(hans) Pulmonology p147-152 Flashcards
what is the etiology of asthma?
unknown, but thought to be associated with obesity and atopic disorder
what are the causes for asthma exacerbation?
allergens, infection/cold air, emotional stress/exercise, catamenial (related to mentstrual cycle), aspirin, NSAIDs, beta blocers, histamine, GERD
dx?
symptoms worse at night
nasal polyps and sensitivity to aspirin
eczema or atopic dermatitis
increased length of expiratory phase of respiration
increased use of accessory respiratory muscles
asthma
a pt comes with and the only sx is cough, can this be asthma?
yes
what is the best initial test for acute asthma exacerbation?
peak expiratory flow, arterial blood gas
what is the best initial treatment for asthma?
always start with inhaled short-acting beta agonist
name 3 short acting beta agonist for asthma
albuterol, pirbuterol, levalbuterol
after adding short term beta agonist for asthma, your pt ‘s symptoms are still not under control, what is your best next step?
add low dose inhaled corticosteroids
2 side effects of inhaled steroids?
dysphonia, oral candidiasis
what is the asthma drug that is associated with Churg-Strauss and hepatotoxicity?
zalfirlukast
what particular electrolyte will relieve bronchospasm?
magnesium
what 2 vaccines are given to all asthma pts?
influenza, pneumococcal
2 ways to quantify the severity of the asthma?
- dec peak expiratory flow
2. ABG with an increased A-a gradient
for asthma exacerbation, why would you want to get chest x-ray?
to see if there is any infection leading to the exacerbation (asthma pt predisposes to pneumothorax)
what particular drug is very effective in COPD by dilating bronchi and dec secretion?
ipratropium, tiotropium (anticholinergic)
what is the best initial long-term control agent?
low dose inhaled corticosteroids
name the 6 low dose inhaled corticosteroids
beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone
name the 3 main types of alternate long term control agents if low dose inhaled corticosteroids
- cromolyn and nedocromil
- theophylline
- leukotriene modifiers
what is the mech of cromolyn and nedocromil?
inhibits mast cell mediator
in terms of controlling asthma symptoms, what is drug is added at last?
oral corticosteroids (prednisone)
you have given short acting beta agonist and low dose inhaled corticosteroid but still symptoms are not under control, what is the next agent you can add?
long acting beta agonist
you have given SABA, LABA, inhaled corticosteroid but still not working, what is the best next step?
maximize the dose of the ICS
in what case can omalizumab can be added?
SABA, LABA and ICS are given while the pt has increased IgE level
what is the artificial form of acetylcholine used in diagnostic testing for asthma?
methacholine which provoke bronchoconstriction and increase bronchial secretion
