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