Wannamaker 10-3-07 Asthma

Front 1

TEST QUESTION

Asthma is a chronic inflammatory disorder involving what inflammatory factors

Back 1

Mast cells, eosinophils, neutrophils
Cytokines, leukotrienes, histamine

Front 2

TEST QUESTION

Asthma is a Chronic inflammatory disorder that causes reversible airflow obstruction caused by what?

Back 2

Bronchial hyperresponsiveness to stimuli

Front 3

Symptoms of Asthma

Back 3

Dyspnea
Wheeze
Chest tightness
Cough
Allergic rhinitis

Front 4

Asthma triggers

Back 4

Exercise
Allergan exposure
Cold air
Inhaled irritants
Tobacco smoke

Front 5

TEST QUESTION

Triad Asthma

Syndrome of:

Back 5

Asthma
Nasal polyps
Aspirin sensitivity

Front 6

TEST QUESTION

Asthma Diagnosis

Back 6

Spirometry

*Reversibility of reduced FEV1
12% improvement of FEV1

Front 7

Explain the spirometry test for asthma involving beta2 agonist

Back 7

Obtain FEV1 by spirometry, 3 efforts
Administer inhaled short acting beta2 agonist
Albuterol (Ventolin) Metered Dose Inhaler (MDI) 2 puffs, 2 minutes apart
Albuterol 2.5mg via aerosol nebulizer
Repeat spirometry, 3 efforts

Front 8

Explain the spirometry test for asthma involving steroid

Back 8

Spirometry, 3 efforts
Systemic steroids for 2 weeks
Prednisone 20mg P.O. daily
Repeat spirometry

Front 9

Describe Bronchoprovacation Testing


(rarely used)

Back 9

Inhalation of Methacholine or Histamine in attempt to trigger bronchospasm
High risk
Reserved for suspected asthma with normal spirometry

Front 10

Classification (staging) of Asthma

Back 10

Mild Intermittent
Mild Persistent
Moderate Persistent
Severe Persistent (previously Status Asthmaticus)

Front 11

TEST QUESTION

Definition of poorly controlled asthma

Back 11

2 or more exacerbations per week

Front 12

Treatment of Asthma:

Treatment of bronchial hypersensitivity

Back 12

Short acting Beta 2 agonist
*1 Inhaler should last 1 year

(* test question)

Front 13

Treatment of Asthma:

Treatment of chronic inflammation

Back 13

Inhaled steroid
Long acting Beta2 Agonist
Leukotriene blocker
Theophylline
Oral steroid
Other agents

Front 14

Simple, safe, inexpensive way to prevent asthma

Back 14

Identify and avoid triggers

Can be difficult
Getting rid of the family pet
Moving
STOP SMOKING

Desensitization
Allergy shots
Can be life-saving

Front 15

Bronchospasm treatment

Back 15

Short acting Beta2 Agonists

Mainstay of treating exacerbation
Selectivity preferred over Epinephrine (Primatene Mist): less side effects
Inhaled route preferred
-Less systemic side effects
-MDI or nebulizer delivery

Subcutaneous route available

Front 16

Short acting Beta 2 Agonists

Back 16

1) Albuterol (Proventil, Ventolin)
2) Levalbuterol (Xopenex)
L-isomer of Albuterol (less side effects- tachy cardia, jitteriness, shakes)
3) Metaproterenol (Alupent)
4) Pirbuterol (Maxair)
5) Terbutaline (Brethine)

Front 17

Albuterol:
Meter Dose Inhaler Rx:

Back 17

2 puffs every 4 hours prn

Front 18

How many puffs in one inhaler

Back 18

200 inhalations per MDI
200/52 weeks = 4 puff/week = 1-2 exacerbations

Front 19

Nebulizer solution Rx:

Back 19

2.5mg hourly prn for exacerbation

Front 20

Albuterol syrup Rx:

Back 20

Age 2-6: 0.1mg/kg P.O. TID
Age 6+: 2mg P.O. QID

Front 21

Terbutaline (Brethine) Rx:

Back 21

Subcutaneous administration
0.25mg in lateral deltoid area
May repeat after 15 minutes

Front 22

TEST QUESTION

Inhaled Corticosteroids (6)

Back 22

Beclomethasone (Qvar)
Budesonide (Pulmicort)
Flunisolide (Aerobid)
Fluticasone (Flovent)
Mometasone (Asmanex)
Triamcinolone (Azmzcort)

Front 23

Corticosteroids taken long term can suppress ______-______-_____ axis (true)

Back 23

Hypothalamus-Pituitary-Adrenal

Front 24

Corticosteroids Can lead to ________ in children (true)

Back 24

short stature

Front 25

Corticosteroids short kids that grow up to be of _______ stature in adults

Back 25

normal

Front 26

“Poor man’s Steroid”
More accepted in pediatric patients
(2 examples)

Back 26

Mast Cell Stabilizers

Cromolyn (Intal)
4 times daily
MDI or nebulizer
Nedocromil (Tilade)
MDI 4 times daily

Front 27

Long-acting Beta2 Agonists (2)

Back 27

Formoterol (Foradil)
Salmeterol (Serevent)
1 inhalation twice daily

Front 28

Leukotriene agents (2 types)

Back 28

5-Lipoxygenase inhibitor
Leukotriene Receptor Antagonist

Front 29

5-Lipoxygenase inhibitor (1)

Back 29

Zileuton (Zyflo)
Dosed 4 times daily

Front 30

Leukotriene Receptor Antagonist
(2)

Back 30

1) Montelukast (Singulair)
Dosed P.O. once daily in the P.M.
1-5 years: 4mg
6-14 years: 5mg
15+: 10mg
2) Zafirlukast (Accolate)
Twice daily on empty stomach

Front 31

Systemic Corticosteroids Ideally used for 5 days, ______ maximum

Back 31

2 weeks

Front 32

Intravenous Systemic Corticosteroid (1)

Back 32

Methylprednisolone (SoluMedrol) 2mg per kg loading dose, then 1mg per kg IV q 6 hours

Front 33

Systemic Oral steroids (2)

Back 33

Prednisone tablets: 20mg daily
Prednisolone syrup: Metabolite of Prednisone

Front 34

Xanthine (1 example)

Back 34

Theophylline (TheoDur)

Front 35

Problems with Theophylline

Back 35

Monitor serum levels
Drug-drug interactions problematic

Front 36

IgE blocker (1 example)

Back 36

Omalizumab (Xolair)

Front 37

Antihistamines Benefit in astmatics?

Back 37

inconclusive

"Throwing everything at the patient"

Front 38

What's Advair (Fluticasone/Salmeterol)?

Back 38

Steroid/Long acting Beta2 Agonist

Dose of Advair:
Doses 100/50, 250/50, 500/50
1 inhalation twice daily