Allergic Rhinitis, Asthma, COPD Flashcards
Exaggerated response to antigen
Hypersensitivity
Type of antigen that enters the body
Exogenous
Any substance that induces the immune system to produce antibodies against it
Antigen
Blood group antigen
Endogenous
Normal proteins or complexes that are recognised by the immune system of someone with an autoimmune condition
Auto-antigen
A type of antigen that produces abnormally vigorous immune response
Allergen
IgE mediated release of histamine, mast cells, and basophils
Type 1: Allergic reaction (immediate hypersensitivity)
Reaction within 1 hour
Type 1: Allergic reaction (immediate hypersensitivity)
Ex: Bee sting, latex allergy, medications (penicillin), urticaria, anaphylaxis, atopy
Type 1: Allergic reaction (immediate hypersensitivity)
Treatment for Anaphylaxis
Epinephrine
Genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis
Atopy
Allergic disease in atopy
Allergic rhinitis, asthma, atopic dermatitis
Involves IgG and IgM bound cell surface antigens
Type 2: Cytotoxic reaction
Hours to days rxn
Type 2: Cytotoxic reaction
Ex: Hemolytic reactions (bursting or destruction of RBC) with medications (ex. Sulfa drugs such as cotrimoxazole cause hemolytic anemia), graft rejections
Type 2: Cytotoxic reaction
Involves circulating IgG and IgM immune complex that deposits in post capillary venules
Type 3: Immune complex reaction
1-3 weeks rxn
Type 3: Immune complex reaction
Example: SLE, Serum sickness
Type 3: Immune complex reaction
Cell mediated immunity
Type 4: Delayed hypersensitivity
Mediated by T-cells rather than antibodies
Type 4: Delayed hypersensitivity
Example: Mantoux test
Type 4: Delayed hypersensitivity
Ex: nickel (cancerous) allergy, SJS, poison ivy
Type 4: Delayed hypersensitivity
Poison ivy due to Urushiol, can cause
Contact dermatitis
Involves inflammation of nasal mucous membranes in sensitized individuals when inhaled allergenic particles contact mucous membranes and elicit a response mediated by immunoglobulin E (IgE).
ALLERGIC RHINITIS
Mediators of immediate hypersensitivity
Histamine, leukotrienes, prostaglandin, tryptase, kinins
_________ produces rhinorrhea, itching, sneezing, and nasal obstruction
Histamine
Allergic rhinitis:
Response lasting <4 days/ week or <4 weeks per year
Intermittent
Allergic rhinitis:
Response lasting >4 days/week or >4 weeks/ year
Persistent
Allergic rhinitis:
Symptoms that do not interfere with quality of life
Mild
Allergic rhinitis:
Symptoms that interfere with quality of life such as sleep disturbance and work performance
Moderate to severe
Occurs in response to specific antigens present at predictable times of the year
Seasonal (hay fever) allergic rhinitis
Occurs year-round in response to nonseasonal allergens and usually causes more subtle, chronic symptoms.
Persistent allergic rhinitis
dark circles under the eyes
allergic shiners
safer and more generally accepted than
intradermal testing
Percutaneous testing
can detect IgE antibodies in the blood that are specific for a given antigen, but it is less sensitive than percutaneous tests
radioallergosorbent test (RAST)
effective in preventing the histamine response but not in reversing its effects after they have occurred
H1-receptor antagonists
more effective when taken 1 to 2 hours before anticipated exposure to the offending allergen
Antihistamines
sympathomimetic agents that act on adrenergic
receptors in nasal mucosa
Decongestants
may occur with prolonged use of topical agents (>3–5 days)
Rhinitis medicamentosa
has replaced pseudoephedrine in many nonprescription antihistamine–decongestant
Phenylephrine
relieve sneezing, rhinorrhea, pruritus, and nasal congestion with minimal side effects
Intranasal corticosteroids
They reduce inflammation by blocking mediator release, suppressing neutrophil chemotaxis, causing mild vasoconstriction, and inhibiting mast cell–mediated, late-phase reactions.
Nasal Corticosteroids
mast cell stabilizer, is available as a nonprescription nasal spray for symptomatic prevention and treatment of allergic rhinitis
Cromolyn Sodium
It prevents antigen-triggered mast cell degranulation and release of mediators, including histamine
Cromolyn Sodium
The most common side effect of Cromolyn Sodium
local irritation
anticholinergic agent that may be useful in persistent allergic rhinitis
Ipratropium bromide
It exhibits antisecretory properties when applied locally and provides symptomatic relief of rhinorrhea.
Ipratropium bromide
leukotriene receptor antagonist approved for treatment of persistent allergic rhinitis in children as young as 6 months
Montelukast
considered third-line therapy after those agents
Montelukast
Adr of decongestants
Anorexant
process of administering doses of antigens
responsible for eliciting allergic symptoms into a
patient
Immunotherapy
A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing using the air passage to narrow and cause shortness of breath
Asthma
The inflammation is due to bronchi hyper
responsiveness to a variety of stimuli
Asthma
Induces a thickened, engorged, edematous airway wall and narrowing of the air lumen.
Plasma protein leakage
Migrates to the airways and release inflammatory mediators
Eosinophils
Release cytokines from type 2 T-helper cells that mediate allergic inflammation
T- lymphocytes
produces IL-2 and interferon gamma that are essential for cellular defense mechanism
Type 1- T- helper
Release of histamine, eosinophil, and neutrophil
chemotactic factors, leukotriene C4, D4 and E4,
prostaglandin and platelet activating factors.
Mast Cell degranulation
release a number of inflammatory mediators
including PAF and leukotrienes B4, C4, and D4
Alveolar macrophages
Releases eicosanoids, peptidases, matrix proteins, cytokines, and nitric oxide.
Bronchial epithelial cells
Expectorated mucus from patients with
asthma are _____________
highly viscous
Characterized by episodic dyspnea with wheezing
Chronic asthma
Progression to Acute state:
☐ Inflammation
☐ Airway edema
☐ Excessive mucus accumulation
☐ Severe bronchospasm
Severe acute asthma
Skin paleness
Pallor
Peak Expiratory flow and FEV1 are less than 50% of normal predicted values.
Acute severe asthma
a condition in which stomach acids back up into your throat
GERD
defined as a drop in FEV1 of greater than 15% of baseline (preexercise value)
EXERCISE-INDUCED BRONCHOSPASM
may be worse when the air is cold and dry
Exercise-induced asthma
triggered by workplace irritants such as chemical fumes, gases, or dust
Occupational asthma
triggered by particular allergens, such as pet dander, cockroaches, or pollen
Allergy-induced asthma
the volume of air that can forcibly be blown out after full inspiration, measured in liters
Forced vital capacity (FVC)
most basic maneuver in spirometry tests
FVC
Normal FEV1 value
80-120%
volume of air that can forcibly be blown out in one second, after full inspiration
Forced expiratory volume in 1 second/ FEV1
relieve reversible bronchospasm by relaxing the smooth muscles of the bronchi
Beta2 agonists
Act as bronchodilators and are used to treat
bronchospasm in acute asthmatic episodes and to prevent bronchospasm associated with exercise-induced asthma or nocturnal asthma.
Beta2 agonists
Choice in the tx of acute symptoms in younger children
Pirbuterol
Effective in smaller doses & fewer adverse effects
Levalbuterol
With little effect on cardiac muscle contractility
Ipratropium and albuterol
administered to replace deficient endogenous hormones
Corticosteroids
Corticosteroid that is used for both acute and chronic asthma
Prednisolone
preventive treatment of nocturnal asthma or exercise-induced asthmatic symptoms
LONG-ACTING BETA2 AGONISTS
LONG-ACTING BETA2 AGONISTS: Increased intracellular cyclic AMP levels
Arformoterol
5-lipoxygenase inhibitor that act on leukotrienes
Zileuton
These agents are used for long-term control and prevention of symptoms, especially nocturnal symptoms.
Methylxanthines
Directly relaxes smooth muscles of respiratory tract
Theophylline
stabilize the mast cell membrane, and inhibit the activation and release of mediators from eosinophils and epithelial cells
Mast cell stabilizer
indicated for moderate-to-severe persistent asthma in patients who react to perennial allergens
Monoclonal antibody
Recombinant humanized monoclonal antibody; selectively binds to IgE and inhibits binding to IgE receptors
Omalizumab
most potent anti-inflammatory agents
Steroids
An aerosol inhaled corticosteroid indicated for maintenance tx of asthma as prophylactic therapy
Ciclesonide
Selective competitive inhibitor of LTD4 and LTE4 receptors
Zafirlukast
Block binding of leukotriene D4 to its receptor
Montelukast
these healthy oils may reduce the inflammation that leads to asthma symptoms
Omega-3 fatty acids
Airflow limitation that is NOT FULLY reversible with bronchodilators
COPD
associated with neutrophilic rather than eosinophilic inflammation
COPD
Poorly responsive even to high dose inhaled
corticosteroids and is associated with progressive,
inexorable loss of pulmonary function over time,
especially with continuous smoking
COPD
Enzyme that disrupts the lining of the alveoli
Protease
associated with chronic or recurrent excessive mucus secretion into the bronchial tree
Chronic bronchitis
Blue bloaters
Chronic bronchitis
Pink puffers
Emphysema
Pulmonary HTN
Cor pulmunale
Cor pulmunale is also known as
Right-sided HF
Emphysema is located in
Alveoli
emphysema associated with smoking and typically most severe in the upper lobe
Centriancinar
Most severe in the lower lungs. No smoking
Panacinar
What deficiency is associated with no smoking but has emphysema
Alpha 1 antitrypsin deficiency
least common; involves the distal airway structure, ducts, and sacs
Distalacinar
The stimulus for activation of inflammatory
cells and mediators is an exposure to noxious particles and gas through ___________
Inhalation
most common etiologic factor in acquiring COPD
tobacco smoke
dilated airspace in the lung parenchyma
Bullae
a major component of alveolar walls
Elastin
Breaks down elastin
Elastase
MOST SIGNIFICANT SYMPTOM OF COPD
Breathlessness
may occur particularly during exertion and
airflow obstruction exacerbation
Wheezing
Nonpharmacologic therapy for those with Chronic Hypoxemia
Long-Term Oxygen Therapy
Normal FEV1
Stage 0
FEV1: Greater than or equal to 80%
Stage 1: Mild COPD
FEV1: 50-79%
Stage 2: Moderate COPD
FEV1: 30-49%
Stage 3:Severe COPD
FEV1: <30%
Stage 4: Very Severe COPD
With anti oxidant and mucokinetic property
Oral N acetyl cysteine
May elicit bronchospasm: if so:
Inhalant therapy of NAC + Bronchodilator
via midline sternotomy or video assisted thoracoscopy
Bullectomy
A drug used as an antidepressant.
Bupropion
Can markedly reduce nicotine cravings.
Bupropion
associated with an increased risk for seizures
Bupropion
a new agent became available to assist in tobacco cessation attempts
Varenicline
a nicotine acetylcholine receptor partial agonist that has shown benefit in tobacco cessation.
Varenicline
relieves physical withdrawal symptoms and
reduces the rewarding properties of nicotine
Varenicline
Lungs w/ ribs w/ diaphragm
Thorax
Chronic bronchitis is located in
Bronchioles
Increases in markers (e.g _________ & ____________) of oxidants are seen in the epithelial lining fluid of COPD patients.
Hydrogen peroxide & nitric oxide
Little or no dyspnea
Stage 1: Mild COPD
Dyspnea on moderate exertion
Stage 2: Moderate COPD
Dyspnea on mild exertion
Stage 3:Severe COPD
Dyspnea even at rest
Stage 4: Very Severe COPD
Neozep
Paracetamol + Chlorpheniramine + Phenylephrine
rebound vasodilation with congestion
Rhinitis medicamentosa
Found in fish, flaxseed and other foods
Omega-3 fatty acids