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Pharmacotherapeutics > Asthma Exacerbations (exam 2) > Flashcards

Asthma Exacerbations (exam 2) Flashcards

1
Q

asthma exacerbation

A

episode of progressive increase in asthma symptoms

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2
Q

asthma exacerbation occurs as a result of

A

exposure to external agents
poor adherence to controller medication

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3
Q

preferred term to tell patients for asthma exacerbation

A

flare up

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4
Q

all patients should have a

A

written asthma action plan

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5
Q

how does an asthma action plan help a patient with self management?

A

how to identify worsening asthma
changes to reliever and controller if symptoms worsen
when to use OCS
when to seek medical care

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6
Q

green zone of asthma action plan

A

no limitation of activities
no nighttime awakenings
reliever use less than 3 times/week
no cough, wheezing, SOB, tightness of chest
PEF greater than 80%

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7
Q

yellow zone of asthma action plan

A

some limitation, but still can do some activities
nighttime awakenings
increased symptoms and reliever use
PEF 50-79%

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8
Q

red zone of asthma action plan

A

cannot do usual activities
very SOB
reliever needed more than 3-4 hours
no improvement/worsening after less than 24 hours in yellow zone
PEF less than 50%

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9
Q

Reliever changes for exacerbations

A

increase frequency of low dose budesonide/formoterol, SABA or ICS-SABA

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10
Q

MART controller changes for exacerbations

A

continue usual maintenance dose
increase reliever

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11
Q

maintenance ICS with SABA as reliever controller changes for exacerbations

A

quadruple ICS dose

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12
Q

maintenance ICS-formoterol with SABA as reliever controller changes for exacerbations

A

quadruple maintenance ICS-formoterol

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13
Q

maintenance ICS plus other LABA with SABA as reliever controller changes for exacerbations

A

step up to higher dose formulation of ICS plus LABA

consider adding separate ICS inhaler to quadruple ICS dose

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14
Q

when to give oral corticosteroid therapy for exacerbations

A

patient doesn’t respond to increase reliever and controller medication after 2-3 days
deteriorates rapidly
PEF/FEV1 less than 60%
history of sudden severe exacerbations

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15
Q

course of therapy for OCS in adults?

children?

A

adults 5-7 days

3-5 days

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16
Q

mild-moderate exacerbation

A

not agitated
talks in phrases
prefers sitting to lying
accessory muscles not used
RR less than 30 breaths/min
plus rate 100-120 bpm
O2 90-95%
PEF over 50%

17
Q

severe exacerbation

A

agitated
talks in words
hunched
RR over 30 breaths/min
accessory muscles used
pulse rate over 120 bpm
O2 under 90%
PEF less than 50%

18
Q

treatment for mild-moderate exacerbation in primary care setting

A

SABA
OCS
oxygen

19
Q

treatment for severe exacerbation in primary care setting

A

transfer to acute care facility
start with SABA, SAMA, oxygen and systemic steroid

20
Q

initial assessment in the ED for asthma exacerbations

A

ABCs
a - airway
b- breathing
c - circulation

21
Q

when would someone go to the ICU for an asthma exacerbation?

A

drowsiness
confusion
silent chest

22
Q

treatment for mild-moderate asthma exacerbation in the ED

A

SABAs
consider ipatropium bromide
oral corticosteroids
oxygen

23
Q

treatment for severe asthma exacerbation in the ED

A

SABAs
ipatropium bromide
oxygen
oral or IV corticosteroids
consider IV magnesium, high dose ICS

24
Q

discharge planning for asthma exacerbation

A

reliever PRN
continue course of oral corticosteroid
continue on ICS at inc step
follow up appointment with primary care 2-7 days after discharge

25
Q

what is the preferred regimen post discharge from ED?

A

budesonide-formoterol MART

26
Q

systemic corticosteroids

A

most effective anti-inflammatory
improvement observed in 4 hours

27
Q

oral corticosteroids MOA in treatment of asthma exacerbations

A

reduces mucus production
reduces airway edema
reduces bronchial hyperresponsiveness
increases number of B2 receptors and improves responsiveness

28
Q

is IV or oral corticosteroids better for asthma exacerbations?

A

both are equal!

IV given to those who cannot take by mouth

29
Q

dose and effect of systemic corticosteroids

A

minimize dose and duration to minimize adverse effects
5-7 days of OCS

30
Q

if corticosteroid therapy is long, there is risk for

A

the body producing less cortisol

31
Q

when should corticosteroids be tapered

A

for therapy over 2 weeks
and
long term of high doses

32
Q

why do we taper corticosteroids?

A

prevents cortisol deficiency
prevents sudden worsening of symptoms

33
Q

do we have to taper steroids for asthma exacerbations?

A

no!

regimen is only 5-7 days

34
Q

when should magnesium sulfate be used for asthma exacerbations?

A

severe exacerbations not responding to initial treatment

35
Q

adverse effects of magnesium sulfate

A

hypotension
facial flushing
sweating
depressed deep tendon reflexes
hypothermia
cardiac, CNS and respiratory depression

36
Q

MOA of magnesium sulfate

A

blocks calcium ion influx into smooth muscle which results in bronchodilation and anti inflammatory effects

Pharmacotherapeutics (8 decks)

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