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Therapeutics > asthma > Flashcards

asthma Flashcards

1
Q

obstructive lung disease

A
  • trouble blowing air out
  • no change in volume of lungs
  • asthma and COPD
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2
Q

restrictive lung disease

A
  • difficulty getting air into lungs
  • decreased volume of air the lungs can hold
  • no change in air flow
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3
Q

asthma

A
  • hypersens rxn -> inflammation and bronchoconstriction
  • most persistent chronic childhood disorder
  • obstruction is reversible
  • in atopic pts
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4
Q

characteristic sx of asthma

A
  • cough esp at night or early AM
  • wheezing
  • breathlessness
  • chest tightness
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5
Q

mainstay of asthma tx

A
  • ICS
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6
Q

immune response in asthma

A
  • IgE -> T and B cells activated -> mast cell degranulation -> histamine, leukotriene, and cytokine release
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7
Q

early phase response in asthma

A
  • bronchospasm
  • edema
  • airflow obstruction
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8
Q

late phase response in asthma

A
  • airway inflammation
  • airflow obstruction
  • airway hyperresponsiveness
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9
Q

allergens

A
  • IgE reactions
  • pollen
  • animal dander
  • dust mites
  • mold
  • cockroaches
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10
Q

inhaled irritants

A
  • ACh -> bronchoconstriction
  • perfumes
  • tobacco smoke
  • cleaning agents
  • airborne chemicals
  • wood burning stoves
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11
Q

counseling for animal dander

A
  • keep animals out of bedrom
  • seal/ filter air ducts to bedroom
  • HEPA filters
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12
Q

counseling for dust mites

A
  • keep humidity < 50%
  • remove carpets
  • wash bedding weekly in hot water
  • encase mattress, pillow, and box springs in allergen covers
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13
Q

counseling for cockroaches

A
  • use poison bate or traps

- dont leave food or trash exposed

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14
Q

counseling for pollen and outdoor molds

A
  • use AC

- stay indoors when pollen count is high

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15
Q

counseling for indoor molds

A
  • fix all water leaks
  • clean moldy surfaces
  • reduce humidity < 50%
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16
Q

asthma triggers/ exacerbating factors

A
  • GERD
  • obesity
  • rhinitis
  • occupational triggers
  • viral respiratory infections
  • exercise
  • ASA/ NSAIDs
  • strong emotions
  • menstrual cycles
  • sulfite sensitivity
  • BB- including eye drops
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17
Q

main domains when determining severity of asthma

A
  • impairment

- risk

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18
Q

asthma impairment domain

A
  • frequency and intensity of sx
  • fn limitations
  • effect of QOL
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19
Q

asthma risk domain

A
  • future exacerbations
  • loss of pulmonary function
  • risk of ADRs from meds
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20
Q

asthma treatment goals to reduce impairment

A
  • prevent asthma sx
  • infrequent use of SABA - < 2 days/week
  • maintain near normal pulm fn and ADLs
  • meet pts expectations
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21
Q

asthma treatment goals to reduce risk

A
  • prevent recurrent exacerbations
  • prevent loss of lung fn
  • provide optimal pharmacotherapy
22
Q

asthma action plan

A
  • use peak flow meter to det how well lungs expel air
  • can help pt ID loss of control, triggers, when to seek emergency care
  • set up zones based on personal best
  • estab personal best
  • once personal best estab use every morning before meds
23
Q

green zone

A
  • 80-100% of pts personal best

- cont activities and maintain meds

24
Q

yellow zone

A
  • 50-80% of pts personal best
  • contact provider
  • may need med adjustment
25
Q

red zone

A
  • < 50% of pts personal best

- emergency

26
Q

establishing a personal best

A
  • use peak flow meter
  • take 3 readings daily
  • estab over 2-3 weeks
  • best= HIGHEST reading
27
Q

follow up care for asthma

A
  • every 2-6 weeks while gaining control
  • every 1-6 months once controlled
  • at 3 mo intervals if reduction in therapy is anticipated
28
Q

what must you assess at every asthma visit

A
  • asthma control and med adherence
  • med technique
  • asthma action plan
  • pt concerns
29
Q

asthma control test

A
  • used to assess risk domain

- score of < 19 means asthma is not under conrol

30
Q

how many steps should you increase if asthma is not well controlled

A
  • one step up
31
Q

how many steps should you increase if asthma is very poorly controlled

A
  • step up by 1-2 steps

- consider short course PO steroids

32
Q

asthma risk factors for death

A
  • prior severe exacerbations= intubation or ICU admission
  • 2+ hospitalizations or 3+ ED visits/ year
  • > 2 canisters of SABA per month
33
Q

stepping down asthma therapy

A
  • must be well controlled for at least 3 mo
  • gradual decrease 25-50%
  • closely follow up in 2-6 weeks
  • consider hx of exacerbations
  • use LEAST amount of med needed for control
34
Q

rescue regimens for asthma

A
  • SABA- albuterol
35
Q

maintenance regimen for asthma

A
  • ICS
  • LABA- always in combo with ICS
  • LAMA- always in combo with ICS
  • leukotriene antag
  • theophylline
36
Q

therapeutic considerations for asthma tx

A
  • cost and coverage
  • ability to use device
  • product avail
  • adverse effects
  • pt population, lifestyle, preference
37
Q

MDI advantages

A
  • < 1 min
  • small/ portable
  • no drug prep
  • mechanical ventillation
38
Q

MDI disadvantages

A
  • technique/ timing is essential
  • freon effect
  • requires breath hold
  • oropharyngeal deposition
39
Q

MDI steps for use

A
  • hold in L position
  • exhale completely
  • put lips on mouth piece and breath in deeply and slowly while depress canister
  • remove from mouth and hold breath 10 sec
40
Q

what type of inhalers are HFA

A
  • MDI
41
Q

DPI advantages

A
  • < 1 min
  • less technique/ timing
  • small/ portable
  • usually cost less than MDI
42
Q

DPI disadvantages

A
  • some dose prep
  • requires breath hold and fast inhalation
  • oropharyngeal deposition
  • no mechanical ventilation
43
Q

what type of inhalers are respiclicks

A
  • DPI
44
Q

nebulizer advantages

A
  • minimal technique/ timing
  • no breath hold
  • mechanical ventilation
45
Q

nebulizer disadvantages

A
  • more expensive
  • drug prep required
  • admin time 5-15 min
  • bulky, less portable, requires power source
  • must clean regularly
46
Q

step 1 asthma tx

A
  • SABA

- for intermittent asthma only

47
Q

step 2 asthma tx

A
  • low dose ICS

- alternatives: mast cell stabilizer, LTRA, theophylline

48
Q

step 3 asthma tx

A
  • low dose ICS + LABA
    OR
  • mod dose ICS alone
  • alt- replace LABA with LTRA or theophylline
49
Q

step 4 asthma tx

A
  • mod dose ICS + LABA

- alt- replace LABA with LTRA or theophylline

50
Q

step 5 asthma tx

A
  • high dose ICS + LABA

- also consider xolair for pts who have allergies

51
Q

step 6 asthma tx

A
  • high dose ICS + LABA + PO steroid

- also consider xolair for pts who have allergies

Therapeutics (5 decks)

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