Asthma

Question 0

Asthma characteristics

Answer 0

Bronchoconstriction
Inflammation
Airway remodeling

Question 1

Hallmark of asthma

Answer 1

Bronchial wall hyper-responsiveness

Question 2

What is the early phase of asthma reaction

Steps

Answer 2

Bronchoconstriction

• antigenic stimulation of bronchial wall
• mast cell degranulation releases: histamine, chemotactic proteolytics, heparin

Question 3

Late phase of asthma

Characteristics

Answer 3

Bronchial inflammation

• Cell recruited: neutrophils, monocytes, eosinophils,
• Release of cytokines, vasoactive, arachidonic acid
• Epithelial & endothelial cell inflammation
• Release of interleukin 3-6, interferon gamma

Question 4

What is FEV1/FVC

Answer 4

Used in dx of obstructive and restrictive lung disease

Begin to occur at 6 yo, in kids that ddeveloped symptoms by 3 yo.

Question 5

Atopy

Answer 5

Genetic predisposition to developing IgE response to common allergens

Question 6

What is the classic triad

Answer 6

Asthma
Nasal polyps
Aspirin allergy

Question 7

What virus is strongly associate with developing asthma in later years

Answer 7

RSV: respiratory syncytial virus

Question 8

What allergies increase risk for asthma

Answer 8

NSAIDS, ASA

Question 9

Definition

Answer 9

Reversible Airway obstruction
Airway inflammation
Increased bronchial hyper responsiveness

Question 10

What is the % of people that don’t recognize severe symptoms of their asthma

Answer 10

Symptoms accommodators 10%

Question 11

What do ace inhibitors induce

Answer 11

Bronchospasm

Question 12

Symptoms of asthma

Answer 12

Recurrent wheezes
Dyspnea
Productive or proximal cough
Chest tightness
Prolonged I/E ratio
Atopic eczema, urticaria, dermatitis

Question 13

X ray findings

Answer 13

1. Increased bronchial wall markings/inflammation
2. Flattening diaphragm
3. Chronic inflammation,
4. accessory muscle use
5. Hyperinflation
6. Patchy infiltrates

Question 14

Labs

Answer 14

ABG: hypoxemia, hypercarbia
CBC: eosinophilia
Increase IgE 
FENO, EBC
Sputum sample

Question 15

PFT test

Answer 15

+Metacholine challenge: causes bronchoconstriction

-rules out asthma , + false test

Question 16

What is Rule of 2?

Answer 16

> 2x a week during day
2x a month during night
2 inhalers a year
Any present = control is inadequate

Question 17

What are the categories of severity

Answer 17

Mild intemittent
Mild persistent
Moderate persistent
Severe persistent

Question 18

What is the pharmacological management of asthma, the general management strategy.

Answer 18

1. Corticosteroids-long term
2. Beta agonists-caution
3. Rx other factors: GERD, sinusitis
4. Prevent exercise & cold induced asthma

Question 19

First line agent & most common for reactive airway

Answer 19

Inhaled corticosteroid

Controls it, no cure, doesn’t modify

Question 20

What is Xolair?

Answer 20

• Immunomodulator
• Ant IgE therapy omalizumb: binds to FC portion of IgE antibody to prevent binding to receptors on mast cells
• Possible adjunct therapy

Question 21

Indicated for mild to severe asthma

Answer 21

Leukotriene receptor antagonist

Montelukast (Singular), accolate, zyflo

Question 22

Atrovent

Answer 22

Anti cholinergic

Question 23

Rx for peds cold & exercise induced asthma

Answer 23

Mast cell stabilizers
Cromolyn Na (intal), nedocromil (tilade)

Question 24

ER management for Asthma

Answer 24

1. Short acting beta agonist albuterol

2. Anticholinergic Atrovent

Question 25

Indications for systemic corticosteroids

Answer 25

FEV1 or PEF < 50%
No immediate response
PO Rx taken already

Question 26

Beta agonist

Use & side effects

Answer 26

Rescue

SE: tachycardia

Question 27

Adverse effects of inhaled corticosteroids

Answer 27

Dysphonia
Candidiasis
Glaucoma & cataract risk slightly increased
Osteoporosis

Question 28

What happens with uncontrolled asthma

Answer 28

Reduces linear growth

Question 29

MOA of leukotriene

Indications

Answer 29

Attentuate bronchoconstriction & inflammation

Mild to mod asthma

Question 30

Bronchospasm during anesthesia

Answer 30

• 100% O2
• Remove aggregating factors: light anesthesia, allergen, VA, secretion
• bronchodilation
• Beta agonist
• volatile agent

Question 31

Rx for branchospasm, aggressive

Answer 31

Epinephrine - nebulized
SQ 1:1000, 0.1-0.5 mg, may repeat 10-15 min
IV 0.1-0.25 mg, single dose MAX 1 mg

Question 32

Short acting beta agonist

Answer 32

Albuterol
Dose: multiple puffs (4-12) via ETT (2 in an awake pt)
Each MDI puff = 90 mcq

Proventil, ventolin, accuneb

Question 33

What other med & doses to use for pt status asthmaticus/ bronchoconstriction

Answer 33

Terbutaline - used also for premature labor
SQ: 0.25 mg may repeat x 1
IV: 10 mcq/kg over 2-3 min

Question 34

What are the last considerations

Answer 34

Magnesium sulfate

Heliox: helium + oxygen

Question 35

Which drug causes dose dependent adrenal suppression?

Answer 35

IV steroids: May & should be given as prophylaxis in steroid dependent patient

Question 36

What are some glucocorticoid pharm actions

Answer 36

Prolong therapy can atrophy adrenal cortex

Decreased healing diminished protective response to inflammation & immune response to infection

Question 37

Which group of med causes iatrogenic Cushing’s syndrome

Answer 37

Glucocorticoid

Question 38

MOA of glucocorticoids

Answer 38

Effect mediated by GC receptors

Decreased inflammation & increased capillary permeability

Question 39

Hydrocortisone dosing

Answer 39

Stress dosing ( replacement) for known adrenal suppressed or on chronic steroids
Minor 25 mg/day for 1-2 days
Mod 50-75 mg/day for 1-2 days
Major 100-150 mg/day for 2-3 days

Anti-inflammatory 15-240 mg q 12
Status asthmaticus 1-2 mg/kg q 6h x 24 h

Question 40

Dose of hydrocortisone for
Anti-inflammatory
Status asthmaticus

Answer 40

Anti-inflammatory 15-240 mg q12

Status asthmaticus 1-2 mg/kg q6 x 24hrs

Question 41

Churg Strauss syndrome is ass with

Answer 41

Leukotrienes

Question 42

Beta agonist rescue inhalers

Answer 42

Ventolin
Albuterol
Proventil
Accuneb