Ch. 40 - Asthma & Other Pulmonary Disorders Flashcards
Muscular, elastic structures whose diameter, or lumen, varies with the contraction or relaxation of smooth muscle.
Bronchioles
Diameter of airways controlled by what?
Two branches of the autonomic nervous system & controls the amount of air entering the lungs.
The two branches of the autonomic system that controls airways
Sympathetic branch
Parasympathetic branch
Activates beta2-adrenergic receptors and causes bronchiolar smooth muscle to relax.
The airway diameter increases (bronchodilation), increasing O2 to tissues.
sympathetic branch of the autonomic system
Causes bronchiolar smooth muscle to contract
The airway diameter is narrowed:
Bronchoconstriction occurs
Results in less airflow
Parasympathetic branch of the autonomic nervous system
Common route of administration for pulmonary drugs
Inhalation/Aerosol Therapy
The respiratory system offers what for delivering drugs?
A rapid and efficient mechanism
The rich blood supply of the pulmonary system allows for what?
Quick absorption and onset of action
Delivers the drug directly to the sites of action
Aerosol therapy onset of action
almost immediate
Aerosol drugs administered for local effects do what?
Offer immediate relief of bronchospasm
Loosen thick mucus
Side effects are reduced, but systemic effects can still occur
r/t aerosol therapy
Disadvantage of aerosol therapy
Difficult to measure a precise dose
Side effects occur if the patient swallows the drug or does not rinse their mouth after inhalation
A chronic disease that has both inflammatory and bronchospasm compoenets
Asthma
Asthma symptoms occur when?
From exposure to triggers
Upon exertion (exercise-induced)
Common triggers of asthma
Air pollutants
allergens
Checmicals and food
Respiratory infections
Stress
Severe, prolonged form of asthma unresponsive to drug treatment that may lead to respiratory failure
Status asthmaticue
Components of Asthma
Bronchospasm
Mucus Production
Inflammation
Asthma has what two components?
Bronchoconstriction
Inflammation
Goals of drug therapy for asthma
To terminate acute bronchospasms in progress (quick-relief medications)
To reduce the frequency of asthma attacks (long-acting medications)
beta2-adrenergic agonists, anticholinergics, systemic corticosteroids
Quick-relief medications for asthma
inhaled corticosteroids, mast cell stabilizers, leukotriene modifiers, long-acting beta2-adrenergic agonists, methylxanthines and immunomodulators
long-acting medications for asthma
Most effective drugs for relieving acute bronchospasm
beta adrenergic agonist
beta-adrenergic agonist prototype
albuterol
beta-adrenergic agonist/albuterol MOA
Activate beta2 receptors in bronchial smooth muscle to cause bronchodilation
Beta-adrenergic side effects
Fewer cardiac side effects than older nonselective beta-adrenergics
Beta-adrenergic agonist duration range
ultrashort-long-acting
Alternative bronchodilators occasionally used alternatively to beta-agonists in asthma therapy
anticholinergic drugs
Anticholinergic/ipratropium (Atrovent) MOA
Block parasympathetic nervous system with bronchodilator effect
Anticholinergic administration form for asthma
Inhaled
Group of bronchodilators related to caffeine
Methylxanthines
Once mainstay of chronic asthma pharmacotherapy
Methylxanthines
theophylline
Example of a Methylxanthine
Infrequently prescribed b/c of the narrow margin of safety, especially with prolonged use
Interact with numerous drugs
Methylxanthines
Potent anti-inflammatory drugs
Corticosteroids
Corticosteroid prototype
beclomethasone
drugs of choice for long-term prophylaxis of asthma
Inhaled corticosteroids
Must be taken daily
Systemic side effects rarely observed
Inhaled corticosteroids
used for short-term therapy of severe, acute asthma
Oral corticosteroids
Oral corticosteroids limit to therapy
under 10 days
Designed to attach to specific receptor on a target cell or molecule
Monoclonal Antibodies
Used for asthma prophylaxis
monoclonal antibodies
Omalizumab (Xolair) approved 2003
monoclonal antibody example
Omalizumab (Xolair) MOA
Attached to receptor on immunoglobulin E (igE)
mediators of immune response
Leukotrienes
Involved in allergic and asthmatic reactions
Leukotrienes
Leukotrienes prototype
montelukast (Singulair)
Primarily used for asthma prophylaxis
montelukast (Singulair)/leukotriene modifier
Reduce inflammatory component of asthma
montelukast (Singulair)/leukotriene modifier
used when persistent asthma not controlled with other drugs
oral leukotriene modifiers
Inhibit mast cells from releasing histamine and other chemical mediators
mast cell stabilizers
safe for prophylaxis of asthma
mast cell stabilizers
Less effective than inhaled corticosteroids
mast cell stabilizers
Ineffective at relieving acute bronchospasm
mast cell stabilizers
Obstructed airflow commonly caused by: bronchitis
emphysema
asthma
COPD
Pharmacotherapy goals of COPD
Relieve symptoms
Avoid complications
Bronchodilators
Mucolytics and expectorants
Oxygen therapy
Antibiotics
Roflumilast (Daliresp)
Drug Classes for COPD
Used to reduce the viscosity of the bronchial mucus and to aid in its removal
Mucolytics and expectorants
Assists breathing and has been shown to reduce mortality in patients
O2 therapy
May be prescribed for patients with multiple bouts of pulmonary infections
Antibiotics
Anti-inflammatory effects on the airways by inhibiting the enzyme phosphodiesterase-4.
Oral tablet that is administered once daily
roflumilast (Daliresp)
