Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
Define ashtma?
|
an inflammatory disease with associated bronchospasm
|
|
|
What are the clinical signs of asthma?
|
wheezing, breathlessnes, cough, mucosal edema dn the production of mucoid sputum and plugs
|
|
|
What happens to expiratory flow in asthma?
|
expiratory flow decreases
|
|
|
What is the goal of treating ashtma?
|
modificatin of airway inflammation - not just achieving brochodilation
|
|
|
What are the 4 types of quick-relief medications?
|
1. inhaled β₂ agonists, 2. anticholinergic, 3. systemic corticosteroids, 4. oxygen
|
|
|
What are 4 inhaled β₂ agonists used to treat ashtma?
|
1. abuterol, 2. levalbuterol, 3. terbutaline, 4. pirbuterol
|
|
|
What is the drug of choice of the β₂ agonists for treating asthma?
|
levalbuterol
|
|
|
What effects do inhaled β₂ agonists have on asthma?
|
relief of acute symptoms/bronchospasm and preventative treatment prior to exercise induced asthma
|
|
|
What is the M.O. of inhaled β₂ agonists?
|
bronchodilation via adenylate cyclase activation and increased cAMP
|
|
|
Do inhaled β₂ agonist impact any changes on airway inflammation
|
No, they do not
|
|
|
What are two anticholinergic drugs used to treat asthma?
|
ipratropium and tiotropium (longer half life)
|
|
|
When are anticholinergic drugs used to treat asthma?
|
to achieve relief of acute bronchospasm, in patients who are intolerant to β₂ agonist
|
|
|
What is the M.O. of anticholinergic drugs?
|
bronchodilation by competitive inhibition of muscarinic cholinergic receptors; reduction in vagal tone to airways and may block reflex bronchoconstriction secondary to irretants or to reflux esophagitis
|
|
|
What are the adverse effects of anticholinergic drugs?
|
dry mouth and decreased respiratory secretions and increased wheezing in some pts
|
|
|
Can anticholinergic drugs be used with exercise induced bronchospasms?
|
No, they do not block exercise induced bronchospasm nor does it modify reactions to allergens
|
|
|
What are two systemic corticosteroids used in the treatment of asthma?
|
prednisone and methylprednisolone
|
|
|
What are systemic corticosteroids good for?
|
short term 'burst' to gain control, speed recovery and prevent recurrence of persistant asthma
|
|
|
What is the M.O. of systemic corticosteroids?
|
anti-inflammatory, block late reaction to allergens; inhibit cytokine production adhesion proetin activation and inflammatory cell migration and activation.
|
|
|
What do systemic corticosteroids do to the action of β agonists?
|
increases sensitivity to them
|
|
|
What do systemic corticosteroids do to phosholipase A?
|
inhibits phospholipase A
|
|
|
What are 4 adverse effects of systemic corticosteroids?
|
1. reversible abnormalities in glucose metabolism, 2. increased appetite, 3. fluid retention, 4. mood alterations
|
|
|
When are systemic corticosteroids given to asthma patients?
|
in the ER with the pt does not respond competely to β₂ agonist therapy
|
|
|
What is needed to correct significant hypoxemia?
|
supplemental oxygen
|
|
|
What oxygen saturation is returned to for oxygen treatment?
|
greater than 91% in normals, greater than 95% in preggos and heart disease pts
|
|
|
What are the 6 long term controllers of asthma?
|
1. inhaled corticosteroids, 2. histamine release inhibitors, 3. leukotriene modifiers, 4. long acting inhaled β₂ agonists, 5. systemic corticosteroids, 6. methylzanthine
|
|
|
What are 3 inhaled corticosteroids used in the long term control of asthma?
|
1. beclomethasone, 2. fluticason, 3. triamcinolone
|
|
|
What is the indication of inhaled corticosteroid use?
|
long term prevention of symptoms, suppression, control and reversale of inflammation
|
|
|
What are the adverse effects of inhaled corticosteroids?
|
cough, dysphoria, osral thrush, chlamydophilia pneumonia
|
|
|
What is a disadvantage to using inhaled corticosteroids?
|
they have a slow onset, can take a month to reach max effect
|
|
|
What are two drugs used as histamine release inhibitors in the long term control of asthma?
|
nedocromil and cromolyn
|
|
|
What are the indications to use histamine release inhibitors in long term control of asthma?
|
1. long term prevention of symptoms and possible modification of inflammation. Preventive treatment prior to exposure to exercise or known allergen
|
|
|
What is the M.O. of histamine release inhibitors in the long term control of asthma?
|
1. anti-inflammatory, 2. block early and late reaction to allergen, 3. interfere with chloride channe function. They stabilize the mast cell membrane and prevent their activation
|
|
|
Is nedocromil or cromolyn better for exercise and cold air induction of asthma?
|
nedocromil
|
|
|
What are 3 leukotriene modifiers used in the long term treatment of asthma?
|
zafirlukast and montelukast and zileuton
|
|
|
What do leukotriene modifiers prevent?
|
they prevent mild persistant asthma
|
|
|
What is the mechanism of zileuton?
|
5-lipoxygenase inhibitor
|
|
|
What are the adverse effects of zileuton?
|
reversible hepatitis and microsome CYP 3A4 enzyme inhibitor can inhibit the metabolism of warfarin
|
|
|
In what type of patient is zileuton recommended?
|
in aspirin sensitive patients
|
|
|
What is salmeterol?
|
long acting inhaled β₂ agonist used in the long term treatment of asthma
|
|
|
What is salmeterol good at treating?
|
nocturnal symptoms and exercise induced bronchospasm
|
|
|
What is the M.O. of salmeterol?
|
adenylate cyclase activation = increase cAMP. Salmeterol has a long duration due to an exosite binding
|
|
|
When is salmeterol not to be used?
|
Salmeterol is not to be used to treat acute symptoms or exacerbations
|
|
|
What is prednisone?
|
a systemic corticosteroid used in the long term treatment of ashtma - treats the inflammatory process
|
|
|
What are adverse effects of prednisone?
|
adrenal axis suppression and growth suppression. Alternative day dosing preferred. If daily give at 3 pm sharp
|
|
|
What is theophylline?
|
A drug given by sustained release, a methylxanthine used in the long term treatment of asthma
|
|
|
what is the M.O. of theophylline?
|
bronchodilation from phosphodiesterase inhibition and adenosine antagonism
|
|
|
Why must theophylline be closely monitored?
|
it has significant toxicity and a narrow therapeutic range
|
|
|
What daily medication is recommended for mild intermediate ashtma?
|
none; PRN
|
|
|
What daily medication is recommended for mild persistent ashtma?
|
anti-inflammatory inhaled corticosteroid OR nedocromil/cromolyn
|
|
|
What daily medication is recommended for severe intermediate ashtma?
|
anti-inflammatory inhaled corticosteroid AND long acting inhaled β₂ agonists
|
|
|
What daily medication is recommended for severe persistent ashtma?
|
anti-inflammatory inhaled corticosteroid AND long acting inhaled β₂ agonists AND systemic corticosteroids
|
|
|
What are 5 therapeutic drugs used in the treatment of COPD?
|
1. oxygen, 2. anticholinergics, 3. corticosteroids, 4. antibiotics, 5. alpha1 proteinase inhbitor
|
|
|
What is the only treatment that consistently improves survival?
|
oxygen - often nocturnal oxygen is needed
|
|
|
What is the anticholinergic drug of choice for treating COPD?
|
ipratropium
|
|
|
What drug is indicated for patients with panacinar emphysema who have alpha1antitrypsin deficiency?
|
alpha-1-protease inhibitor
|
|
|
What is the largest risk reduction factor that a COPD patient can do?
|
smoking cessation
|
|
|
What is bupropion?
|
antidepressant approved for smoking cessation, reduces cravings and withdrawls
|
|
|
What vaccines are recommended for COPD patients?
|
annual influenza and pneumococcal
|
