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47 Cards in this Set
- Front
- Back
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Asthma symptoms
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inflammation-wheezing
breathless chest tightness |
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guidelines for asthma called
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EPR 3
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causes of asthma
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atopy- IgE predisposition, allergys, strongest likeiness
occupational/chemical hygiene hypothesis- not really used much any more |
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extrinsic asthma
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immune system involved
treat by removal of allergen |
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intrinsic asthma
subtypes |
immune system not involved
exercise induced occupational infection-most common for children under 4 pharmacologic- not allergy, bodily effects |
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drugs that can induce asthma
other triggers |
BB
NSAIDSs environment, comorbid conditions |
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early phase vs late phase
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early is bronchoconstriction- saba
late is inflammation - aka saba now useless, ICS useful cromolyn works on both |
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classifications of asthma
PEFs in hospital |
mild persistent- >70
moderate persistent- 40-69 severe persistent- <40 |
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pulmonary function tests do
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differentiate tween diseases
track progression evauluate lung damage |
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FEV1/FVC likely to be below what in asthma patient
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80%
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drawback of spirometery
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pt limited
difficult |
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Peak flow is , for
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less reproducible measure of FEV1
dependant one pt effort home asthma monitoring integrate into asthma action plan take into account sex, hieght and age |
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Obstructive vs restrictive airway disease
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o-limit flow at expiration
r-limit flow inspiration |
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reversible obstructive airway obstruction
-how test? -what improvement is significant for improvement |
FEV1 gold standard
-reveribility of airway disease significant at 12% 20% noticable relief |
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goals asthma therapy
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reduce impairment- chronical
reduce risk-exasterbations |
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what is trigger avoidance
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identify allergens and ...avoid
includes getting inactivated vaccine |
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rescue therapy
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SABA
anticholinergics- additive benefit to SABA systemic corticosteroids- in addition to saba |
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maintenance therapy
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inhaled corticosteroids- long term, adverse effects increase with dose
LABA- not for acute, not as monotherapy, preferred adjunt to ics leukotriene modifiers- alternate step 2 mast call stabilizer- alternate step 2 methylxanthines-bronchdilatory effects alternate step 2 immunomodulators-STEP 6 |
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Step wise approach
up consider down consider |
up- compliance, techniques, triggers
down-severity decreases or control increases check every 3, 6 months |
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Asthma control types
about syptoms nightime awakes interferance FEV |
Well controled- <2 days/wk, FEV 80% proxy
Not well controlled- 2 days/wk, nighttime 1-3 nights/wk -some limitations -SABA use 2 days a wk -FEV 60-80% poor control -all time, more 4 days wk wakeups, very limited, SABA multi times day |
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asthma severity
intermittent which step |
symptoms less 2 wk
awake- less 2 month saba-<2 week minor limitations STEP ! |
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severity
persistant mild step? |
symptoms not daily
4 wakeups month SABA not daily or multi a day STEP 2 |
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severity
persistent moderate step? |
daily symptoms
wakeup not daily SABA daily some limitations STEP 3 |
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asthma severity
severe stepin, other consider? |
really shitty
step 4 or 5 consider short course oral cortico |
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What to do with classification of control
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well controlled- maintain step, consider step down after 3 months
not well controlled- consider step up, revaluate 2-6 wks poor controlled consider short oral course, step up 1 or 2 steps, reevaluate in 2 wks |
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Steps and what each one has...
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1- SABA
2-Low ICS 3-low ICS and LABA 4-med ICS and LABA 5-high ICS and LABA 6-high ICS and LABA and ORAL coritco |
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asthma action plan
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based personal best off day of 3
plan w/ physicion doses and freq, schduelde |
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SABAs
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albuterol HFA
Albuterol Levoalbuterol - asthma only Levoalbuterol HFA- asthma only Pirobuterol |
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LABA
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Arformoterol - COPD
Formoterol NS- COPD Formoterol DPI Salmeterol ULtra long acter -Indacaterol COPD |
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ICSs
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Beclomethasone
Budesonide Ciclesonide Flunisolide Fluticasone Mometasone |
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ICS and LABA
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Budesonide and Formoterol
Fluticasone and Salmeterol Fluticasone and Salmeterol Mometasone and Formoterol |
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Anticholinergics
asthma |
ipratropium HFA- COPD
tiotropium- COPD w/ albuterol- copd |
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leuk mod
MCS MAB |
Zileuton- COPD
Montelukast- COPD Cromolyn Sodium- Asthma Omalizumab- Asthma |
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smoking health risk
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cancer- highly lung but many others
women- reduce fertility, f with babies respiratory diseases cardio diseases-aortic aneurysm, CHD, stroke peridontal disease oseatoporosis, cataracts, aging |
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2nd hand health risks smoking
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children
sudden infant death syndrome resp infecition ear prob adults lung cancer cardio |
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benefits quiting
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its in that fuckin table
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nicotine binds where
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cns
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nicotine withdrawl
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peak first wk
agressive, anxiety diff concentrate confused weight gain insomnia sweating headache dizzy constipated |
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non pharm methods
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ask, advise, assess, assist, arrange
enhance motivation 5 rs relevance, risks, rewards, roadblocks, repetition |
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Pharmaclogical agents for smoking cess names
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Nicotine gum
Nicotine lozenge nicotine patch nicotine NS nicotine inhaler Bupropion (zyban) Varenidine (chantix) |
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nicotine gum
adv dis general info |
dosing based off more or less than 25 cigs
max 24 / day do not eat or drink within 15 min befor tking oral fixiation |
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nicotine lozenge
adv ds general info |
time based dosing
if cig w/i 30 mins of waking then high dose max 20 a day oral fixation |
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nicotine patch
adv ds general |
24 h patch
also for light smokers (skip step 1) vivid dreams watch skin rxn consistant lvls |
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nicotine ns
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rapid absorb
2 sprays, max 80 / day aka 40mg lots disadvantages |
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inhaler
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oral fix
mouthpiece puff for around 20 mins min 3 wks max 12 wk cold temp effectivness decline |
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Bupropion
brand how CI |
zyban
non nicotine antidepressant CI- seizure, anorexia, bulemia MAOI CI weight gain delay |
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Varenidine
brand how CI |
chantix
partial nicotine receptor agonist, block dopamine stim neuropsychotric events- BB watch if renal after eating nausea common, and insomnia but temp |
