ASTHMA Flashcards

Question

Moderate to Severe Asthmatic Episode-PEFR

Answer 1

PEFR normal is 9.5 L/sec Decreased

Answer 2

MVV normal is 160 L/min Decreased

Answer 3

Normal or increased

Answer 4

IRV Normal or decreased

Answer 5

Normal or decreased

Answer 6

Normal or decreased

Answer 7

Normal or increase

Answer 8

Normal or increased

Answer 9

An ABG will initially show acute alveolar hyperinflation with hypoxemia, but may show hypercarbia in status asthmaticus

Answer 10

Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis) The PaCO2 will sharply go up and PaO2 will sharply go down because the muscles become over fatigues and can no longer compensate so they hypoventilate

Answer 11

Increased antero-posterior diameter (barrel chest) Translucent (dark) lung fields Depressed or flattened diaphragms

Answer 12

Eosinophils Charcot-Leyden Crystals: Product of the breakdown of eosinophils combined with lysophospholipase Cast of muscus from small airways (Kirschman spirals) IgE Levels-Elevated in extrinsic asthma

Answer 13

This is the shunt % Normal is \<10 In asthma moderate to severe stages will **increases**

Answer 14

This is the delivery of O2 Normal is 1000 mL In asthma moderate to severe stages will decrease

Answer 15

This is the O2 consumption Normal is 250 mL/min In asthma moderate to severe stages will be normal

Answer 16

This is the Content A-V delta Normal is 5 vol% In asthma moderate to severe stages is normal

Answer 17

This is the extraction ratio Normal is 25% In asthma moderate to severe stages will increases

Answer 18

This is the venous saturation Normal is 75% In asthma moderate to severe stages will decrease

Answer 19

Identify and Reduce Exposure to Risk Factors Assess, treat, and monitor asthma Manage Asthma Exacerbations Special Considerations Treatment Protocols

Answer 20

Avoid risk factors Take medications correctly Understand the difference between “controller medications” and “reliever” medications (also called rescue medications) Monitor the status using symptoms and, if relevant, PEFR Recognize signs that asthma is worsening and take action Seek medical help as appropriate Look at your asthma action plan and for indications if status if getting worse

Answer 21

From controlls to uncontrolled 1. Confirm Diagnosis 2. Enviromental control, education, and action plan 3. Fast acting bronchodilator on demand 4. Inhaled Corticosteroid (ICS)-2nd Line Leukotriene Recptor Anatagonist (LTRA) 5. Add LABA if older than 12 but if 6-11 increase ICS 6. Add LTRA if older than 12 but if 6-11 add LABA or LTRA 7. Anti IgE 8. Prednisone

Answer 22

Asthma exacerbation is defined as a progressive increase in shortness of breath, cough, wheezing, or chest tightness, or any combination of these symptoms

Answer 23

Maintanence and control of chronic asthma through the **suppression of activated inflamatory genes** in the airway epithelial cells First line therapy in mild, moderate and severe asthma as it is considered to be the most effective long term therapy

Answer 24

It is considered to be a first line of defense in asthma but not for COPD Not considered first line therapy for treatment of COPD (used in combination: ICS/LABA). This is because COPD has a different pattern of inflammatory cells in comparison to asthma (neutrophils are seen in COPD). Oral and ICS do not influence the inflammatory changes driven by neutrophils. Patients with stable COPD should not be given systemic steroids.

Answer 25

Mediator antagonists (Nonsteroidal) Agents that are prophylactic, antiallergic, antiasthmatic Act as antagonists to mediators of inflammation These are not steroids Includes Anti-Leukotrienes like Singulair

Answer 26

Zafirlukast – ACCOLATE

Answer 27

For the prophylaxis and chronic treatment of asthma Effective in preventing bronchoconstriction and other asthmatic airway responses in allergen, exercise and cold air challenges

Answer 28

Selectively competes for leukotriene receptor LTD4 and LTE4 sites, preventing the inflammatory response of airway contractility, vascular permeability and mucus secretion. Inhibits asthma reactions induced by exercise, cold air, allergen and aspirin Leukotrienes are more potent than histamines in causing bronchospasm. They are also potent stimulants of mucus secretion _Oral Vs. Inhaled_ * Oral will inhibit early and late phase asthma and cause modest bronchodilation * Inhaled format inhibits early phase only

Answer 29

For the prophylaxis and chronic treatment of asthma Effective in preventing bronchoconstriction and other asthmatic airway responses in allergen, exercise and cold air challenges Approved for use in children as young as 6 months Useful for mild-moderate asthma, Also approved for allergic rhinitis

Answer 30

Selectively competes for leukotriene receptor LTC4, LTD4 and LTE4 sites, preventing the inflammatory response of airway contractility, vascular permeability and mucus secretion. Leukotrienes are more potent than histamines in causing bronchospasm. Also inhibits both early and late phase bronchoconstriction

Answer 31

Laryngitis, pharyngitis, cough Nausea, diarrhea, pain Otitis, sinusitis

Answer 32

This drug is indicated for the prophylaxis and chronic treatment of asthma, and is approved for use in adults and children over 12 years of age It is a controller not a reliever and has no use in an acute asthma attack

Answer 33

Leukotriene receptor antagonist like Accolate. Inhibits the formation of leukotrienes from arachidonic acid. By interrupting the synthesis of these biologically active leukotrienes their contribution to the inflammatory responses in asthma is effectively blocked Inhibits the 5-LO enzyme which would otherwise catalyze the formation of leukotrienes from arachidonic acid

Answer 34

Headache, neck pain General pain Abdominal pain Loss of strength Nausea, vomiting, constipation, flatulence Liver enzyme elevations Recommend monitoring liver enzymes during treatment – liver enzymes may decrease or return to normal during tx or after discontinuation Contraindicated in patients with acute liver disease or with elevated liver enzymes Taken at meals and at bedtime.

Answer 35

Xolair – Omalizumab An injectable Biologic used with Asthmatics with allergic components that are not well controlled with maximized conventional therapy. Biologic means made of animal or human protein – genetically engineered It is an anti-IgE monoclonal antibody that inhibits the immunologic cascade by blocking IgE Expensive treatment not covered by all drug programs Symptoms are inadequately controlled with inhaled corticosteroids. Xolair has been shown to significantly decrease the incidence of asthma exacerbations and improve control of asthma symptoms in these patients. Safety and efficacy have not been established in other allergic conditions. Anaphylaxis rare. However, can occur after first dose or 1 year into treatment therefore, pt. must be monitored appropriately following injection

Answer 36

Indicated for the treatment of moderate to severe asthma in adults and peds (\>12 years old) who have a positive skin test to aeroallergen Patients must have S.Q injections every 2 or 4 weeks – comes in a 150 mg vial, dependent on the weight and serum IgE level of the patient Issues: Anaphylaxis, expensive, requires an injection, duration of treatment Anaphylaxis rare – can occur after the first dose or 1 year into tx, Pharmacokinetics – after administration – absorbed slowly – peak effect in 7-8 days, excreted by the liver, half-life of aprox 26 days (may be weight related – increasing weight, increases clearance) Not indicated for acute relief of SOB Not a replacement for inhaled corticosteroids Not optimal as monotherapy in persistent asthma May allow reduction of high-dose ICS or allow for decreasing of ICS dos May allow reduction in asthmatic rescue agents

Answer 37

Inhaled Corticosteroids QVAR

Answer 38

Inhaled Corticosteroids azmacortt

Answer 39

Inhaled Corticosteroids Aerobid AeroBid-M

Answer 40

Inhaled Corticosteriods ## Footnote Flovent HFA Flovent Diskus

Answer 41

Inhaled Corticosteriods Alvesco

Answer 42

Inhaled Corticosteroid Pulmicort Turhuhaler

Answer 43

Inhaled Corticosteroid Asmanex Twisthaler

Answer 44

SYSTEMIC CORTICOSTEROIDS Medrol Solu-Medrol

Answer 45

SYSTEMIC CORTICOSTEROIDS Solu-Cortef

Answer 46

LONG-ACTING 2-AGENTS (LABA) SEREVERT

Answer 47

LONG-ACTING 2-AGENTS (LABA) Foradil

Answer 48

LONG-ACTING 2-AGENTS (LABA) Brovana

Answer 49

INHALED CORTICOSTEROIDS AND LABA Advair Diskus

Answer 50

INHALED CORTICOSTEROIDS AND LABA Symbicort

Answer 51

MAST-CELL STABILIZING AGENTS Intal

Answer 52

LEUKOTRIENE INHIBITORS (ANTILEUKOTRIENES) Accoclate

Answer 53

LEUKOTRIENE INHIBITORS (ANTILEUKOTRIENES) Singulair

Answer 54

XANTHINE DERIVATIVES Aminophylline, Theo-Dur

Answer 55

Asthma rates continue to increase in both sexes however self reported rates are higher in women than in men

Answer 56

COPD FEV1/FVC \>70% and FEV1 \< 80% of predicted in response to bronchodilator therapy If post bronchodilator therapy FEV1 increases \> 0.4 L then the COPD pt. may also have underlying asthma and will benefit from a combined therapy of bronchodilators and inhaled steroids

Answer 57

COPD-Increases in neutrophils and macrophages Asthma-Increases in eosinophils inflammation

Answer 58

COPD-Non drug oriented that is more focused on rehab Asthma-Drug oriented

Answer 59

COPD-\> 40 yrs of age Asthma- \< 40 yrs of age

Answer 60

More common in COPD

Answer 61

Asthma-Infrequent COPD-Often

Answer 62

Asthma-Often COPD-Infrequent

Answer 63

COPD-Presistent and Progressive Asthma-Intermittent and Variable

Answer 64

COPD-Progressively worsening Asthma-Stable

Answer 65

COPD-Neutrophils Asthma-Eosinophils

Answer 66

COPD-Helful in patient with moderate to severe disease Asthma-Essential

Answer 67

COPD-Regular therapy Asthma-Only use as needed

Answer 68

Asthma-Rarly used COPD-Essential

Answer 69

Bronchoconstriction & bronchospasm, mucosal swelling, and increased production of thick tenacious mucus.

Answer 70

Increased respiratory rate, work of breathing, heart rate, cardiac output, and blood pressure. The patient may also have a prolonged (forceful) expiration and a decreased peak expiratory flow rate.

Answer 71

Bronchoconstriction, bronchospasm, pulmonary vasodilation, airway inflammation, and increased mucus production.

Answer 72

Luekotriene antagonist, Montelukast Sodium (Singulair).

Answer 73

Cromolyn (intal) and Nedocromil (tilade).

Answer 74

It can be used to treat patient that are 12 years of age and above. They must have a moderate to severe persistent asthma have asthma triggered by year-round allergens in the air, and continue to have asthma symptoms even though they are taking inhaled steroids.

Answer 75

True. A methacholine challenge test is performed to determine how reactive or responsive your lungs are to different asthma triggers in the environment. The test can help your doctor evaluate symptoms suggestive of asthma and help diagnose whether or not the patient has it.

Answer 76

They affect only people allergic to a specific substance.

Answer 77

The effect everyone if the dose is high enough.

Answer 78

Tobacco smoke, wood smoke, chemicals in the air, ozone, perfumes, household cleaners, cooking fumes, paints, and varnishes.

Answer 79

Vapors, dust, gases, and fumes.

Answer 80

Viral and sinus infections, exercise, reflux disease herd, medications (NSAIDS), beta blockers, and emotional anxiety.

Answer 81

Antihistamines, decongestants, anti-inflammatory agents, anti-leukotrienes, bronchodilators, and anticholinergics.

Answer 82

Mast cell stabilizers, corticosteroids, and bronchodilators.

Answer 83

Beta-agonist bronchodilators, methylxanthines, and anticholinergics.

Answer 84

PDE inhibitors such as theophylline, aminophylline, and theobromide.

Answer 85

They block the veal nerve in bronchoconstriction and can be used alone or along with bronchodilators. Some examples include Atrovent and Spiriva (tiotropium bromide). These are better for COPD rather than asthma.

Answer 86

(1) To prevent chronic and troublesome symptoms, (2) to maintain normal breathing, (3) to maintain normal activity levels including exercise, (4) to prevent recurrent asthma flare-ups, (5) to minimize the need for emergency room, and (6) to provide optimal medication therapy with no or minimal effort.

Answer 87

You use a rescue inhaler more than 2 times a week, you awaken at night with asthma symptoms more than 2 times a month, you use more than 2 canisters a year of rescue medications (inhaler).

Answer 88

Short-acting beta-2 agonists, inhaled anticholinergics, short-acting theophylline, epinephrine/ adrenaline injection.

Answer 89

Corticosteroids, tablets or syrup steroids, mast cell stabilizers, long-acting beta-2 agonist, sustained-release tablets, sustained release methylxanthines, anti-leukotrienes.

Answer 90

It’s a form of antigen extract to desensitize the patient to asthma triggers. It can help to reduce asthma symptoms, as well as the need for medications. It can also help reduce the risk of severe asthma attacks after future exposure to the allergen. It has been shown to possibly be as effective as inhaled steroids.

Answer 91

It likely means that the patient isn’t moving any air and may be going into respiratory failure. This is a very dangerous situation and may require intubation and mechanical ventilation.

Answer 92

Decreased airflow, low peak flows, and an increased residual volume. The FVC may be decreased due to air trapping, and the FEV1/FVC ratio is decreased.

Answer 93

It will decrease during inspiration by 10-20 mmHg.

Answer 94

Eosinophils.

Answer 95

It is an abnormally large decrease in the patient’s stroke volume, systolic blood pressure and pulse wave amplitude during inspiration.

Answer 96

* Asthma is a condition in which a person’s airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe. * The disease is chronic, obstructive, inflammatory, and varies with different levels of severity. * There will be recurring episodes of paroxysmal dyspnea, wheezing on expiration and inspiration caused by constriction of the bronchi, coughing, and viscous mucoid bronchial secretions. * The episodes may be precipitated by inhalation of allergens or pollutants, infection, cold air, vigorous exercise, or emotional stress. * It’s essentially hyperreactivity of the airways

Answer 97

During the course of inflammation bronchial hyperreactivity will occur * In comparison to healthy people the airways of patient with asthma react more sensitive to various stimuli * The consequence is paroxysmal and recurring obstruction in the airways

Answer 98

Allergic type of asthma often exists in combination with other diseases pertaining to the **atopic syndrome**, such as allergic rhinitis or neurodermatitis.

Answer 99

* They all have in common a polygenic predisposition for excessive production of IgE.

Answer 100

* Causes can include * Stress * Cold or dry air * Smoke * Noxious inhaled agents * GERD * Anxiety * Acetylsalicylic acid/NSAIDs * **Analgesic Asthma Syndrome** * Viruses * Infections.

Answer 101

* Often, the two types cannot be rigorously distinguished especially when they occur in adult asthmatics. Only 30 % of patients suffer from a purely extrinsic or intrinsic asthma; the rest display hybrid forms of both types.

Answer 102

* After a few minutes of coming into contact with a corresponding allergens IgE antibodies will appear * These antibodies will activate mast cells, which will release mediators such as leukotriene, prostaglandin, and histamine * **Type 1 hypersensitivity reaction** * These mediators will cause bronchospasm and attract inflammatory cells * The inflammatory cells will create long term chronic inflammation

Answer 103

* The immunological process is similar to extrinsic asthma but without a triggering allergen, rather there is infectious agents (viruses) that can be triggering factors

Answer 104

* Shortness of breath * Expiratory stridor * Chronic cough * Mostly dry and in spasms (cough variant asthma) * Thoracic tightness * **Symptoms respond to appropriate anti-asthma therapy**

Answer 105

* Mainly involves the medium sized and small bronchi

Answer 106

* Improvement in FEV₁ \>/= 12% and \>/= 200 mL % Improvement= [(Post FEV1-Pre FEV1)/ Pre FEV1] x 100

Answer 107

* An essential part of diagnosis asthma is the PFT * In a PFT an obstruction with an increase in airway resistance can be observed * FEV1 is reduced * Given an approximately constant vital capacity, this yields a reduced **Tiffeneau-Pinelli index: FEV1 / VC \< 70 %.** * A decisive factor in differential diagnosis (e.g. in comparison to **COPD**) is the reversibility of the obstruction, tested in a **bronchodilator reversibility test** * The FEV1 value improves significantly either directly after administration of inhaled bronchodilator medication (e.g., 400 μg salbutamol) or in case of a lack of response, after administration of inhaled glucocorticoids over 4 weeks. * If the pulmonary function testing does not show any abnormalities despite suspected asthma, a **provocation test** (methacholine challenge test) can confirm a diagnosis. * The patient inhales methacholine or histamine, and due to the hyperreactivity of the airways, this provokes bronchoconstriction, which leads to a reduced FEV1 value by least 20 % and a doubling of resistance. * The following inhalation of salbutamol dilates the bronchial tubes and normalization of the pulmonary function parameters should be achieved.

Answer 108

* pH * Increased * PaCO₂ * Decreased * Due to hyperventilation * HCO₃ * Slightly Decreased or Normal * PaO₂ * Normal

Answer 109

**Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)** * pH * Normal * PaCO₂ * Normal * HCO₃ * Normal * PaO₂ * Normal but starting to decrease

Answer 110

**Acute Alveolar Hyperventilation with Hypoxemia (Acute Respiratory Alkalosis)** * In severe asthma attacks, it will be a case of impending respiratory failure * pH * Decrease * PaCO₂ * Increase * HCO₃ * Decrease * PaO₂ * Severe Decrease

Answer 111

* Patients with left-sided heart failure who have developed a lung congestion with shortness of breath. Bilateral basal rales during auscultation of the lungs and a chest x-ray with signs of pulmonary congestion lead to the right diagnosis.

ASTHMA Flashcards

(138 cards)