Term
|
Definition
| hyperactivity of airway releases leukotrienes and histamine which cause smooth muscle proliferation, mucous gland hypertrophy, hypersecretion, inflammatory cells, edema, and loss of epithelium |
|
|
Term
| what are the 3 effector cells in asthma, at what point to they come into play |
|
Definition
mast cells - immediate response
eosinophils - late response
T cells - chronic response |
|
|
Term
| mast cell: location, 6 things they release |
|
Definition
3-5x more in respiratory tract of asthmatic
histamine, PGE, PAF, LTD, LTC, LTE |
|
|
Term
| eosinophils: effect, 1 thing they release |
|
Definition
primary airway effector
number in bronchial lavage fluid is related to bronchial hyperreactivity
major basic protein- damages airway epithelium |
|
|
Term
| T cells: effect, 2 thing they release |
|
Definition
number is proportional to bronchial hyperreactivity
releases interleukins |
|
|
Term
|
Definition
intrmittent
wheeze, cough, dyspnea, chest tightness |
|
|
Term
| 5 qualifications for intermittent asthma |
|
Definition
<2d/w
<2d/mo nocturnal symptoms
FEV >80%
FEV:FEC normal
SABA use <2d/wk |
|
|
Term
| 5 qualifications for persistant mild asthma |
|
Definition
>2d/wk
3-4d/mo nocturnal asthma
FEV >80%
FEV:FEC normal
SABA use >2d/wk |
|
|
Term
| 5 qualifications for persistant moderate asthma |
|
Definition
>2d/wk
>2d/mo nocturnal asthma
FEV >60% <80%
FEV:FEC <5% reduction
SABA use daily |
|
|
Term
| 5 qualifications of persistant severe asthma |
|
Definition
continous symptoms
frequent nocturnal symptoms
FEV <60%
FEV:FEC >5% reduction
hospitlized in last year for asthma |
|
|
Term
| 4 ways asthma is diagnosed |
|
Definition
reversible airway obstruction
history of symptoms
spirometric pulmonary function tests
methocholine challenge test |
|
|
Term
| 5 goals of asthma therapy |
|
Definition
normal activity and exercise levels
near normal pulmonary function tests
prevent chronic symptoms
prevent recurrent exacerbations
avoid medication SE |
|
|
Term
| 2 types of B2 agonists and their 8 drugs |
|
Definition
SABA: albuterol, levabuterol, terbutaline, pirbutrol, bitolerol, metaproterenol
LABA: salmeterol, formoterol |
|
|
Term
| SABA: onset, duration, usage |
|
Definition
rapid onset 5-15min inhaled
4-6h duration
DOC mild asthma, rescue inhaler (not anti-inflammatory |
|
|
Term
|
Definition
|
|
Term
|
Definition
relax bronchial smooth muscle (adenylyl cyclase > cAMP > PKA > MLCK > smooth muscle relaxation)
stabilizes mast cell membranes |
|
|
Term
|
Definition
more in oral/suryp (often used in kids)
tremor, tachyarrhythmia, muscle cramps |
|
|
Term
| 2 types of corticosteroids used in asthma and their 6 drugs |
|
Definition
inhaled: trimacinolone, flutocasone, budesonide
systemic- methylprednisone, prednisone, prednisolone |
|
|
Term
| how are steroids used in asthma, time of onset |
|
Definition
used in moderate to severe asthma with SABA PRN
continous prevention
onset in 4-12h |
|
|
Term
|
Definition
stimulate glucocorticoid receptors
inhibit inflammation
reduce mucous production
increase B2 receptors (increases SABA effectiveness) |
|
|
Term
|
Definition
only 10% of steroid reaches lung, 90% is metabolized by first pass if oral
increases deposition in lung by decreasing particle velocity and zise |
|
|
Term
| 3 techniques for inhaling and exhaling corticosteroids and their benifits |
|
Definition
open mouth: decreases particle size but also aim
closed mouth: increases aim but increases particle size
nose exhaling: helps with coating of mucosa in allergies |
|
|
Term
| what are 2 propellents used in inhalers |
|
Definition
chlorofluorocarbon (CFC)
hydrofluroalkaline (HFA) |
|
|
Term
| explain how to use an inhaler |
|
Definition
shake and remove cap
exhale slow with pursed lips
close/open mouth technique
press once
slowly inhale over 5 sec
hold breath 10 sec
exhale slowly
wait 1 min before next puff |
|
|
Term
| what is the story for the other drugs (non steroid or B2 agonist) used in asthma |
|
Definition
| the old man and liz needed chrome from chrome mountain, i prayed they throw the line to tio but monte leukast was za first leukast to salute on this |
|
|
Term
| what are the 9 other drugs used in asthma |
|
Definition
omalizumab
nedcromil
chromolyn
ipratropium
throphylline
tiotropium
monteleukast
zafirleukast
zileuton |
|
|
Term
|
Definition
| monoclonal anti-IgE antibody |
|
|
Term
| MOA nedcromil and chromolyn |
|
Definition
| inhibit mast degranulation and thus release of histamine and leukotrienes |
|
|
Term
|
Definition
| short acting muscarinic antagonist decreases PANS decreasing smooth muscle contraction |
|
|
Term
|
Definition
blocks adenosine (a bronchoconstrictor)
decreases PDE III in smooth muscle of bronchi
decreases PDE IV in inflammatory cells thus decreasing cytokines |
|
|
Term
|
Definition
| long acting muscarinic antagonist (with no M2 action) decreases PANS decreasing smooth muscle contraction |
|
|
Term
| MOA monteleukast and zafirleukast |
|
Definition
block leukotriene receptors (cys-LT)
anti-inflammatory
causes bronchodilation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| SE nedcromil, chromolyn 4 |
|
Definition
anaphylaxis
laryngeal edema
headache
rash |
|
|
Term
|
Definition
| atropine like in high dose |
|
|
Term
|
Definition
| CNS, CV, increase HR, GI, diuretic like |
|
|
Term
|
Definition
| atropine like in high dose |
|
|
Term
| SE monteleukast, zafirleukast, zileuton |
|
Definition
|
|
Term
|
Definition
| severe allergen induced asthma |
|
|
Term
| use nedcromil, chromolyn 3 |
|
Definition
adjunct in mild-moderate asthma
exercise asthma
allergen asthma |
|
|
Term
| use ipratopium and tiotropium 2 |
|
Definition
in combination with B2 agonist (combivent, dunoeb) for COPD
pt with B2 intolerance
never acute use |
|
|
Term
| use monteleukast, zafirleukast, zileuton 2 |
|
Definition
alternate to steroid in mild asthma
adjunct to steroid in severe asthma |
|
|
Term
| age ok for use in monteleukast, zafirleukast, zileuton and administration |
|
Definition
monteleukast 1yo+ oral
zafirleukast 5yo+ oral
zileuton 10yo + oral |
|
|
Term
| ipratopium and tiotropium: onset, dosing timing, administration |
|
Definition
|
|
Term
| throphylline: administration 3, pharmacokinetic quality |
|
Definition
P450 inhibitor
oral, rectal, parentrail |
|
|
Term
| nedcromil, chromolyn: administration, age ok to use, benifits based on age |
|
Definition
inhaled
ok in kids - better than steroid but has not anti-inflammatory effect so steroid is still DOC |
|
|
Term
| omalizumab: age for ok use, administration, dosing timing |
|
Definition
|
|
Term
| explain the six stages of asthma treatment |
|
Definition
1. SABA PRN
2. LABA daily, SABA PRN
3. steroid daily, SABA PRN
4. LABA med dose daily, SABA PRN
5. LABA lg dose daily, SABA PRN
6. systemic steroid daily, steroid daily, SABA PRN
treat for 3mo, if stable step down a level |
|
|
Term
| what is the DOC for childhood asthma, what are 2 alternates |
|
Definition
steroid inhaled daily
monteleukast, cromolyn |
|
|
Term
| define and what is cause of exercise asthma |
|
Definition
pulmonary function decline (maybe only symptom or seen in 80% asthmatics)
caused by hyperventilation of cold air, respiratory heat, and water loss |
|
|
Term
| TX exercise induced asthma |
|
Definition
<3h exercise: albuterol or terbutaline, chromolyn alternate
>3h exercise mild asthma: LABA
>3h exercise mod asthma: corticosteroid |
|
|
Term
| define and hat is cause of nocturnal astham, 3 signs |
|
Definition
asthma in sleep or upon waking
worse 2-6am due to increased PANS, decreased epinepherine, increased inflammatory mediators, and GERD
morning cough, bronchospasm, esp in expiration (carcadian association) |
|
|
Term
|
Definition
LABA
corticosteroids if moderate to severe |
|
|
Term
| signs of aspirn induced asthma 3, when would you use aspirin anyways |
|
Definition
rhinorrhea, wheeze, SOB
desensitize for post MI arthritis |
|
|
Term
| what drug should you avoid in asthmatics |
|
Definition
non-specific BB (even timolol opthalamic)
be careful with B1 specific too |
|
|
Term
| causes or associations with COPD 8 |
|
Definition
asthma
cardiac disease
renal disease
smoking
grain
coal
asbestos
pollution |
|
|
Term
| pathological changes in chronic bronchitis |
|
Definition
| increased mucous and glands lead to obstruction, inflammation, edema, infection, bronchial hyperplasia of smooth muscle |
|
|
Term
| pathological changes in emphysema |
|
Definition
| increased proteases cause inflammation, fibrosis, destruction of alveolar wall and tissue which enlarge air space distal to terminal bronchioles, decrease elastic recoil and support leading to airway collapse without accessory muscle support to increase expiration |
|
|
Term
| 5 avenules of tx for COPD |
|
Definition
primary intervention - stop smoking
primary therapy - bronchodilators
corticosteroids
long term O2 treatment
immunizations - pneumococcus q6mo |
|
|
Term
| 2 drugs that help stop smoking, their MOA and SE |
|
Definition
buproprion: sustained release tablet antidepressant (SE suicide)
varenicline: nicotinic partial agonist decreases dopamine in mesolimbic tract and thus decreases reinforcement for smoking
SE: N/V, suicide |
|
|
Term
| what are the indications for long term O2 therapy, what is the timeframe |
|
Definition
15-20 h/d reduces mortality
PaO2 <55
right heart failure
polycythemia
impaired neuropsychological function with PaO2 <60 |
|
|
Term
| what is the drug combination used for bronchodilation in COPD |
|
Definition
ipratoripum or tiotropium + SABA PRN
add throphylline if unable to control |
|
|
Term
| explain how steroids are used in COPD |
|
Definition
really only benifit asthmatics
if not asthmatic, give 20-30mg prednisone for 2-3wks and if successful switch to inhaled steroid |
|
|
Term
| explain the physiology of a cough |
|
Definition
involves CNS, PNS, bronchial smooth muscle
physiological, normal response that helps clear debris |
|
|
Term
| what are the 4 antitussives |
|
Definition
codiene
hydrocodone
dextromethorphan
bensonate |
|
|
Term
| what is an expectorant and its MOA |
|
Definition
| guaifensin: increases respiratory fluid output by decreasing viscosity and surface tension |
|
|
Term
|
Definition
isomere of codine levorphanol (L isomere is addicting) acts on medulla to increase threshold
equal in effectiveness to codiene |
|
|
Term
|
Definition
GI
high dose causes CNS depression |
|
|
Term
| causes of acute rhinitis 6 |
|
Definition
virus
bacteria
foreign body
hypothyroid
pregnancy
drug induced - medicamentosa |
|
|
Term
| 9 causes of chronic rhinitis |
|
Definition
allergy - hay fever, perennial
vasomotor rhinitis
tumor
polyp nasal septal deviation
enlarged adenoids
sinusitis
CSF rinorrhea |
|
|
Term
| 5 modes of tx for rhinitis |
|
Definition
avoid allergen
reversible H1 antagonist
decongestant
corticosteroid - inhaled
cromolyn - inhaled |
|
|
Term
| when should you use reversible H1 antagonist in rhinitis 3 |
|
Definition
perennial
allergic rhinits or conjunctivitis |
|
|
Term
| what are 4 decongestants used in rhinitis |
|
Definition
pseudophredrine
phenhyleephrine
naphazoline
oxymetazoline |
|
|
Term
|
Definition
stimulate a1 (symphathomimetrics)
often in combo with H1 antagonist |
|
|
Term
|
Definition
| rebound congestion upon DC |
|
|
