Final Resp /PNA/TB/Asthma/TB Flashcards
What percent with FEV1 indicates COPD
FEV1 <70%
FEV1 definition
How much air you exhale in 1 second
FVC1
Amount of air you exhale in 1 breath
SABA Meds
Albuterol/Levalbuterol
Use prn /emergency
Acute Bronchitis
When does acute bronchitis usually come
Inflammation of trachea, bronchi, bronchioles.
Cough with NO evidence of pneumonia
Self Limited
Usually comes after a resp infx (URI)
What bacterial infection is common I smokers (Acute Bronchitis)
What type of cough is acute bronchitis and how long it last?
Is there pulmonary consolidation?
S/S?
What lab can you get?
H. Influenzae
After URI
Dry, non productive then purulent.
The cough Lasts 1-2 weeks
No pulmonary consolidation
S/S: cough and normal vital signs.
Get CBC (check WBC) , CXR mb if you think PNA.
ACUTE BRONCHITIS MEDS
Wheezing?
Nightime relief
Who are they c/I
Wheezing: Bronchodilator: SABA ALBUTEROL
Night time Relief: Cough suppressant
Antitussive :
Dexomethorphan or Dex/Guafinisen
C/I Parkinson, can’t clear secretions, Preg Cat C, SSRI takers.
What medications do you give if you have chronic bronchitis but then develops acute bronchitis ?
Give ABX
If an elderly person starts to cough and has had for several weeks, what should you consider?
Think Pertussis and get CXR bc maybe PNA.
Defintion of ASTHMA
(RIH)
What part of body is affected
1 REVERSIBLE airway obstruction
2 INFLAMMATION
3 Airway Hyperresponsiveness
Because of many triggers, allergy, environmental
The bronchial mucosa
What happens when mast cells activate in the lungs?
What do mast cells release when activated?
Broncho constriction , mast cells release leukotrienes (they the ones that cause broncho constriction)
S/S of ASTHMA
When time of day is it worse?
Wheezing, chest tightness, cough, difficult breathing, cough,
Response to a trigger
Worse at night
What is silent chest in wheezing
Severe asthma attack (status asthmaticus. Wheezing absent
Decreased tactile remits
Medical emergency
Intubate
What is a diagnostic test for ASTHMA
FVC vs FEV
SPIROMETRY
The lower the score, the more constriction
FVC: Forced Vital Capacity
How much air Is blown out
FEV: Forced expiratory volume
How quick it is done
Asthma Severity
Intermittent
PEF
Medication used
STEP 1 NAEPP
Exercise induced asthma girlies
PEF > 80%
SABA <2 days/week
Albuterol PRN
Asthma Severity
Mild Persistent
How many excaerbations a year
PEF %
Medication used
STEP 2 NAEPP
Symptoms >2x/week + Wake up @ night 3-4x/ month
2 exacerbations / year using oral
glucocorticoids
Minor limitation
PEF > 80%
Asthma Severity
Moderate Persistent
PEF:
Medication used (used daily)
STEP 3 NAEPP
Daily symptoms and night awakening
PEF > 60%
SABA needed Daily
Asthma Severity
Severe Persistent
PEF:
Medication used
STEP 4-6 NAEPP
Continued symptoms and night time symptoms (day and night) no rest
need SABA multiple times/day
PEF <60%
Severe limitation
Step 1 NAEPP
Just PRN Albuterol and Levalbuterol
Step 2 NAEPP
BBF
Daily: Low dose Inhaled Corticosteroid
Beclomethasone (Vanceril)
Budesonide (Pulmicort)
Fluticasone ( Flovent)
PRN: SABA/ICS
Step 3 NAEPP
S: B/F
Daily:
PRN:
Daily:
Low Dose ICS/Formeterol
Symbicort: Budesonide/ Formeterol
PRN: ICS/Formeterol (MART)
Step 4 NAEPP
*asthma specialist
Daily:
PRN:
Daily:
Medium ICS/Formoterol (Symbicort)
PRN: ICS/Formeterol (MART)
Step 5 NAEPP
*Asthma specialist
Daily:
Medium to high dose ICS LABA LAMA
PRN: SABA
Step 6 NAEPP
*asthma specialist
Daily:
HIGH dose ICS/LABA + OCS
PRN: SABA
SABA
Does it have anti inflammatory effect?
AE:
Does not have anti inflammatory effect
Not used alone for chronic asthma
AE: Inc HR, Low sugar, low Postassum, Mag
PRN use
Inhaled Corticosteroid
What does it prevent
Is this short or long term?
Long term steroid therapy , dc inflammation , reduce hyper responsiveness
PREVENT ATTACKS
Meds: -side, -sone
LABA
How long does bronchodilator last
What medication you use it with
12 hours of bronchodilation
Maintenance, use with corticosteroid
Salmeterol (Serevent
Arformoterol (Brovana)
LAMA
How long does bronchodilator last
s/e
M:ASTT
12-24 hours
Control lung inflammation and then long term , do not take alone
Anoro Ellipta
Spiriva Respimat
Trilogy Ellipta
Turdoza Presser
s/e: dry mouth, constipation, urinary retention
Systemic Glucocorticoids
How long do you take med for ?
Severe/Acute Exacerbations
Systemic steroid therapy
Prednisone
Short Term course; 5-10 days
What time do you give Leukotriene Modifiers?
Theophylline at what # can cause ventricular arrhythmia ? What is the normal value
Give @ night, and it peaks late at night into early AM
> 35 mcg/mL
5-15 Is nl range
Omalizumab (Xolair)
BBW FOR WHAT!!!
What is dosing measured with
Anaphylaxis after 1st dose so stay ready!
Let patient know,
Based on IgE level and body weight
How do patient at home check status of Asthma?
How often should moderate-severe check?
What is normal PEF
PEF Meters
Morning , evening, exacerbation, before taking medication
80-100
FENO Fractional Exhaled Nitric Oxide Testing, how should you use this test
What # is a diagnostic test
What other diagnosis should you rule out that can cause increased FENO level
Helps dx asthma if uncertain and used as conjunction
FENO level > 50 ppb
Allergic Rhinitis and Atopy
