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Asthma Flashcards

1
Q

What cells are involved in an asthma attach?

A

mast cells, Eosinophils, neutrophils, T-lymphocytes, macrophages, epithelial cells

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2
Q

Can asthma be reversed

A

yes spontaneously or with treatmentthis is a big difference because you can not reverse COPD

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3
Q

what are Asthma risk factors

A

Innate ImmunityHost factor- geneticsEnvironment Factors

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4
Q

what are some symptoms of asthma

A

WheezingHistory of cough thats worse at night, trouble breathing

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5
Q

When do the symptoms of asthma tend to get worse

A

Exercise Viral infectionInhalant Agents Irritantschanges in weatheremotional responseStressMenstrual cycles

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6
Q

How is Asthma diagnosed

A

episodic symptoms of airflow obstruction or hyperresponsivenessAirflow obstruction is at least partially reversibleFEV1 of >200ml and >or= 12% from baseline measure after SABA

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7
Q

What are the goals of Asthma therapy

A

Reduce impairmentprevent symptomsrequire infrequent use of SABAmaintain norm. pulm functionmaintain norm. activity levelsmeet pt’s and Fams expectations and satisfaction with asthma care

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8
Q

How do you reduce the risk of asthma with therapy

A

prevent exacerbations and minimize ED visitsprevent loss of lung functionprevent reduced growth lung growthprovide optimal pharmacotherapy

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9
Q

what drugs belong to SABA beta 2 agonist?

A

AlbuterolLevabuterolPirbuterol

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10
Q

using a SABA more than 2 days a week indicated what

A

need to begin long term control medications

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11
Q

Ipratropium

A

Anticholinergicnot the preferred agentCan not use in Pts under 12MDI-2puffs every 6 hoursTake longer to workMore Side effects

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12
Q

Albuterol & ipratropium combo dosing forMDI-metered dose inhaledNeulizer

A

MDI- 1inh every 6 hoursNeb: 3ml every 6 hours

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13
Q

Why are low does inhaled corticosteroids preferred treatment for step 2

A

decreased the number and activity of inflammatory cells (better at reducing inflammation from eosinophils& neutrophilsInhibit bronchoconstrictor mech.

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14
Q

What are the side effects of Inhaled steroids

A

cough, dysphonia, oral thrush

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15
Q

what are the effects of high does inhaled steroids

A

Adrenal suppressionOsteoporosisskin thinningeasy bruisingcataracts

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16
Q

what are the effects of low dose inhaled steroids

A

growth suppression in childrengrowth velocity may be altered

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17
Q

What are Inhaled corticosteroids

A

BudesonideFluticasoneMometasoneCiclesonideBeclomethasone

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18
Q

What are step 2 alternatives to low dose inhaled steroidsage>12

A

Mast cell stabilizers: cromolyn (now only used via nebulizer)nedocromilLTRA(more effective)montelukast, ZafirlukastTheyophilline( has a lot of side effects) related to caffeine narrow therapeutic index

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19
Q

How do mast stabilizers work?

A

stabilize mast cellsblock chloride channelscan be used as preventative therapy for exercise unknown allergiesgreat safety profile but questionable efficacy

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20
Q

What are LTRA drugs

A

Montelukast or Zafirlukastthey interfere with leukotriene mediators

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21
Q

What are things to watch for with people who are on LTRA

A

Think they start with L so they affect the liver (ALT)hepatitisCan cause depression in children (kids want to jump off a mountain)

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22
Q

How does Zafirlukast interaction and CYP problems

A

food decreases bioavailabilityCYP 2C9 inhibitorincreased warfarin levels

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23
Q

what is theophylline metabolized by?

A

CYP1A2 & CYP3A4

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24
Q

What is used for step 3 in asthmaticsage>12

A

Medium dose ICS (1st)or Low dose ICS & LABAor Low dose ICS+LTRA,theophylline, Zeluton

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25
what is really important about using a LABA
it has no anti-inflammatory properties never use as mono therapy
26
What is the black box warning with LABAs
increased risk of asthma exacerbation and asthma related death with regular use of LABA
27
what are two kinds of LABAs
Salmeterol and Formoterol (faster think stars with F like F1 race car)
28
what is so special about mometasone
you only need to take it once
29
what should be used in Step 4 asthmaage>12
medium dose+LABAorMed dose ICS+LTRAorTheophylline, or Zileuton or Tiotropium
30
what to use with step 5 asthmaticsAge>12
High dose ICS+LABA and consider omalizumab
31
what to use with step 6 asthmaticsAge>12
High dose ICS+LABA+ oral steroid and consider omalizumab
32
how does omalizumab work
bind to portion of IgE antibody preventing the binding to its high affinity receptor on mast cells and basophils
33
what are some adverse effects of omalizumab
urticaria and anaphylaxis
34
what are some oral steroids
prenisolone, prednisone, methylprenisolone
35
what are some non-pharmacologic treatment
avoid triggersremove carpetvacuumwindows closedair filters
36
what is the first line treatment for exercise induced bronchospasms
SABA
37
what is second like for EIB
LTRA
38
what is the last line for EIB
cromolyn
39
If a patient has asthma and GERD how do you treat them
treat the GERD because it is often that if you stop it that will relieve the asthma symptoms
40
what are COPD risk factors
smokingalpha1 antitrypsinoccupationair pollutioninfectionsocioeconomic status
41
what is the hallmark of COPD
dyspnea
42
what are some other classic symptoms of COPD
chronic coughsputum production
43
what are the two 24 hour long acting LABA
vilanterolindacterol
44
what is a 12 hour acting LABA
arformoterol
45
Why is tiotropium a better anticholinergic
more selective and has a higher affinity for muscarinic receptor
46
what has been shown to increase survival in chronic respiratory failure?
oxygenneed to have levels >90%
47
In COPD patients who experience exacerbations what is first line treatment
oxygen 1st then SABA2nd line-short acting anticholinergicsteroid
48
what 3 cardinal symptoms must present for use of antibiotics in an exacerbation
increased dyspneasputum volumesputum purulenceonly need two of the 3 symptoms if purulent sputum is one of them or a person on a ventilator
49
how long do you give the antibiotics for?
7-10 days
50
what are the nighttime awakenings for intermittentages 5yo> what is their stage?
less than or = 2Step 1
51
what are the nighttime awakenings for mildages 5yo> what is their stage?
3-4x/monthstep 2
52
what are the nighttime awakenings for moderateages 5yo> what is their stage?
>1x/week but not nightlystep 3
53
what are the nighttime awakenings for severeages 5yo> what is their stage?
7x/weekstep 4or5
54
what are the nighttime awakenings for intermittentages 0-4yo what is their stage?
0stage 1
55
what are the nighttime awakenings for mildages 0-4yo what is their stage?
1-2x/monthstep 2
56
what are the nighttime awakenings for moderateages 0-4yo what is their stage?
3-4x/monthstep 3
57
what are the nighttime awakenings for severeages 0-4yo what is their stage?
>1x/weekstep 3
58
For ages 0-4 what is step 1 asthma treatment
SABA
59
For ages 0-4 what is step 2 asthma treatment
Low dose ICS
60
For ages 0-4 what is step 3 asthma treatment
medium dose ICS
61
For ages 0-4 what is step 4 asthma treatment
medium dose ICS & montelukast or LABA
62
For ages 0-4 what is step 5 asthma treatment
high dose ICS & montelukast or LABA
63
For ages 0-4 what is step 6 asthma treatment
High dose ICS & montelukast/LABA & oral steroids
64
when would you consider stepping down asthma meds
when asthma has been controlled for at least 3 months
65
what is the treatment for age 5-11 step 1
SABA PRN
66
what is the treatment for age 5-11 step 2
Low dose ICSalternate:LTRA or theophylline
67
what is the treatment for age 5-11 step 3
med dose ICS or low dose ICS+LABA or LTRA or theophylline
68
what is the treatment for age 5-11 step 4
med dose ICS+LABAalternatemed dose ICS+LTRA or theo
69
what is the treatment for age 5-11 step 5
high dose ICS+LABAalternatehigh dose ICS+LTRA or theo
70
what is the treatment for age 5-11 step 6
high dose ICS+LABA+ oral steroidalternateHigh dose ICS+LTRA/theo+oral steroid

Pharmacology (14 decks)

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