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WI-18 Pulmonary > Asthma > Flashcards

Asthma Flashcards

1
Q

atopy

A

genetic tendency to develop an IgE response to common environmental proteins

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2
Q

atopy results in

A

wheezing
eczema
season rhinitis

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3
Q

triggers of asthma

A 
URI 
Allergens 
cold 
exercise
latex
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4
Q

mc chronic dz in childhood

A

asthma

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5
Q

asthma and gender

A

mc in boys in childhood, equals out in adolescence

boys “out grow”

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6
Q

characterization of asthma

A
  1. Airway obstruction (mucous)
  2. airway hyperactivity (bronchial spasm)
  3. chronic airway inflammation (edema)
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7
Q

fundamental issue in asthma

A

immunological inflammatory response

prolonged local airway inflammation and hyper-responsiveness

hypersensitivity to triggers = over production of IgE and blockage of Beta-2 receptors

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8
Q

normal reaction to allergens in pulmonary system

A

non specific still causes activation of local inflammatory cells

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9
Q

pathophysiology of asthma

A

immune system activation causes release of leukotrienes, histamine and prostaglandins

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10
Q

immune system activation of asthma causes:

A

smooth muscle contraction

mucous hyper secretion

vasodilation with endothelial leak and local edema

impairment of mucociliary elevator

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11
Q

smooth muscle contraction

A

narrows the airway lumen and limits expiratory flow

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12
Q

mucous hyper secretion

A

clogging smaller airways and narrowing airway lumen of larger bronchioles

causes cough

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13
Q

vasodilation with endothelial leak and local edema

A

decreased ability to exchange oxygen

loss of lung compliance

narrowing airway of lumen

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14
Q

impairment of mucociliary elevator

A

decreased ability to remove allergens and particulates from the lung

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15
Q

anatomic results of pathophysiologic process

A
  1. mucosal thickening and infiltration of airway wall with inflammatory cells
  2. hypertrophied and contracted airway smooth muscle
  3. damaged bronchiole cells, exposing nerves to stimulation
  4. increased number of mucus glands, hyper secretion and plugging of airways
  5. airway remodeling and fibrosis
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16
Q

hygiene hypothesis

A

extreme hygiene results in a weakened immune system unable to self regulate

HYPERSENSITIVITY

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17
Q

triggers of asthma

A 
atopy 
exercise
URI 
GERD
weather 
tobacco
pollution
ASA/NSAIDS
hormones, emotions
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18
Q

exercise induced asthma

A

bronchospasm following exercise in patients with underlying asthma

tx: SABA prophylactic
dx: exercise challenge test or document in pts with asthma

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19
Q

GERD asthma

A

cough secondary to GERD

susceptible to lifestyle modifications, acid reducing medications (PPI)

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20
Q

clinical features of asthma

A 
wheezing 
cough 
SOB 
chest tightness 
accessory muscle use 
short sentences 
anxiety
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21
Q

wheezing

A

loudest in chest

does NOT clear with cough

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22
Q

coughing asthma

A

common presenting symptom

nocturnal, seasonal recurrence lasts >3 weeks, likely due to asthma

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23
Q

increased likelihood of asthma

A
  1. episodic symptoms
  2. personal history of atopy
  3. history of asthmatic symptoms
  4. triggers: exercise, allergen exposure, ASA, viral URI
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24
Q

decreased likelihood of asthma

A

lack of improvement following anti-asthma medications

onset of symptoms after age 50

history of prolonged cig smoking

concomitant symptoms

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25
Q

exam findings that support asthma diagnosis

A

play-bluish, swollen nasal mucosa

lichenifield plaques

nasal plus

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26
Q

diagnosis of asthma is based upon

A

clinical picture + pulmonary function testing

spirometry is diagnostic test of choice

27
Q

parameters of spirometry

A

FVC
FEV1
FEV1/FVC ratio

28
Q

peak flows

A

less accurate, can be done at home

need to be confirmed in office

allows us to measure progress

29
Q

diagnostics used in asthma

A 
pulse ox
PEF 
ABG 
allergy test
exercise challenge test
30
Q

classic CXR findings in asthma

A

mc - normal

hyperinflation, flat diapraghm

31
Q

medications to use with caution

A

non-selective COX inhibitors

non-selective BB

ACE I

32
Q

who gets spacers?

A

children and elderly

33
Q

benefit of nebulizer

A

facemaske or mouthpiece

long delivery without depending on patient use

delivers medicine deep into the lungs

34
Q

bronchodilators list (6)

A 
SABA 
LABA 
Anticholinergic
mg 
Combined alpha and beta 
Methylxanthines
35
Q

immunomodulators list (4)

A

ICS

leukotriene modifiers

mast cell stabilizers

systemic steroids

36
Q

SABAs

A

beta 2 agonists

rescue medicines

37
Q

ADRs of SBA

A 
hypokalemia 
palpitations 
tachycardia 
HTN 
angina
38
Q

LABAs

A

controller medications that prevent bronchospasm by relaxing bronchial smooth muscle

LONG lasting bronchodilator (>12 hrs)

39
Q

SABAs drug

A

albuterol (proventil, ventolin, ProAir)

Pirbuterol (maxair)

Levalbuterol (Xopenex)

40
Q

LABAs drug

A

Salmeterol (servant)

formoterol (foradil)

41
Q

LABA FDA

A

ALWAYS used with ICS

NEVER as a mono therapy

42
Q

ICS

A

controller medications that use local anti-inflammatory affect

high inflammatory activity with LOW systemic response

not for emergency use takes 1-2 weeks

43
Q

adjusting ICS in asthma

A

when initiating therapy start low, go slow

44
Q

ICS adr

A

local affects

oropharyngeal candidiasis

dysphonia

low risk systemic adverse affects

45
Q

leukotriene receptor antagonist

A

inhibits 5-lipoxygenase (zileuton) or competitive inhibition of leukotriene (montelukast, zafirlukast)

46
Q

advantages of leukotriene receptor antagonist

A

improve FEV1

decrease asthma symptoms

oral therapy

47
Q

list of leukotriene receptor antagonist

A

Zilueton (Zyflo)

Montelukast (Singular)

Zarfirlukast

48
Q

disadvantages of leukotriene receptor antagonist

A

not as effective of ICS

linked to risk of suicidal thoughts and depression

49
Q

Cromolyn

A

mast cell stabilizer

only effective by inhalation

minimal adverse effects but not as effective as ICS

50
Q

Omalizumab (Xolair)

A

monoclonal Ab targeting Fc of IgE

> 12 yrs old

SubQ infection, dosed 2-4 weeks, dose based on IgE

Expensive!!

51
Q

systemic corticosteroids

A

acute exacerbation or severe uncontrolled asthma

Burst of anti-inflammatory activity (5-10 day)

IV or PO

can have ADR

52
Q

consider systemic steroid if: (5)

A
  1. decreasing lung fxn over days
  2. lack of sustained relief from rescue medication
  3. repeated drops in PEF over 1 or more days to below 60%
  4. freq. night time symptoms
  5. req. for emergency nebulizer or parenteral bronchodilator tx
53
Q

anticholinergics

A

long history of use but NOT FDA approved

reverse cholinergic mediated bronchoconstriction

54
Q

ipratropium

A

anticholinergic

atrovent or nebulizer solution

used adjunct to SABA

55
Q

how to triggers produce bronchospasm

A

vagal reflex mechanisms

parasympathetic-ally innervated

56
Q

metylxanthines

A

theophylline

PDE5 inhibitor produced by bronchodilator

57
Q

disadvantage of methylxanthines

A

little effect

small therapeutic index

many drug interactions

58
Q

ADR of metylxanthines

A

HA, N/V, rumor, insomnia

arrhythmia, seizures, hypoK

59
Q

antihistamines

A

adjunct OTC medications for allergy mediated asthma

no FDA asthma approval

60
Q

asthma and pregnancy complication

A

low birth weight
increased likelihood of prematurity
neonate death

try to avoid hypoxia in both mother and deaths

61
Q

DOC of pregnancy

A

ICS

albuterol, veclomethasone, budesonide, prednisone, theophylline are safe

62
Q

perioperative pts and asthma

complications

A

acute bronchospasm from intubation

impaired cough
hypoxemia
atelecasis
respiratory infection

63
Q

perioperative pts and asthma

management

A

pre-op: evaluate symptoms, med use, PFTs

oral steroid to optimize before sx

WI-18 Pulmonary (11 decks)

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