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Physiology > Asthma > Flashcards

Asthma Flashcards

1
Q

Syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment

A

Asthma

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2
Q

Heterogenous disease characterized by chronic airflow inflammation that varies markedly both spontaneously and w/ treatment

A

Asthma

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3
Q

Asthma

A

AIRWAY HYPERRESPONSIVENESS

AIRFLOW INFLAMMATION

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4
Q

Measures how much air an individual can EXHALE during a forced breath during the first second

A

FEV 1

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5
Q

Total amount of air exhaled during the FEV test

A

FVC

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6
Q

Should be 75-80 %
REDUCED in obstructive diseases
May be NORMAL or INCREASED in restrictive diseases

A

FEV 1/FVC ratio

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7
Q

Major risk factor for asthma

A

atopy

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8
Q

Most consistent findings in asthma have been associated with polymorphisms of genes on

A

chromosome 5q

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9
Q

Hygiene hypothesis

A

Proposes that LACK OF INFECTIONS in early childhood PRESERVES THE TH2 CELL BIAS at birth whereas EXPOSURE TO INFECTIONS and endotoxin results in a shift toward a predominant PROTECTIVE TH1 IMMUNE RESPONSE

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10
Q

Mast cells

A

Important in initiating the ACUTE BRONCHOCONSTRICTION responses to allergens and several other indirectly acting stimuli (exercise, hyperventilation and fog)

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11
Q

Dendritic cells

A

Specialized macrophage-like cells in the airway epithelium which are major antigen presenting cells –

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12
Q

Characteristic feature of asthma airways

A

Eosinophil infiltration

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13
Q

Eosinophils

A

Linked to the development of AHR through the release of basic proteins and oxygen derived free radicals

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14
Q

Neutrophils

A

Resistant to the anti-inflammatory effects of corticosteroids

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15
Q

T-lymphocytes

A

Play a very important role in coordinating the inflammatory response in asthma through the release of specific cytokines

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16
Q

IL-4, IL-5 and IL-13

A

Mediate allergic inflammation

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17
Q

Chemokines

A

Involved in ATTRACTING INFLAMMATORY CELLS from the bronchial circulation into the airways

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18
Q

TNF-α and IL-1β

A

Proinflammatory cytokines that amplify the inflammatory response and has a role in SEVERE DISEASE

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19
Q

IL-13

A

Induces MUCUS HYPERSECRETION

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20
Q

Airway remodeling

A

Increased airway smooth muscle, fibrosis, angiogenesis and mucus hyperplasia

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21
Q

Major pathology of asthma

A

airway hyperresponsiveness

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22
Q

Symptoms of Asthma

A

wheezing
shortness of breath
chest tightness
cough

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23
Q

2 key defining features of asthma

A

history of respiratory symptoms such as wheeze, SOB, chest tightness and cough that vary over time and intensity

AND

variable expiratory airflow limitation

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24
Q

Most frequent PE finding in px with asthma

A

wheezing on auscultation esp on forced expiration

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25
Q

Provide quick relief of asthma symptoms and bronchoconstriction

A

SABA - Salbutamol (Albuterol), Terbutaline

26
Q

Adverse effects of SABA

A 
tremor
tachycardia (palpitations)
hyperglycemia
hypokalemia
hypomagnesemia
restlessness hypoxemia
27
Q

Preferred reliever for patients prescribed as-needed controller therapy for mild asthma

A

Low dose ICS (Budesonide)-Formoterol

28
Q

Adverse effects of LABA – Formoterol, Salmeterol

A

tachycardia
headache
cramps

29
Q

Adverse effects of SAMA (Ipratropium bromide, Oxitropium bromide)

A

dry mouth (MC)
bitter taste
glaucoma
urinary incontinence

30
Q

The most effective anti-inflammatory medications for asthma

A

Inhaled corticosteroids (ICS) – Beclomethasone, Budesonide, Ciclesonide, Fluticasone propionate, Fluticasone furoate, Mometasone, Triamcinolone

31
Q

Local adverse effects of ICS

A

oropharyngeal candidiasis

hoarseness/dysphonia

32
Q

Systemic side effects of ICS

A

osteoporosis
glaucoma
cataract

33
Q

Adverse effects of LAMA (Tiotropium bromide)

A

dry mouth

34
Q

Anti IgE that neutralizes circulating IgE without binding to cell-bound IgE

A

Omalizumab

35
Q

An add-on option for px with SEVERE ALLERGIC ASTHMA uncontrolled on high dose ICS-LABA

A

Anti-IgE - Omalizumab

36
Q

An add-on option for px with SEVERE EOSINOPHILIC ASTHMA uncontrolled on high dose ICS-LABA

A

Anti-IL5- Mepolizumab or Reslizumab and anti-IL5R - BenRalizumab

37
Q

An add-on option for px with SEVERE EOSINOPHILIC OR TYPE 2 ASTHMA uncontrolled on high dose ICS-LABA

A

Anti-IL4R – Dupilumab

38
Q

Short term adverse effects of oral corticosteroids – prednisone, prednisolone, methylprednisolone, hydrocortisone

A 
sleep disturbance
reflux
appetite increase
hyperglycemia
mood changes
39
Q

Long term adverse effects of oral corticosteroids

A 
cataract
glaucoma
hypertension
diabetes
adrenal suppression osteoporosis
40
Q

Preferred reliever for step 1 and 2

A

as needed LOW DOSE ICS-FORMOTEROL

other reliever

SABA

41
Q

Preferred reliever for step 1 and 2

A

as needed LOW DOSE ICS-FORMOTEROL

other reliever

SABA

42
Q

Preferred controller for step 1

A

as needed LOW DOSE ICS FORMOTEROL

other controller options

LOW DOSE ICS taken whenever SABA is taken

43
Q

Preferred controller for step 2

A

daily LOW DOSE ICS or as needed LOW DOSE ICS-FORMOTEROL

other controller options

daily LTRA
OR
LOW DOSE ICS taken whenever SABA is taken

44
Q

Preferred reliever for step 3,4 and 5

A

as needed low dose ICS - formoterol for patients prescribed maintenance

45
Q

Preferred controller for step 3

A

LOW DOSE ICS-LABA

other controller options

MEDIUM DOSE ICS or LOW DOSE ICS +/- LTRA

46
Q

Preferred controller for step 4

A

MEDIUM DOSE IC-LABA

other controller options

HIGH DOSE ICS, add on TIOTROPIUM or add on LTRA

47
Q

Preferred controller for step 5

A

HIGH DOSE ICS LABA
refer for phenotypic assessment +/- add on therapy i.e. tiotropium, anti IgE, anti IL5/5R, anti IL4R

other controller options

add LOW DOSE OCS

48
Q

SABA

stimulate adenycyl cyclase –> inc cAMP –> bronchodilation

A

Procaterol
Salbutamol
Terbutaline
Albuterol

49
Q

Adverse effects of SABA

A

tremor
palpitation
mild hypokalemia

50
Q

SAMA

(-) cholinergic reflex components

A

Ipratropium

51
Q

Adverse effects of SAMA

A

dry mouth
urinary retention
glaucoma

52
Q

Methylxanthines

(-) PDE activity –> inc cAMP –> bronchodilation

A

Theophylline
Aminophylline
Doxofylline

53
Q

ICS

A

Beclomethasone
Budesonide
Fluticasone

54
Q

Adverse effects of ICS

A

hoarseness
dysphonia
oral candidiasis
pneumonia

55
Q

Systemic Steroids

A

Prednisone
Methylprednisone
Hydrocortisone

56
Q

Adverse effects of systemic steroids

A 
truncal obesity
easy bruisability
osteoporosis
DM
HPN
ulcers
proximal myopathy
cataracts
depression
57
Q

LABA

should NOT be given in the absence of ICS

A 
Formoterol
Salmeterol
Bambuterol
Vilanterol
Indacaterol
Olodaterol
58
Q

LAMA

blocks acetylcholine’s effects on muscarinic receptors

A

Tiotropium

59
Q

Leukotriene Modifying Drugs

A

BLOCK LEUKOTRIENE RECEPTORS

Montelukast
Zafirlukast

INHIBIT LIPOXYGENASE

Zileuton

60
Q

Cromones

(-) mast cells and sensory nerve activation

A

Cromolyn sodium

Nedocromil sodium

61
Q

Anti-IgE

A

Omalizumab

Physiology (98 decks)

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