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MED234 Respiratory > Dubin Asthma > Flashcards

Dubin Asthma Flashcards

1
Q

Asthma relievers - immediate

A

SABA, Ipratroprium (anticholinergics), Oral or injected steroids.

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2
Q

Asthma controllers - long term

A

ICS, LTRAntag, LAB2A, Methlxanthines (Theophylline), Omalizumab (anti ige)

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3
Q

Classifications for intermittent asthma

A
  • Symptoms less than once per week
  • Brief exacerbations
  • Nocturnal s/s 2 or less per month
  • FEV1 greater than 80% predicted
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4
Q

Classifications for mild Persistent asthma

A
  • Symptoms MORE than 1/week, but LESS than 1/day
  • Exacerbations may affect activity/sleep
  • Nocturnal s/s 2 or MORE per month
  • FEV1 greater than 80% predicted
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5
Q

Classifications for Moderate Persistent asthma

A
  • Symptoms DAILY
  • Exacerbations may affect activity/sleep
  • Nocturnal s/s MORE than 1/per week
  • FEV1 60-80% predicted
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6
Q

Classifications for Persistent asthma

A
  • Symptoms DAILY
  • FREQUENT exacterbaations
  • FREQUENT nocturnal asthma symptoms
  • LIMITATION of physical activity
  • FEV1 less than 60% predicted
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7
Q

Short Acting Beta 2 Agonists (SABA) MOA

A

SAB2A relax bronchial smooth muscle by activating Adenylate Cyclase and STIMULATION cAMP PRODUCTION.

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8
Q

Preferential SAB2A for tx of asthma bronchospasm.. If this doesn’t work, try what?

A

Albuterol.

If albuterol doesn’t work, the try isomer Levalbuterol.

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9
Q

Name 5 SAB2A

A

Albuterol, Pirbiterol, Terbutaline, Metaproterenol, Levalbuterol

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10
Q

Name 3 LAB2A.

Use these when?

A
  • Use as CONTROLLERS for DAILY SYMPTOMS (moderate persistent/Severe Persistent)
  • Salmeterol, Formoterol, Fluticasone/Salmeterol (Advair)
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11
Q

What is the PREFERRED controller LAB2A?

A

Advair = Solmeterol (LAB2A) + Fluticasone (ICS)

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12
Q

What is an extremely potent inhaled B1 and B2 agonist? Used frequently?

A

Isoproterenol

- Dangerous SE if used too much (Death)

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13
Q

Name 2 Mast Cell stabilizers

A
  • CROMOLYN (use with albuterol)

- Nedocromil

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14
Q

Name 2 Leukotriene Modifiers

A
  • MONTELUKAST

- Zafirlukast

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15
Q

Name the most common methylxanthine and its MOA.

A

THEOPHYLLINE (IV)

- MOA: phosphodiesterate inhiitor that PREVENTS cAMP BREAKDOWN

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16
Q

Therapeutic blood range for theophylline.

If blood level too high, what happens?

A

10-20

SE - seizures.

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17
Q

When should theophylline be added to therapy regimen?

A

When person has difficulty breaking asthma with LABA (especially night time asthma).
- To achieve maximal bronchodilation and diaphragm contraction.

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18
Q

Name of anticholinergic and MOA.

A

Ipratroprium.

- Anticholinergic that decreases ACh release to decrease PSNS vagal stimulation to airway smooth muscle.

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19
Q

Name of 5 inhaled steroids

A

Beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone acetonide.

20
Q

Uses of inhaled steroids.

A
  • ONLY IN ASTHMATICS. as relievers.

- Never in hospitals - only use oral or IV steroids.

21
Q

Use for IV steroids.

A

Steroid burst for status asthmaticus.

22
Q

Adverse effects of long term use or oral steroids.

A

Adrenal suppression, buffalo hump, moon facies, purple stria, posterior capsule cataracts, necrosis of femoral head, thin skin, blood sugar elevation.

23
Q

When is immunotherapy used?

A
  • When ALLERGIES ARE THE MAIN TRIGGER of asthma
  • In patients with severe anaphylaxis.
  • Indicated in kids with SEVERE persistent asthma exacerbated by allergies.
24
Q

Name and MOA of immunotherapy.

A

Omalizumab - monoclonal antibody developed against IgE to decrease total serum IgE levels.

25
Q

In 85% of deaths due to asthma, what is the duration of the final episode?

A

12 hours or longer

26
Q

Four main causes of death in asthmatics.

A
  1. Asphyxia
  2. Barotrauma/Ventilator
  3. Nosocomial Infection
  4. Unexpected
27
Q

Three components of “Sudden Asphyxic Asthma”

A
  1. Rapid decomposition
  2. Extreme hypercapnia (CO2 in blood) with metabolic and respiratory acidosis.
  3. Silent chest on auscultation.
    (also, airway devoid of inspissated mucus; more neuts than eosino in submucosa @ autopsy)
28
Q

Do previous admissions in the past year and life threatening attacks in the past increase risk of asthmatic death?
What are other risk factors?

A

Yes

- 3+ meds, marked circadian cariation in lung function, physiological abnormalities)

29
Q

Important physical findings to identify High-Risk asthmatics for unexprected deaths.

A
  1. Tachycardia (120+)
  2. Tachypnea (20-30bpm)
  3. RONCHI/WHEEZING (or COT to lack of wheeze)
  4. Hyperinflation of chest
  5. ACCESSORY MUSCLE USE.
  6. PULSUS PARADOXUS
  7. Cyanosis
30
Q

What condition can wheezing and then lack of wheezing indicate?

A

STATUS ASTHMATICUS - air exchange gets so bad that no air is moving and you have a silent chest.

31
Q

What do you look for in accessory muscle use

A

Skin over thorax retracted into intercostal spaces during inspiration. Expiratory phase prolonged relative to inspiratory phase.

32
Q

What is pulsus paradoxus?

A

Exaggerated inspiratory decrease in systolic pressure.

- Drop exaggerated about 15 because CO is restricted.

33
Q

Four important signs of development of status asthmaticus.

A
  1. SaO2 less than 90%
  2. Normal of high PaCO2 with hyperventilation
  3. Metabolic acidosis
  4. Severe obstruction/Bronchoconstriction that does not improve 30% with B2-agonists.
34
Q

Treatment of status asthmaticus

A
  • High dose, IV, systemic steroid burst.

- Inhaled bronchodilators

35
Q

Describe PFTs in asthma

A
  • Reduced FEV1 during acute attack, resulting in decreased FEV1/FVC ratio
  • FEV1 increases with bronchodilator (SAB2A)
  • Increased RV/TLC due to air trapping.
  • FEV25-75 at 45%??
36
Q

DLCO in asthma

A

decreased

37
Q

ABG for asthma

A

PaO2 between 55-70

PaCO2 between 25 and 35

38
Q

Lab findings that indicate allergic asthma (IGE mediated).

A

In sputum - Curschmann Spirals, Charcot-Leyden Crustals, eosinophils.

39
Q

Define extrinsic asthma, intrinsic asthma, occupational, cough variant asthma, and refractory asthma.

A
  • Extrinsic - dyspnea post-exposure to known allergen
  • Intrinsic - dyspnea for unknown reason
  • Occupational - asthma brough on by occupational expssure
  • Cough variant - cough (or hoarseness/inability to sleep) is only symptom
  • Refractory - refractory to standard care
40
Q

What is this?

A 42yo woman with no hx of asthma is exposed to acetic acid at work. She develops persistent asthma-like pheontype.

A

RADS - Reactive Airway Dysfunction Syndrome.

- Not IgE mediated, so NOT an allergic occupational asthma

41
Q

What happens to RV/TLC% in asthma?

A
  • increased - increased RV

- AIR TRAPPING

42
Q

What is a methacholine challenge and what does a positive test indicate?

A

(+) if FEV1 decreaes by 12-20% or more.

- Indicates bronchial hyper reactivity.

43
Q

Stepwise Approach to Asthma Control

A
  1. SAB2A prn
  2. Low dose ICS
  3. Low does ICS+LABA or med dose ICS
  4. Med dose ICS + LABA
  5. High dose ICS + LABA
  6. High dose ICS + LABA + Oral CS
44
Q

What does this woman have?
35yoF with urticarial, SOB, wheezing. She ate tuna fish and took aspirin for HA prior to onset. PE reveals nasal polyps.

A

She has NSAID induced asthma, part of SAMTER’S TRIAD of:

  1. Nasal Polyps
  2. Asthma
  3. NSAID allergy
45
Q

Urticaria and anaphylactic allergic reaction - give what?

A

Epinephrine

MED234 Respiratory (15 decks)

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