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31 Cards in this Set
- Front
- Back
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what are the precipitating factors of asthma? (3)
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1. respiratory infections primarily viral
-baterial pneumonia rarely a problem 2. inhaled allergens: house dust mites dermatophagoides pteronyssinus 3. medications aspirin and NSAIDs due to COX inhibition pure beta blockers |
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what is exerise induced bronchospasm?
what is it treated with? |
occurs within minutes of starting exercise
beta-2 agonists prevent symptoms in >80% |
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what is the hygiene hypothesis?
hygiene environment favors Th1 or Th2? |
use of antibiotics, western lifestyle and diet increase incidence of asthma
-hygiene environment favors Th2 |
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what test would be most likely to be healpful in diagnostic evaluation of asthma and to formulate a treatment plan?
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spirometry before and after bronchodilator administration
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what is given to induce bronchoprovocation to test for asthma?
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methacholine is useful in pts w/ suggestive asthma symptoms
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what are the morphological changes ass with asthma?
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-smooth mm hypertrophy due to constriction
-epithelial damage inflammatory cell infiltration edema vascular dilation mucous gland hypertrophy and hypersecretion |
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what is asthma? what cells are involved?
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chronic inflammatory disorder of airways
eosinophils, Tc, mast cells are all involved |
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when are asthma attacks most common?
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night and early morning
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what is the diff bet asthmatic and idiosyncratic asthma?
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allergic: idiosyncratic:
+ family hx - family hx + skin test - skin test high serum IgE non atopic + response to normal serum provoca- Ige tion w/Ag |
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what is the relatioship bet IgE and asthma?
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High IgE=high probability of having asthma
IgE interacts w/epithelial cells, eosinophils, plateles, and Macrophages |
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what are the effects of beta-2 agonists?
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bronchodilation
no effect on hyperresponsiveness-->dont change dz -drug of choice for exercise induced bronchospasm -increase mucociliary clearance -decrease mast cell degranulation |
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what is ipratropium bromide?
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-anticholinergic agent
-muscarinic antagonist prevents bronchocontstriction mediated by CNX -not indicated for asthma but COPD |
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what are the effects if ICS on air way inflammation?
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reduce mortality
-profound anti-inflammatory effect -decreased mucous gland secretion -decreased number of eosinphils -decreased endothelial cell leak -decreased Tc -decreased no. of mast cells -improvement of PFT |
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what are some examples of ICS?
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bedomethasone dipropionate
triamcinolone acetonide budesonide flucticasone propionate (churg strauss syndrome side effect) mometasone furoate |
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what are methyxanthines and what are they used for?
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adenosine receptor antagonists
used more for COPD -added to antiinflammatory therapy for additive effects tox: seizures-monitor levels |
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what are long acting beta agonists?
what cant they be used for? |
not for rescue
salmeterol-should never be used alone -well tolerated from cardiac perspective formoterol-starts working in 15 min |
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what is DDx for asthma?
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upper airway dz
allergic rhinitis and sinusitis cystic fibrosis laryngeal dysfxn obstruction foreign body vocal chord dysfxn |
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how is intermittent asthma define?
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night time symptoms:
-no more than 2 night time awakenings/mo. -no more than 2 attacks/wk -no more than using inhaler 2X/wk one cannister lasts 1 yr |
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give an example of a PDE inhibitor?
how is PDE involved in an asthma attack? |
PDE4 inhibition: anti-inflammatory activity
abolishes Ag induced eosinophil influx and bronchoconstriction PDE3 inhibition: causes bronchodilation -theophylline (a methylxanthine) non selective inhibitors are all PDE isoenzymes - |
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what are long term meds of asthma?
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ICS
LAB2A methylxanthines (theophylline) leukotriene modifiers anti-IgE therapy |
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what arequick relief meds of asthma?
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SAB2A (albuterol)
anticholinergics-ipratropium systemic corticosteroids in emergency |
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what is albuterol?
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beta 2 adrenergic agonists
increase cAMP in smooth mm leading to bronchodilation side effect: tremor |
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what are anti-IgE Ab?
name the drug what are its indications? |
Omalizumab, Xolair
decrease both bound and unbound IgE decrease processing of IgE at Ag processing center >12 yo given at step 5 when symptoms are inaquetely controlled w/ICS |
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what is status asthmaticus?
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asthma that does not respond to conventional therapy implies severe asthmatic exacerbation
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managing asthma step wise approach >12yo:
step 1 |
SABA
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managing asthma stepwise approach >12yo
step 2 |
ICS
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step 3
what is diff about this step from preceeding steps? |
combination therapy-do better than increasing dose of ICS
action at multiple sites ICS+LAB2A |
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step 4
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higher dose of ICS and LAB2A
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step 5
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ICS+LABA+anti-IgE therapy
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step 6
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ICS+LABA+ oral corticosteroids+ anti IgE therapy
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**cromolyn MOA?**
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***used in management of asthma
-mast cell degranulation inhibition*** |
