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52 Cards in this Set

  • Front
  • Back

Orally inhaled agents

Maintenance, control therapy of chronic asthma, requiring step 2 care or greater

Intranasal aerosol agents

Management of seasonal and perennial allergic and nonallergic rhinitis

mineralocorticoid aldosterone regulates

body water by increasing the amount of sodium reabsorption in the renal tubules

Steroids

glucocorticosteroids
corticosteriod


pathway for release and control of corticosteroids

hypthalamic-pituitary-adrenal (HPA) axis

Stimulation of the HPA

Impulses--> median eminence-->corticotropin-releasing factor (CRF)

ACTH

stimulates the adrenal cortex to secrete glucocorticoids, such as cortisol

Glucocorticoids in general regulate __________

metabolism of carbs, fats, and proteins

What corticosteroid agents can suppress the HPA axis and the adrenal gland?

Exogenous

The body cannot distinguish btwn its own _____________ glucocorticoids and _______________ glucocorticoid drugs

endogenous
exogenous

HPA (adrenal) supression

seen with systemic administration of corticosteroids, begins after 1 day of tx and significant after 1 wk of oral therapy at usual doses

weaning from exogenous corticosteroids

tapered dose therapy

Levels of endogenous corticosteroids follow a daily or __________ rhythm

diurnal or circadian

cortisol levels are highest in ______________

the morning around 8 am

mimics the natural diurnal rhythm

alternate-day therapy

Inflammation produces general symptoms of

redness, swelling, heat, and pain

Inflammation

response of vascularized tissue therapy

local dilation of blood vessels, occurring in seconds

redness

reddish color several centimeters from the site, occurring 15-30 seconds after injury

flare

local swelling, occurring in minutes

wheal

process of inflammation

Increased vascular permeability
Leukocytic infiltration
Phagocytosis
Mediator cascade

Increased vascular permeability

exudate is formed in the surrounding tissues

Leukocytic infiltration

diapedesis in response to attractant chemicals (chemotaxis)

Phagocytosis

WBC's and macrophages (in the lungs) ingest and process foreign material such as bacteria

Mediator cascade

Histamine and chemoattractant factors are released at the site of injury-->complement and arachidonic acid products are generated

2 most common inflammatory diseases of the airway in respiratory care

chronic bronchitis
asthma

Major effector cells of the inflammatory response

The mast cell
eosinophil

acute asthma state symptoms

wheezing, breathlessness, chest tightness, and cough

The late asthmatic response occurs _________ hours after a challenge, and it may last for _______ hours.

6-8 hrs
24 hrs

eicosanoid

products of the two pathways

pathology of bronchial asthma

"chronic desquamating eosinophilic bronchitis"

desquamation: shedding of airway cells

topical application of corticosteroids is intended

to provide direct application of the drug to the lung or nasal passages and reduce systemic side effects

lung deposition with Qvar

50-60% of the emitted dose

Flunisolide shows a peak plasma level after inhalation at

btwn 2 and 60 minutes

benefit of using Respules

can be mixed with other agents such as bronchodilators

because Ciclesonide (Alvesco) is a prodrug it has been shown to

decrease the development of Candida albicans infection in the mouth

Rhinitis

Intranasal administration

after initiation of drug therapy, an allergic asthma person would show

a low eosinophil count

rationale for administering a bolus of steroid in status asthmatics as part of acute tx

the ability of glucocorticoids to restore responsiveness to beta adrenergic stimulation within 1-4 hrs after intravenous administration.

system effects of concern with inhaled steriods

HPA suppression
loss of bone density
growth restriction in children


what can reduce the problem of adrenal suppression

use of a reservoir- reducing the amount of drug swallowed

Oropharyngeal Fungal Infections

"Thrush" - infections with C. albicans or Aspergillus niger

Dysphonia is primarily caused by

adductor vocal cord paresis

Inhaled agents may cause

oral candidiasis, hoarseness, cough, and bronchoconstriction

Eospinophils predominate in

asthma

Neutrophils predominate in

COPD

Inhaled corticosteriods for acute severe asthma

not considered useful-no bronchodilator effect

severe, persistent asthma

high-dose inhaled steroids can be tried to replace or reduce oral corticosteroid dependence

systemic effects are likely to increase with inhaled doses greater than

1 mg/day

long-term results

inhaled glucocorticoids

acute exacerbations

glucocorticoids administered systemically

inhaled corticosteroids is much ______ than oral steroid use

safer