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43 Cards in this Set

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describe extrinsic causes of asthma
caused by environmental factor- usually called allergic asthma becuase patients have pos responses to challenge with specific antigens and inc IgE
describe intrinsic causes of asthma
attributed to pathophysiologic disturbances- no family hx, neg response to antigenic challenge, normal IgE
Is asthma common?
yes
more pediatric admissions than any other ds
55% inc from 1982 to 1996
Early/immediate symptoms of asthma?
bronchoconstriciton
vascular leak
HA
proteases
leukotrienes C4 and D4
prostaglandins
Late/sustained symptoms of asthma?
TH2 cytokines- GM-CSF, IL 3, 4, 5, 9, and 13
How many asthmatics have identifiable allergies?
large percentage of adults don't
50% of kids don't
give examples of precipitants to asthma attacks
viral URT infection
exercise/rapid respiration
cold air
chemicals (sulfur dioxide)
What causes airway hyperactivity?
inflammation of airway mucosa
acute stage of airway inflammation
early recruitment of cells to airway
sub-acute stage of airway inflammation
recruited and resident cells activated to cause more persistent inflammation
chronic stage of airway inflammation
persistent level of cell damage and ongoing repair; permanent abnormalities in airway
What is of more benefit, drugs that only target bronchoconstriction or drugs that more broadly address inflammation
drugs that more broadly address inflammation
What are the two types of asthma drugs
short term relievers- relax airway sm mm
long term relievers- anti-inflammatory
Do aerosol treatments work for most patients
over 90% can be managed by them alone
this inhaler usually contains a large-column holding chamber (spacer) that fits between the inhaler and mouth; the inhaler discharges into it, and the patient inhales from it
metered-dose inhaler
this inhlaer is not as cheap or portable, but doesn't require hand/breathing coordingation
nebulizer
this inhaler was developed as an alternative to CFC propellants
dry powder inhaler
What is the preferred therapy for bronchoconstriction?
inhalation beta agonist
What may regular use of beta agonist inhaler cause?
potentiate bronchial hyperresponsiveness- tachyphylaxis with diminished beta2 receptors
MOA of bronchodilators (5)
1. relaxes sm mm;
2. inhibits release of bronchoconstricting agents;
3. inhibits microvascular leakage;
4. increases mucociliary transport;
5. beta agonists stimulate adenylyl cyclase --> inc sm mm relax
toxicity from bronchodilators?
cardiac arrhythmias from beta-1 stimulation
possible tachyphylaxis or tolerance to beta agonists

*beta2 selectives are usually safe
when can muscarinic antagonists be helpful?
when patients are intolerant of inhaled beta agonists;
to enhance nebulized albuterol effect;
role in COPD
what limits the quantity of muscarinic antagonists given
systemic adverse effects (urinary retintion, tachycardia, loss of accomodation, agitation)
muscarinic antagonist MOA
blocks action of ACh from parasympathetic neurons --> blocks bronchoconstriction and icreased secretion of mucous that accompanies vagal activity
How many asthmatics are tx with methylxanthines
less than 1%, still used because of high compliance
methylxanthine MOA
antagonism of adenosine receptors --> relaxes bronchial sm mm;
stimulates CNS and cardiac mm; diuretic;
inhibits phosphodiesterases (inc cAMP);
effects Ca conc;
may be anti-inflammatory
side effects of methylxanthines
arousal, tremor, convulsions, tachycardia, arrythmias, weak diuretic
how are methylxanthines administered
are readily absorbed after oral, rectal, and parenteral administration- take your pick
What is the major drug interaction of methylxanthines
interacts with many; but major is with macrolide antibiotics- can cause build up of theophylline due to inhibition of P450 --> seizures
is the TI of methylxanthines high or low?
low
give 4 reasons to use corticosteroids
1. anti-inflammatory
2. reduces bronchial reactivity and increases airway caliber
3. reduces frequency of asthma attacks
4. potentiates effects of beta agonists
corticosteroid MOA (3)
1. inhibits eosinophil-induced inflammation
2. inhibits cytokine production
3. inhibits release of arachidonic acid from cell membranes --> dec prostaglandins and leukotrienes
Adverse effects of inhaled corticosteroids
minimal:
cataracts
dec. bone density
oral candidiasis
adverse effects of oral corticosteroids
severe:
wt gain
iatrogenic Cushing's syndrome
adrenal suppression
What drugs are used for prophylaxis only?
cromolyn and
nedocromil (ne-dOk'-ra-mill)
How are cromolyn and nedocromil used?
insoluble salts used with inhalers --> plasma conc peaks in 15 minutes --> excreted unchanged
What types of asthma do cromolyn and nedocromil block?
antigen and exercise-induced asthma
What happens when cromolyn and nedocromil are used regularly for more than 2-3 months?
reduce bronchial hyperactivity
What's more potent: cromolyn, inhaled glucocorticoids, or nedocromil
inhaled glucocorticoids > nedocromil > cromolyn
cromolyn and nedocromil MOA (5)
1. inhibit delayed Cl channes
2. reduce mast cell degranulation
3. inhibit release of infl mediators
4. block effects of chemotactic peptides
5. inhibit IgE production
When are leukotriene pathway inhibitors used?
aspirin or exercise induced asthma
How are leukotriene pathway inhibitors administered?
orally
leukotriene pathway inhibitors MOA
inhibit synthesis or action --> no LTB4 (neutrophil chemoattractant); LTC4 or LTD4 (bronchoconstriction, reactivity, mucosal edema, and hypersecretion)