and pursed lips. what are they experiencing?
asthma exacerbation
what is a red flag in an asthma exacerbation?
quiet breath sounds
what is the samter triad?
aspirin sensitivity
nasal polyps
asthma
what diagnostics should be done for a patient that is having an asthma exacerbation? (2)
blood gas
CXR
a patient that is hyperventilating, has decreased CO2, normal or elevated pH, normal SPO2, and normal or increased PaO2 is most likely experiencing what level of asthma exacerbation?
mild
a patient that is hyperventilating, has decreased CO2, elevated pH, and decreased SPO2 and PaO2 is most likely experiencing what level of asthma exacerbation?
moderate
a patient who has greatly increased CO2, decreased pH, SPO2, and PaO2 is most likely experiencing what level of asthma exacerbation?
severe
when would we have to order a CXR for patient with an asthma exacerbation?
infection is suspected - fever, sputum, fatigue
what are the 3 steps in emergent treatment for a patient that presents with an asthma exacerbation?
- apply oxygen
- SABA (albuterol) + SAMA (ipratropium)
- corticosteroids - oral or IV
in a patient with asthma exacerbation does not respond to any treatment with SABA, SAMA, or corticosteroids, what should we do? (2)
IV magnesium
intubate
