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IM RESPI & CARDIO (VHD) > BRONCHIAL ASTHMA > Flashcards

BRONCHIAL ASTHMA Flashcards

1
Q 
◦ Episodic shortness of breath
◦ Wheezing
◦ Cough
◦ Chest tightness
◦ Mucus production
A

ASTHMA

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2
Q
  • Most common chronic disease associated with significant morbidity and mortality
  • children (8.4%) - greatest among boys (2:1 male-to-female ratio)
A

Asthma

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3
Q

Triggers of Airway Narrowing

A
  1. Allergens
  2. Irritants
  3. Viral INfection
  4. Exercise and cold, dry air
  5. Air pollution
  6. Drugs
  7. Occupational exposures
  8. Hormona changes
  9. Pregnancy
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4
Q

Type of Airway Inflammation that leads to contration, hyperresponsive, smooth-muscle proliferation

A

Type 2 Inflammation

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5
Q

Type of Airway Inflammation that smooth muscle constrict and airway hyperresponsiveness.

A

Non-type 2 Inflammation

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6
Q

Is the genetic tendency toward specific IgE production in response to allergen exposure.

A

Atopy

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7
Q

Druga that cause asthma

A

Beta blockers

ACE inhibitors

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8
Q

PE of asthma

A
  1. Tachypnea
  2. Tachycardia
  3. use of accessory muscle
  4. Wheezing, prolonged expiratory phase
  5. chest become silent with loss of breath sounds in severe
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9
Q

cholinergic agonist, inhaled in increasing concentrations is most commonly used

A

Methacholine

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10
Q

positive response in perfomance when Challenge with exercise and/or cold, dry air

A

≥10% drop in FEV1 from baseline

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11
Q

should prompt consideration of ABPA

A

IIgE Levels >1000 IU/mL

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12
Q

Detect IgE directed at specific antigens (radioallergosorbent test [RAST]), can be useful in confirming atopy.

A

Skin tests, or their in vitro counterparts

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13
Q

◦ approximate indicator of eosinophilic inflammation in the airways
◦ used to assess adherence to ICSs
◦ Elevated levels (>35–40 ppb) in untreated patients - eosinophilic inflammation.

A

Exhaled Nitric Oxide Fraction of exhaled nitric oxide (FeNO)

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14
Q

Levels ____ in patients with severe asthma on moderate- to high-dose ICS – poor adherence or persistent type 2 inflammation despite therapy

A

> 20–25 ppb

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15
Q

Chest roentgenography of asthma

A

normal but in more severe patients may show hyperinflated lungs

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16
Q

High-resolution CT in asthma px

A

show areas of bronchiectasis in patients with severe asthma, and there may be thickening of the bronchial walls, but these changes are not diagnostic of asthma.

17
Q

◦ Relax airway smooth-muscle cells of all airways

◦ inhibition of mast cell mediator release, reduction in plasma exudation, and inhibition of sensory nerve activation

A

B2-Agonists

18
Q

B2 Agonist
◦ begins within 3-5 minutes
◦ duration of 4-6 h

A

SABA (albuterol)

19
Q

B2 Agonist
◦ duration of 12 h, given BID
◦ Formoterol - quick onset comparable to the short-acting β2-agonists
◦ Their use in asthma is generally restricted to use in combination with an ICS.

A

LABA (salmeterol and formoterol)

20
Q

Side Effects of B2 Agonist

A

muscle tremor and palpitation

21
Q

Prevent cholinergic nerve-induced bronchoconstriction and mucus secretion
◦ Long-acting muscarinic antagonists (LAMA)
◦ tiotropium bromide or glycopyrronium bromide
◦ may be used as an additional bronchodilator in patients with asthma that is not controlled by maximal doses of ICS-LABA combinations
◦ Side effects: dry mouth, urinary retention and glaucoma

A

Anticholinergics (Ipratropium bromide)

22
Q

An oral compound that increases cyclic AMP levels by inhibiting phosphodiesterase, is now rarely used for asthma due to its narrow therapeutic window, drug-drug interactions, and reduced bronchodilation as compared to other agents.

A

Theophylline

23
Q

◦ cornerstone of asthma therapy
◦ MOA:
◦ reducing inflammatory cell numbers and their activation in the airways.
◦ ICS reduce eosinophils in the airways and sputum, and numbers of activated T lymphocytes and surface mast cells in the airway mucosa.
◦ major effect is to switch off the transcription of multiple activated genes that encode inflammatory proteins such as cytokines, chemokines, adhesion molecules, and
inflammatory enzymes.

A

Inhaled Corticosteroids

24
Q

They are generally used regularly twice a day as first-line therapy for all forms of persistent asthma. Doses are increased, and they are combined with LABAs to control asthma of increasing severity

A

Inhaled Corticosteroids

25
Q

◦ lowest doses possible (due to side effects) are used in patients who cannot achieve acceptable asthma control.
◦ are also used to treat asthma exacerbations, frequently at a dose of 40–60 mg/d of prednisone or equivalent for 1–2 weeks.
◦ Intravenous preparations are frequently used in hospitalized patients. Patients are rapidly transitioned to it once their condition has stabilized
◦ Intramuscular triamcinolone acetonide has been used to achieve asthma control and reduce exacerbations

A

Chronic oral corticosteroids (OCSs)

26
Q

an inhibitor of 5-lipoxygenase - inhibit production of leukotrienes

A

Zileuton

27
Q

inhibit the action of leukotrienes at the CysLT1

receptor

A

Montelukast and Zafirlukast

28
Q

are particularly effective in aspirin-exacerbated respiratory disease, which is characterized by significant leukotriene overproduction.

A

Leukotriene modifiers

29
Q

inhibit mast cell and sensory nerve activation and are, therefore, effective in blocking trigger-induced asthma such as Exercise-Induced Asthma.

A

Cromolyn sodium and nedocromil sodium

30
Q

is a blocking antibody that neutralizes circulating IgE without binding to cell-bound IgE and, thus, inhibits IgE-mediated reactions.

A

Omalizumab

31
Q

◦ markedly reduce blood and tissue eosinophils and reduce
exacerbations
◦ patients symptomatic on moderate- to high-dose ICS/LABA, with two or more exacerbations that require OCS per year and with an eosinophil count of ≥300/µL, IL-5–active drugs reduce exacerbations by about half or more.

A

Anti-IL-5

32
Q

Anti-IL-5 that blocks IL-5

A
  • mepolizumab

- reslizumab)

33
Q

Anti-IL-5 that blocks IL-5 receptor

A

benralizumab

34
Q

binds to this subunit and, thus, blocks signaling through both receptor IL-4 AND IL-13.

A

Dupilumab

35
Q

ASTHMA ATTACKS

A

◦ increasing chest tightness, wheezing, and dyspnea that are often not or poorly relieved by their usual reliever inhaler.
◦ unable to complete sentences and may become cyanotic
◦ Arterial blood gases : hypoxemia, PCO2 is usually low

36
Q

Tx of asthma attacks

A

β2-agonist administered up to every 1 h

IM RESPI & CARDIO (VHD) (11 decks)

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