Astham COPD Flashcards
Asthma results from
Combo of inflammation and bronchoconstriction
COPD overview
Chronic, progressive, largely irreversibly characterized by airflow restrictions and inflammation
S&S COPD
Chronic cough Excessive sputum Wheezing Dyspnea Poor exercise tolerance
COPD 2 main conditions
Chronic bronchitis
Emphysema
Chronic bronchitis
Chronic cough, excessive sputum which results in hypertrophy of mucus secreting glands in epithelium of large airways
Emphysema
Enlargement of air space within bronchioles and alveoli brought on by deterioration of the walls of the airspaces
Two main pharmacologic classes for asthma COPD
Anti-inflammatory agents
Glucocorticoids (pred, dex)
Bronchodilators
Beta 2
Three main routes for asthma meds
MDI, DPI (dry powder), neb
MDIs
Start inhaling before activating, only 10% of drug reaches lungs (21% with spacer)
Short acting B2s - PRN
Salbutamol
Levalbuterol
Long acting B2
Aclidinium bromide Arformoterol Formoterol Indacaterol Salmeterol Taken on fixed schedule
Ventolin contras
Hypersensitivity
Tachydysrhythmias
Ventolin dose
10 puffs MDI q 5 prn (kids under 20kg max 15, over 20kg max 30)
Neb 5mg prn
Bronchospasm and anaphylaxis
Peds half it if under 20kg, over 20kg same dose, max 3 doses
Atrovent class
Parsympatholytic
Anticholinergic
Bronchospasm, anaphylaxis
Dose
500mcg or 10 puffs if pt hasn’t received 3 doses of neb
Less than 20kg half it
Events leading to asthma
Allergen binds to IgE
Mast cells release histamine, leukotriends, prostaglandins and interleukins which cause broncho constriction and release more inflamm cells (eosinophils, leukocytes, macrophages) which release their on mediators
Chronic bronchitis defined by
Chronic cough and excessive sputum production
Emphysema defined as
Enlargement of air space within bronchioles and alveoli brought on by deteriotion of walls in these air spaces
Patho of COPD
From frequent irritation and inflammation bronchial edema and increase mucus secretion. Also, inflammation inhibits protease inhibitors and protease enzymes break down elastin which destroys alveolar wall
Two main classes of drugs for asthma and COPD
Antiinflammatory agents and bronchodilators
Three advantages of inhalation
Enhanced effect by direct drug delivery
Systemic effects minimized
Relief is rapid
Four types of inhalation devices
MDI, respimat, dry powder, nebs
Respimats
Deliver drug as a fine mist
Spacers
Increases amount to lungs (21% vs 10%) and eliminates depositing of drug in mouth
MOA gluccorticoids in asthma
Decreased synthesis and release of inflammatory mediators (leukotriends, histamine, prostaglandins)
Decreased activtation of inflammatory cells (eosinophils, leukocytes)
Decreased edema of airway mucosa (secondary to decreased vasc perm)
may increase B2 receptors (# and responsiveness)
Inhaled glucocorticoids
Largely devoid of serious tox, most serious is adrenal suppression - usually minimal.
Candidiasis
Thrush in the mouth, any infection from candida (yeast)
Bone loss
From long term steroids. To address this use lowest dose possible, insure adequate calcium and D, lift weights
Oral steroids sides
Adrenal suppression, hyperglycemia, peptic ulcer, growth suppression
Leukotrien modifiers
Suppress leukotrienes which promote smooth muscle constriction and increase vessel perm, also potentiate inflamm reaction
Beta 2
Bronchodilation but also somewhat suppress histamine and increase ciliary motility
LABAs (long acting B2)
Preferred over SABAs in COPD, need steroids in asthma to go with it, LABA alone increase risk of death - increase risk of severe asthma
When is SABA not enough
rescue inhaler use twice a week
THeophylline
MOA relaxing smooth muscle, probably by blocking adenosine receptors, enhance calcium perm in sarcoplasmic reticulum, inhibit cyclic nucleotide phosphodiesterase (increase in cAMP)
Use only after B2 and antichols
Tox - N/V diarrhea insomnia restlessness dysrhythmias
Other methylxanthis are aminophylline and dyphylline
Iptratropium bromide
Approved for COPD, off label asthma
Blocks muscarinic receptors
30 seconds effect, 50% in effect in 3 minutes, persist for 6 hours
Adverse effects atrovent
Quaternary (carries positive charge) keeps drug in lungs
May raise intraoccular pressure
Glucocoricoid combos
Fluticasone/salmeterol (advair) -DPI
Budesonide/formoterol (symbicort) -MDI
Steroid/B2 in that order for those ones
FEV1
Forced expiratory volume in 1 second. Single most useful asthma test
75% of predicted value in asthmatics
FVC
Measured with spirometer. Total volume of air pt can exhale
Also FEV1/FVC ratio
5% lower than normal in asthma 70-85% depending on age
PEF
Peak expiratory flow. Maximal rate of airflow during expiration.
Check every morning, monitor if drops to 80% of personal best
Classes of asthma
Intermittent, mild persistent, moderate persistent, severe persistent
Impairment (day to day) and Risk (risk of adverse event)
EIB exercised induced bronchospasm
Loss of heat and or water from lung. B2 prophylatically immediately before
COPD measurement
Post bronchodilator FEV1/FVC of less than 0.7 indicates COPD
Classes of COPD - 4
Mild, moderate, severe, very severe
Tx for stable COPD
Bronchodilators, glucocorticoids, PDE 4 inhibitors
PDE 4 inhibitor
PDE inactivates cAMP, keeping cAMP up results in decreased inflammation, cough, mucus production
Adverse effects include diarrhea, reduced appetite, weight loss, nausea, headache and back pain, insomnia, depression
half of asthma triggered by
Allergens
Ventolin contras
Hypersens and tachydysrhythmias
Repeat PRN
Prednisone
Contras severe SOB, already taking pred, pneumonia or SIRS criteria
Dex
Contras hypersens, systemic fungal infections, hypersens to benzyl alchohol or sodium sulfite, pneumonia or SIRS met
Methylpred contras
Hypersens
Systemic fungal infection
Pneumonia or SIRS
100-250mg IV over 1 min or diluted in 50-100mL NS over 15 minutes
Mag contras
Heart block, renal failure
Mag dose
2g IV in 50mL NS over 10 for bronchospasm
Methylxanthines MOA
Block adenosine receptors
Enhance calcium perm of sarcoplasmic reticulum
Increase cAMP
Theophylline dose
400mg/250mL 5-15mcg/mL (wtf?)
