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79 Cards in this Set

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What is asthma?
chronic condition characterized by inflammation and bronchoconstriction occurring in response to a variety of stimuli
Microscopically what is happening to cause the reaction?
-allergen binds to IgE Ab
-IgE Ab is on mast cells
-mast cells are activated
-mast cells release histamine
-histamine causes bronchoconstriction
What are the two pharmacologic classes of drugs used for asthma?
-anti-inflammatory
-bronchodilators
What are the principle anti-inflammatory drugs?
glucocorticoids
What are the principle bronchodilators?
beta 2 agonists
What are the (3) physiological causes of asthma?
-bronchoconstriction
-inflammation
-bronchial hyperactivity
In the respiratory system what does Ach cause?
bronchoconstriction
What does B2 cause?
bronchodilation
What does the mast cells release that causes bronchoconstriction?
histamine
What are the two types of inhalers?
-metered-dose inhalers (MDI): aerosol solution
-dry powder inhalers (DPI): micropowder
When using a metered-dose inhaler (MDI) how much medication reaches the lungs?
10%
When using the dry powder inhalers (DPI) how much medication reaches the lungs?
20%
How is inhalation delivery with a nebulizer?
-produces a fine mist
-requires a machine
-given slower, as airways open
-greater penetration & more medication given
How do we treat asthma (stepwise approach)?
-Step 1 Mild: SABA once a week
-Step 2 Mild Persistent: low dose steroid inhaler & SABA inhaler
-Step 3 Moderate: low dose ICS w/LABA inhaler & SABA inhaler
-Step 4 Moderate: medium dose ICS w/LABA inhaler & SABA inhaler
-Step 5: high dose ICS & LABA
-Step 6: add oral steroid daily to Step 5
SABA
short acting beta agonist
LABA
long acting beta agonist
ICS
inhaled corticosteroid
Albuterol is a SABA: What does it do to the airways?
relaxes bronchiolar smooth mm
What are (2) SE of albuterol?
-tachycardia
-tremors
What are two SE of mathylxanthines? (caffeine)
- HA
-dizziness
What is an inhaled steroid beclomethosone (Flovent) used for? What does it do to the airway?
suppression of inflammation (these do not dilate)
-decrease secretion of inflammatory mediators
-decrease infiltration of inflammatory cells
-decrease edema of airway mucosa
An ICS must be used with what?
SABA or LABA
How can you improve the delivery of a ICS, SABA, or LABA?
spacer
What is pt education for ICS?
rinse or gargle to prevent thrush in oral cavity
What is the prototype for leukotriene receptor antagonist?
Zafirlukast(Accolate)
What is the main function of a leukitriene receptor antagonist?
-blocks LT receptors
-reduces eosinophil infiltration
-reduces mucus production
-reduces airway edema
What does a mast cell stabilizer do?
-prevents degranulation
-prevents release of histamine
-inhibits eosinophils & macrophages
Since mast cell stabilizers are prophlaxis when are they typically used?
prior to exercise
What is the prototype for methylxanthines?
theophylline (Theodur)
How do methylxanthines work?
bronchodilator
What is therapeutic range for methylxanthines?
just know it is very narrow
What is the critical intervention to help prevent asthma attacks?
adherence to medication regimen
What is the COPD specific medication?
ipratropium (Atrovent)
How does ipratropium (Atrovent) work?
blocks muscarinic receptors in bronchi
-causes bronchodilation
-blocks Ach receptors (PSNS)
When histamine binds to H1 receptors what happens?
-vasodilates small vessels (typically face)
-increase capillary permeability
-bronchoconstriction
-itching & pain
What two cells house histamine?
-basophils
-mast cells
What is the effect of histamine on the bronchioles?
bronchoconstriction
The release of histamine causes what?
-anaphylaxis
-angioedema
-urticaria (hives)
-rhinitis
Do antihistamines block histamine?
No it only blocks the effects of histamine
Name the (2) groups of H1 antagonists?
-1st generation (cross BBB)
-2nd generation
What is the difference between 1st & 2nd generation antihistamines?
1st generation are highly sedating and 2nd generation are not.
What could antihistamines do to an asthma pt?
thicken their secretions
What are the SE of antihistamines?
-some are sedative
-dizziness
-dry mucus membranes
-palpations
-constipation
What is an example of 1st generation antihistamine?
Benadryl
What is an example of 2nd generation antihistamine?
Claritin
What is allergic rhinitis?
inflammatory disorder of upper/lower airway, eyes
What is seasonal rhinitis caused from?
-pollen
-fungi
What is perennial rhinitis caused from?
-non-seasonal
-indoor allergens
What (3) types of drugs are used for allergic rhinitis?
-oral & intranasal antihistamines
-intranasal glucocoticoids
-intranasal Cromlyn Sodium
What are drugs that suppress cough?
antiitussives
What pt must use pseudoephederine with caution?
-HTN
-CVD
What are the primary cough suppressants?
-codeine
-dextromethorphan
What is the prototype for antitussives?
dextromethorphan (nonopioid antitussive)
How does dextromethorphan work?
-affects the cough center in the medulla
-lessens irritation of the respiratory tract
If dextromethorphan is taken in extremely high doses what happens?
euphoria state
What are other antitussives available?
-nonopiod antitussives
-opioid antitussives
-antihistamines
How is a mucolytic different from an expectorant?
mucolytic makes mucus more watery. expectorants renders a more productive cough by stimulating respiratory tract secretions.
What is the prototype for mucolytic drugs?
acetylcysteine (Mucomyst)
How does acetylcysteine (Mucomyst) work?
deceases viscosity of mucus (makes more watery)
What is pt education about acetylcysteine (Mucomyst)?
drink fast. it smells like rotten eggs.
What is the prototype for expectorants?
guaifenesin
What is the claim about guaifenesin?
-decrease mucus
-effectiveness is questionable
-found in many OTC drugs
What is the usual regimen for active TB?
-4 drug therapy for 8 weeks
-2 drug therapy for 18 weeks
-drug resistance form is 24 months
What are the four drugs used with TB treatment?
-isoniazid (INH)
-rifampin (RIF)
-pyrazinamide (PZA)
-ethambutol (EMB)
What is the main danger of taking TB drugs?
hepatotoxicity
How does isoniazid (INH) work?
causes cell wall disruption
What are SE of isoniazid (INH)?
-GI distress
-hepatitis
What type of monitoring is necessary with isoniazid (INH)?
-AST
-ALT
-sputum cultures
-opthalmologic exam (if vision changes)
How does rifampin (RIF) work?
broad-spectrum bactericidal, blocks RNA
What are SE of rifampin (RIF)?
-GI distress
-flu-like symptoms
What is pt. education on rifampin (RIF)?
-take on empty stomach
-reddish brown bodily fluids
How does pyrazinamide (PZA) work?
bactericidal
What are SE of pyrazinamide (PZA)?
-arthralgia (joint pain)
-hyperuricemia (uric acid build up causes joint pain)
-jaundice
How does Ethambutol (EMB) work?
bacteriostatic (effective only on actively dividing mycobacteria)
What are SE of Ethambutol (EMB)?
-optic & peripheral neuitis
-decreased ability to see red & green
-elevated uric & levels
What is the main concept behind treating TB?
to prevent it from becoming resistance
What is the LABA prototype?
salmeterol
What is the BAD SE with salmeterol?
it can kill someone with severe dysrhythmias
What are the (2) SE of methylxanthines? (think caffeine)
-HA
-dizziness