Respiratory/renal Allergies And Asthma Set2

Front 1

Mast Cell Stabilizers
a)indications/role (4)
b)ADR's
c)2ex

Back 1

a1)exercise-induced asthma
a2)2nd line as monotherapy
a3)4-6wks to therapeutic response
a4)very safe and no ADRs

b)NONE
c)Cromolyn, Nedocromil

Front 2

Theophylline
a)indications/role (1)
b)PK (2)
c)ADR's (4 of many)

Back 2

a1)LAST LINE as combo w/ inhaled corticosteroid + other meds

b)half life is 6h; serum levels want at 5-15

c)n/v, irritability, arrhythmias, dizziness

Front 3

Theophylline drug interactions
a)3 that incr levels
b)3 that decr levels
c)synergistic toxicity w/ ____ = arrhythmias

Back 3

a)CCB, allopurinol, carbamamzepine
b)barbiturates, charcoal, ketoconazole
c)sympathomimetics

Front 4

Omalizumab
a)indications/role (3)
b)ADR's (3)

Back 4

a1)LAST LINE for pts w/ severe persistent and PERENNIAL ALLERGIC ASTHMA (year round triggers)
a2)great in pts w/ high IgE
a3)expensive

b1)injetion site rxns
b2)HA
b3)viral infexns

Front 5

Systemic Corticosteroids
a)indications/role (2)
b)Prolonged ADR's (4)

Back 5

a1)SECOND line as combo w/ steroids and LAB2
a2)long term when taken daily

b1)cushings, osteoporosis, HTN, glucose intolerance

Front 6

Principles of asthma pharmacotherapy (6)

Back 6

1)all pts get albuterol for prn stuff
2)use of albuter over 2x/wk = need for long term control therapy
3)selection of therapy is dictated by asthma severity
4)initiate therapy w/ high-end recommendations; then step down as control is achieved
5)after change in therapy reeval in 2-6wks
6)when stable, reeval @ 1-6months for adherence, ADR's, etc

Front 7

Intermittent asthma severity
a)preferred treatment
b)alternative treatment

Back 7

a)albuterol prn symptoms
b)exercise-induced symptoms give albuterol/mast cell stabilizer b4 exercise

Front 8

Mild persistent asthma
a)preferred treatment
b)alternative treatment

Back 8

a)low dose ICS
b)mast cell stabilizer & LK modifier (especially w/ allergies)

Front 9

Moderate persistent asthma
a)preferred treatment
b)alternative treatment

Back 9

a)low/med dose ICS & LA inhaled B2agonist
b)low dose ICS & LK modifier OR theophylline OR zileuton

Front 10

Severe persistent asthma (level 4)
a)preferred treatment
b)alternative treatment

Back 10

a)med dose ICS and LA B2agonist
b)med dose ICS and LK modifier OR theophylline OR zileuton

Front 11

Severe persistent asthma (level 5)
a)preferred treatment
b)alternative treatment

Back 11

a)high dose ICS and LA B2agonist
b)?

Front 12

Severe persistent asthma (level 6)
a)preferred treatment
b)alternative treatment (2)

Back 12

a)high dose ICS and LA B2agonist
b1)AND if needed systemic corticosteroids (omalizumab if pt has allergies)
b2)can also consider adding LK modifier, theophylline, zileuton

Front 13

Risk factors for death due to asthma (6)

Back 13

1)history of severe exacerbations (intubation/ICU)
2)2 or greater hospitalizations in past year
3)4 or greater ED visits in past year
4)greater than 2 SABA canisters per month
5)low socioeconomic status/inner city residence
6)illicit drug use

Front 14

Classification of chronic asthma symptoms does NOT...

Back 14

determine the severity of acute asthma exacerbations

Front 15

Classifying severity of acute asthma
a)Mild
b)moderate
c)severe
d)Severe and Life threateneing

Back 15

a)FEV over 70%; O2 sat over 95%
b)FEV 40-70%; O2 sat 90-95%
c)FEV less than 40%; O2sat less than 90%
d)FEV under 25%

Front 16

3 main treatments of acute asthma

Back 16

1)oxygen
2)bronchodilators (albuterol)
3)corticosteroids

Front 17

Albuterol adult ACUTE dose (2)

Back 17

Nebulizer 5mg q20min x3, then q1-4h prn

MDI (90mcg/puff) 4-8puffs q20min x3, then q1-4h prn

Front 18

Albuterol pediatric ACUTE dose (2)

Back 18

Nebulizer (0.15mg/kg, min 2.5mg) 1 dose q20min x3, then 1-4h prn

MDI 4-8puffs q20min x3, then q1-4h prn

Front 19

When to use albuterol nebulizer

Back 19

ONLY if can't use MDI b/c they have the same efficacy

Front 20

Ipatropium role in acute asthma?

Back 20

in SEVERE exacerbations w/ high dose albuterol; never monotherapy b/c delayed onset

Front 21

Ipatropium ACUTE adult dose

Back 21

Nebulizer (0.5mg) 1 dose q20min x3, then q1-4h prn

Front 22

Ipatropium ACUTE pediatric dose

Back 22

Nebulizer (0.25mg) 1 dose q20min x3, then q1-4h prn

Front 23

Theophylline and acute asthma

Back 23

NOT USED IN ACUTE ASTHMA

Front 24

Systemic B2agonists
a)agents (2)
b)when to use and why?

Back 24

a1)epinephrine
a2)terbutaline (brethine)

b)emergency situations ONLY, b/c no advantage over inhalation therapy

Front 25

Inhlaled LABA's and acute asthma (2)

Back 25

1)hold LABA while recieveing frequent albuterol treatments to decr SE's
2)NOT indicated in acute asthma

Front 26

Systemic corticosteroids and acute asthma (4)

Back 26

1)use methylprednisolone or prednisone
2)used in all pts w/ exacerbation
3)speed resolution of airflow obstruction and reduce relapse rate
4)oral and IV prednisone have equal efficacy

Front 27

Ratio of methylprednisolone and prednisone

Back 27

methylprednisolone 4mg = prednisone 5mg

Front 28

Prednisone/Methylprednisolone adult ACUTE dose

Back 28

40-80mg/day in 1-2doses until FEV1 reaches 70% (complete 5-10d course)

Front 29

Prednisone/Methylprednisolone pediatric ACUTE dose

Back 29

1mg/kg/day (max 60mg/day) in 2 doses until FEV1 reaches 70% (complete 5-10d course)

Front 30

Systemic corticosteroids in acute astham ADR's (immediate ADR's of em) (5)

Back 30

1)edema
2)HTN
3)insomnia
4)euphoria
5)leukocytosis

Front 31

Inhaled ICS and acute asthma

Back 31

NOT USED, but con't during exacerbation due to taking long time to act

Front 32

LK modifiers and acute asthma (2)

Back 32

1)role in acute asthma has NOT been established
2)safe to con't during the exacerbation

Front 33

Magnesium Sulfate Infusion and Acute asthma (2)

Back 33

1)helpful in exacerbations that are severe and life threatening
2)helpful in exacerbations that are severe and NOT resonding after 1hr of standard treatments

Front 34

Helium-Oxygen mixtures and Acute asthma (4)

Back 34

1)mix of 65% He, 35% O2
1)helpful in exacerbations that are severe and life threatening
2)helpful in exacerbations that are severe and NOT resonding after 1hr of standard treatments
3)conflicting results of efficacy

Front 35

Acute Asthma therapies NOT recommended (4)

Back 35

1)Abx
2)Hydration
3)mucolytics
4)Sedation (codeine)

Front 36

Mild ACUTE exacerbations treatment (3)

Back 36

1)oxygen not necessary
2)MDI albuterol 4-8puff q20min x3; then q1-4h prn
3)Prednisone 40-80mg po qd for 5-10d

Front 37

Moderate ACUTE exacerbatinos treatment (4)

Back 37

1)oxygen til O2 sat above 95%
2)Albuterol Neb, 5mg q20min x3, then q1-4h prn OR...
3)MDI albuterol 4-8puff q20min x3; then q1-4h prn
4)Prednisone 40-80mg/day until FEV1 reaches 70% for 5-10d

Front 38

Severe ACUTE exacerbations treatment (4)

Back 38

1)oxygen til O2 sat above 95%
2)Albuterol Neb, 5mg q20min x3, then q1-4h prn AND IPATROPIUM OR...
3)Albuterol Neb, 15mg 1mg/hr by cont. infusion and ipatropium
4)Prednisone 40-80mg/day until FEV1 reaches 70% for 5-10d

NO MDI ALBUTEROL ALL NEBULIZER AT THIS STAGE

Front 39

Severe & Life Threatening ACUTE exacerbations treatment (3)

Back 39

1)oxygen intubate and ventilate w/ 100% O2
2)Albuterol Neb, 15mg 1mg/hr by cont. infusion and ipatropium
4)IV methylprednisolone b/c of intubation (switch to PO when extubated), 40-80mg/day until FEV1 reaches 70% (complete 5-10d course)

NO MDI ALBUTEROL ALL NEBULIZER AT THIS STAGE

Front 40

MDI
a)advantage (3)
b)disadvantage (2)

Back 40

a1)convient/portable
a2)inexpensive
a3)efficient

b1)technique dependent upon hand-breath coordination
b2)they do not monitor # of puffs remaining

Front 41

MDI technique (CLOSED mouth technique) (7)

Back 41

1)shake
2)exhale completely
3)place upright inhaler @ opening of mouth
4)begin slow/deep inhalation
5)actuate canister once after start of inhalation & cont inhalation
6)hold breath for 10s
7)wait 1min and repeat

Front 42

Difference b/w MDI closed/open mouth technique

Back 42

open mouth the MDI is placed 2in (2fingers) away from open mouth

Front 43

Spacers? (3) (w/ MDI)

Back 43

1)provide space b/w MDI mouthpiece and pt
2)minimizes deposition of meds on back of throat
3)allows propellant to evaporate

Front 44

Chambers (4) (w/ MDI)

Back 44

1)one-way valve
2)eliminates the hand-breath coordination reqd for MDI use
3)eliminates deposition of meds on back of throat
4)masked once for pediatric pts

Front 45

DPI
a)advantages (4)
b)disadvantages (4)

Back 45

a1)convenient/portable
a2)less coordination reqd
a3)no propellants reqd
a4)some tell how many doses are left

b1)requires deep/forceful inspiration flow to aerosolize meds
b2)may cause more pharyngeal deposition
b3)NOT for kids under 5yo
b4)if exhale into device, dose is lost

Front 46

DPI technique (7)

Back 46

1)hold parallel to ground
2)trigger/actuate device once
3)exhale completely (but not into device)
4)place mouthpiece in mouth and close mouth around it
5)breathe in quick/forceful inhalation
6)hold breath for 10s
7)wait 1min b4 repeating for 2nd dose

Front 47

Nebulizer types (2)

Back 47

1)Jet; aerosolize solution using jet streatm of pressurized gas
2)Ultrasonic; aerosolize solution using high frequency ultrasonic waves by power souce (w/ or w/o a fan)

Front 48

Nebulizer
a)adv (2)
b)disadv (4)

Back 48

a1)pt coordination not reqd
a2)can deliver higher doses

b1)expensive
b2)bulky, not portable
b3)requires assembly/preparation
b4)more time to admin a dose

Front 49

Nebulizer technique (5)

Back 49

1)assemble nebulizer
2)add meds and qs w/ sterile solution to nebulizer
3)begin treatment
4)breathe slow, deep inhalations thruout
5)stop treatment when nebuilzer begins to sputter

Front 50

3 types of pts that need Peak Flow monitoring

Back 50

1)severe persistent
2)moderate persistent
3)any pt w/ history of severe exacerbations

Front 51

Peak Flow technique (7)

Back 51

1)move indicator to bottom
2)stand up
3)take deep breath
4)place mouthpiece in mouth and close lips around it
5)blow out as hard/fast as you can
6)repeat 2x and record best measurement in log
7)USE EVERY MORNING B4 WAKING B4 ASTHMA MEDICATION TAKEN

Front 52

Zones of Peak Flow monitoring (3)

Back 52

a)Green (80+% FEV1); cont as usual
b)Yellow (50-80% FEV1); use SABA, call MD to incr daily meds)
c)RED (less than 50% FEV1); call MD/ER

Front 53

Written axn plan instructs pts on what? (5)

Back 53

1)level of control
2)daily management
3)early signs of worsening asthma
4)meds for worsening asthma
5)when to seek medical care

Front 54

Allergic rhinitis
a)def
b)common symptoms (3)

Back 54

a)inflammation of nasal mucus membrane in response to exposure to inhaled allergen
b)sneezing, nasal itching, watery rhinorrhea

Front 55

Seasonal allergic rhinitis (2)

Back 55

1)occur in response to seasonal pollens
2)commonly called "hay fever"

Front 56

Perennial allergic rhinitis (2)

Back 56

1)occurs greater than 2h per day AND greater than 9months/year
2)happen in response to indoor allergens like (mites, roaches, dander)

Front 57

Nonallergic rhinitis (5)

Back 57

1)triggered by temp, humidity, pollution, chemicals, spicy foods
2)(-) skin tests, nasal smear for eosinophils
3)can get nasal polyps
4)less itching than allergic rhinitis
5)vasomotor/NARES

Front 58

Infectious rhinitis (sinusitis) (2)

Back 58

1)cause by viral respiratory infexn or bacterial sinus infexn
2)nasal discharge will be thicker and colored yellow-green

Front 59

Rhinitis medicamentosa (2)

Back 59

1)caused by long-term use (3-5d) of decongestant nasal sprays or cocaine use
2)rebound congestion due to #1

Front 60

Symptoms of allergic rhinits (6)

Back 60

1)paroxysms of sneezing
2)itching (ENT,ears)
3)clear, watery rhinorrhea
4)congestion/snoring
5)postnasal drip (causing cough, hoarseness)
6)pain (face,ear,HA,throat)

Front 61

First line in allergic rhinitis w/ asthma and 3ex

Back 61

NASAL CORTICOSTEROIDS
1)mometasone
2)fluticasone
3)beclomethasone

Front 62

Nasal corticosteroids used in younger kids (2)

Back 62

1)fluticasone FUROATE (VERAMYST)
2)mometasone (NASONEX)

FOR KIDS UNDER 2

Front 63

Systemic Antihistamines (ALLERGIC RHINITIS)
a)role (2)
b)2nd gen ADR's (2)

Back 63

a1)first line for symptom relief (sneezing, itch, conjunctivitis, rhinorrhea)
a2)more effective @ preventing histamine effects than reversing effects

b1)QT prolongation in some
b2)especially w/ CYP3A4 drug interactions

Front 64

2nd Gen AH's that can be used in young kids AND ____ is a metabolite of terfenadine

Back 64

1)zyrtec (6months old)
2)clarinex (6months old)

fexofenadine

Front 65

Nasal Antihistamines (ALLERGIC RHINITIS)
a)role
b)ADR's
c)ex

Back 65

a)2nd line for symptoms of allergic rhinitis
b)drowsy, anticholinergic
c)Astelin

Front 66

Nasal Mast Cell Stabilizers (ALLERGIC RHINITIS)
a)indications
b)ADR's (5)

Back 66

a)alt to nasal corticosteroids
b)sneeze, burn, irritation, HA, bad taste in mouth

Front 67

LK modifiers (ALLERGIC RHINITIS)
a)indications (3)

Back 67

a)montelukast is only FDA approved agent for AR
b)adv for pts w/ asthma and allergy
c)can be used in 6month olds

Front 68

Systemic decongestants role (2) and ADRs (3) (ALLERGIC RHINITIS)

Back 68

1)first line for symptomatic relief of nasal congestion
2)do not treat allergic rhinitis, just congestion

1)higher risk of stroke w/ HTN
2)avoid in arrhythmias, hyperthyroidism
3)rhinitis medicamentosa

Front 69

Short acting decongestnat
Intermediate acting
Long acting

Back 69

SA)phenylephrine
IA)tetrahydrozoline
LA)afrin

Front 70

Nasal Anticholinergics (ALLERGIC RHINITIS)
a)role (3)
b)ADR's (3)
c)ex

Back 70

1)VASOMOTOR RHINITIS
2)not first line
3)additive therapy for rhinorrhea not controlled w/ nasal corticosteroids

1)HA, epistaxis, drynose

1)Atrovent (ipatropium) spray

Front 71

Systemic Corticosteroids and allergic rhinitis? (2)

Back 71

1)for severe, debillitating allergic rhinitis
2)short course of therapy to provide relief of severe symptoms

Front 72

Immunotherapy and ALLERGIC RHINITIS (3)

Back 72

1)symptom relief within months but full effects after years
2)used in pts w/ con't symptoms despite appropriate allergen avoidance and drugs
3)give small exposure to allergen to induce tolerance

Front 73

Preferred treatment of Kids under 3 for allergic rhinitis (2)

Back 73

1)Nasal mast cell stabilizer
AND/OR
1)systemic antihistamine (avoid 1st gen)

Front 74

Allergic conjunctivitis def's (2)

Back 74

inflammation of conjunctiva in response to allergen

conjunctive is mucous membrance lining eyelids

Front 75

Pathophysiology of allergic conjunctivitis (3)

Back 75

1)IgE mediated response causes mast cell degranulation of contact w/ allergen
2)release of histamine, PG, LK
3)incr vascular permeability and migration of eosinophils and neutrophils

Front 76

Symptoms that histamine causes (3)

Back 76

1)itch
2)redness
3)edema

Front 77

Symptoms that PG's cause (4)

Back 77

1)sensitized nerves
2)enhanced pain b/c of #1
3)edema
4)redness

Front 78

LK causes what symptoms (3)

Back 78

1)chemotaxis
2)edema
3)vascular permeability

Front 79

Chemotactic factors from eosinophils and neutrophils cause what symptoms (2)

Back 79

1)cell destruction
2)disruption of ocular surface

Front 80

Differential diagnosis of allergic conjunctivitis (3)

Back 80

1)itchy=allergy
2)burn=dry eye
3)eye lid stuck together in morning= bacterial infexn

Front 81

Common allergens causing seasonal/perennial conjunctivitis (5)

Back 81

1)house dust mites
2)grass, tree, weed pollen
3)pets
4)cockroaches
5)mold

Front 82

Nonpharmachologic treatment of allergic conjunctivitis beside preventing allergies like from asthma triggers (3)

Back 82

1)allergen avoidance
2)cold compress
3)artificial tears

Front 83

Rx meds used for allergic conjunctivitis (6)

Back 83

1)topical antihistamines
2)oral antihistamines
3)mast cell stabilizers
4)topical NSAIDs
5)corticosteroids
6)immunotherapy

Front 84

Topical antihistamines and allergic conjunctivitis
a)2meds
b)dose
c)ADR (2)
d)cautions

Back 84

a)epinastine (Elestat), azelastine (Optivar)
b)1 drop ou bid
c)burn/sting, blurry vision
d)wait 10min after putting in to put contacts back in

Front 85

Oral antihistamines and allergic conjunctivitis
a)which to use (3)
b)them vs topical

Back 85

a)fexofenadine, claritin, zyrtec
b)oral is less effective

Front 86

Mast cell stabilizers and allergic conjunctivitis
a)drug
b)dose
c)ADR (3)

Back 86

a)nedocromil (Alocril)
b)1-2drops bid
c)bad taste, burning, HA

Front 87

Combo antihistmaine/Mast cell stabilizer and allergic conjunctivitis
a)drug
b)dose
c)caution

Back 87

a)patanol
b)1-2drops bid
c)has benzalkonium which can be absorbed by contact lenses

Front 88

Combo antihistamine/mast cell stabilizer and allergic conjunctivitis
a)drug
b)dose
c)caution

Back 88

a)Ketotifen (Zaditor)
b)1drop ou bid
c)same one as patanol

Front 89

Topical NSAIDs and allergic conjunctivitis
a)drug
b)dose
c)ADR

Back 89

a)ketorolac (acular)
b)1 drop QID*****
c)burning

Front 90

Corticosteroids and allergic conjunctivitis
a)drug (2)
c)dose
d)only indicated for... (2)
e)other

Back 90

a)prednisolone, loteprednol (Lotemax)
b)1-2drops QID*****
c1)intraocular pressure needs to be monitored by eye Dr if used more than 10days
c2)possible cataract formation, glaucoma, bacterial infexn
d)LATER DOWN THE LINE AS FAR AS THERAPIES GO

Front 91

Immunotherapy and allergic conjunctivitis
a)what is it?
b)done where?
c)helpful in...

Back 91

a)allergen vaccination
b)allergy specialist center
c)persistent allergic conjunctivitis and atopic keratoconjunctivitis (SEVERELY ALLERGIC PPL)

Front 92

OTC Topical decongestants allergic conjunctivitis
a)what ones used? (4)
b)good for...
c)ADR

Back 92

a)phenylephrine, naphazoline, afrin, tetrahydrolazine
b)redness
c)rebound vasodilation w/ long term use

Front 93

OTC Topical Antihistamines and allergic conjunctivitis
a)which used
b)combo products (2)

Back 93

a)pheniramine
b)Naphacon-A, Visine-A

Front 94

Treatment steps for seasonal conjunctivitis (3)

Back 94

Step 1)topical antihistamine and/or topical NSAID

Step 2)topical antihistamine w/ vasoconstrictor

Step 3)dual axn antihistamine/mast cell stabilizer AND/OR oral AH

Front 95

Treatment steps for perennial conjunctivitis (2)

Back 95

Step1) topical mast cell stabilizer OR dual axn topical AH/mast cell stabilizer

Step2)immunotherapy or topical corticosteroids

Front 96

Admin technique of eye drops (4)

Back 96

1)do not touch tip of applicator to eye/fingers
2)tilt head back
3)place drop in conjunctival sack (pull eyelid down)
4)apply gently pressure to corner of eye for 30s-1min (helps stop drainage)