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SU18: Internal med final > Asthma > Flashcards

Asthma Flashcards

1
Q

does asthma primarily affect children or adults?

A

children (10%)

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2
Q

what percent of adults have asthma?

A

6%

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3
Q

what is the life of the disease?

A
  • many cases spontaneously resolve after puberty

- progress to COPD

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4
Q

asthma

A
  • inflammatory airway disease with an exaggerated contractile response
  • secondary to variety of stimuli
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5
Q

how is asthma characterized?

A

REVERSIBLE episodes of hyperresponsiveness

  • difficulty breathing
  • coughing
  • wheezing
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6
Q

pathophysiology of asthma

A
  • contraction of airway smooth m.
  • thickening of airway wall secondary to inflammatory response
  • plugging of airway with mucous
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7
Q

asthma pts experience decreased airway diameter + increased airway resistance =

A

difficulty with EXPIRATION

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8
Q

etiology of asthma

A

environment + genetic susceptibility

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9
Q

unavoidable triggers of asthma

A
  • respiratory tract illnessess
  • physical exertion
  • hormonal fluctuations
  • extreme emotion
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10
Q

asthma triggers that can be addressed/treated

A
  • inhaled allergens
  • respiratory irritants
  • comorbid conditions
  • medications
  • influenza
  • pneumococcal infection
  • dietary sulfites
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11
Q

Aspirin and NSAIDS will exacerbate symptoms in what percentage of asthmatic pts?

A

3-5%

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12
Q

medical management of asthmatic pts

A
  • routine management of syms and lung fxn
  • pt education
  • control environmental factors and comorbid conditions that contribute to asthma severity
  • pharmacologic therapy
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13
Q

goals of medical management of asthmatic pts

A
  • reduce impairment

- reduce risk

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14
Q

what is considered reduce impairment of asthmatic pts?

A
  • freedom from frequent syms
  • minimal need (≤2d/wk) of inhaled short-acting beta agonists to relieve syms
  • maintenance of normal daily activities, including athletics and exercise
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15
Q

why do you want to reduce risk of asthmatic pts?

A
  • prevent recurrent exacerbations and ED care

- optimization of pharmacotherapy with minimal or no adverse effects

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16
Q

pharmacologic management of intermittent asthmatic pts

A

inhaled quick-acting beta-2 agonists prn

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17
Q

what is the most common asthma inhaler?

A

Albuterol - has least CV effects

18
Q

pharmacologic management of persistent asthmatic pts

A
  • inhaled glucocorticoids scheduled

- inhaled quick-acting beta-2 agonists prn

19
Q

can inhaled glucocorticoids be used in emergencies?

A

no, they’re slow acting - takes a couple of hours to take effect

20
Q

inhaled glucocorticoids

A

steroid that decreases inflammation within airway

21
Q

additional drugs that asthmatic pts can be prescribed?

A
  • leukotriene inhibitors

- inhaled long-acting beta-2 agonists

22
Q

character of well-controlled asthma

A
  • daytime syms no more than 2x/month
  • nighttime syms no more than 2x/month
  • short acting B agonists for relief of asthma symptoms needed <3d/wk
  • no interference w normal activity
  • oral steroids courses and/or urgent care visits no more than 1x/yr
23
Q

character of severe disease

A
  • frequent exacerbations
  • exercise intolerance
  • multiple scheduled meds
  • ED visits
24
Q

assessment of risk factors for future exacerbations

A
  • oral glucocorticoids for asthma in last yr
  • hospitalized in last yr
  • admitted to intensive care or intubated within past 5 yrs
  • current cig smoker
  • increase in asthma syms after taking Aspirin or NSAIDS
25
Q

asthmatic pt that are not a candidate for elective care

A
  • current syms such as SOB, wheezing, increased respiratory rate
  • +/- poor compliance with drug therapy
  • ED visit within last 3 months
26
Q

mods to dental care

A
  • remind pts to take regularly scheduled meds and bring emergency inhaler with them
  • stress/anxiety management, N2O sedation
  • avoid Aspirin/NSAIDS
27
Q

arachidonic acid produces which enzymes

A
  • lipoxygenase

- cyclooxygenase (COX-1 and COX-2)

28
Q

leukotrienes trigger what?

A

anaphylactoid syndromes

29
Q

COX-1 acts on what?

A
  • prostaglandins

- thromboxane A2

30
Q

COX-2 acts on what?

A
  • prostaglandins

- prostacyclin

31
Q

role of prostaglandins (COX-1)

A
  • gastric mucosal barrier

- renal fxn

32
Q

role of thromboxane A2

A
  • platelet aggregation

- vasoconstriction

33
Q

role of prostaglandins (COX-2)

A
  • pain, inflammation, fever

- renal fxn

34
Q

role of prostacyclin

A
  • platelet inhibition

- vasodilation

35
Q

Aspirin and NSAIDS block which enzyme?

A

cyclooxygenases (COX-1 and COX-2)

36
Q

syms of asthma attack

A
  • breathlessness
  • wheezing
  • cough
  • chest tightness
37
Q

asthma attack

A
  • sudden onset with peak syms after 10-15 mins

- typically self-limiting

38
Q

treatment of asthma attack

A
  • inhaled short-acting beta-2 agonists
  • 2-8 puffs, repeat Q20 mins
  • supportive care via O2 and vitals
  • activate EMS prn
39
Q

what is used to treat acute broncospasm

A
  • beta-2 adrenergic agonist, albuterol
40
Q

status asthmaticus

A
  • severe, prolonged asthma attack (>24 hrs)
  • can lead to exhaustion, dehydration, peripheral vascular collapse, death
  • true medical emergency
41
Q

status asthmaticus is associated with what?

A

respiratory infection

42
Q

T/F: pts with asthma have no issue getting O2 in but have a problem getting rid of CO2?

A

true

SU18: Internal med final (25 decks)

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