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Family Medicine > Respiroloy > Flashcards

Respiroloy Flashcards

1
Q

Discuss the pathophysiology of Asthma

A
  • variable airflow limitation and airway hyperresonsiveness represented by exaggerated contractile response of the airway to variety of stimuli
  • atopic march: eczema, food allergies, environmental allergies
    - strongest predictor for development
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2
Q

Discuss the symptoms and diagnosis of asthma

A 
Signs and Symptoms
- Wheezing
- Cough
- Dyspnea
- Reduce air entry on auscultation
Diagnosis
- obstrutive pattern on spirometry
- Children 6-11 have FEV1/FVC <0.8 and increased FEV1 post-bronchodilator >=12% 
- Adults have FEV1/FVC <0.75 and increase in FEV1 post-bronchodilator by >=12% and >=200mL
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3
Q

Discuss possible triggers for asthma exacerbation

A
  • Allergens exposure
  • Respiratory infection
  • Cigarettes
  • Animal dander
  • Dust mites
  • cold/dry air
  • exercise or emotional factors
  • B Blockers/ASA/NSAIDs
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4
Q

Discuss the management of asthma

A
  • Environmental control
  • Education
  • Action plan
    Medication
  • Short-Acting Bronchodilator on demand for very mild
  • Inhaled Corticosteroid for maintenance therapy for mild asthma (symptoms 3x per week)
    - leukotriene receptor antagonist second line
    - start at low dose and progress
  • Long acting bronchodilator used as third line add on
    - must be on ICS if using LABA
    - if less than 12 then increase ICS before
  • Third line to add LTRA
  • Fourth line prednisone
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5
Q

Discuss the dosing of inhaled corticosteroids

A 
Low Dose
- <12 <=200mcg/day
- >12 <=250mcg/day
Medium Dose
- <12 201-400 mcg/day
- >=12 251-500 mcg/day
High Dose
- <12 >400mcg/day
- >=12 >500mcg/day
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6
Q

Discuss proper MDI use

A
  • Shake inhaler well
  • Remove cap
  • put inhaler into spacer
  • Breather out away from spacer
  • Bring spacer to mouth and close lips around
  • Press top of inhaler
  • Breathe in slowly (if not using spacer only press top once starting to breath in)
  • remove inhaler from mouth and hold breath for 10 seconds
  • wait 1 minute and shake in between
  • rinse mouth when finished to reduce risk of oral thrush
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7
Q

Discuss the monitoring of asthma

A
  • Asthma symptom control
    - poor control warrant dose increase
    - good control warrant decrease
  • Peak expiratory flow tested in office or spirometry
  • Inhaler technique
  • Adherence to asthma treatment
  • Exposure to asthma triggers in the environment
  • Presence of comorbidities
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8
Q

Discuss the characteristics of good asthma control

A
  • Daytime Symptoms <4x/week
  • Nighttime symptoms <1x/week
  • Normal physical activity
  • Infrequent and mild exacerbation
  • No absences due to asthma
  • Need for SABA <4dose/week
  • FEV1 >=90% best
  • sputum eosinophils <2-3%
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9
Q

Discuss the pathophysiology and symptoms of COPD

A 
Pathophysiology
- airflow limitation caused by inflammatory response to inhaled toxins
Signs and Symptoms
- Productive cough
- Dyspnea
- Decreased breath sounds
- Wheezes
- Prolonged expiratory phase of breathing
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10
Q

Discuss the screening for COPD

A

Spirometry in patient’s over 40 who currently or previously smoked and have one of the following
- Cough regularly
- Productive cough regularly
- Short of breath with minimal exertion
- Wheeze with exertion or at night
- Frequent colds that persist long
Lung Cancer Screen in 55-74 with 20year smoking history

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11
Q

Discuss the Triggers and Signs of COPD exacerbation

A 
Triggers
- Respiratory infection
- Environmental pollution
- pulmonary embolism
- comorbid respiratory or cardiac condition
Signs
- Change in amount or color/purulence of sputum
- More short of breath
- change in mood
- Fatigue
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12
Q

Discuss the MRC dyspnea scale of symptoms and impairement of lung function

A

Normal
- MRC 1 dyspnea only with strenuous exercise
- Normal spirometry
Mild
- MRC 2 dyspnea when hurring on level ground or walking up hill
- FEV1 >80% predicted and FEV1/FVC <0.7
Moderate
- MRC 3 walk slower than people because of breathlessness or has to stop for breath
- MRC 4 stop for breath after walking 100m
- 50% <= FEV1 < 80% predicted
- FEV1/FVC <0.7
Severe
- MRC 5 too breathless to leave house or breathless with dressing
- 30%

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13
Q

Discuss possible complications of COPD

A
  • Weight loss
  • Pneumothorax
  • Frequent acute exacerbations
  • Right heart failure
  • Chronic respiratory failure
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14
Q

Discuss the management of COPD

A 
Education
- inhaler
- action plan
Smoking Cessation
- most important intervention to slow lung decline
Exercise or Pulmonary Rehabilitation
- All patients should exercise
Vaccination
- influenza
- Pneumovax <65 or Prevnar >65
Pharmcotherapy
- Mild: SABA prn
- Moderate: SABA and LABA prn
- Severe (>1 AECOPD/year): Long acting anticholinergic + ICS/LABA + SABA prn
Oxygen
- severe hypoxemia (PaO2 <55mmHg or SaO2 <88%)
- PaO2 <59mmHg or SpO2 <89% with evidence of right heart failure or cor pulmonale or erytrhocytosis (Hct >55%)
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15
Q

List the Common Asthma/COPD Inhalers and their side Effects

A 
SABA (blue)
- Salbutamol (ventolin)
- tachycardia
- arrhythmia
- irritability
- difficulty sleeping
- muscle cramps
LABA (orange)
- formoterol (oxeze)
- salmeterol (serevent)
- same as SABA
ICS (red)
- Fluticasone (flovent)
- Beclomethasone (ovar)
- hoarseness
- sore throat
- thrust
ICS + LABA
- Fluticasone + Salmeterol (Advair - purple)
- Pulmicort + Oxeze (Symbicort - red)
- shaky hands
- tachycardia
- thrush
- sore throat
- hoarse
Short-Acting Anticholinergic
- Ipratropium bromide (atrovent)
- dry mouth
- urinary retention
Long-Activing Anticholinergic
- Tiotropium (spiriva)
- same as SAAC
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16
Q

Discuss the dosing and weaning of nicotine replacement therapy

A

Gum
- 1st cigarette <30 minutes after waking then 4mg
- 1st cigarette >30 minutes after waking then 2mg
- week 1-6 1 piece q1-2h
- week 7-9 1 piece q2-4h
- week 10-12 1 piece q4-8h
Transdermal Patch
- >10cigarettes/day then
- 21mg/day for 4 weeks -> 14mg/day for 2 weeks -> 7mg/day for 2 weeks
- <10cigarettes/day then
- 14mg/day for 6 weeks -> 4mg/day for 2 weeks
Oral Inhaler
- 6-16 cartridges per day; using 1 q1-2 hours
- continuous puffing for 20 minutes
- use for 3-6 months

17
Q

Discuss buproprion dosing and side effects for smoking cessation

A 
Dosing
- 150mg PO qAM for 3 days -> 150mg POD BID
- begin 1-2 weeks before quitting date
Side Effects
- SHAARES
18
Q

Discuss varenicline (champix) dosing and side effects for smoking cessation

A 
Dosing
- Days 1-3: 0.5mg PO qAM
- Days 4-7: 0.5mg PO BID
- Weeks 2-12: 1mg PO BID
- begin week prior to quit date
Side effects
- nausea
- sleep disturbance
- constipation
- flatulence
19
Q

Discuss the screening for lung cancer

A
  • Annual low dose CT for adults 55-74 with 30 pack year smoking history who currently smoke or quit within last 15 years

Family Medicine (12 decks)

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