Pharm Block 2- Respiratory

Front 1

asthma

Back 1

-bronchoconstriction due to hyperresponsiveness of the airways to physical, chemical and pharmacological stimuli

Front 2

asthma pathology

Back 2

-dec airway caliber
-bronchiolar edema
-inc airway smooth muscle contractility
-inc bronchial mucous secretion
-airway epith damage
-airway inflamm

dec in FEV1

Front 3

smooth muscle in asthma

Back 3

-muscarinic cholinergic receptors (ACh--> vasconstrict)
-adrenoreceptors, mainly B2 (epi from adrenal medulla --> relaxation)
-receptors for arach acid metabolites, histamine, adenosine

Front 4

airway epithelium

Back 4

-creates a permeability barrier; removes inhaled particulate matter through ciliated cells
-secrete mucus which is reg by muscarinic rec on parasymp ganglia and in submucosal glands

Front 5

vascular endothelium in lungs

Back 5

-barrier to fluid flux of blood into tissue
-pulm edema caused by leaky capillaries (can compromise gas exchange)
-barrier to extravasation of inflamm cells into lungs

Front 6

mast cells

Back 6

-degranulate on binding allergen to its IgE on membrane
-granules contain bronchoconstrictors, chemotactic factors, leukotrienes, PGs

Front 7

Mediators released from mast cells, infiltrating eosinophils and mac's

Back 7

-cause bronchoconstriction
-lead to inflamm--> inc mucus secretion, shedding of epithelial cells, inc capillary permeability

Front 8

mediators of bronchoconstriction

Back 8

-histamine
-adenosine
-leukotrienes
-thromboxane

Front 9

mediators of inflamm

Back 9

-PGs
-leukotrienes
-various cytokines
-histamine
-proteases

Front 10

what does the inflammation in the ariway from an allergen cause?

Back 10

-a hyperresponsive constrictor response of airway smooth muscle
-to repeated exposures to allergens and other stimuli

Front 11

treatment of asthma

Back 11

-bronchodilators to dec bronchoconstriction (primary symptom)
-anti-inflamm agents to dec the level of airway smooth muscle hyperresponsiveness resulting from inflamm

Front 12

b2 agonists

Back 12

-albuterol and salmeterol (long acting)
-directly stimulates smooth muscle relaxation and mucociliary transport
-acts on GPCR--> inc cAMP

Front 13

prolonged action of salmeterol

Back 13

-long lipophilic tail binds to extrareceptor in the vicinity of the adrenoreceptor
-anchors it better in cell membrane

Front 14

b2 agonist toxicity

Back 14

-overreliance on these drugs with delay in seeking medical care
-arrhythmias
-HTN in asthmatics--> DON'T use b-blockers

Front 15

methylxanthines

Back 15

-theophylline, caffeine
-relaxes smooth m in airway

Front 16

theophylline mech and s/e

Back 16

-phosphodiesterase inhibitor
-adenosine antagonist
-narrow ther window dt stimulant effects on CNS and CV (convulsions)

Front 17

anticholinergic uses in asthma

Back 17

-ipratropium bromide and tiotropium (long acting)
-relax airway smooth muscle and dec mucus secretion

Front 18

who are anticholinergics ineffective in?

Back 18

-asthmatics who have sympathetic dominated tone
-more effective to use B2 agonists for them

Front 19

ipratropium pharmacokinetics

Back 19

-high dose delivery to airways
-poorly absorbed, limiting access to CNS

Front 20

anti-inflamm agents used in asthma

Back 20

-beclomethasone (a glucocorticoid)
-treat the chronic inflamm underlying asthma
-inhibit production of PGs, leukotrienes, cytokines
-bind to GC receptor and are transported to nucleus

Front 21

beclomethasone effects in nucleus

Back 21

-inc txn of lipocortin-1: phospholipase A2 inhibitor (dec PGs and LTs)
-dec txn of inflamm mediators
-inc txn of B2 receptor protein (inc responsiveness to B2 agonists)

Front 22

beclomethasone use

Back 22

-not effective in acute attack
-must used over an extended period
-can cause oropharyngeal candidiasis and horseness

Front 23

cromolyn sodium use

Back 23

-prevents bronchoconstriction and inflamm due to mast cell activation
-prevents transmembrane incflux of Ca2+ --> prevents degranulation
-must be used BEFORE exposure to known stimulant

Front 24

leukotriene blocking drugs

Back 24

-zafirlukast and zileuton
-blocks bronchoconstriction and inflamm caused by LTs
-particularly effective in aspirin-induced asthma

Front 25

COPD

Back 25

-use bronchodilators and corticosteroids
-add antibiotics (azithromycin) to treat acute exacerbationgs, acute bronchitis, as prophylaxis

Front 26

cystic fibrosis

Back 26

-A/R mutation for CFTR
-abnormal mucus that causes tissue destruction and affects mucociliary clearance
-treat with inhaled bronchodilators, azithromycin, rhDNAase, dornase alpha

Front 27

recombinant human deoxyribonuclease

Back 27

-rhDNAase, dornase alpha
-dec sputum viscosity
-cleaves extracell DNA that has been released from infiltration neutrophils (DNA is very viscous)