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Asthma And COPD Flashcards

1
Q

Causes of airway narrowing in asthma exacerbation

A

Contraction smooth muscle
Mucus plugs in lumen
Thickening / edema of bronchial mucosa
Cellular infiltration

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2
Q

Most easily reversible cause of asthmatic airway obstruction

A

Contraction of smooth muscle (edema / infiltration is covered with sustained anti-inflammatories)

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3
Q

Short term control of asthma is achieved with

A

Relaxation of airway smooth muscle with
B agonists
Sometimes can use Theophylline (methylxanthine) or antimuscarinics

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4
Q

Long term control of asthma most effectively achieved with

A

Anti-inflammatory agent like ICS
Or:
LTRA (leukotrine pathway antagonist)
Cromolyn or Nedocromil (mast cell de granulation inhibitor)
Omalizumab (monoclonal Ab targeted against IgE)

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5
Q

Bronchoconstriction in asthma can be IgE mediated or non IgE mediated. Name a few of non IgE mediated reasons

A

ASA
cold air
Exercise

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6
Q

Name 3 inflammatory cells involved in pathophysiology of airway inflammation

A 
Lymphocytes
Mast cells
Eosinophils
Neutrophils
Macrophages
Dendritic cells
Airway smooth muscle
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7
Q

Name 3 inflammatory mediators involved in asthma

A 
Chemokines
Cytokines
Cysteinylleukotriens
Nitric oxide
IgE
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8
Q

Name 6 comorbidities and complicating factors of asthma

A 
Allergies
Viral or bacterial infections
Nonselective B blockers
Air pollution
ASA/ NSAID sensitivity
Food sensitivity
GERD
OSA
OBesity
Stress/ depression
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9
Q

Step 1 Asthma Tx

A

SABA PRN

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10
Q

Step 2 asthma TX (0-4 years)

A

Preferred: low-dose ICS
Alternatives:
Cromolyn
LRTA (Singulair)

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11
Q

Step 2 asthma Tx (5-11 years)

A 
Preferred:
Low-dose ICS 
Alternative:
Cromolyn/Nedocromil
LRTA
theophylline
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12
Q

Step 2 asthma Tx (12 + years)

A 
Preferred:
Low-dose ICS
Alternative:
Theophylline
Cromolyn, Nedocromil
LRTA
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13
Q

Clinical presentation of asthma

A

Reversible bronchoconstriction
SOB
chest tightness
Wheeze
Eosinophilic or lymphocytic inflammation of bronchial mucosa
“Remodeling” of bronchial mucosa (hyperplasia)

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15
Q

Step 3 Asthma Tx (12+ years)

A 
Preferred:
Low-dose ICS & LABA
OR
MED-dose ICS
Alternatives:
Low-dose ICS & THeophylline;
Low-dose ICS & LRTA
Low-dose ICS & Zileuton (also an LRTA)
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16
Q

Step 4 asthma Tx (0-4 years)

A

Preferred: MED-dose ICS &

Either LABA or Singulair

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17
Q

Step 4 asthma Tx (5-11 years)

A 
Preferred:
MED-dose ICS & LABA 
Alternatives:
MED-dose ICS & LTRA;
MED-dose ICS & theophylline
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18
Q

Step 5 asthma tx (0-4 years)

A

Preferred:
HIGH DOSE ICS &
EITHER
LABA OR SINGULAIR

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19
Q

Step 5 asthma Tx (5-11 years)

A 
Preferred:
HIGH DOSE ICS & LABA
alternatives: 
HIGH DOSE ICS & theophylline;
HIGH DOSE ICS & LRTA
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20
Q

Step 5 Asthma Tx (12 + years)

A

Preferred:
HIGH DOSE ICS & LABA
alternatives:
Consider Omalizumab for pets with allergies

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21
Q

Step 6 asthma Tx (0-4 years)

A

HIGH DOSE ICS & LABA
Or HIGH DOSE ICS & Singulair
AND
ORAL STEROIDS

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22
Q

Step 6 Asthma Tx (5-11 years)

A

HIGH DOSE ICS & LABA & ORAL STEROID
Alternatives:
HIGH DOSE ICS & theophylline & oral steroid;
HIGH DOSE ICS & LRTA & oral steroid

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23
Q

Step 6 Asthma Tx (12+ years)

A

HIGH-DOSE ICS & LABA & ORAL STEROID
AND
Consider Omalizumab for pts with allergies

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24
Q

Name a SABA - action, dose, side effects and contraindications

A

Albuterol
AKA Ventolin or Proventil
Action: bronchial smooth muscle relaxation
Onset: 15 minutes
Duration: 3-4 hours
Dosing: 0.15 mg/kg/dose (MAX: 5 mg/ DOSE)
OF 0.5% solution: 0.01-0.05 ml/kg/dose (MAX: 1 ml/ DOSE)
Premixed 0.083% solution 1 vial= 2.5 mg in 3 ml NS (= standard adult)
Premixed 0.63 mg/3ml NS and 1.25mg/3ml (=peds)

25
Q

Albuterol pregnancy category / lactation?

A

Category C and lactation compatible

26
Levalbuterol (Xopenex): Difference between this and albuterol; Why you might choose; Dosing and side effects
As effective as Albuterol without cardiac side effects; R-isomer of Albuterol S/E: tachycardia, palpitations, tremor, insomnia, nervous, nausea, headache Dosing: 0.31 to 0.63mg
27
Atrovent: | what it is, how it works, when indicated
AKA Ipratroprium Bromide Inhibits effects of acetylcholine at muscarinic receptors> > bronchodilation * enhances bronchodilation of Albuterol Duoneb or Combivent = combined form of Albuterol and Atrovent
28
Inhaled corticosteroids: Names 🎯HOW HELPS asthma 🎯Advantage of ICS RX over oral steroid RX
Fluticasone, Beclomethasone, budesonide; Works by reducing bronchial inflammation and reactivity ADVANTAGE OVER SYSTEMIC CORITCOSTEROIDS: avoids the systemic SE's
29
``` Methylxanthines: method of action (MOA) Examples What is VERY IMPORTANT to monitor.. SE's and signs toxicity ```
MOA: inhibits cAMP -induced bronchoconstriction Examples: theophylline (aminophylline; theobromine; caffeine) Must monitor Theophylline levels (narrow therapeutic window!!) SE's: N/V; H/A.....(neuro and GI-related) Toxicity: arrhythmias, seizures in addition to N/V and H/A
30
Tx of "mild intermittent" asthma
Ie, sx
31
Tx of moderate persistent
ie for daily sx but not continuous/ > 1x /week/ night ICS + LABA PEDS: ICS + LTRA
32
``` Cromolyn and Nedocromil: MOA Use Dosing SE's ```
anti inflammatory / blockade Cl channels/ modulate mast cell release and eosinophil recruitment; Not preferred for persistent asthma but can be used for prophylaxis; QID dosing preferred SE's: cough, dry mouth, 🎯ANGIOEDEMA
33
How does the flu affect asthmatics?
Exacerbations!
34
Immunomodulators: Omalizumab / Xolair- MOA INDICATIONS
Inhibits binding of IgE | K mm
35
Step 3 asthma TX (age 0-4)
Med-dose ICS
36
Step 3 TX asthma (5-11 years)
Either: Low-dose ICS & LRTA; or low-dose ICS & LABA; or low-dose ICS and theophylline OR: Med-dose ICS
37
``` LABA's: Names MOA Duration and 🎯lipophilic or hydrophilic? SE's Adverse events/ warning ```
Salmeterol /Serevdnt (partial agonist), Formoterol/ Foradil (full agonist) Selective B agonists that achieve their long duration of action via their lipid solubility Duration:5-12 hours NEVER recommended as monotherapy for asthma! Use LABA & ICS per NIH guidelines
38
What stage asthma do we start to see LABA use?
Stage 3
39
``` Leukotreine inhibitors: Names MOA When indicated SE's Warning! 🎯 what to monitor while on these? ```
Montelukast/ singular Zafirlukast/ accolate [zileuton/zyflo= 5 lip oxygenase inhibitor] MOA: interrupt leukotreine pathways SE's: insomnia/ dream abnormalities, N/V/D, elevated LFTS, vasculitis, cramps, eosinophilia Warning! SINGULAIR may increase suicidal thinking/ mood changes (2008 FDA)
40
Systemic corticosteroid- | Memorize dosing
Prednisone/ prednisolone 1-2 mg/kg /day
41
Oral steroids: MOA Indications SE's
``` For most severe cases Suppresses, controls, reverses inflammation SE's related to dose.... Adrenal suppression Growth suppression HTN Cushings Osteoporosis Dermal thinning StriAe Muscle weakness Weight gain Cataracts Glaucoma Increased risk infection! ```
42
COPD -definition
Common Preventable Progressive Treatable disease Characterized by increased inflammatory response in lungs Exacerbations contribute to overall severity
43
COPD: | Forms
Chronic bronchitis: chronic cough x 3 mo/ 2 years in a row Emphysema: permanent enlargement airspaces distal to terminal bronchioles + destruction airspace walls (Fibrosis in early stages) Asthma: airway obstruction reversible + wheeze + tightness+ broncho reactivity
44
COPD: | Patho
- chronic inflammation - excessive lysis of elastin and other structural proteins of lung matrix - Changes to acinar ... Permanent dilation / destruction - destruction of alveoli (loss of capillary bed) - hyperplasia
45
Differential DX
``` Asthma Bronchiectasis CHF panbronchitis Obliterating bronchitis Pulm HTN TB Pneumonia Pleural effusion ```
46
Tiotroprium/ Spiriva: MOA Duration INDICATIONS🎯
Antimuscarinic; longer acting than Atrovent | Duration: 24 hours
47
GOLD 1-4
1: mild airflow limitation 2: moderate
48
GOLD ABCD
A: less SX / less airflow limitations / 0-1 hospitAlizations B: MORE SX / less airflow limits / still 0-1 hospitAlizations C: less SX / more airflow limits / 2+ exacerbations with 1+ hospitalization D: MORE SX / more airflow limits / 2+ exacerbations with 1+ hospitAlization
49
``` Romufilast: Indications Duration MOA SE's🎯 C/I's ```
Indicated in COPD duration 24 hours MOA: selectively inhibits PDE4>> antiinflammatory effect via suppression of cytokine release; inhibition of neutrophil infiltration, and attenuation of pulmoNary remodeling SE's: 1st 6 months- diarrhea and weight loss! 🎯 h/a, n/v, dizziness, back pain C/I: severe hepatic dz; substrate of CYP1a2, Pregnancy categoryC / passes into breAstmilk
50
Atrovent SE's: 🎯
Dry mouth, constipation, urinary retention
51
Risk fx for COPD
``` A-1 anti trypsin deficiency (genetic) Fam hx Smoking Female Prematurity of lungs Teen smokers Poorly controlled asthma Lots of lower resp infections before age 6 Pollutants Occupational exposure ```
52
ICS Names WhAt they do What decreases their effectiveness
``` Pulmicort, Flovent, Asmanex, Aerobid, QVAR -less SX -better quality life - better PEF -less exacerbations Less effective in: -smokers African am peds with poorly controlled asthma Neutrophil predominant inflammation ```
53
What organisms cause exacerbations in COPD
H. FLU! M catarrhal is S pneumonia Viruses
54
ICS | SE's
``` Thrush Dysphonia Reflex cough Slower growth Bone mineral density down Varicella Thin skin/ bruising Cataracts, glaucoma Glucose metabolism effects HypothAlamic-pituitary-adrenal axis function (issue with higher doses) ```
55
COPD pts: increased risk of ... (R/T meds) and how to address
increased risk of bone fractures; need Vitamin D + Ca+
56
Use caution when prescribing Atrovent (anticholinergic) to
pts with glaucoma or urinary outflow issues

Pharmacology (17 decks)

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