Shared Flashcard Set

Details

Respiratory Diseases
Exam #2
63
Pharmacology
Graduate
03/14/2010

Additional Pharmacology Flashcards

 


 

Cards

Term
Asthma
Definition

Chronic inflammatory disease of the bronchial tubes and lung tissue

  • indued by multiple mediators
  • Bronchial hyper-responsiveness

Term
changes that take place in asthmatic lungs
Definition

  • muscles surrounding bronchial tubes constrict, airways narrow
  • lining of airway becomes inflamed, swollen and there is an increase in mucous production

Term
symptoms of asthma
Definition

 

  • cough
  • wheezing
  • chest tightness
  • shortness of breath
  • increased mucous production
  • speech may be impacted by breathing changes
  • fatigue

 

Term
Asthma triggers
Definition

 

  • Respiratory infections: viral, pneumonia
  • allergens: pollen, dust mites, animal dander
  • Gastroesophageal reflux (GERD)
  • Environment: cold air, tobacco smoke  (adrenergic hyperactivity)
  • Emotions: anxiety, stress
  • exercise: especially in cold dry climate
  • drugs/preservatives: ASA, Sulfites, β blockers
  • Occupational stimulation: flour, farmers hay mold

 

Term
Goals of asthma therapy
Definition

  • prevent troublesome symptoms - cough, breathlessness in night, am, after exercise
  • maintain normal lung function
  • maintain normal activity
  • prevent recurrent exacerbations/hospitalizations
  • optimal drug therapy with no side effects

Term
Types of asthma
Definition

Intermittent

Persistent or chronic

Seasonal allergic

 

do not exist on their own, types of asthma overlap in patients

Term
Intermittent asthma
Definition
patients with episodic illness with extended symptom free periods
Term
Persistent or chronic asthma
Definition

daily symptoms or symptoms several times per week without extended symptom free periods

  • most patients seen

Term
seasonal allergic asthma
Definition
daily asthmatic symptoms during an allergy season
Term
status asthmaticus
Definition

  • any patient not responding to therapy can be considered to be in status asthmaticus
  • an acute emergency
  • need bronchodilators and oxygen right away

Term
symptoms of poorly controlled persistent asthma
Definition

  • waking up at night > 2/month with severe breathlessness
  • refilling salbutamol (ventolin) > 1/month
  • exercise-induced bronchoconstriction
  • missing school/work
  • hospitalization
  • need to adjust therapy

Term

Quick relief Asthma Therapy 

 

Definition
  • Short acting β2 agonists (Salbuterol)
  • anticholinergics (Spiriva)
  • Systemic corticosteroids (tablets, used only temp. for anti-inflammatory effects, bad side effects with long term use)
Term
Long term control asthma treatment
Definition
  • Inhaled Conicosteroids
  • Long-acting β2 agoists (ie salmeterol)
  • Theophylline
  • Leukotriene modifiers
  • Cromolyn and nedocromil
Term
Why asthma makes it difficult to breath
Definition

In asthmatic person:

  • muscles of bronchial tubes tightnen and thicken
  • ari passage become inflammed and mucus filled
  • air flow becomes difficult
Term

Quick relief asthma Medication

 

Definition

Reliever/Rescue

  • Inhaled β2 selective agonist ie, Salbutamol (ventolin)
  • Terbutaline (Bricanyl)
  • Systemic corticosteroids (Prednisone)
Term
β2 Agonists
Definition

i.e. Salbutamol

  • relax airway smooth muscle or relieve bronchospasm
  • Treat intermittent episodes of bronchospasm and prevention of exercise induced asthma
  • Quickest for acute asthmatic attack
  • Give systemic corticosteroid 1st (will not take effect for around 2 hrs), then these
Term
Anticholinergics for asthma
Definition
  • ↓Ipratropium (Atrovent), Tiotropium (Spiriva)
  • Blockad of colinergic receptors ↓ the formation of cGMP, resulting in ↓ contractility of smooth muscle
  • Bronchodilation
  • Used for patients with pollen, allergic induced asthma
Term
Ipratropium or Tiotropium
Definition

)Anticholinergic asthma durgs

  • not well absorbed into circulation (advantage, stays topical) b/c are quaternary ammonium compounds
  • max bronchodilation reached in 2 hrs (vs 30 mim for β2 agonists) (disadvantage)
  • given by inhalation or nasal spray
  • minimal side effects (b/c topical)
Term
Systemic corticosteroids for asthma
Definition
  • Used for moderate to severe exacerbations to speed recovery adn prevent recurrence
  • ↓ inflammation and improve mucus production
  • oral or IV
Term
Asthma controller medications
Definition

controller or preventer

  • inhaled corticosteroids (local inflammation)
  • long acting β2 agonists
  • leukotriene modifiers
  • slow release Theophylline (a zantine like caffiene)

 

Term
Inhaled Corticosteroids
Definition

1st line treatment for asthma, even in patients < 5 years of age 

 

Studies show they:

  • control symptoms
  • improve lung function
  • decrease hospitalization
  • decrease risk of death
  • decrease cost of care

Term
Inhaled corticosteroid agents
Definition

Budesonide

Beclomethasone

Fluticasone

Triamcinolone

Term
Adverse effects of inhaled corticosteroids
Definition

  • Deposition of drugs in mouth and upper airway
  • May lead to oral Candidiasis (thrush)
    • decrease local immune system in mouth 

Term
how to reduce adverse effects of inhaled corticosteroids
Definition

  • administer with a spacer (Nebulizer)
  • Rinse and spit after use

Term
Long acting inhaled β2 agonists
Definition
Formoterol (Oxeze) and Salmeterol (Serevent)
Term
Use of Long acting β2 agonists
Definition

  • adjunct therapy to inhaled steroids
  • available alone and as combo therapy with steroids
  • Especially helpful for night time symptoms and exercise induced asthma
  • not to be used to treat acute symptoms or exacerbations

Term

The arachidonic acid pathway

and Arthritis

 

Definition

Membrane phospholipids are injured→ phospholipase A2 released→ Arachidonic acid released→ (Cyclooxygenase acts to form)→ Prostaglandins and Thromboxanes 

= Inflammation

Term
agents that block production of Phospholipase A2
Definition

Corticosteroids

 

  • blockage of phospholipase A2 inhibits the production of arachidonic acid and FLAP and therefore the activation of both the arthritis and asthma pathways

 

Term
agents that block the action of Cyclooxygenase
Definition
NSAID drugs i.e. Celebrix, aspirin
Term
The arachidonic acid pathway and asthma
Definition

membrane phospholipids are injured→

5-Lipoxygenase activating protein (FLAP)→ activates 5-Lipoxygenase → activates Leukotrienes (LTB4, LTC4)

Leads to asthma

Term
Leukotriene antagonists 
Definition

 

  • block leukotriene receptors that mediate airway inflammation, edema, bronchoconstriction and secretion of thick, viscous mucus
  • administered orally
  • Zileuton, Montelukast, Zafirlukast

 

Term
Zileuton
Definition

5-lipoxygenase inhibitor

 

  • prevents activation of leukotrienes

 

Term

Montelukast (Singulair) and

Zafirlukast (Accolate)

 

Definition

LTD4 receptor antagonists

 

Term
Leukotriene modifiers
Definition

Prevent binding of Leukotrienes to target tissue preveting: Bronchoconstriction, mucosal edema, bronchial hyper-reactivity 

 

beneficial in patients with exercise induced bronchospasm (already on steroids) and patients with environmental allergies

Term
Events of asthma
Definition

 

  1. bronchoconstriction
  2. mucosal edema
  3. bronchial hyper-reactivity

 

Term
Theophylline
Definition

  • Class of Methyl Xanthines (with Theobromine and caffeine)
  • many are sustained release
  • mild to moderate bronchodilator used principally as adjuvant to inhaled corticosteroids for prevention of nocturnal asthmatic symptoms
  • may have mild anti inflammatory effects and immunosuppressant effects

Term
Actions of Theophylline
Definition

Include:

  • Bronchodilation
  • improved respiratory muscle function
  • improved gas exchange
  • enhanced mucociliary clearance
  • enhances catecholamine secretion
    • Risk of sympathetic stimulation
    • Serum levels measurable

Term
Pharmacokinetics of Theophylline
Definition

  • Variable half life: reduced in smokers and children age 1-9
  • Metabolized by CYP 450 - Watch drug interactions
    • Ciprofloxacin- severely ↓ its clearance (can lead to toxicity)

Term
Theophylline adverse effects
Definition

  • Watch for GI, CNS and cardiac stimulation
  • CNS effects - headaches, anxiety, restlessness, insomnia, dizziness, seizures
  • Death

Term
Mast cell stabilizers
Definition

Cromolyn sodium (Intal)

  • maintenance drug
  • prevents mast cells from rupturing and spilling histamine (degranulation) after it has contact with antigen
  • administered via inhalation or intra-nasal spray

Term
Cromolyn and Nedocromil
Definition

Mast cell stabilizers

  • Taken daily regardless of absence of symptoms
  • not effective during acute attack
  • can also be used as preventive treatment prior to exercise or unavoidable exposure to known allergens

Term
β blockers
Definition

  •  Induce bronchoconstriction
  • blocking β2 receptors in airways prevents Salbutamol from working
  • Selective β blockers (Cardio-selective blockers i.e. Atenolol)
    • Less bronchoconstriction than nonselective β blockers

 

Term
Drug induced bronchospasm
Definition

ASA and NSAIDS
can induce severe bronchospasm


Ace inhibitors

Can cause cough (Lisinopril)

Treated with Aspirin

Use these drugs cautiously in asthmatics (cough is a symptom of asthma and ACE inhibitors)

Term
Asthma vs COPD
Definition

       Asthma               COPD

Age of onset   <40 > 40

Smoking not causal Usually >10 pk/yr

Sputum Infrequently Often

Allergies Often Infrequent

Course Stable Progressive

Spirometry Normalizes Never normalizes

Symptoms Intermittent/vary Perisitent

Term
Pathophysiology and normal course of COPD
Definition

  • enlarged mucus glands
  • dilated bronchial gland ducts
  • inflammation in bronchioles
  • mucus plugged
  • fibrotic distortion

Term
COPD medications
Definition

  • Bronchodilators: anticholinergics, β2 agonists, methyxanthines
  • Glucocorticoids
  • Mucolytics
  • Oxygen
  • Respiratory stimulants
  • antibiotics
  • vaccinations (ie pneumonia)
  • lifestyle modifications 

Term
Chronic Obstructive Pulmonary Disease (COPD) patients
Definition

  • Used to describe patients with 1 or more of:
    • chronic bronchitis
    • Emphysema
    • Asthma

Term
COPD
Definition

Lung diseases that inflame airways, obstruct breathing and trap bad air in the lungs, including emphysema and chronic bronchitis

  • steady ↑ prevalence, while other major causes of death ↓
  • (largely due to increase in populations age)
  • Rise in younger people and women, due to effects of smoking (even years after they quit) as well as exposure to 2nd hand smoke and pollutants

Term
Spirometry
Definition

  • new campaign to ↑ awareness of COPD by encouraging people over 45 who may be at risk to get spirometry
  • test that determines lung fxn by measuring air a person can breath out and the time it takes

Term
Anticholinergics for COPD
Definition

Iprotropium (Atrovent)

  • relaxation of bronchial smooth muscle by inhibitio of cGMP
  • Bronchodilating effects are equal to or more than beta agonists
  • Tiotropium (Spiriva) once daily
Term
Combined β2 agonists and anticholinergics for treatment of COPD
Definition
  • Combination more effective than either alone
  • Combivent = Salbuterol + Ipratropium

 

Term
Long acting β2 agonists
Definition

Salmeterol (Serevent)

  • Approved for use in COPD in 1997
Term
Salmeterol (Serevent)
Definition
  • Long acting β2 agonists
  • used for COPD since 1997
  • 2 puffs BID vs. Ipratropium QID
    • Equal or superior to ipratropium, greatest benefit in those with bronchodilator response

 

Term
Corticosteroid use for COPD
Definition
  • Controversial
  • Only appropriate for symptomatic patients with moderate and severe COPD
  • Long term use with oral steroids not advised
Term
Other therapies for COPD
Definition
  • Long term oxygen
  • Antibiotics
  • flu and pneumonia vaccines
Term
Mucolytics
Definition
Acetylcysteine (Mucomyst)
Term
Pharmacotherapeutics of Acetylcysteine (Mucomyst)
Definition

Breaks up thick, tenacious sputum in patients whose physical condition makes it difficult to cough them up

 

Antidote for severe Acetaminophen overdose(causes 2nd peak of tylenol to not go quite as high)

 

Usually given by Nebulizer

 

Fast acting, onset of action within 1 minute

Term
Expectoants
Definition

Guaifenesien (Robitussin)

  • ↓ viscosity of secretions so they can be coughed up
  • Available in many OTC preperations
Term
Guaifenesin
Definition
An expectorant
Term
Antitussives
Definition

Dextromethorphan (DM)

  • used to suppress the cough reflex (Acts centrally in the brain) when chronic nonproductive coughing accompanies a disorder of the respiratory tract
  • not used in peds
Term
Antihistamines
Definition
  • Sedating: Diphenhydramine (Benadryl)
  • Non-sedating: Loratiadine (Claritin)
  • Block the H1 receptor site, preventin histamine action whtn an antigen is encountered
  • Resotres normal air flow through the upper respiratory tract
  • many available OTC
Term
Autocoids
Definition

Local hormones

  • Histamine
  • Serotonin (5-Hydroxythyptamine)
  • Prostaglandins
  • Leukotrienes
Term
Histamine
Definition

Mediates a range of cellular responses:

  • allergies
  • inflammatory reactions
  • gastric acid secretion
  • Neurotransmission in CNS

No clinical application

Cliically we aim to block its effects (Antihistamines)

Supporting users have an ad free experience!