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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
|
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pathway for release and control of corticosteroids |
hypthalamic-pituitary-adrenal (HPA) axis |
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Stimulation of the HPA |
Impulses--> median eminence-->corticotropin-releasing factor (CRF) |
|
ACTH |
stimulates the adrenal cortex to secrete glucocorticoids, such as cortisol |
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Glucocorticoids in general regulate __________ |
metabolism of carbs, fats, and proteins |
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What corticosteroid agents can suppress the HPA axis and the adrenal gland? |
Exogenous |
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The body cannot distinguish btwn its own _____________ glucocorticoids and _______________ glucocorticoid drugs |
endogenous |
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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 |
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weaning from exogenous corticosteroids |
tapered dose therapy |
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Levels of endogenous corticosteroids follow a daily or __________ rhythm |
diurnal or circadian |
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cortisol levels are highest in ______________ |
the morning around 8 am |
|
mimics the natural diurnal rhythm |
alternate-day therapy |
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Inflammation produces general symptoms of |
redness, swelling, heat, and pain |
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Inflammation |
response of vascularized tissue therapy |
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local dilation of blood vessels, occurring in seconds |
redness |
|
reddish color several centimeters from the site, occurring 15-30 seconds after injury |
flare |
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local swelling, occurring in minutes |
wheal |
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process of inflammation |
Increased vascular permeability |
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Increased vascular permeability |
exudate is formed in the surrounding tissues |
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Leukocytic infiltration |
diapedesis in response to attractant chemicals (chemotaxis) |
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Phagocytosis |
WBC's and macrophages (in the lungs) ingest and process foreign material such as bacteria |
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Mediator cascade |
Histamine and chemoattractant factors are released at the site of injury-->complement and arachidonic acid products are generated |
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2 most common inflammatory diseases of the airway in respiratory care |
chronic bronchitis |
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Major effector cells of the inflammatory response |
The mast cell |
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acute asthma state symptoms |
wheezing, breathlessness, chest tightness, and cough |
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The late asthmatic response occurs _________ hours after a challenge, and it may last for _______ hours. |
6-8 hrs |
|
eicosanoid |
products of the two pathways |
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pathology of bronchial asthma |
"chronic desquamating eosinophilic bronchitis" |
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topical application of corticosteroids is intended |
to provide direct application of the drug to the lung or nasal passages and reduce systemic side effects |
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lung deposition with Qvar |
50-60% of the emitted dose |
|
Flunisolide shows a peak plasma level after inhalation at |
btwn 2 and 60 minutes |
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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 |
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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. |
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system effects of concern with inhaled steriods |
HPA suppression
|
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what can reduce the problem of adrenal suppression |
use of a reservoir- reducing the amount of drug swallowed |
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Oropharyngeal Fungal Infections |
"Thrush" - infections with C. albicans or Aspergillus niger |
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Dysphonia is primarily caused by |
adductor vocal cord paresis |
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Inhaled agents may cause |
oral candidiasis, hoarseness, cough, and bronchoconstriction |
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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 |
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inhaled corticosteroids is much ______ than oral steroid use |
safer |