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79 Cards in this Set
- Front
- Back
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1. What is COPD 2. What are the clinical symptoms 3. Who is it common in 4. What does the disorder include |
1 Slowly progressive airway obstruction due to chronic inflammation 2. Cough, Mucus Hypersecretion, Dyspnea 3. Smokers 4. Chronic Bronchitis (inflammation of bronchi), Emphysema (Airway collapse during expiration) |
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What happens to air exchange in Emphysema |
Air gets trapped |
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1. What is Asthma 2. What is it characterized by 3. What are the symptoms 4. How are the stimuli characterized |
1. Chronic Inflammatory disorder 2. Recurrent episodes of hyper-responsiveness to stimuli that causes bronchoconstriction 3. Recurring cough, wheezing, tight chest, SOB 4. Extrinsic (allergenic) or intrinsic (non-allergenic) |
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What changes occur in the bronchi and bronchioles during asthma |
1. Air trapped in alveoli 2. Bronchocontriction 3. Inflammation and increased mucous secretion |
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Which symptoms are amenable to drug therapy |
1. Excessive airway smooth muscle tone 2. Inflammation 3. Mucus plugging 4. Pulmonary edema |
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How does extrinsic asthma occur |
External stimuli (i.e. dust) trigger plasma cells to make antigen specific IgE antibodies
IgE/antigen bind to mast cells and cause degranulation and release of inflammatory mediators |
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1. What is Intrinsic Asthma 2. What are the triggers 3. What is the MOA 4. Which nerve is responsible for the symptoms |
1. Non-allergenic asthma 2. Anxiety, stress, exercise, dry air 3. Unknown 4. Vagus |
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Draw out the pathophysiology of Asthma |
Draw pictures |
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What are the 2 treatment strategies that Asthma and COPD drugs target |
1. Controllers 2. Relievers
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What are the 2 ways in which Asthma and COPD drugs are divided based on their targets |
1. Airway muscle tone (Bronchodilators) 2. Inflammation (Anti-inflammatory agents) |
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What is the function of Bronchodilators |
Relax smooth muscle that line bronchioles |
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What is the effect of the sympathetic nervous system on bronchiole airway smooth muscle |
Action = Relaxation Receptor = beta 2 adrenergic Action = Bronchodilation (increased air flow) |
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What is the effect of the parasympathetic nervous system on bronchiole airway smooth muscle |
Action = Contract & secrete Receptor = Muscarinic (M3) Action = Bronchoconstriction (obstruct air flow and increase secretion)
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What is the pathway of Bronchoconstriction |
1. Ach binds to M3 (muscarinic) receptor and activates Gq 2. PLC is activated and increases DAG and IP3 hydrolysis 3. DAG and IP3 increase Ca in cytoplasm 4. Ca binds to calmodulin and activate myosin 5. Myosin binds to actin and causes contraction |
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Other than Ach what else will cause Bronchoconstriction |
Adenosine: it increases Ca levels by activating A1 receptor on PLC |
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What is the pathway of bronchodilation |
1. Activate Beta 2 receptors (GPCR) 2. Activate Gs 3. ATP converted into cAMP 4. cAMP activates PKA 5. PKA promotes Ca intake and inhibition of MLK (prevents myosin from binding to actin) |
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What is the function of Anti-inflammatory agents |
Prevents the release of stored asthma mediators from mast cells |
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What are Corticosteroids |
steroid hormones produced in the adrenal cortex |
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What is the function of glucocorticoids |
Regulate glucose metabolism |
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What is the function of mineralcorticoids |
salt and water balance |
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What are the 5 goals of therapy |
1. Normal activity level 2. Normal pulmonary function rates 3. Prevent symptoms (cough, breathlessness) 4. Avoid adverse effects of medications 5. Avoid drug interactions |
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What would you use for Mild, Moderate, and Severe COPD |
Mild = bronchodilator as needed Moderate = bronchodilator and anti-inflammatory drug Severe = antibiotic, bronchodilator, and anti-inflammatory drugs and oxygen therapy |
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What is the difference between Asthma and COPD |
Asthma: Allergen Mast cell and epithelial cell CD4 + Eosinphil Bronchoconstriction & airway hyper response Reversible
COPD: Smoke Macrophage + Epithelial Cell CD8 + Neutrophil Small airway narrowing, alveolar destruction Irreversible |
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What are the Beta 2 Adrenergic Agonists |
1. Salbutamol (albuterol) 2. Terbutaline 3. Salmeterol (long acting, 12 hours) |
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What is the beta 2 agonists MOA |
stimulate adnenyly cyclase |
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What is the route of the beta 2 agonists |
All are inhaled Albuterol = tablet Terbutaline = tablet and SC |
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Which drug is recommended for an acute asthma attack |
Albeuterol |
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Which drug is recommended for a severe asthma attack |
SC Terbutaline or Epi |
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What should beta2 agonist be administered with and why |
Corticosteroids It improves efficacy and prevents tolerance |
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What are the adverse effects a beta 2 agonists |
Beta 1 on heart may get stimulated = tachcardia
Skeletal tremor
Tolerance |
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What are the drug interactions of beta 2 agonists |
Propranolol for hypertension |
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Which drug is a methylxanthine |
Theophylline |
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What is the MOA of theophylline |
Inhibits phosphodiesterase & adenosine receptors |
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What is the route of administration for theophylline |
Aerosal |
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When do you use Theophylline & why |
2nd line for acute asthma attack because has a narrow therapeutic window (i.e given under supervision)
COPD |
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What are the adverse effects of Theophylline |
Anaphylaxis
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What are the drug interactions of Theophylline |
Metabolized by CYP450 drug interactions may result in toxic concentrations |
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What are the anticholinergics |
1. Ipratropium (short acting) 2. Tiotropium (long acting) |
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What is the MOA for the anticholinergics |
Block muscarinic receptor therefore no bronchiolconstriction |
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What is the route of administration for anticholinergics |
Aerosol |
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When do you use Ipratropium |
1. COPD 2. Acute asthma attack if pt can't use beta agonist 3. Sever asthma attack = ipratropium + beta agonist |
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What are the adverse effects of Ipratropium |
Atropinic effects
Caution with Glaucoma and Prostatic Hypertrophy |
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What are leukotriene Modifiers products of |
Arachidonic acid metabolism |
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What do leukotrienes do to the bronchioles |
Bronchoconstriction, edema, mucous secretion, Inflammation |
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What is the leukotriene synthesis inhibitor |
Zileuton |
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What is the MOA of Zileuton |
5-Lipoxygenase inhibitor |
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What is the rout of administration for Zileuton |
Oral |
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When would you give Zileuton |
Persistent Asthma ASA induced Asthma Exercise Induced Asthma |
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What are the adverse effects of Zileuton |
Hepatotoxicity |
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What are the drug interactions of Zileuton |
Inhibits CYP450 maybe interfere with metabolism of Theophylline & warfarin |
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What are the Leukotriene Receptor Blockers |
1. Zafirlukast 2. Montelukast |
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What is the MOA for the Leukotriene Receptor Blockers |
Reversible inhibitor of cysteinyl leukotriene 1 receptor
Prevents chemotactic infiltration of neutrophil and eosinophil |
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How is Zafrilukast administered |
Oral |
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When do you use Zafrilukast |
Mild to moderate asthma |
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Who should you not give Zafrilukast to |
Kids < 8 years old |
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What are the adverse effects of Zafrilukast |
hepatotoxicity |
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What are the drug interactions of Zafrilukast |
CYP45- inhibitor
(affects metabolism of Theopylline and warfarin) |
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How is Montelukast administered |
oral |
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What is montelukast used for |
persistent asthma |
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What are the drug interactions of montelukast |
CYP 450 |
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Who should you not give montelukast too |
Kids < 6 years old |
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What are the adverse effects of montelukast |
Hepatotoxicity |
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Which 4 classes are anti-inflammatory |
1. Corticosteroids 2. Mast cell blocker 3. Anti-IgE monoclonal antibodies 4. Leukotriene Modifiers |
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What are the corticosteroids & which are inhaled , IV, oral |
Beclometasone Fluticasone Flunisolide Budesonide Mometasone (inhaled) Methylpredinsolone (IV) Prednisone (oral) |
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What is the MOA of the Corticosteroids |
Blocks release of arachidonic acid
Increases sensitivity of beta agonists (prevent tolerance/desensitization)
Prevent long term changes in airways |
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What is the first line anti-inflammatory therapy |
Corticosteroids |
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What are the adverse effects of corticosteroids |
1. Thrush 2. Suppression adrenal gland 3. Osteoperosis and cataracts 4. Growth retardation in kids 5. Loss of glucose control in diabetes |
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How do you prevent the side effects of corticosteroids |
alternate day therapy |
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What are the mast cell blockers |
Cromolyn sodium Nedocromil |
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Who is Nedocromil approved for |
Patients > 12 years old |
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What is the MOA for Mast cell stabilizers |
Inhibit release of mediators from mast cell
Inhibit nt release from nerve endings |
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What is the route of administration of mast cell stabilizers |
Aerosol |
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When do you use the mast cell stabilizers |
mild to moderate asthma |
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What are the mast cell stabilizers the drug of choice for anti-inflammation |
Allergic Asthma |
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What is the monoclonal antibody |
Omalizumab (Xolair) |
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What is Omalizumab MOA |
Prevents IgE binding to mast cell
Prevents IgE production |
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What do you use Omalizumab |
Allergic Asthma |
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What is the route of administration for Omalizumab |
Injection |
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What is the adverse effect of Omalizumab |
anaphylaxis |
