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21 Cards in this Set
- Front
- Back
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Allergic Rhinitis |
mediated by histamine & leukotrienes. |
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Asthma (천식) |
-하기도에서 Th2 inflammation; -근육 hypertrophy = 섬유화된 공간으로 내강 줄어듬 + secretion도 차게 된다.
cf) 참고로 찬공기에 의해서도 bronchoconstriction됨. |
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COPD (Chronic obstructive pulmonary disease) |
Two modes: -Chronic bronchitis: inflammation & excess mucus -Emphysema: alveolar membranes break down
대부분의 원인은 담배. epi & macrophage를 자극한다 --> fibrosis + protease (leads to emphysema + mucus hypersecretion) |
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MDI (metered dose inhalers) |
-일정한 약을 흡입할 수 있다. |
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Inhaled Drugs |
-Metered dose inhalers (MDIs) a. with spacer/mask b. with spacer/mouthpiece -Dry powder inhalers (DPI) a. Turbuhaler = 돌리면 가루가 나와서 기도로 들어감. b. Diskus = 버튼을 돌리면 가루가 장전이 되고 이걸 들이마신다. -Nebulizers -Nasal sprays |
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Drugs for Asthma |
*Bronchodilators = adrenergic agoinst, anticholinergics, methylxanthines (이거 배웠죠? ^^) *Anti-inflammatory drugs = steroid, cromolyn, leukotriene inhibitors
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Adrenergic Agonsits |
eg) ephedrine, epinephrine (used for status asthmaticus), isoproteronol
*adverse effect: tacyhcardia, nervousnes, agina. Inhalation을 하면 부작용이 더 적다. |
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b2 pharmacokinetics |
short acting: PRN (as needed) for symptoms long acting: not PRN ever
-Shoring acting: albuterol (use = MDI, neb) -Long acting: salmeterol (available only in combination = anticholinergics과 함께 쓴다)
**강조함: b2 agonist side effect: a. muscle tremor b. Tachycardia c. Hypokalemia d. Restlessness e. Hypoxemia. 설명: COPD, asthma 가 있으면 막힌 폐포 쪽으로 못 가게 vasoconstriction이 일어납니다 (hypoxic pulmonary vasoconstriction due to reversal of hypoxic pulmonary vasoconstriction) |
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Anticholinergics |
Reduces bronchospasms and mucus. Used in COPD bronchospasm/asthma.
-Ipratropium: Onset = 30 min (NOT short acting) -MDI (combo w/ albuterol), Neb.
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Methylxanthines |
-oral, iv -primary action: CNS excitation, bronchodilation -cardiac stimulation, vasodilation, diuresis가 생길 수 있다.
eg) theophylline, aminophylline. -DDI 가 많다 (fluoroquinolones를 함께 쓰면 독성 증가한다)
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Anti-inflammatory Drugs |
-glucocorticoid: decrease release of inflammatory mediator -세포막 내에 receptor가 있습니다. -b receptor sensitivity 높히고 cytokine 줄이고 mucus secretion 줄여짐. 너무 많이 쓰면 Cushing 와요. -inhaled (gargle and use spacer) --> oral cadidiasis, dysphonia (disorder of the voice)
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Inhaled Corticosteroicds |
Fluticasone: MDI - combo with salmeterol Budesonide: DPI, neb
--> almost all of these also have intranasal prep for allergic rhinitis. |
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Mast-Cell stabilizer = 최근들어서 많이 쓰고 있습니다. |
-mast cell: histamine을 만들어요.../예방적으로 사용합니다. -can be used for allergic rhinitis -MDI. Cromolyn, Nedocromil.
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Leukotriene Modifier |
-two approaches: a. inhibit leukotriene synthesis: zileuton 질루톤 b. inhibit leukotriene receptors: montelukast 몬테루카스트
cf) anti-IgE = omalizumab
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Asthma Treatment summarized: |
-mild intermittent: Albuterol MDI PRN -Mild persistent: add inflammatory -moderate persistent: long acting b-2 agonist를 깔아줘야 됩니다. -severe: high inhaled steroid / systemic steroid를 넣어줍니다.
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COPD Treatment summarized: |
-asthma: 기관지만 낙힌 것이기 때문에 산소가 거기를 통과하면 문제 해결됩니다 (bronchodilator로 해결할 수 있습니다) -COPD: empysema 때문에 고농도의 산소를 줘야 한다. -치료: ipratropium/O2 in advanced stage.
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Allergic rhinitis medication |
a. Antihistamines b. Intranasal glucocorticoids c. Intranasal cromolyn d. Montelukast e. Sympathomimetics (decongestants)
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Decongestants |
Pseudoephedrine을 사용합니다. Leads to vasoconstriction of nasal arteries/shrinkage of swollen membranes. |
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Antihistamines |
1st generation - 졸려요. 2nd generation = fexofenadine, loratidine, desloratidine. |
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Cough suppressants (진해제 - antitussive) |
-Opioid: codeine/reduce cough reflex centrally -Non-opioid: dextromethorphan (reduces cough reflex centrally), benzonatate (local anesthetic으로 작용; decreases stomach R sensitivity) |
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Expectorant (거담제 = 가래를 잘 뱉게 하는 것) |
-유일하게 FDA 허가받은게 Guaifenasin 입니다. -hypertonic saline & acetylcysteine: 감기 때는 쓸 수 있어도 천식에 쓰면 치명적일 수 있다 (bronchospasm) -normal saline (inhaled): used to hydrate lung |
