Lec 4 COPD II Flashcards
Corticosteroids mechanism of action:
Reduce bronchial reactivity and asthma exacerbations
their most important Action for their effect on airway obstruction is:
inhibition of lymphocytic eosinophillic, mucosal inflammation of asthmatic airways.
complete list of mechanism of action of corticosteroids:
1)reduce amount of mast cells and eosinophils
2)increase number of B-adrenergic receptors, improve receptor responsiveness
3)reduce mucus production
4)reduce BHR
5)reduce airway edema
cornerstones of Asthma treatment
B agonists and corticosteroids
Urgent treatment of asthma:
systemic corticosteroids
oral dose of prednisone WITH an intravenous dose of 1mg/kg methylpredinsolone every 6 hours.
patients improve in 10 weeks
The best time to administer corticosteroids is:
early in the morning after ACTH has peaked
but also to prevent nocturnal asthma, administer it in late afternoon
-they are NOT bronchodialators
-they are used when the patient is poorly responding to SABAs.
-Oral therapy of corticosteroids is as efective as IV route
aerosol treatment used for:
used to avoide adverse effecte of systemic corticosteroids
beclonathasone,budesonide,flunisolide, fluticasone,mometasone,ciclesonide,triamcinolone all do what:
Corticosteroids that minimize systemic absorption
Inhaled corticosteroids Uses:
reduce exacerbations
reduces risk of asthma death
(delayed for response)
Adverse effects of inhaled corticosteroids:
-systemic effects at high doses:
-skin thinning
-decreased bone mineral density
-adrenal supression
-oropharyngeal candidiasis
-dysphonia
-growth retardation
Nystatin,miconazole,clotrimazole treat:
rinse mouth to prevent this
oral candidiasis
Flucoconazole,ketokonazole,itraconazole are methods of:
methods of systemic treatment of Oral candidiasis
parents that dont want their child taking corticosteroids often go for:
Cromolyn and nedocromolyn
stabilizers of mast cells
Is only effective as prophylaxis
cromolyn and nedocromil
This drugs effect inhibits antigen and exercise mediated asthma:
Cromolyn and nedocromil sodiums
drugs that block early and late phase responses Thru mast cell inhibition:
Cromolyn and nedocromil sodiums
Doses of nedocromil and cromolyn:
4 times daily
cromolyn can be reduced to 3
nedocromil can be reduced to 2
it provides prophylaxis for 1-2 hours
cough,weezing,bad taste and headache are side effects of:
Nedocromil
Leukotriene receptor antagonist doses:
(zafirlukast and Montelukast)
Zafirlukast- Oral twice daily
Montelukast- Oral once daily
BLACK BOXED LEUKOTRIENE IS:
Monteleukast, neuropsychatric events
Adverse effects of Leukotriene modifiers:
-Hepatic enzyme increase in ZAFIRLUKAST
-Zileuton can cause hepatotoxicity
5-lipoxygenase inhibitor dose :
Zileuton- oral, 4 times daily
**Improve FEV1 **
Omalizumab: monoclonal antibody MOA
Prevents IgE from binding to mast cells basophils
Uses of Omalizumab:
moderate severe asthma that isnt controlled by corticosteroids
improves asthma related quality of life
Dosage of omalizumab:
subcutaneous every 2-4 weeks
dosage based on inital IgE level and patient weight
Adverse effects of omalizumab:
Injection site: redness and itching
anaphyalxis
Mild asthma attacks are managed with:
B2- receptor agonists (as effective as subcutaneous epinephrine injection
Severe attacks of asthma treated with:
-oxygen
-aerosol albuterol
-systemic treatment of prednisone or methylprednisolone
used as a reliever treatment:
(track 1)
As needed only low dose ICS-Formeterol
reliever treatment for track 2:
as needed ICS-SABA
COPD medicaitons:
inhaled bronchodialators
-B2-adrenergic agonists
-anticholinergic agents (muscarinic antagonists)
