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pharm exam 3
asthma and COPD disease
| Question | Answer |
|---|---|
| asthma patho | Airway hyperresponsiveness Chronic inflammation of airway Results in bronchospasms and narrowing of airway passage |
| Asthma: airway hyperresponsiveness | IgE mediated, can be direct or indirect triggers |
| asthma has chronic inflammation of airway due to | Mucosal edema and excess mucus |
| asthma results in bronchospasms and narrowing of airway passage | accumulation of Leukotrienes and Mast Cells |
| asthma is | reversible with treatment |
| Asthma Clinical Presentation: Symptoms | Wheezing Shortness of Breath Tightness in the chest Cough Paroxysmal dyspnea |
| Asthma Clinical Presentation: diagnosis | History of at least 4 symptoms Evidence of variable expiratory airflow with Pulmonary Function Tests |
| Asthma Clinical Presentation: associated diseases | Allergies Atopy (eczema) |
| how many symptoms does a pt need to be diagnosed with Asthma | 4 |
| Paroxysmal dyspnea is | SOB that wakens pt at night about 1-2 hours after they fall asleep and normally goes away with sitting up |
| asthma symptoms may be triggered by | change in temps, stress or URTI |
| examples of triggers of asthma | pollen, smoking, exercise, mold, infections, food, medicines, dust mite, stress, pollution, pets, cold air |
| COPD is | Preventable progressive disease with no cure |
| COPD is caused by | Persistent airflow limitation |
| COPD has more | mucus production than asthma |
| components that make up COPD | Emphysema and Chronic bronchitis |
| Emphysema | Irreversible Damages the alveoli |
| Symptom of Emphysema | SOB |
| Emphysema component of COPD | structural issue with alveoli, makes them floppy |
| Chronic bronchitis | Bronchi get irritated/swollen Mucus build up |
| symptoms of Chronic bronchitis | coughing, wheezing, chest pain |
| chronic bronchitis component of COPD | functional issue |
| COPD Clinical Presentation: Symptoms | Wheezing Shortness of Breath (SOB) Chest tightness Chronic cough Chronic sputum production Paroxysmal dyspnea Recurrent lower respiratory infections (LRI) |
| symptoms of COPD will | worsen over time |
| COPD Clinical Presentation: Diagnosis | Symptoms Known risk factors Pulmonary function tests |
| COPD Clinical Presentation: Risk factors | smoking, family history, lung irritants, medical history |
| family history risk factor of COPD | AAT deficiency gene - alpha-1 antitrypsin |
| COPD is one of the | leading causes of death |
| Pulmonary Function Tests (PFTs) | Spirometer vs Peak Flow Meter |
| spirometer | Bedside handheld peak flow meter Not as reliable, good for patient self assessment Only measures inspiration |
| Pulmonary Function Test occurs | within lung center |
| when do you repeat PFTs | after 15-30 min |
| peak flow meter is | hand held device, used in the hospital mainly with lung diseases and shows how well disease is controlled but is not as specific as spirometry |
| Spirometry Result Interpretation values | FEV1, FVC, FEV1/FVC |
| Forced Expiratory Volume (FEV1) | Volume of air exhaled in the first second of a forced breath |
| Forced Vital Capacity (FVC) | The total volume of air that can be forcibly exhaled from the lungs after a full breath |
| FEV1/FVC ratio normal | > 0.7 can vary with age, with lower ranges accepted in geriatric pts |
| FEV1/FVC ratio low | < 0.7 indicates obstructive defect with increased airway resistance |
| FEV1 is used for | asthma |
| FEV1/FVC ratio is used for | COPD |
| asthma assessment is used to | determine if its reversible |
| how does asthma assessment work | Post-Bronchodilator administration yielding FEV1% change > 12% indicates reversibility |
| FVC and FEV1 normal | equal to or greater than 80% |
| FVC and FEV1 mild | 70-79% |
| FVC and FEV1 moderate | 60-69% |
| FVC and FEV1 severe | less than 60% |
| FEV1/FVC normal | equal to or greater than 70% |
| FEV1/FVC mild | 60-69% |
| FEV1/FVC moderate | 50-59% |
| FEV1/FVC severe | less than 50% |
| asthma age of onset | usually childhood |
| COPD age of onset | usually over 40 years old |
| asthma history | family history typical |
| COPD history | smoking history typical |
| asthma pattern of symptoms | Intermittent and variable Triggered by exercises, allergens, etc |
| COPD pattern of symptoms | Chronic and progressive/ continuous with “better” and “worse” days |
| asthma lung function | Bronchodilator reversibility with change in FEV >12% “Reversible” airflow limitation |
| COPD lung function | FEV1 may be improved by therapy but FEV1/FVC <0.7 persists “Irreversible” airflow limitation |
| asthma lung function between symptoms | May be normal |
| COPD lung function between symptoms | Persistent airflow limitation |
| asthma Sputum Production/Cough | limited or no sputum production Nocturnal cough more common |
| COPD Sputum Production/Cough | Sputum production Morning cough more common |
| asthma time course | May improve spontaneously or with treatment |
| COPD time course | Slowly progressive despite treatment |
| asthma treatment | Inhaled corticosteroids are preferred maintenance Rescue inhaler use indicative of condition |
| COPD treatment | Long-acting bronchodilators are preferred maintenance Exacerbations indicative of condition |
| long term goal of asthma management | achieve long term asthma symptom control and long term asthma risk minimization |
| achieving long term asthma symptom control | few/no asthma symptoms no sleep disturbances due to asthma unimpaired physical activity |
| achieving long term asthma risk minimization | no exacerbation improved or stable lung function no requirement for maintenance systemic corticosteroids no medication SE |
| how should you achieve long term goal of asthma management | using leas amount of meds as possible |
| goals for treatment of stable COPD | reduce symptoms and reduce risk |
| reducing COPD symptoms | Relieve Symptoms Improve Exercise Tolerance Improve Health Status |
| reducing COPD risks | Prevent Disease Progression Prevent and Treat Exacerbations Reduce Mortality |
| stable COPD is | progressive and there is no cure |
| Pharmacologic Treatment Options | Bronchodilators Inhaled Corticosteroids (ICS) Adjunctive Therapies – Oral Biologics – Injectable Oxygen Therapy |
| bronchodilators examples | Short and Long Acting Beta2 Agonists (SABA or LABA) Short and Long Acting Anticholinergics (Muscarinic Antagonists) Methylxanthines |
| Adjunctive Therapies – Oral | Mast Cell Stabilizers Leukotriene Modifiers PDE3/4 Inhibitors PDE4 Inhibitors |
| Biologics – Injectable | Monoclonal Antibodies |
| Biologics – Injectable are the | newest treatment option |
| Oxygen Therapy is | prominent and used for COPD |
| Medication Administration via Inhalation | nebulizers and inhalers |
| nebulizers are machines that | turns liquid medication into a mist for inhalation through mask or mouthpiece |
| when are nebulizers used | when patients can not use inhalers properly |
| pro to nebulizers | Requires little to no technique, all pt needs to do is inhale |
| inhalers are | Small, portable devices |
| how do inhalers work | Deliver med directly to lungs |
| con to inhalers | Requires proper technique |
| are all inhalers the same | no |
| what is key to successful drug delivery to lungs | pt education |
| types of inhalers | metered dose inhaler (MDI) dry powdered inhaler (DPI) soft mist inhaler (SMI) |
| metered dose inhaler (MDI) | HFA inhaler (HydroFluorAlkane) |
| metered dose inhaler (MDI) aren't great because | HFA eats away at the ozone layer |
| metered dose inhaler (MDI) use | propellants to get med into the lungs |
| metered dose inhaler (MDI) requires | good technique with a slow deep breath |
| dry powdered inhaler (DPI) is a | breath actuated inhaler, typically circular |
| dry powdered inhaler (DPI) delivers | dry powder to the lungs (not a mist!!) |
| dry powdered inhaler (DPI) is | propellant free so better for the ozone |
| dry powdered inhaler (DPI) requires | good technique with a fast deep breath in order to actuate med out |
| soft mist inhaler (SMI) uses | a mechanical spring to create the mist |
| soft mist inhaler (SMI) is | propellant free so better for the ozone |
| soft mist inhaler (SMI) delivers | a slow-moving, long-lasting mist to the lungs |
| MDI technique | Shake inhaler Exhale out Insert inhaler into mouth, press down on actuator Inhale slowly and deeply Close mouth, hold breath for 10 seconds Slowly breathe out |
| why is it important to hold breath for 10 seconds with med in mouth | med is going at a rate that is so high and bouncing off walls of mouth so if you didn't close your mouth, it would come right back out if mouth breather |
| a spacer is a | Device that is placed on the mouthpiece of an MDI |
| a spacer creates | a space between the mouth and the medication |
| a spacer helps | the medicine break into smaller droplets |
| a spacer allows for | easier and deeper access into the lungs |
| valved holding chambers are | a one way valve at mouthpiece |
| valved holding chambers is a device that | does more than just creating space |
| valved holding chambers do what | trap and hold the medication |
| valved holding chambers allow for | taking of slow deep breath which may be repeated |
| advantage of spacers and valved holding chambers | used for kids and adults better ability to get medication into lungs |
| disadvantage of spacers and valved holding chambers | not always covered by insurance and can be expensive |
Created by:
leh195