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316 Pharmacology > Exam 3: Asthma and broncoconstriction > Flashcards

Exam 3: Asthma and broncoconstriction Flashcards

1
Q

Pathophysiology of asthma

A

Chronic respiratory inflammatory disorder of the bronchial mucosa

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2
Q

Exposure to asthma stimuli/trigger results in

A

Constriction of bronchial smooth muscle (bronchospasm)
Obstruction (reversible and non-reversible)
Inflammation (mucus hyper secretion, edema)

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3
Q

Common asthma triggers

A 
Allergens
Smoke 
Chemical fumes 
Exercise 
Stress 
Viral infection
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4
Q

IgE mediated response

A

Allergen exposure –> IgE production -> lgE binds to mast cells

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5
Q

Subsequent exposure to allergen ->

A

Allergen bings to IgE antibody complexes causing mast cell degree

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6
Q

Mast cell degranulation vasoactive mediators

A

Vasodilation
Increased Capillary
Edema

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7
Q

Chemotactic mediators

A
  • Cellular infiltration of neutrophils, lymphocytes, eosinophils
  • Bronchospasm, mucus secretion, impaired muccociliary function, thickening of airways, increasing bronchial smooth muscle contraction
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8
Q

Asthma attack causes

A 
Bronchospasm, dyspnea, retractions
Wheezing 
Mucus secretion 
Hypoventilation 
Puplus paradoxus
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9
Q

Mucus secretion is

A

air-trapping (hyperinflation of alveoli)- increased expiratory time, expiratory wheezing, cough

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10
Q

Hypoventilation can cause

A

Hypoxemia, hypercapnia, respiratory acidosis

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11
Q

What is pulses paradoxes

A

Fall of >10mmHg SBP during inspiration

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12
Q

Compensatory mechanism of asthma attack

A

Tachycardia, tachypnea

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13
Q

Asthma attack symptoms

A 
Expiratory wheeze
Prolonged expiration 
Chest tightness/pain 
cough 
retractions 
SOB/dyspnea 
Increased HR & RR 
DECREASE SpO2
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14
Q

Moderate distress asthma attack

A 
Accessory muscle use 
Retractions 
Nasal Flaring 
Increased HR 
Loud respiratory wheezing 
Pulsus paradoxus 
SpO2 91-95%
Cannot lie down, may need to sit
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15
Q

Asthma attack for infant

A

quiet cry in infants

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16
Q

Asthma attack severe distress symptoms

A 
Tripod position 
Talking in words vs. sentences 
RR AND HR increasing 
Loud BIPHASIC wheezing 
pulses paradoxus
SpO2 < 91%
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17
Q

Pulsus paradoxes moderate distress

A

10-20 mmhg

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18
Q

Pulsus paradoxes severe distress

A

20-40 mmHg

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19
Q

Asthma attack can lead to

A

Respiratory failure

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20
Q

Symptoms of respiratory failure

A 
Silent chest 
Absent wheeze 
Bradycardia 
severe hypoxemia 
diaphoresis 
agitation 
drowsiness 
Pulpus paradoxus absent
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21
Q

status asthmaticus

A

Episode that is unresponsive to beta 2 agonists/first line bronchodilators

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22
Q

How to diagnose asthma

A

Pulmonary function test
Peak flow meter
Presence of cough wheezing, dyspnea, night Time symptoms

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23
Q

FEV1

A

Forced expiratory volume in 1 sec

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24
Q

For pulmonary function test, compare FEV1 to

A

Normal value to get percentage

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25
Peak flow meter measures
Peak expiratory flow
26
what could be signs of asthma?
Allergies, colds lasting longer than 10 days, nocturnal cough
27
Goal of treatment for disorders of airway flow
Prevent exposure to triggers that cause symptoms, to provide quick relief, and to control the disease
28
Quick relief treatment for disorders of airflow
Short acting beta 2 agonists Anticholinergics Systemic corticosteroids
29
Controlled treatment for disorders of airflow
Long acting beta 2 agonists Inhaled corticosteroids Leukotriene modifiers Mast cell stabilizer
30
Bronchodilators drug class
Adrenergic: short acting beta 2 agonists
31
Bronchodilators are
rescue medication for bronchospasm
32
Bronchodilators moA
Selective Beta2 adrenergic agonists, sympathomimetics- imitate the effects of NE at the receptor site Relax smooth muscle lining airways No anti-inflammatory effects
33
what medication -provides quick relief of symptoms -Use only 1-2 times per week May prescribe for use prior to physical activity
Bronchodilators
34
Albuterol moA
Imitates NE on Beta 2 receptor in bronchial smooth muscle
35
Albuterol indication
Acute bronchospasm
36
Administration albuterol
oral inhalation, nebulized, mDI
37
Albuterol side effects
``` Tachycardia Nervouseness Tremors Dizziness Angina ```
38
Albuterol contraindication
Allergy to drug | -- tachydysrhythmia; tachycardia dur to digitalis toxicity
39
Albuterol precautions
``` Diabetes mellitus Hyperthyroidism CV disease Hypertension Angina ```
40
Albuterol interactions
Beta blockers reduce effectiveness of beta-2 agonists MAOI and TCAs increase hypertension, tachycardia, and angina Increases dosing of anti diabetic drugs due to hyperglycemia effects of beta2 agonists
41
Albuterol is an example of a ____ beta 2 agonist
Short acting
42
Example of a long acting beta 2 agonist
Salmeterol
43
Salmeterol is a
Long acting bronchodilator, LABA
44
What medication is used for COPD due to their increased risk of asthma related deaths
inhaled powder, nebulized
45
Combined therapy with ICS
Salmeterol and fluticasone (Advair) Formoterol and budesonide (Symbicort) Formoterol and mometasone (Dulera)
46
Even when taking salmeterol, always keep
a rescue medication on hand, like albuterol
47
Drug class alternative to SABA's for patients using beta-blockers
Anticholinergics
48
Ipratropium drug class
Anticholinergic
49
Ipratropium moA
Block EACh at parasympathetic in bronchial smooth muscle | -Bronchodilation
50
Short acting bronchodilator like ipratropium prevents
Mucus production
51
Ipratropium side effects
Can't pee, can't see, can't spit, can't shit - Increased intraocular pressure in patients with glaucoma upper respiratory infections
52
Combination drug anticholinergic + short acting beta-2 agonists
ipratropium + albuterol (Combivent/ DuoNeb)
53
Ipratropium administration
inhaler, nebulizer
54
ipratroprium caution in patients with
Glaucoma Prostatic hypertrophy Blasses neck obstruction
55
Ipratroprium is contraindicated in individuals with
Allergy to soy or peanuts
56
Ipratropium interactions
Beta-2 agonists enhance bronchodilation
57
Theophylline drug class
Xanthines
58
Methylxanthine is a
CNS stimulant
59
Theophylline moA
Blocks adenosine receptors and STIMULATE CNS which cause - relaxation of smooth muscles of the bronchioles - increases contractions of diaphragmatic muscles
60
Therapeutic index of theophylline
Narrow! | 10-20 mcg
61
Therapeutic index Xanthines
5-10 mcg
62
Theophylline and caffeine interaction
Caffine increases side effects, cigarette smoking decreases half life by 50%!!
63
Side effects of theophylline
``` Headache Irritability Restlessness Insomnia Tremors Seizures Tachycardia Dysrhythmias Nausea Vomiting Diarrhea ```
64
Xanthines administration
Oral
65
Xanthines patient teaching
Reduce or eliminate caffeine intake have periodic levels drawn stop is experiencing seizure or dysrhythmias
66
Xanthines caution in patient with
``` Heart disease Liver or Renal dysfunction Acute pulmonary edema Hyperthyroidism Diabetes mellitus Peptic ulcer disease ```
67
Xanthines contraindications
Cardiac disorder that cannot withstand myocardial stimulation
68
Xanthines interactions
Cimetidine (Tagamet), some fluoroquinolonescaffeine increase risk of toxicity Nicotine, phenobarbital, and phenytoin (Dilantin) decrease blood level
69
Corticosteroids are an effective _______ of asthma
long-term control
70
Administration of corticosteroid
Oral | Inhalation
71
Oral corticosteroids are used for
short term management of post-exacerbation symptoms
72
Inhalation corticosteroids are used for
long term management of chronic asthma
73
Corticosteroid inhalation medication used how frequently
once or BID
74
Inhaled corticosteroid medication may be combined with
SADA's and LABA's
75
Examples of corticosteroids
QVAR, Beconase Pulmicort Flovent
76
Corticosteroids precautions
Peptic ulcer disease; diabetes mellitus; hypertension; renal dysfunction; use of NSAIDs
77
Contraindications corticosteroids
Recent live virus immunization (oral) Systemic fungal infection (oral) Oral candidiasis (inhaled)
78
corticosteroids interactions
Potassium depleting diuretics increase risk of hypokalemia NSAIDs increase risk of GI bleedings Effects of insulin and oral hypoglycemics are decreased.
79
Inhaled corticosteroids examples
beclomethasone (Beconase) | fluticasone (Flovent)
80
Corticosteroid, inhaled moA
Anti-inflammatory | Inhibits production of inflammatory mediators
81
Corticosteroid, inhaled administration
Inhaled BID or used in nebulizer once/day Do not shake inhaler, do not use with spacer RINSE mouth after use
82
Corticosteroids inhaled side effects
Hoarseness | Thrush (oral Candida, upper respiratory infections)
83
Corticosteroid oral side effects
``` suppression of adrenal function muscle wasting bone demineralization (osteoporosis) hyperglycemia peptic ulcer disease infection F/E imbalances (hyponatremia, hypokalemia, ```
84
Corticosteroids oral examples
prednisone, | dexamethasone
85
dexamethasone is also available as an
Ophthalmic preparation for inflammation of the eyes/conjunctivitis and as an parenteral (IV/IM) preparation, known as DECADRON
86
Corticosteroids, oral used
Daily QOD
87
Corticosteroids, oral has what type of effect? local or systemic
It is a systemic steroid
88
Corticosteroids, oral Side effects
``` Increase appetite Weight gain Restlessness Insomnia Mood changes, Cushing's ```
89
cromolyn,Mast cell stabilizers control
Inflammation by inhibiting mast cell degranulation
90
cromolyn,mast cell stabilizer example
Cromolyn
91
cromolyn,mast cell stabilizer moA
Suppresses inflammation by stabilizing the cytoplasmic membrane of mast cells -- Inhibiting the release of chemical mediators
92
cromolyn,mast cell stabilizer indications
Prophylaxis for moderate asthma | Exercise induced asthma
93
cromolyn,mast cell stabilizer route
Nebulizer metered dose inhaler PO
94
is cromolyn,mast cell stabilizer a bronchodilator?
NO! keep rescue medication on hand
95
cromolyn,Mast cell stabilizer side effects
``` Allergic reaction Dry mouth Headache Bitter aftertaste Cough tingling burning ```
96
cromolyn,Mast cell stabilizer precautions
Liver or kidney disease
97
cromolyn,Mast cell stabilizer contraindications
Allergy to cromolyn CAD Cardia disrhythmias
98
cromolyn,Mast cell stabilizer interaction
no known interactions
99
Leukotriene Modifiers is a ______ medication
Long term control
100
Leukotriene Modifiers are used in
prophylaxis in exercise induced asthma and allergic rhinitis
101
Leukotriene Modifiers examples
montelukast (Singulair) zariflukast (Accolate) zileuton (Zyflo)
102
Leukotriene Modifiers MoA
Selective leukotriene receptor antagonist --Binds to receptors in bronchial smooth muscle and macrophages in upper airway to prevent airway edema, smooth muscle contraction and inflammation
103
Leukotriene Modifiers administration
Oral, once/day in the evening or 2 hours prior to exercise for exercise induced asthma; can mix oral granule with applesauce, rice, or ice cream
104
Leukotriene Modifiers side effects
Headaches Fatigue Dyspepsia Liver damage (zariflukast and zileuton)
105
Leukotriene Modifiers precautions
Severe asthma
106
Leukotriene Modifiers contraindications
Liver dysfunction acute asthma exacerbations status asthmaticus
107
liver dysfunction that is contraindicated in Leukotriene Modifiers
Zileuton | Zafirlukast
108
Leukotriene Modifiers interactions
phenobarbital and phenytoin may necessitate higher dosages zileuton can increase levels of warfarin, theophylline, and propranolol zafirlukast can increase levels of warfarin , tolbutamide, carbamazepine, and phenytoin.
109
Monoclonal anti-IgE Antibody example
omalizumab
110
Omalizumab, Monoclonal anti-IgE Antibody indication
Adjunctive therapy for preventative purposes for moderate to severe asthma
111
Omalizumab, Monoclonal anti-IgE Antibody moA
Selectively binds to free IgE thereby inhibiting the release of allergic mediators from mass cells
112
Omalizumab, Monoclonal anti-IgE Antibody administration
Bi-monthly or monthly subcutaneous injection in provider's office
113
Omalizumab, Monoclonal anti-IgE Antibody side effects
Injection site run Viral infections upper respiratory infections low risk for anaphylaxis
114
Omalizumab, Monoclonal anti-IgE Antibody precautions
Potential for producing anaphylaxis | Monitory for hypersensitivity run!!
115
Why are most asthma medications inhaled
Locally distributed to the airways Quicker response Lower dose required Systemic effects minimized
116
Metered dose inhaler can be used
With or without spacer
117
Dry powder inhaler are
Capsules places into inhaler
118
Nebulizer is a
Liquid aerosolized
119
When a spacer is used, more
medication reaches its sites of action in the lungs, and less is deposited in the mouth and throat
120
Administration technique for dry powder inhaler
Inhaled dry, micronized powder use differently | - Close your mouth tightly around the mouthpiece of the inhaler and breath in quickly, do not breathe in through nose
121
Nebulizer administration technique
Converts a drug solution into a mist | Requires face mask or mouthpiece

316 Pharmacology (19 decks)

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