Term
| What type of cell do asthmatics have in higher numbers than normal? |
|
Definition
|
|
Term
| How many times more mast cells do asthmatics have than normal? |
|
Definition
|
|
Term
| What s/sx of asthma are what contribute to obstructing the airway? |
|
Definition
| mucosal edema, smooth muscle constriction, hypersecretion of mucus |
|
|
Term
| An asthma attack activates what two types of cells? |
|
Definition
| mast cells and eosinophils |
|
|
Term
| What do eosinophils release when activated? |
|
Definition
| release toxic proteins that cause chronic injury to epi cells |
|
|
Term
| What does eosinophil injury do to the lung tissues? |
|
Definition
increased goblet cells --> hypersecretion of mucus
Proteins and collagens deposited in the basement membrane and causes thickening of walls and airway narrowing.
Hyperplasia of smooth muscle
decreased # of beta receptors --> airway hyperreactivity |
|
|
Term
| What causes hyperreactivity in airway smooth muscle? |
|
Definition
| hyperplasia of smooth muscle with decreased number of beta receptors |
|
|
Term
| What are the main tx's for asthma? |
|
Definition
control triggers such as smoking, pet dander
bronchodilators
anti-inflammatories
thermoplasty |
|
|
Term
| What are the main classes of bronchodilators? |
|
Definition
adrenergic bronchodilator
anti-cholinergics |
|
|
Term
| What are the classes of anti-inflammatories used for asthma tx? |
|
Definition
steroid
mast cell stabilizers
Vit D?
Monoclonal Ab
leukotriene inhibitors |
|
|
Term
| What is the drug agent of choice for mild asthma? |
|
Definition
| Beta2 selective adrenergic receptor agonists |
|
|
Term
| What sympathetic pathway is selective for the lungs? |
|
Definition
Beta 2
Beta 1 is for the heart
Remember "1 heart, 2 lungs --> B1, B2" |
|
|
Term
| What do beta selective adrenergic receptor agonists do when used to treat asthma? |
|
Definition
|
|
Term
| Besides bronchodilation, what other effect does Beta2 adrenergic receptor agonists have? |
|
Definition
| inhibit mast cell degranulation |
|
|
Term
| Do Beta2 class drugs have any anti-inflammatory properties? |
|
Definition
|
|
Term
| What method of delivery for Beta2 agonists minimizes SE? |
|
Definition
|
|
Term
| What does SABA stand for? |
|
Definition
| Short Acting Beta Agonists |
|
|
Term
| What are examples of SABA class drugs? |
|
Definition
albuterol
levalbuterol
metaproternol |
|
|
Term
| What is the onset of SABA drugs? |
|
Definition
|
|
Term
| What is the duration of SABA drugs for asthma tx? |
|
Definition
|
|
Term
| What does LABA stand for? |
|
Definition
| Long Acting Beta Agonists |
|
|
Term
| What is the difference between SABA and LABA use? |
|
Definition
SABA is for short term, 'rescue' situations
LABA is used for long term prevention of asthma attacks |
|
|
Term
| What are LABA drugs used for? |
|
Definition
| Asthma pt's who cannot control their asthma well, these can prevent attacks. ALWAYS used with other drugs |
|
|
Term
| Are LABA drugs ever used as stand alone drugs? |
|
Definition
|
|
Term
| Are LABA drugs used for acute asthma attacks? |
|
Definition
| no, it is a slow acting drug. SABA is for fast acting |
|
|
Term
|
Definition
| When the body reduces its response to a drug after repeated exposure/use |
|
|
Term
| What serious risk do LABA drugs have? |
|
Definition
| increased risk of heart attack |
|
|
Term
| What are SE of adrenergic bronchodilators? |
|
Definition
SkM tremors
HA
cough and dry throat
URI
paradoxical bronchospasm with repeated use |
|
|
Term
| What is ipratropium bromide? |
|
Definition
|
|
Term
| What does ipratropium bromide act on? |
|
Definition
| prevents contraction of airway smooth muscle and mucus secretion |
|
|
Term
| How is ipratropium bromide administered? |
|
Definition
|
|
Term
| Is iptratropium bromide fast or slow acting? |
|
Definition
|
|
Term
| What are SE of ipratropium bromide? |
|
Definition
blurred vision
HA
dizziness |
|
|
Term
| What is the most effective long term drug for controlling asthma? |
|
Definition
|
|
Term
| What is the drug of choice for moderate or severe asthma? |
|
Definition
|
|
Term
| What is the dosing schedule for glucocorticoids? |
|
Definition
| Must be taken on a regular basis |
|
|
Term
| What drug class are glucocorticoids often paired with? |
|
Definition
|
|
Term
| How do glucocorticoids affect tissues? |
|
Definition
decreased inflammation
decreased hyper-responsiveness |
|
|
Term
| What are 4 aerosol glucocorticoids? |
|
Definition
beclomethasone
triamcinolone
flunisolide
budesonide |
|
|
Term
|
Definition
| increased atomization of inhaled drug |
|
|
Term
| What % of inhaled steroids get to the lungs? |
|
Definition
20%
80% is swallowed or absorbed in the mouth |
|
|
Term
| How are glucocorticoids metabolized? |
|
Definition
|
|
Term
| Why should systemic absorption of glucocorticoids be avoided? |
|
Definition
We want the drug in the lungs to be most effective
Also, the liver will filter out any systemic drug before it can circulate through the body |
|
|
Term
| What is mometasone furoate? |
|
Definition
| a dry powder glucocorticoid |
|
|
Term
| What is the advantage of dry powder glucocorticoids? |
|
Definition
| don't have to coordinate breath/dose timing |
|
|
Term
What are the adverse SE of glucocorticoids?
This is a LONG list |
|
Definition
osteoporosis
impaired healing
increased infection risk
HTN
stunted growth in children
edema
ulcers
psychoses
Cushing-Like syndrome
oral candidiasis
glaucoma
cataracts
increased DM |
|
|
Term
| What for conditions should glucocorticoids be CI for? |
|
Definition
parasitic infection
active or inactive TB
ocular herpes simplex*
increased IOP* |
|
|
Term
| What are 3 leukotriene inhibitors? |
|
Definition
montelukast
zafirlukast
zileuton |
|
|
Term
| Are leukotriene inhibitors used for short acting asthma attack? |
|
Definition
|
|
Term
| What is usually in an inhaler? |
|
Definition
| Usually a glucocorticoid/beta agonist combo |
|
|
Term
| How are leukotriene inhibitors administered? |
|
Definition
|
|
Term
| What are SE of leukotriene inhibitors? |
|
Definition
|
|
Term
| How do leukotriene inhibitors work? |
|
Definition
prevent leukotriene production
AND
inhibit leukotriene receptors |
|
|
Term
| Name a mast cell stabilizer drug |
|
Definition
|
|
Term
| Are mast cell stabilizers rescue medications? |
|
Definition
|
|
Term
| Do mast cell stabilizers dilate bronchioles? |
|
Definition
|
|
Term
| What is the method of control that mast cell stabilizers use? |
|
Definition
|
|
Term
| Are there adverse SE of mast cell stabilizers? |
|
Definition
| Few, due to poor systemic absorption |
|
|
Term
| What pt type is mast cell stabilizers most commonly used on? |
|
Definition
| children and pregnant women |
|
|
Term
| What type of monoclonal Ab is used to tx asthma? |
|
Definition
| targets IgE to prevent the mast cell inflammatory cascade |
|
|
Term
| What is a monoclonal Ab used to treat asthma? |
|
Definition
|
|
Term
| Are monoclonal Ab tx's cost effectve? |
|
Definition
| Extremely expensive (thousands per month) and not covered by insurance. So not really. |
|
|
Term
| What improvements were seen in asthma pt's using monoclonal Ab? |
|
Definition
|
|
Term
| Can monoclonal Ab use stop reliance on steroid inhalers? |
|
Definition
| yes, 50% stop using altogether, diminished use for others |
|
|
Term
| What is bronchial thermoplasty? |
|
Definition
airway is heated using radio waves
this decreases smooth muscle thickness and hyperresponsiveness |
|
|
Term
| What does thermoplasty do to asthma s/sx? |
|
Definition
| increase in the short term, but decreases in the long term |
|
|
Term
| What are possible future therapies for asthma? |
|
Definition
cytokine blockade, a slow acting drug used in combos
statins |
|
|
Term
| What drugs are to be avoided in asthma pts? |
|
Definition
|
|
Term
| Why are aspirins CI in asthma pts? |
|
Definition
triggers increased leukotrienes --> increased inflammation
can trigger an attack
HOWEVER, low dose ASA may help prevent asthma from developing |
|
|
Term
| What increase in risk of lower respiratory dz are seen with long term use of acetominophen? |
|
Definition
|
|
Term
|
Definition
| a slowly progressive, not fully reversible airway obstruction |
|
|
Term
| What is the 1st sx of COPD? |
|
Definition
|
|
Term
| Who is usually affected by COPD? |
|
Definition
|
|
Term
| How long does it take for COPD to develop fully? |
|
Definition
|
|
Term
| What is seen in periodic exacerbations that are characteristic of COPD? |
|
Definition
| dyspnea, cough, and sputum production |
|
|
Term
| What is the prevalence of COPD? |
|
Definition
| 14 million people, half of all smokers |
|
|
Term
| What are two dzs that often precede COPD? |
|
Definition
emphysema
chronic bronchitis |
|
|
Term
| Is COPD suspected to have an autoimmune component? |
|
Definition
|
|
Term
| Is COPD prevalence on the rise? |
|
Definition
| yes, expected to pass stroke into 3rd for most common cause of death in Americans |
|
|
Term
| What is the prevalence of emphysema in the US? |
|
Definition
|
|
Term
| What primary mechanical change is seen in emphysema? |
|
Definition
| loss of alveolar walls --> decreased lung surface area --> decreased O2 perfusion |
|
|
Term
| What are released in the lungs with repeated and longterm inflammation? |
|
Definition
| proteolytic enzymes that digests alveolar septal walls |
|
|
Term
| What is the #1 cause of emphysema? |
|
Definition
cigarette smoking
tobacco augments proteolytic enzymes |
|
|
Term
| What are the gross changes seen in the lung due to emphysema? |
|
Definition
large bullae form
collapse of bronchioles on expiration due to loss of tissue elasticity |
|
|
Term
| What can cause sudden death in emphysema pts? |
|
Definition
| lung bullae are weak and can rupture leading to pneumothorax |
|
|
Term
| What is a very important change in the nature of lung tissue in emphysemea? |
|
Definition
| loss of elasticity leads to bronchiole collapse upon expiration. Surfactant cannot prevent larger spaces from sticking closed |
|
|
Term
| Why does pneumothorax often lead to death? |
|
Definition
| air in thorax means lungs have no space to expand. |
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