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568 > Unit 3- Asthma > Flashcards

Unit 3- Asthma Flashcards

1
Q

Asthma definition

A

bronchoconstriction, airway inflammation, reversible airflow limitation

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2
Q

Asthma essentials of dx

A

episodic or chronic sx wheezing/dyspnea or cough

sx worse HS or early AM

prolong expiration and diffusse wheezing

limited airflow on PFT or positive bronchoprovacation challenge

reversibly airflow obstruction

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3
Q

Asthma more common in

A

males <14

blacks

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4
Q

asthma triggers

A

dust mites
cockroaches
cat dander
seasonal pollens

URI, rhinosinusitis, postnasal drip, aspiration, GERD, cold air, stress

tobacco, crack, coke, meth (increase sx and need for meds, decrease lung function)

air pollution

ASA/NSAID/tartazine dyes

workplace agents

catamenial- women during menses

exercise- during or 3 min after ends, peak 10-15 min, resolves by 60

cardiac- d/t HF

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5
Q

Cells present in asthma attack

A 
eosinophils
neutrophils
lymphocytes (t-cells)
IgE- central role in allergic asthma
IL-5: promotes eosinophilic inflammation

goblet cell hyperplasia> plugs airway c mucus> collagen deposit under basement membrane, hypertrophy of bronchial SM> airways edena, mast cell activation

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6
Q

Asthma predisposing factors

A 
genetics
obsetiy 
atopy-strongest predictor
tobacco exposure
RSV or viruses
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7
Q

Lifestyle modifiatons for asthma

A 
NO SMOKING
pets
humidity (keep indoor <50%)
eliminate carpet
limited stuffed toys (Wash weekly)
encase pillow and mattress in dust-mite proof
control cockroaches
avoid outdoor activity when pollution index high
avoid BB and sulfite- foods
get annual FLU
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8
Q

Asthma s/sx

A 
episodic wheezing
difficulty breathing
chest tightness
cough
excess sputum
attacks variable
occur spontaneously or triggers
worse at night
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9
Q

Physical exam for asthma

A 
nasal polyps
nasal mucosal swelling
increased secretion
eczema
atopic dermatitis
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10
Q

T or F: asthama has a prolonged inspiratory phase

A

FALSE

asthma has a wheezing or prolonged expiratory phase

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11
Q

Sign of severe asthma attack

A

globally diminished lung sounds
absent wheeze
use of accessory muscles (flaring and retractions)

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12
Q

asthma management steps

A
  1. eval severity (new dx, not on LABA)
    a. assess pt recall of
    previous 2-4wk and
    spirometry> assign
    severity
    b. more frequent and
    intense
    exacerbation=greater
    underlying disease
    severity
  2. iniate tx using stepwise approach
    a. tx purpose: pt has
    >=2 exacer. requiring
    PO steroids in past
    year> considered
    same at pt w/
    persistent asthma
  3. assess asthma control and adjust tx PRN
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13
Q

T or F: 0-4yr can not do lung function test

A

TRUE

d/t not being old enough to cooperate

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14
Q

NAEPP asthma dx and management

A
  1. Assess and monitor asthma severity and asthma control
  2. Pt education to poster partnership for care
  3. control environment factors and comorbid conditions affecting asthma
  4. pharm agents (2 categories)
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15
Q

NAEPP asthma dx and management - pt education

A

all pt should have written action plan that includes instructions for daily management and measures to take in response to change in status

be taught to reconize sx and control need for therapy

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16
Q

NAEPP asthma dx and management - control environmental factors

A

reduce exposure to irritants and allergens= may reduce med need

comorbid conditions = rhinisinusitis, GERD, obseity , OSA

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17
Q

NAEPP asthma dx and management - pharm agents

A

quick relievers= act directly to relax SM

long term (controllers)= act to attenuate airway inflamm. and taken daily to achieve and maintain control

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18
Q

T or F: NAEPP recommend using weekly anti-inflammatory therpy w inhaled corticosteroids for persistent asthma

A

FALSE

they recommend DAILY

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19
Q

SABA medications

A 
albuterol
levalbuterol
bitolrerol
pirbuterol
terbutaline

1-2 puffs
severe=6-12 q30-60min

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20
Q

SABA MOA:

A

relax SM> increase airflow and decrease sx

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21
Q

T or F: nebulized SABA are more effective

A

FALSE

DOES NOT offer more effective but DOES provide higher dose

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22
Q

What does repetitive ABA admin do

A

produces incremental bronchodilation

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23
Q

Alternative if SABA not working

A

Anticholinergics
corticosteroids
antimicrobials

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24
Q

Anticholinergic MOA

A

reverse bronchospasm but NOT allergen or exercise induced.
Decrease mucus gland secretions

IPORATROPIUM BROMIDE

25
Q

With intolerance to Beta 2 agonist of bronchospasms d/t BB what do you give

A

ANTICHOLINERGICS

Iporatropium bromide

26
Q

Corticosteroid MOA

A

systemic steroids are PRIMARY for pt w mod-severe exacer who dont respond promptly and completely to SABA

reduce rate of relapse and speed resolution of obstruction

Prednisone, methylprednisone

27
Q

Antimicrobial MOA

A

consider likihood of acute bacterial RTI

28
Q

Long term controllers examples

A

anti-inflammatory

long term bronchodilators

29
Q

Inhaled corticosteroids

A

PREFERRED 1st LINE for persistent asthma

use twice daily
max response not usually observed for months
dry powder inhales:not used w/ inhalation chamber
systemic effects may be seen w/ high dose of steroids

30
Q

Systemic corticosteroids

A

most effective in achieving prompt control of asthma during exacerbation in child and adult

alternating days is preferred than daily tx
requires concurrent tx w/ Ca and Vit D to prevent bone mineral loss
avoid rapid discontinuation to prevent adrenal insufficiency

31
Q

When do bone density test need to be done with systemic steroids

A

after 3 months

32
Q

Mediator inhibitors (long term broncho)

A

Cromolyn sodium and nedocromil

prevent sx, improve function with mild persistent or exercise induced

effective before allergen exposure, dont relieve sx once present

33
Q

Long acting beta 2 agonists (LABA)

A

Salmetrol and Formoterol

Delivery: dry powder device
MOA: bronchodilate up to 12 hr after single dose
prevent sx, nocturnal sx, and prevent exercise induced

SHOULD NOT BE used as monotherapy

34
Q

T or F: LABA should be used as monotherapy

A

FALSE

They have no anti-inflammatory effects need to be used with steroids

35
Q

Anticholinergics, short acting muscarinic agents, long acting muscarinic agents

A

reverse vagally mediated spasms but not allergen or exercise

  1. Ipratroprium bromide (SAMA): less effective than SABA
  2. Tiotropium add on therapy: improve lungs and reduce frequency of exacerbation
36
Q

Phosphodiesterase inhibitor

A

Theophylline

use for mild dilation
MOA: anti-inflammatory and immunodilator properties>enhances mucociliary clearance and strengthens diaphragmatic contracions
MONITOR serum concentractions d/t narrow therapeutic range

37
Q

Leukotriene modifiers

A

Zileutonn or Zafirlukast or montelukast

Alt to low-dose inhaled steroids in pt with mild persistent, but as monotherapy are less effective than inhaled steroids

38
Q

Omalizumab and Reslizumab

A

recombinant antibody that binds IgE without activating mast cells:

TREATS severe asthma in 18 or older

39
Q

Vaccinations for asthma

A

pneumovac and flu

40
Q

Oral sustained release beta 2 agonists

A

reserved for pt with nocturnal asthma or persistent mod-severe who DO NOT respond to other therapies

41
Q

Mild exacerbation

A

minor changes in airway function

PEF>80%

pt respond quick and full to inhaled SABA
Can initiate inhaled steroid if not one one

42
Q

T or F: doubling the dose of steroids is helpful in mild asthma

A

FALSE

is not effective or recommended

43
Q

Moderate asthma exacerbation

A

goal: correct HYPOXEMIA, reverse obstruction and reduce reoccurrence

44
Q

T or F: systemic steroids should be given if peak flow if <50% baseline

A

FALSE

should be given if <70% baseline or pt doesnt respond to several SABA tx

45
Q

The improvement of ___ after ___ minutes correlates to the severity of asthma

A

FEV1

30 minutes

46
Q

Acute (severe) asthma exacerbation

A

all pt should IMMEDIATELY get O2, high dose of inhaled SABA and systemic corticosteroids

Albuterol repeat in 20 minutes x3

Ipratropium bromide:: reduce rate of hospitalization when added to inhaled SABA

Short course PO steroids

IV mag FEV1<25

47
Q

When can you D/C pt home with severe asthma

A

when PEF or FEV1 has returned to 60% or more

48
Q

What is contraindicated in severe asthma

A 
mucolytic agents (may worsen cough and airflow)
Hypnotics (d/t resp depression)
49
Q

Tx for all asthma

A

SABA

Albuterol as MDI 1 puff repeat q20 x3

50
Q

How to dx <5 with PFT/spirometry

A

clinical judgement and assessment of sx

51
Q

How to determine is obstruction is reversible

A

test before and after short acting dilator

FEV1
FVC
FEV1/FVC

52
Q

FEV1

A

forced expiratory volume in 1 sec

53
Q

FVC

A

forced vital capacity

54
Q

FEV1/FVC

A

compared to reference norms for age, weight and gender

Airflow indicated by reduced

55
Q

A positive or negative response to bronchodilators confirms asthma

A

positive

56
Q

Peak expiratory flow meters

A

handheld devised for personal manageent

usually lowest when awakening
highest several hours before midpoint of day

measures in the AM before taking dilator and in afternoon after taking dilator

20% change in PEF suggest inadequate control

57
Q

When to refer for asthma

A

atypical presentation or uncertain dx
comorbid conditions: rhinosinusitis, tobacco, environmental allergies, bronchopulm mycosis
suboptimal response to therapy
not meeting goads after 306 months
requires high dose steroids for control
>2 course of prednisone in past 12 months
life-threatening exacerbation require hospitalization in last 12 mo
social or psych issues interfering with asthma

58
Q

When to admit asthma to hospital

A

Poor response to SABA after 2 tx 20 min apart

O2 <95 on RA
inability to speak in sentences

accessory muscles

change in alertness

PEF <50%

568 (8 decks)

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