B4.078 Treatment of Pulmonary Disorders Flashcards
advantages of inhalation delivery
higher concentration of drug at the site of action
limits systemic side effects
disadvantages of inhalation delivery
airway hypersensitivity
delivery may be deranged due to underlying lung disease, mucous production
70% of people don’t use inhalers with the proper technique
what are 2 methods of inhalation
metered dose inhaler
nebulizer
discuss metered dose inhaler delivery
bronchodilator
beta 2 receptor agonists
improve airflow in obstructive lung diseases
what is Advair?
combo of LABA/ICS
dry powder administration
easier to take than a traditional inhaler
what is the principle behind nebulizer delivery
air passes through a liquid to turn it into an aerosol, which is then inhaled
what are some benefits to using nebulizers
cheaper drugs than metered dose inhalers
can be more effective if improper technique used on an inhaler (same effectiveness if both used properly, however)
downside to nebulizers
takes 10-15 minutes
what is bronchiectasis
inflamed and easily collapsible airways
progressive airway destruction with loss of airway clearance with colonization by bacteria
frequent exacerbations resulting in repeated antibiotics and hospitalizations
types of systemic pharm interventions for pulm disorders
inhalation oral IV intramuscular/subQ injection transdermal
most common drug in pulmonary medicine (oral admin)
prednisone
glucocorticoid that suppresses inflammation systemically
used for asthma, COPD, autoimmune diseases, etc
IV drug used in pulmonary medicine
prostacyclin
vasodilator for pulmonary hypertension
short half life, unstable
injections used in pulmonary medicine
influenza and pneumococcal vaccines
biologics
transdermal drug used in pulmonary medicine
nicotine patch for smoking cessation
also can treat inflammatory diseases
side effects of glucocorticoids like prednisone (long term)
euphoria buffalo hump hypertension thinning skin thin arms and legs, muscle wasting benign intracranial hypertension cataracts moon face with red cheeks increased abdominal fat easy bruising poor wound healing osteoporosis hyperglycemia
what is transrepression
activated receptor interacts with specific transcription factors (AP-1 and NF-kB) and prevents transcription of pro-inflammatory genes
inhibits cell mediated and humoral immunity
what is transactivation
glucocorticoids bind to the cytosolic glucocorticoid receptor (GR)
newly formed complex translocates into the nucleus, where it binds to glucocorticoid response element (GRE) resulting in the regulation of gene expression
increased gluconeogenesis and other negative side effects**
what is a focus of glucocorticoid drug development
blocking binding at GRE (blocking transactivation)
non pharmacological interventions for pulm disorders
pressure
gases
surgical
potpourri
negative pressure
devices work by producing an intermittent negative pressure around the thorax and abdomen
transpulmonary pressure increases, thereby assisting inhalation and inflating the lungs
passive elastic recoil deflates the lungs
positive pressure
elevation of central airway pressure above atmospheric pressure
pressure gradient between central airways and the alveoli causes air to move into the pulmonary parenchyma
as the lung inflates, alveolar pressure also becomes positive relative to atm pressure
exhalation takes place when mouth pressure returns to atm and gradient is reversed
what is a protective strategy to avoid damage from positive pressure ventilation
volume restriction and airway pressures below 30 cm H2O
indications for invasive positive pressure ventilation (intubation)
respiratory failure
hemodynamic instability
paralysis (trauma, anesthesia)
decreased level of consciousness
indications for noninvasive positive pressure ventilation
hypoxia
hypercapnia
obstructive sleep apnea
