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29 Cards in this Set
- Front
- Back
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Asthma Patho |
Airway inflammation from an immune response to allergen (sometimes unknown allergen) Allergen binds to IgE antibodies on mast cells which then release histamine, leukotrienes, prostaglandins, and activation on the inflammatory response cells. EDEMA MUCUS SMOOTH MUSCLE CONSTRICTION AND HYPERTROPHY AND FURTHER BRONCHIAL HYPERACTIVITY |
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COPD Patho |
Results from chronic bronchitis and emphysema. Leads to airway inflammation and airway obstruction sooo AIR TRAPPING |
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Chronic Bronchitis Characteristics |
Chronic cough and excessive sputum production L/T hypertrophy of mucus secreting glands in large airways |
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Emphysema Characteristics |
Enlargement of air space within bronchioles and alveoli brought on by deterioration of the walls of these air spaces. |
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Two Main Drug Classes for Asthma and COPD |
Anti inflammatory Agents (glucocorticoids) Bronchodilators (b2 agonists) |
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Asthma/COPD Prototype Drugs |
Anti-Inflammatory: Beclomethasone, Prednisone Other Anti-Inflams: Cromolyn (mast cell stabilizer) and PO Zafirlukast (leukotriene modifier) B2 Bronchodilators: Albuterol SABA, Salmeterol LABA Methylxanthines: Theophylline Anticholinergic: Ipratropium |
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MDI |
deliver a measured dose with each actuation. Wait at least 1 minute between doses. Spacers can help increase delivery of med |
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DPI |
Dry-powder inhalers - breath activated and deliver dry powder to lungs. require less coordination. A little more effective than MDI in that they deliver more drug to lungs. |
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Glucocorticoid's mechanism
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suppress inflam, decrease synthesis of leukotrienes, histamins, prostaglandins, decrease airway edema, decrease bronchial hyperactivity, decrease mucus.
Used on fixed schedule in asthma pts, not PRN.
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Glucocorticoids Adverse Effects
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Adrenal suppression, because glucocorticoids increase systemic steroids and mimic mineral/corticoids from adrenal so pituitary stops making them. (hyperglycemia too). Must never stop glucosteroid drugs abruptly, pt can die w/ induced adrenal insuff.
Oropharyngeal candidiasis and dysphonia are common
Bone loss - so encourage Ca++ and D intake
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Leukotriene Modifiers - Zileuton, Zafirlukast, and Monetlukast |
Suppress the effects of leukotrienes, compounds that promote smooth muscle constriction, blood vessel permeability, and inflam responses directly as well as through recruitment of eosinophils. |
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SABA Adverse Rxns (Albuterol, Levalbuterol) |
When taken in excess, tachycardia, angina, and seizures. ***If your pt needs their rescue inhaler more than 2x a week, it is time to step up therapy |
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LABA - Salmeterol, Brovana, Pressair |
LABAs are preferred over SABA for pts with stable COPD. In asthma however, LABAs are not first line of therapy and MUST ALWAYS be combined with a glucocorticoid because LABA use alone = increased incidence of asthma-associated death. |
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Anticholinergics - Ipratropium, "pium" suffixes |
Improve long fxn by blocking muscarinic receptors in the bronchi thereby reducing bronchoconstriction. |
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Diagnosing Asthma |
FEV1 should be within predicted normal values, in asthma will be 75% maybe less. Four classes of Asthma severity: 1- intermittent 2- mild persistent 3- moderate persistent 4- severe persistent |
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Diagnosing COPD |
Need FEV1/FVC of less than 0.70 and must have respiratory symptoms as well |
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Asthma/COPD Prescribing Progression |
Asthma > ICS, LABA, LAMA COPD > LAMA, LABA, ICS SABA 1-2x/wk, if more need to step up therapy |
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Patho of COPD (Detailed) |
Detailed |
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Glucocorticoids General Action |
Decrease inflammation leading to decreased airway edema, decreased mucus production, decreased airway hyper-reactivity, and may help beta-2 agonists work better |
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Inhaled Glucocorticoids |
“Sones and ides” Beclomethasone and budesonide are common. |
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Leukotriene Inhibitors |
Usually PO and end in lukast or start with a z Prescribed if pt cannot tolerate ICS or if ICS is inadequate. Adverse rxns are depression/suicidal ideation Leukotrienes modifiers suppress the effects of leukotrienes, which are compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through recruitment of eosinophils and other inflammatory cells. In patients with asthma, these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion. |
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Cromolyn |
Inhaled anti inflammatory used in asthma to decrease and prevent bronchial inflam. Less powerful than ICS so used as an alternative |
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Asthma Management w/ LABAs |
Three inhaled LABAs are approved for treatment of asthma: salmeterol [Serevent Diskus], formoterol [Foradil Aerolizer], and arformoterol [Brovana], the (R,R)-enantiomer of formoterol. Dosing is every 12 hours. If supplemental bronchodilation is needed between doses, a SABA should be used. As discussed previously, LABAs are not first-choice agents for long-term control, and they should not be used alone. Rather, they should always be combined with an inhaled glucocorticoid, preferably in the same inhaler device |
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Theophylline |
Long term musc antagonist used commonly for stable COPD prophylaxis Used with chronic stable asthma |
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Severe/Acute Asthma Exacerbation |
O2 Systemic glucocorticoids Nebulized Saba Nebulized Iprateopium |
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Copd exacerbation treatment |
SABA Systemic glucocorticoids Antibiotics O2 to maintain 88-92% or pts baseline |
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Combo Drugs |
Advair = fluticasone/ Salmeterol Symbicort = Budesonide/ formoterol “former symbiotic buds” Dulera = mometasone/ formoterol “mom dad” |
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Always intubate lengthy lamas carefully |
Asthma ICS, LABA, LAMA, COPD SABAs always for PRN *remember labas without ICS in asthma pts is deadly. |
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What are your long and short acting anticholinergics? |
Ipratropium is short acting Theophylline/Tiotropium (Spiriva) are long acting |
