NURS 533 Exam 3 Study Guide (Respiratory)
Respiratory, module 9
Be sure to recognize the risk factors that may precipitate an asthma attack.
Uncontrolled symptoms (Chronic airway inflammation, night awakenings, SAVA
usage, inability to engage in ADLs, poor FEV.FVC <80% , bronchial
hyperresponsiveness, airflow obstruction, wheezing, SOB, chest tightness, cough.)
-Frequent SABA usage, inadequate ICS(high vs low inflammation asthma)
-Exposure to smoking, allergens
-Co-morbidities (Obesity, Rhinosinusitis, food allergy)
-Sputum/blood eosinophilia, elevated FeNO(For allergic asthma)
-Pregnancy
-Hx of intubation/tx in ICU for asthma
-1 or more severe exacerbations in the past 12 months.
Know when an inhaled corticosteroid would be added to a patient’s regimen.
-All adults +adolescents with persistent asthma should receive an ICS tx to control
s/sx and reduce risk of future severe exacerbation. It is recommended that pts
with asthma symptoms at least 2 days each month be initiated on daily low dose
ICS and PRN SABA or low-dose ICS formoterol PRN
-PRN Formoterol with low dose ICS is preferred reliever tx for adults and
adolescents with mild asthma
Know when stepdown therapy can be initiated for an asthmatic.
After asthma has been well controlled for 2-3 months?
-Reduce ICS dose by 25-50% at 3 month intervals, complete cessation is not
recommended due to risk of exacerbations
Know which Beta Blockers are not an absolute contraindication for an asthmatic
patient.
, acebutolol, atenolol, bisoprolol, celiprolol, and metoprolol. (cardioselective beta
blockers) Know when you would add a Long Acting Muscarinic agent.
Add LAMA for persistent chronic asthma when unable to achieve control on single
maintenance and reliver therapy
-Adding tiotropium to ICS/LABA tx is associated with better outcome.
-Umeclidinium -
Understand the Black Box Warning for Long Acting Beta Agonist.
-Add on maintenance therapy when asthma is not controlled by ICS alone.
-**Do not use for monotherapy for chronic asthma, due to increased risk of
severe asthma exacerbation, and increased asthma related deaths. Do NOT
use without an ICS -Salmetrol, formoterol, Vilanterol.
Understand how to treat a patient who develops thrush.
-Prevent via use of spacer, rinsing mouth and expectorate after use. Gargle with
nystatin What class of medicine used in the treatment of asthma has a black
box warning about potential death if used alone to treat asthma?
Long Acting Beta Blockers have a black box warning for death if used as
monotherapy in asthmatics.
If you are going to recommend a Beta Blocker for migraines for this patient,
what may be a safer choice?
Cardio-selective beta blockers, particularly at lower doses, may be considered in
instances of strong clinical indication and when alternative therapeutic modalities
are limited. Examples of cardio-selective beta blockers include acebutolol,
atenolol, bisoprolol, celiprolol, and metoprolol. Research suggests that these
medications may be effective in treatment without heightened risk of
exacerbating asthma symptoms and can be used for management of migraines
(Tucker et al., 2023).
Respiratory, module 9
Be sure to recognize the risk factors that may precipitate an asthma attack.
Uncontrolled symptoms (Chronic airway inflammation, night awakenings, SAVA
usage, inability to engage in ADLs, poor FEV.FVC <80% , bronchial
hyperresponsiveness, airflow obstruction, wheezing, SOB, chest tightness, cough.)
-Frequent SABA usage, inadequate ICS(high vs low inflammation asthma)
-Exposure to smoking, allergens
-Co-morbidities (Obesity, Rhinosinusitis, food allergy)
-Sputum/blood eosinophilia, elevated FeNO(For allergic asthma)
-Pregnancy
-Hx of intubation/tx in ICU for asthma
-1 or more severe exacerbations in the past 12 months.
Know when an inhaled corticosteroid would be added to a patient’s regimen.
-All adults +adolescents with persistent asthma should receive an ICS tx to control
s/sx and reduce risk of future severe exacerbation. It is recommended that pts
with asthma symptoms at least 2 days each month be initiated on daily low dose
ICS and PRN SABA or low-dose ICS formoterol PRN
-PRN Formoterol with low dose ICS is preferred reliever tx for adults and
adolescents with mild asthma
Know when stepdown therapy can be initiated for an asthmatic.
After asthma has been well controlled for 2-3 months?
-Reduce ICS dose by 25-50% at 3 month intervals, complete cessation is not
recommended due to risk of exacerbations
Know which Beta Blockers are not an absolute contraindication for an asthmatic
patient.
, acebutolol, atenolol, bisoprolol, celiprolol, and metoprolol. (cardioselective beta
blockers) Know when you would add a Long Acting Muscarinic agent.
Add LAMA for persistent chronic asthma when unable to achieve control on single
maintenance and reliver therapy
-Adding tiotropium to ICS/LABA tx is associated with better outcome.
-Umeclidinium -
Understand the Black Box Warning for Long Acting Beta Agonist.
-Add on maintenance therapy when asthma is not controlled by ICS alone.
-**Do not use for monotherapy for chronic asthma, due to increased risk of
severe asthma exacerbation, and increased asthma related deaths. Do NOT
use without an ICS -Salmetrol, formoterol, Vilanterol.
Understand how to treat a patient who develops thrush.
-Prevent via use of spacer, rinsing mouth and expectorate after use. Gargle with
nystatin What class of medicine used in the treatment of asthma has a black
box warning about potential death if used alone to treat asthma?
Long Acting Beta Blockers have a black box warning for death if used as
monotherapy in asthmatics.
If you are going to recommend a Beta Blocker for migraines for this patient,
what may be a safer choice?
Cardio-selective beta blockers, particularly at lower doses, may be considered in
instances of strong clinical indication and when alternative therapeutic modalities
are limited. Examples of cardio-selective beta blockers include acebutolol,
atenolol, bisoprolol, celiprolol, and metoprolol. Research suggests that these
medications may be effective in treatment without heightened risk of
exacerbating asthma symptoms and can be used for management of migraines
(Tucker et al., 2023).
