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Pharmo for medic school > Astham COPD > Flashcards

Astham COPD Flashcards

1
Q

Asthma results from

A

Combo of inflammation and bronchoconstriction

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2
Q

COPD overview

A

Chronic, progressive, largely irreversibly characterized by airflow restrictions and inflammation

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3
Q

S&S COPD

A 
Chronic cough
Excessive sputum
Wheezing
Dyspnea
Poor exercise tolerance
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4
Q

COPD 2 main conditions

A

Chronic bronchitis

Emphysema

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5
Q

Chronic bronchitis

A

Chronic cough, excessive sputum which results in hypertrophy of mucus secreting glands in epithelium of large airways

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6
Q

Emphysema

A

Enlargement of air space within bronchioles and alveoli brought on by deterioration of the walls of the airspaces

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7
Q

Two main pharmacologic classes for asthma COPD

A

Anti-inflammatory agents
Glucocorticoids (pred, dex)
Bronchodilators
Beta 2

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8
Q

Three main routes for asthma meds

A

MDI, DPI (dry powder), neb

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9
Q

MDIs

A

Start inhaling before activating, only 10% of drug reaches lungs (21% with spacer)

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10
Q

Short acting B2s - PRN

A

Salbutamol

Levalbuterol

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11
Q

Long acting B2

A 
Aclidinium bromide
Arformoterol
Formoterol
Indacaterol
Salmeterol
Taken on fixed schedule
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12
Q

Ventolin contras

A

Hypersensitivity

Tachydysrhythmias

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13
Q

Ventolin dose

A

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

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14
Q

Atrovent class

A

Parsympatholytic
Anticholinergic
Bronchospasm, anaphylaxis

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15
Q

Dose

A

500mcg or 10 puffs if pt hasn’t received 3 doses of neb

Less than 20kg half it

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16
Q

Events leading to asthma

A

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

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17
Q

Chronic bronchitis defined by

A

Chronic cough and excessive sputum production

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18
Q

Emphysema defined as

A

Enlargement of air space within bronchioles and alveoli brought on by deteriotion of walls in these air spaces

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19
Q

Patho of COPD

A

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

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20
Q

Two main classes of drugs for asthma and COPD

A

Antiinflammatory agents and bronchodilators

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21
Q

Three advantages of inhalation

A

Enhanced effect by direct drug delivery
Systemic effects minimized
Relief is rapid

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22
Q

Four types of inhalation devices

A

MDI, respimat, dry powder, nebs

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23
Q

Respimats

A

Deliver drug as a fine mist

24
Q

Spacers

A

Increases amount to lungs (21% vs 10%) and eliminates depositing of drug in mouth

25
Q

MOA gluccorticoids in asthma

A

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)

26
Q

Inhaled glucocorticoids

A

Largely devoid of serious tox, most serious is adrenal suppression - usually minimal.

27
Q

Candidiasis

A

Thrush in the mouth, any infection from candida (yeast)

28
Q

Bone loss

A

From long term steroids. To address this use lowest dose possible, insure adequate calcium and D, lift weights

29
Q

Oral steroids sides

A

Adrenal suppression, hyperglycemia, peptic ulcer, growth suppression

30
Q

Leukotrien modifiers

A

Suppress leukotrienes which promote smooth muscle constriction and increase vessel perm, also potentiate inflamm reaction

31
Q

Beta 2

A

Bronchodilation but also somewhat suppress histamine and increase ciliary motility

32
Q

LABAs (long acting B2)

A

Preferred over SABAs in COPD, need steroids in asthma to go with it, LABA alone increase risk of death - increase risk of severe asthma

33
Q

When is SABA not enough

A

rescue inhaler use twice a week

34
Q

THeophylline

A

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

35
Q

Iptratropium bromide

A

Approved for COPD, off label asthma
Blocks muscarinic receptors
30 seconds effect, 50% in effect in 3 minutes, persist for 6 hours

36
Q

Adverse effects atrovent

A

Quaternary (carries positive charge) keeps drug in lungs

May raise intraoccular pressure

37
Q

Glucocoricoid combos

A

Fluticasone/salmeterol (advair) -DPI
Budesonide/formoterol (symbicort) -MDI
Steroid/B2 in that order for those ones

38
Q

FEV1

A

Forced expiratory volume in 1 second. Single most useful asthma test
75% of predicted value in asthmatics

39
Q

FVC

A

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

40
Q

PEF

A

Peak expiratory flow. Maximal rate of airflow during expiration.
Check every morning, monitor if drops to 80% of personal best

41
Q

Classes of asthma

A

Intermittent, mild persistent, moderate persistent, severe persistent
Impairment (day to day) and Risk (risk of adverse event)

42
Q

EIB exercised induced bronchospasm

A

Loss of heat and or water from lung. B2 prophylatically immediately before

43
Q

COPD measurement

A

Post bronchodilator FEV1/FVC of less than 0.7 indicates COPD

44
Q

Classes of COPD - 4

A

Mild, moderate, severe, very severe

45
Q

Tx for stable COPD

A

Bronchodilators, glucocorticoids, PDE 4 inhibitors

46
Q

PDE 4 inhibitor

A

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

47
Q

half of asthma triggered by

A

Allergens

48
Q

Ventolin contras

A

Hypersens and tachydysrhythmias

Repeat PRN

49
Q

Prednisone

A

Contras severe SOB, already taking pred, pneumonia or SIRS criteria

50
Q

Dex

A

Contras hypersens, systemic fungal infections, hypersens to benzyl alchohol or sodium sulfite, pneumonia or SIRS met

51
Q

Methylpred contras

A

Hypersens
Systemic fungal infection
Pneumonia or SIRS
100-250mg IV over 1 min or diluted in 50-100mL NS over 15 minutes

52
Q

Mag contras

A

Heart block, renal failure

53
Q

Mag dose

A

2g IV in 50mL NS over 10 for bronchospasm

54
Q

Methylxanthines MOA

A

Block adenosine receptors
Enhance calcium perm of sarcoplasmic reticulum
Increase cAMP

55
Q

Theophylline dose

A

400mg/250mL 5-15mcg/mL (wtf?)

Pharmo for medic school (26 decks)

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