Exam 3: Asthma and Bronchodilators Flashcards
What is Asthma?
*Symptoms and Worsening Factors
Airway inflammation leading to obstruction
*Exposed to smoke, worse air quality
*Bronchiole Hyperactivity even when symptom free
What is Croup?
*Tx and Symptom
Usually associated w/ RSV; self-limiting condition
*Neb Epi
*Barking Cough
What is COPD
*2 Subclasses
*Time frame to be considered COPD
Hypersecretion of Mucus and Chronic Cough: 3 mo of the year for 2 consecutive years
*Bronchitis and Emphysema
What is Bronchitis
Inflammation of the Bronchi
What is Emphysema
Alveolar Disease, permanent enlargement of alveoli, can also be from ruptured alveoli
Tx of Airway Obstruction Diseases
Short Term - Sympathomimetics
Long Term - Corticosteroids
What is the FEV1 Airway Function Test
*What are you testing for? Results?
How much air they can expire over 1 second
*Testing for Asthma
*+ Asthma will lessen their FEV1 results
What is the Peak Expiratory Flow Test?
Measures flow of forced expiration; give histamine, then repeat again
What are 4 Early Mediators in Early Asthma
Histamines, Prostaglandin D2, Leukotrienes, Cytokines
What does Histamine do?
Smooth muscle contraction and bronchospasm/mucosal edema
What does Prostaglandin D2 do?
Pro-inflammatory response, potent bronchoconstrictor, enhances histamine effect
What do Leukotrienes do?
Bronchospasm mucus, airway edema, microvascular permeability
What does Lipooxygenase Produce
Leukotrienes
What does Cyclooxygenase Produce
Prostaglandins
How does the SNS effect airway diameter?
*Name 3 Drugs/Classes
Agonist of B2 will open airway
*Epi, Methylxanthines, Antimuscarinics
How does the PNS effect airway diameter?
M3-R keep airway with baseline tone [contraction]
Tx of Asthma and COPD: Sympathomimetics
*Beta 2
Albuterol - 1-3 min onset w/ 30 min peak
Terbutaline - IV
Methylxanthines [Theophylline] - inhibits PDE and adenosine receptors *High toxic risk [seizures, arrhythmia]
Tx of Asthma and COPD: Sympathomimetics
*Broad Beta Agonists
Epi and Isoproterenol
Tx of Asthma and COPD: Sympathomimetics
*Long Acting Beta 2 [LABA]
Salmeterol/Formoterol - Fat soluble so last longer
Tx of Asthma and COPD: Anti-Muscarinics
*3 Drugs
decrease bronchial tone, limited use in asthma
*Atropine
*Iprotropium Bromide - longer acting than atrovent and can be combined with B2 agonist
*Spiriva - longest acting, useful in COPD
What is the Longest Acting Anti-Muscarinic
Spiriva
Tx of Asthma and COPD: Corticosteroids
*MOA
Shut down WBC, 4 ring steroid nucleus that is lipid soluble
*Goes into nucleus to bind to glucocorticoid response elements: can be silencer or enhancer for transcription of genes
Tx of Asthma and COPD: Anti IgE Monoclonal Antibodies
*How often are injections
Targets the part of the IgE that binds to the mast cell that causes granulation response; Mast cell cannot expose it’s insides
*Qmonthly
Tx of Asthma and COPD: Leukotriene Pathway Inhibitors
Inhibit 5-LOX: Zileuton
Inhibit Receptor Binding: Zafirlukast, Montelukast
Mild Asthma/COPD Tx
B2-R agonist PRN, rescue inhaler
Moderate Asthma/COPD Tx
Controller therapy [can help w nocturnal symptoms]
Frequent inhaled corticosteroids for short and long term
Severe Asthma/COPD Tx
Add oral corticosteroids, anti IgE, switch to inhaled over time
