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75 Cards in this Set

  • Front
  • Back
underlying mechanism for asthma
parthological changes in asthma
submucosa swelling
increased mucous
narrowing of passageway
delivery devises for inhaled meds
MDI, PDI, spacer/chamber
spacer/holder/face mask
daily: long-term control geared at
daily: long term-term control meds
corticosteroids (inhaled/sys)
long-acting beta2-agonists
methylxanthines (bronchodilators)
leukotriene modifiers
prn: quick relief meds
short acting beta2-agonists
systemic corticosteroids
The most effective long-term-control therapy for persistent asthma
Inhaled corticosteroids
risk is ____ at _____ dose
small; recommended
ways to reduce potential adverse events by
use spacer; rinse mouth; use lowest dose possible; combo with long-acting beta2-agonists
monitor growth in children
benefits of daily use of inhaled corticosteroid
fewer sx; fewer exacerbations; reduced use of rescue meds; improved lung fxn; decreased airway inflammation
studies of inhaled corticosteroids effect on linear growth in children shows _____ effect with low to medium doses
potential risk appears to be ______ dependent
high doses have a ______ potential for growth _____ or _______
greater; delay; suppression
for severe peristent asthma, _____ doses of inhaled CS have _____ risk than oral CS
high; less
while administering an inhaled CS in a child you should monitor ______
use ____ dose necessary to maintain control
____ therapy when possible
lowest; step down
administer with ______ chambers
advise pt to _____ & _____ following inhalation
inorder to decrease _____ absorption
rinse; spit; systemic
consider adding a ____-_____ beta2 _____ to a ____to____ dose inhaled CS
vs using a ____ dose of CS
long-acting; agonist; low to medium; higher
most important determinant of dosing is _____ judgement
monitor pts clinical _____ to therapy
adjust ____ accordingly
if seeing an improvment in PFT ____ with one med, don't _____ back and forth, ____ dose if necessary
stay; switch; increase
SE of B2 agonists
tachycardia, tremors, anxiety
LA B2-agonists are not a _____ for anti-inflammatory therapy
are not appropriate for ______
beneficial when added to _____ ______
inhaled CS
not for ___ sx or exacerbations
examples of LA Beta2-agonists are
salmeterol (Servevent)
formoterol (Foradil)
examples of SA B2-agonists are
albuterol (proventil)
Pirbuterol (Maxair)
metaproterenol (Alupent)
Levabluterol (Xopenex)
Metaproterenol is a _____ beta agonists
non selective
Levalbuterol is now available in what forms
nppb and MDI
Every asthma pt should have a _____-_____ Beta2-agonist as part of their therapy
short-acting; used for rescue
most effective med for relief of acute bronchospasm
SA Beta2 agonists
more than ____ cannister per ____ indicates inadequate asthma control
one; month
_____ scheduled use is not generally recommended
regularly scheduled use of SAB2A can result in _____ effectiveness and may increase ____
lower; hyperresponsiveness
Caffine, theophylline are examples of _______
Xanthine derivatives
theophylline is a ______ inhibitor and stimulates endogenous ________, which bind to ____ receptors
phosphodiesterase; catecholamines; B2
which is used IV, theophylline or aminophylline?
theophylline; aminophylline doesn't dissovle in water
What is the therapeutic level of theophylline?
adverse effects of theophylline
n/v, anorexia; tachycardia; arrhythmia; CNS (cerebral vasoconstriction); anxiety
factors that decrease theophylline concentrations
antiepiletic drugs (phentoyin (dilatin)(clears faster)
carbamazapine (tegretol)
high protein diet
factos that increase theophylline concentration
abtx, OC, systemic viral illness, cimetidine (tagamet)
decrease matabolism
anticholinergics are useful only in cholinergic-mediated ________ and work well in acute severe asthma in combo with __________
bronchoconstriction; B2 agonists
examples of anticholinergics
ipratropium bromide (Atrovent) (MDI, nppb)
glycopyrate (Robinul)
triotropium (Spiriva)
Combos with B2-agonisits(Combivent)
SE of anticholinergics are _____ than with systemic administration
less; tachycardia; dry mouth; decreased tracheal secretion
mast cell stabilizers _______ the release of _______
inhibit; histamines
Examples of mast cell stabilizers are
Cromolyn (Intal) (DPI); Nedocromil sodium (Tilade)
mast cell stabilizers are indicated for
prophylaxis of mild to moderate asthma regardless of etiology
Leukotriene modifiers are released from _____ ______
mast cells
mechanisms of leukotriene modifiers are
5-LO (lipoxydenase) inhibitors
cysteiny leukotriene receptor antagonist
example of 5-LO is
example of CLRAs are
Zyleuton (Zyflo)
Zafirlukast (Accolate), Montelukast (Singulair)(commonly used in peds and rhinnitis)
leukotriene modifiers are indiciated for
long-term control therapy in mild persistant asthma
LM ______ lung fxn; decrease need for ______; _______exacerbations
improve; SAB2 agonists; prevent
stepwise approach to control of asthma
start _____ and step _____ or start at initial level of ______ and gradually step ___
high; down; severity; up
step wise approach for adults and children >5 is
step 1________, step 2________, step 3_______, step 4_________
quick relief, prn; 1 long-term control med: antiinflammatory;
>= 1 Long-term control med
multiple long term control med: inlcuding oral CS
indicators of poor asthma control
awakens at ______ with sx
has _____ _____ visit
has _____ need for SAB2A
uses more than ______ cansiter of SAB2A in ____ month
night; urgent care; increased; one; one;
what you do next
step up therapy
before increasing medications you should check
inhaler technique; adherence of prescribed regimen; environmental changes; alternative dx
step one tx for adults and children >5
mild intermediate
daily long-term control: not needed
quick relief: inhaled SAB2A prn
step two for adults and children >5
mild persistent
Daily LT control: anti-inflammatory (inhaled CS low dose or Cromooyn or nedocromil)
sustained-release theop (not prefered); leuk modi. may be considered
quick relief: SAB2A prn
step 3 for adults and children >5
moderate persistant
Daily LT control: inhaled CS (med dose) or
inhaled CS (low to med dose and LA bronchodilator (LAB2A or sustained relase theoph)
if needed increase to:
inhaled CS (med to high dose) and LA bronchodil
consider refferal
step 4 tx for adults and children >5
severe persistent
daily LT control: inhaled CS (high dose) and LA bronchodil: inh LAB2A or sustained release theoph OR
LAB2A tabs and
oral CS, long term
quick relief
step 1 tx for children <5 yrs
mild intermittent
Daily LT control: not needed
Quick relief: bronchodilator
prn OR oral B2A; SAB2A; consider systemic CS if current exacerbation is severe
Step 2 tx for infants and young children <5
mild persistent
DLTC: anti-inflam: Cromolyn (nppb) or nedocromil OR
low-dose inhaled CS
quick relief: SAB2A (nppb or oral)
step 3 tx infants and young children <5
DLTC: anti-inflamm: med inh CS OR lower med-dose inh CS & nedocromil or theoph
QR: SAB2A (nppb/oral)
step 4 tx infants and young children <5
severe persistent
DLTC: high-dose inhaled CS
QR: inh SAB2A or nppd
School-age children special considerations:

consider use of _____ or ______ first for step 2 care

encourage active participation in _____ activity
cromolyn or nedocromil; physical
Special considerations for older adults
high prevelance of coexisting ____ lung disease
essential to review pt ____ in using medicaiton and devices
meds have increased ____ ____
_____ clearance is reduced; causing _____ blood levels
obstructive; technique; adverse effects; theoph; increased
systemic corticosteroids can provoke _______, agitation and changes in _____ metabl.

inhaled CS may be associated with dose-dependent reduction in ____ mineral content
confusion; glucose; bone
meds that may exacerbate asthma
NSAIDS; non-selective B-blockers; B-blockers found in some eye drops (Timolol)
Mangagement of EIB

_____ used shortly a exercise

______ may prevent EIB for 1--12 hours

_____ and nedcromil are also acceptable
SAB2A (inh); salmeterol; cromolyn
managing seasonal asthma sx

just a allergy season start daily ___-____ therapy
during allergy season

______ anti-inflammatory therapy
use _____ approach to control sx
continue; stepwise