Exam 3: Asthma and Bronchodilators

Question 1

What is Asthma?
*Symptoms and Worsening Factors

Answer 1

Airway inflammation leading to obstruction
*Exposed to smoke, worse air quality
*Bronchiole Hyperactivity even when symptom free

Question 2

What is Croup?
*Tx and Symptom

Answer 2

Usually associated w/ RSV; self-limiting condition
*Neb Epi
*Barking Cough

Question 3

What is COPD
*2 Subclasses
*Time frame to be considered COPD

Answer 3

Hypersecretion of Mucus and Chronic Cough: 3 mo of the year for 2 consecutive years
*Bronchitis and Emphysema

Question 4

What is Bronchitis

Answer 4

Inflammation of the Bronchi

Question 5

What is Emphysema

Answer 5

Alveolar Disease, permanent enlargement of alveoli, can also be from ruptured alveoli

Question 6

Tx of Airway Obstruction Diseases

Answer 6

Short Term - Sympathomimetics
Long Term - Corticosteroids

Question 6

What is the FEV1 Airway Function Test
*What are you testing for? Results?

Answer 6

How much air they can expire over 1 second
*Testing for Asthma
*+ Asthma will lessen their FEV1 results

Question 7

What is the Peak Expiratory Flow Test?

Answer 7

Measures flow of forced expiration; give histamine, then repeat again

Question 7

What are 4 Early Mediators in Early Asthma

Answer 7

Histamines, Prostaglandin D2, Leukotrienes, Cytokines

Question 7

What does Histamine do?

Answer 7

Smooth muscle contraction and bronchospasm/mucosal edema

Question 8

What does Prostaglandin D2 do?

Answer 8

Pro-inflammatory response, potent bronchoconstrictor, enhances histamine effect

Question 9

What do Leukotrienes do?

Answer 9

Bronchospasm mucus, airway edema, microvascular permeability

Question 10

What does Lipooxygenase Produce

Answer 10

Leukotrienes

Question 11

What does Cyclooxygenase Produce

Answer 11

Prostaglandins

Question 12

How does the SNS effect airway diameter?
*Name 3 Drugs/Classes

Answer 12

Agonist of B2 will open airway
*Epi, Methylxanthines, Antimuscarinics

Question 13

How does the PNS effect airway diameter?

Answer 13

M3-R keep airway with baseline tone [contraction]

Question 14

Tx of Asthma and COPD: Sympathomimetics
*Beta 2

Answer 14

Albuterol - 1-3 min onset w/ 30 min peak
Terbutaline - IV
Methylxanthines [Theophylline] - inhibits PDE and adenosine receptors *High toxic risk [seizures, arrhythmia]

Question 15

Tx of Asthma and COPD: Sympathomimetics
*Broad Beta Agonists

Answer 15

Epi and Isoproterenol

Question 16

Tx of Asthma and COPD: Sympathomimetics
*Long Acting Beta 2 [LABA]

Answer 16

Salmeterol/Formoterol - Fat soluble so last longer

Question 17

Tx of Asthma and COPD: Anti-Muscarinics
*3 Drugs

Answer 17

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

Question 18

What is the Longest Acting Anti-Muscarinic

Answer 18

Spiriva

Question 19

Tx of Asthma and COPD: Corticosteroids
*MOA

Answer 19

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

Question 20

Tx of Asthma and COPD: Anti IgE Monoclonal Antibodies
*How often are injections

Answer 20

Targets the part of the IgE that binds to the mast cell that causes granulation response; Mast cell cannot expose it’s insides
*Qmonthly

Question 21

Tx of Asthma and COPD: Leukotriene Pathway Inhibitors

Answer 21

Inhibit 5-LOX: Zileuton
Inhibit Receptor Binding: Zafirlukast, Montelukast

Question 22

Mild Asthma/COPD Tx

Answer 22

B2-R agonist PRN, rescue inhaler

Question 23

Moderate Asthma/COPD Tx

Answer 23

Controller therapy [can help w nocturnal symptoms]
Frequent inhaled corticosteroids for short and long term

Question 24

Severe Asthma/COPD Tx

Answer 24

Add oral corticosteroids, anti IgE, switch to inhaled over time