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20 Pharm
20 Pharm
81
Medical
Graduate
11/26/2011

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Term
ashtma is clinically characterized by
Definition
recurrent bouts of shortness of breath, chest tighness and wheezing, often associated with coughing
Term
short-term asthma reflief is most effectively achieved by
Definition
agents that relax airway smooth muscle (B-adrenoreceptor stimulants)
Term
asthma is physiologically characterized by
Definition
widespread, reversible narrowing of the bronchial airway and a marked increase in bronchial responsiveness to inhaled stimuli
Term
asthma is pathologically characterized by
Definition
lymphocytic, eosinophilic, inflammation of the bronchial mucosa
Term
airway obstruction and contraction of smooth muscle
Definition
most easily reversed consequence of asthma by current therapy
Term
reversal of edema and cellular infiltration requires
Definition
sustained treatment with anti-inflammatory agents
Term
long-term asthma control is
Definition
most effectively achieved with an anti-inflammatory agent such as an inhaled corticosteroid
Term
long-term asthma control can be achieved (albeit less effectively than an inhled corticosteroid) with
Definition
a leukotriene pathway antagonist or an inhibitor of mast cell degranulation (Cromolyn or nedocromil)
Term
foreign materials that provoke IgE production
Definition
allergens
Term
histamine, tryptase, leukotrienes C4 and D4 and prostaglandin D2
Definition
diffuse through the airway mucosa, triggering the muscle constriction and vascular leakage responsible for the acute bronchoconstriction of the "early" asthma response
Term
late asthma response
Definition
sustained phase of bronchoconstriction, is associated with an influx of inflammatory cells into the bronchial mucosa and with an increase in bronchial reactivity that may last for several weeks
Term
mediators responsibe for late phase reaction
Definition
cytokines of TH2 cells (IL 5, 9, 13).
Term
IL-5, 9, 13 (late phase TH2)
Definition
attrat and activate eosinophils, stimulate IgE production by -lymphocytes and stimulate mucus production by bronchial epithelial cells
Term
benefits of corticosteroid therapy for asthma are attributed to
Definition
their inhibition of the production of pro-inflammatory cytokines in the airways
Term
most asthma attacks are not triggered by inhalation of allergens but by
Definition
viral respiratory infections
Term
bronchial reactivity is assessed by
Definition
measuring the fall in forced expiratory volume in 1 scond (FEV1) provoked by inhaling serially increased concentrations of aerosolized methacholine
Term
bronchospasm can b provoked by nonallergenci stimuli such as
Definition
distilled water, exercise, cold air, sulfur dioxide, and rapid respiratory maneuvers
Term
cromolyn/nedocromil
Definition
prevnent mast cell degranulation
Term
muscarinic antagonists
Definition
inhibit the effect of acetylcholine
Term
adrenoreceptor agonists
Definition
relax airway smooth muscle and inhibit release of bronchoconstricting mediators from mast cells
Term
sympathomimetic agents such as theophylline
Definition
directly relax airway smooth muscle
Term
management of early, acute asthma is best/most often achieved by
Definition
adrenoreceptor agonists, or sympathomimetic agents (relievers, bronchodilators)
Term
B-agonists activate adenylyl cyclase via
Definition
the coupling protein Gs and increase the fomration of intracellular cAMP
Term
(in general) stimulation of B2 receptors
Definition
relaxes airway smooth muscle, inhibits mediator release and causes tachycardia and skeletal muscle tremor (as adverse effects)
Term
epinephrine and isoproterenol
Definition
increase the force of cardiac contraction (mediated mainly by B1 receptors) and are thus reserved for special situations
Term
(in general) adrenoreceptor agonists are best delivered by inhalation because
Definition
this results in the greatest local effect on airway smooth muscle with the least systemic toxicity
Term
bronchial deposition of an aerosol is increased by
Definition
slow inhalation of nearly a full breath and by more than 5 seconds of breath holding at the end of inspiration
Term
because epinephrine stimulates alpha and B1 as well as B2 receptors
Definition
 tachycardia, arrythmias and worsening of angina pectoris are troublesome adverse effects
Term
the cardiovascular effects of epinephrine and of value for treating
Definition
the acute vasodilation and shock as well as the bronchospasm of anaphylaxis, but its use in asthma has been displaced by other, more B2 selective agents
Term
new generation of long-acting B2 selective agonists include
Definition
salmeterol and formoterol (both drugs are poent B2 agonists that achieve their long duration of action (12 hours of more) as a result of high lipid solubility
Term
albuterol
Definition
B2 selective adrenoreceptor agonists (most widely used sympathomimetic for treatment of the bronchoconstriction of asthma at present)
Term
particles generated by a nebulizer
Definition
are much larger than those from a MDI
Term
nebulized therapy should be reserved for
Definition
patients unable to coordinate inhalation from a MDI
Term
methylxanthines
Definition
can be shown to inhibit several members of the phosphodiesterase (PDE) enzyme family
Term
phosphodiesterase
Definition
hydrolyzes cyclic nucleotides
Term
phosphodiesterase inhibition
Definition
results in higher concentrations of intracellular cAMP, and in some tissues cGMP
Term
PDE 4
Definition
appears to be most directly involved in actions of methylxanthines on airway smooth muscle (and on inflammatory cells)
Term
atropine
Definition
potent competitive inhibitor of acetylcholine at postganglionic muscarinic receptors as a bronchodilator
Term
IV atropine causes bronchodilation at
Definition
a lower dose than that needed cause an increase in heart rate
Term
muscarinic antagonists competively inhibit
Definition
the effect of acetylcholine at muscarinic receptors
Term
in the airways, ACh is released from
Definition
efferent endings of the vagus nerves
Term
muscarinic antagonists
Definition
block the contraction of airway smooth muscle and the increase secretion of mucus that occurs in response to vagal activity
Term
ipratropium bromide
Definition
non-selective quaternary ammoium derivative of atropine
Term
although antimuscarinic drugs appear to be slightly less effective than B-agonists in reversing asthmatic bronchospasm
Definition
the addition of ipratropium enhances the bronchodilation produced by nebulied albuterol in acute severe asthma
Term
corticosteroids act by
Definition
their broad anti-inflammatory efficacy mediated in part by inhibition of production of inflammatory cytokines
Term
corticosteroids do not relax airway smooth muscle directly but
Definition
reduce bronchial reactivity and reduce the frequency of asthma exacerbations if taken regularly
Term
regular or "controller" therapy is maintained with
Definition
aerosol corticosteroids
Term
urgent treatment is often begun with
Definition
an oral dose of 30-60mg prednisone per day or an IV dose of 1mg/kg methylprednisone every 6 hours (daily dose is decreased after airway obstruction has improved)
Term
customary to administer corticosteroids
Definition
early in the morning after endogenous ACTH secretion has peaked
Term
in children, inhaled corticosteroid therapy
Definition
has been shown to slow the rate of growth but this effect appears to be transient (asthma itself delays puberty)
Term
cromolyn and nedocromil have no effect on
Definition
airway smooth muscle tone and are ineffective in reversing asthamtic bronchospasm (prophylactic)
Term
cromolyn and nedocromil
Definition
inhibt mast cell degranulation by altering the function of delayed chloride channels in the cell membrane, inhibiting cell activation
Term
when taken regularly (2-4 puffs 2-4 times a day) by patients with perennial (non-seasonal) asthma both cromolyn and nedocromil
Definition
reduce symptomatic severity and the need for bronchodilator medications
Term
leukotrienes result from
Definition
the action of 5-lipoxygenase on arachidonic acid and are synthesized by a variety of inflamatory cells in the airways (mast cells, eosinophils, basophils)
Term
inhalation (study) of leukotrienes causes
Definition
bronchoconstriction and also an increase in bronchial reactivity to histamine, that lasts for several days
Term
zileuton
Definition
5-lipoxygenase inhibitor
Term
zafirlukast and montelukast
Definition
LD4 receptor antagonists
Term
inhibiting 5-lipoxygenase
Definition
prevents leukotriene synthesis
Term
inhibiting binding of LTD4 to its receptor on target tissues
Definition
prevents its action
Term
principal advantage of leukotriene pathway inhibitors
Definition
is that they are taken orally, seeing as how some patients, especially children, comply poorly with inhaled therapies
Term
omalizumab
Definition
anti-IgE monoclonal antibody
Term
more severe asthma
Definition
treatment with a long term controller like an inhaled corticosteroid is necessary to prevent symptoms and restore function
Term
the use of 2 or more canisters of an inhaled B-agonist per month is a marker of
Definition
increased risk of asthma fatality
Term
mild asthma
Definition
occasional inhalation of a bronchodilator may be all this is needed
Term
if FEV1 is less than 80% predicted
Definition
additional treatment is needed
Term
if patient requires "rescue" therapy more than twice a week, if nocturnal symptoms occur more than twice a month
Definition
additional treatment is needed
Term
first "additional" treatment
Definition
lose doese of an inhaled corticosteroid, althogh treatment with a leukotriene-receptor antagonist or with cromolyn may be used
Term
sever frightening attack
Definition
take up to 4 puffs of albuterol every 20 minutes over 1 hour, if clear improvment is not noted after 1st 4 puffs, additional treatments should be taken en route to the ER
Term
antimuscarinics (muscarinic antagonists)
Definition
help inhibit the increase in mucus secretion caused by vagal stimulation
Term
if asthma symptoms occur frequently or if airway obstruction persists depsite bronchodilator therapy
Definition
inhaled corticosteroids should be started
Term
for patients with severe symptoms of airflow obstruction (FEV1 <50% predicted)
Definition
initial treatment with a combination of inhaled and oral corticosteroids (eg 30 mg prednisone for 3 weeks) is appropriate
Term
impressive benefits are noted from addition of a long-acting inhaled B2 receptor agonist (salmetrol or formoterol) when
Definition
inhaled corticosteroids are not sufficient (other option besides combing with another drug is to double the inhaled corticosteroid dose)
Term
combinations or an inhaled corticosteroid and a long-acting B-agonist in a single inhaler are now commonly prescribed
Definition
fluticasone and salmeterol (Advair), budesonide and formoterol (Symbicort)
Term
cromolyn and nedocromil or inhaled leukotriene-receptor antagonists, all avoid
Definition
steroid phobia (although none are as effective as even a low dose of an inhaled corticosteroid)
Term
COPD is characterized by
Definition
airflow limitation that is not fully reversible with bronchodilator treatment
Term
chronic treatment with oral corticosteroids
Definition
may cause osteroporosis, cataracts, glucose interolerance, worsening or HTN and cushingoid changes in appearance
Term
COPD in older patients
Definition
is often associated with neutrophils rather than eosinophilic inflammation, as is seen in asthma
Term
approaches to treatment are similar for asthma and COPD although
Definition
benefits expected (and achieved) are less for COPD than for asthma
Term
theophylline may improve contractile function
Definition
of the diaphragm in COPD patients
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