Ch 76 Asthma and COPD Flashcards
Asthma is a chronic inflammatory disease characterized by _(3)_.
inflammation of the airways, bronchial hyperreactivity,
and bronchospasm.
Allergy is often the underlying cause.
Asthma is treated with (2).
anti-inflammatory drugs and bronchodilators
Most drugs for asthma are administered by inhalation, a route that (3).
increases therapeutic effects (by delivering drugs directly to their site of action),
reduces systemic effects (by minimizing drug levels in blood),
and facilitates rapid relief of acute attacks.
Four devices are used for inhalation:
metered-dose inhalers (MDIs),
dry-powder inhalers (DPIs),
Respimats, and
nebulizers.
Patients will need instruction on their use.
__ are the most effective anti-inflammatory drugs for asthma management
Glucocorticoids
Glucocorticoids reduce symptoms of asthma by ___.
suppressing inflammation.
As an added bonus, glucocorticoids appear to promote synthesis of bronchial beta2 receptors and increase their responsiveness to beta2 agonists.
Inhaled and systemic glucocorticoids are used for ___.
long-term prophylaxis of asthma—not for aborting an ongoing attack.
Accordingly, they are administered on a fixed schedule—not PRN.
Unless asthma is severe, __ should be administered by inhalation.
glucocorticoids
Inhaled glucocorticoids are generally very safe. Their
principal side effects are (2).
oropharyngeal candidiasis and dysphonia,
which can be minimized by employing a spacer device during administration and by rinsing the mouth and gargling after use.
Inhaled glucocorticoids can slow the __.
growth rate of children, but they do not reduce adult height
Inhaled glucocorticoids may pose a small risk for __.
bone loss.
To minimize loss, dosage should be as low as possible, and patients should perform regular weight-bearing exercise and should ensure adequate intake of calcium and vitamin D.
Prolonged therapy with oral glucocorticoids can cause
serious adverse effects, including (5).
adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.
Because of adrenal suppression, patients taking oral glucocorticoids (and patients who have switched from oral glucocorticoids to inhaled glucocorticoids) must be given ___.
supplemental doses of oral or IV glucocorticoids at times of stress
Cromolyn is an inhaled anti-inflammatory drug used for
___.
prophylaxis of asthma
For long-term prophylaxis, cromolyn is taken daily on
a fixed schedule.
Cromolyn reduces inflammation primarily by ___.
preventing the release of mediators from mast cells
For prophylaxis of exercise-induced bronchospasm, cromolyn is taken __.
15 minutes before anticipated exertion
___ is the safest drug for asthma. Serious adverse
effects are extremely rare.
Cromolyn
Beta2 agonists promote __..
bronchodilation by activating beta2 receptors in bronchial smooth muscle
Inhaled short-acting beta2 agonists (SABAs) are the most effective drugs for relieving (2).
acute bronchospasm and preventing exercise-induced bronchospasm
Three inhaled __ have a long duration of action and are indicated for long-term control.
beta2 agonists - arformoterol, formoterol, and salmeterol
___ rarely cause systemic side effects when
taken at the recommended dosage.
Inhaled SABAs
Excessive dosing with oral beta2 agonists can cause
(2).
tachycardia and angina by activating beta1 receptors on
the heart.
Selectivity is lost at high doses.
Inhaled long-acting beta2 agonists (LABAs) can increase
the risk for ___, primarily when used
alone.
asthma-related death
To reduce risk, LABAs should be used only by patients taking an inhaled glucocorticoid for long-term control, and only if the glucocorticoid has been inadequate by itself. For combined glucocorticoid/LABA therapy, the FDA recommends using a product that contains both drugs in the same inhaler.
Theophylline, a member of the methylxanthine family,
relieves asthma by causing __.
bronchodilation