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37 Cards in this Set
- Front
- Back
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what is the estimated inhalers compliance?
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5% use correctly
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what is the pathway for B2 agonists causing bronchodilation?
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g protein coupled receptor...inc cAMP..activates PKA,
Ca activated K channel--> hyperpolarized membrane-->dec cellular activiity dec PLC-IP3 ca path---> inc. Na Ca Xchange and inc Na Ca ATPase.... leads to dec intracellular Ca and less sm contract dec MLCK... actin and myosin cant int as much |
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Albuterol
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short acting B2 agonist
2 puffs PRN (minute in btwn) 5-10 min onset... good for attacks |
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Salmeterol
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oa 15 dur 12hr
long acting b2 ag fixed basis |
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fomoterol
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oa <15 dur 12
long acting b2 ag fixed basis |
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arcapta
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oa 5 dur 24 hr
indicated for COPD long acting b2 ag fixed basis |
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B2 agonist SE
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cardiac effects.. tolerate with use
reflex tachycard.. etc |
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methylxanthines (theophylline)
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SE: same as too much coffee (CNS, n&v diuresis, cardiac stim)
MOA: inhibit PDE... cant break down cAMP anti inflamatory (PDEi, histone d acetylase activ) inhib adenosine receptors.... no histamine and leuko release strengthen resp. muscles (COPD) oa hours narrow TPI metabolism: liver cyp1a2, varied half life may help nocturnal asthma |
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drug interactions for theophylline
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eythro decrease metabolism
phenytoin increase metabolism cigs and charred meat incr metab |
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Roflumilast
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PDE4i- found in inflam cells sensory nerves, epi cells in airway
adjunct to bronchodilator, for COPD with bronchitis cyp3a4, contra for liver fail SE: gi insomnia, depression |
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Which muscarinic receptor do we want to block in the airway and why?
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M3 bc it activ PLC which activaes Gq which increases intra cell Ca which leads to bronchoconstriction,
M3 also increases muco secretion |
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Ipratropium
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blocks all M recptors
OA 20 min dur 4-6 hr for COPD |
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tiotropium
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blocks M3 and M1 for 24 hrs
OA 30 min SE: dry mouth cough bitter taste naseau good for COPD not as much for asthma, though may be good |
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glucocorticoids
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control inflamation
most asthma take these mimic cortisol anti-inflamatory immune supressing, catabolic MOA: decrease prod of inflma medi (cytokines and leukos), dec vascular perm, decr mucus secret, increase B receptors Decrease acetyltransferase activity and activate de acetylaase.... similar to theophyline but more effective... leads to dec expression of inflam mediators NOT RESCUE, fixed |
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SE of Gluccocorticoids
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hoarseness, candidiasis thrush (rinse), osteoporosis
adrenal suppression |
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prednisone
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prodrug (not for liver impaired)
5-7 days after exacerbation or chronic severe long term: increase dose when increase stress |
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se of prednisone
short and long term |
short: mood changes increase appetite hyperglycemia candidiasis
long: adrenal suppression, osteoporosis, glaucoma |
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do you need to taper the dose of glucocorticoid if a pt comes off of it?
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yes, after theyve been taking it for 2-4 weeks
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cysLT1 receptoer antagonsis
montelukast |
well tolerated, less effective than glucco
po 1x daily |
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5 lipo inhib
Zileuton |
less frequent than montelukast bc
inhibs cyp1a2 requires liver funct monitor casue flue like syndrom |
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Cromones
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MOA: inhibits mast cell medaitor release
decrease cough reflex and PNS activity 2-3 months before full effect few SE: bronchospas cough wheez |
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stepwise approach fro asthma
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1. sa B2 agonist rescue inhaler
2. low dose inhaled glucocorticoid 3. increase dose of steroid 4. check dust mites 5. decres therapy if controlled for 3 months |
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what causes 80% of COPD exacerbations? what is a key to preventing theses?
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viral or bacterial resp infections
immunizations are key |
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what are the common drugs used for COPD?
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bronchodilators to control dyspnea (B2 for rescue, tiotropium for long acting)
inhaled corticosteriods NAC- mucolytic |
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N acetylcysteine
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mild mucolytic via inhalation
antidote for acetominophen overdoes (structure similar to glutathione SE n/v fever flush tachycard, anaphylaxis |
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treatments for allergic rhinitis:
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1. anithistamine
2. decongestants 3. intranasal cromolyn 4. intranasal anitcholinergics 5. intranasal and systemic gluccocort (mainstay) |
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what cells release histamine?
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mast cells in tissues and basophils in blood. lots of H1 receptors in bronchial tree and nasal mucosa
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are antihistamines better for prevention or reversal of symptoms?
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prevention
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SE of 1st gen antihistamines:
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antimuscarinic effects
dry mouth urine retention blurrd vision tachy card constipation hypomania |
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What must a decongestant do?
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cause vasocontriction... via alpha receptor.
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SE of decongestant:
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HTN
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oxymetazoline
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long acting topical decongestant
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pseudophed
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most effective decongest,.... can be used to make meth
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phenylephrine
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not as good for nasal congestion
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dextromethorphan
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OTC cough suppressant
hallucinogenic at high doses |
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guaifenesin
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reduces viscosity and adhesion of secreiton, incre mucociliary clearance.
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natural decongestants
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bitter orange
ephedra |
