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Pulmonary > Pathophysiology & drugs for chronic airway flow limitation > Flashcards

Pathophysiology & drugs for chronic airway flow limitation Flashcards

1
Q

Types of chronic airway flow limitation diseases

A

asthma
COPD
bronchiectasis
bronchiolitis

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2
Q

Sx of chronic obstructive airway diseases

A

Cough
Sputum
Dyspnea

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3
Q

COPD - sites, cells and mediators

A

central and peripheral airways, lung parenchyma, pulmonary vasculature
neutrophils, macrophages, CD8, CD4, B lymphocytes
LTB4, IL-8, TNFa

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4
Q

Asthma - sites, cells, and mediators

A

central and peripheral airways
eosinophils, CD4 Th2, mast cells, neutrophils, epithelial cells
LTD4, IL-4, IL-5, TNFalpha, many others

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5
Q

Bronchiectasis - sites, cells, and mediators

A

major bronchi, bronchioles
neutrophils
proteases, reactive oxygen, IL-8

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6
Q

Bronchiolitis - sites, cells, and mediators

A

membranous and respiratory bronchioles, immediately adjacent alveoli
neutrophils, eosinophils, macrophages, lymphocytes, mast cells
immunoglobulins, fibronectin, procoagulants

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7
Q

Changes in airway resistance in obstructive disease

A

resistance decreases from central –> peripheral
but in disease, resistance changes in peripheral
considerable changes can occur before symptomatic

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8
Q

Subtypes of emphysema

A

centrilobunar (acinar) - smoking, upper lobe - respiratory bronchioles
Panlobular (acinar) - lower lobe, AAT patients

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9
Q

Bronchiectasis etiologies

A 
• Cystic Fibrosis
• Cilial Dysfunction Syndromes
foreign bodies
tracheomalacia
relapsing polychondritis
inhalation of noxious fumes/gases
infective
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10
Q

FEV1/FVC for pulmonary disease

A

< 75% - obstructive

> 90% - restrictive

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11
Q

Short-acting beta2 agonists

A

salbutamol

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12
Q

long-acting (~12 hours) beta agonists

A

salmeterol

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13
Q

ultra-long acting beta agonists

A

indacaterol

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14
Q

MOA of beta2 agonists

A

activation of adenyl cyclase –> increase cAMP –> relaxation of bronchial smooth muscle

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15
Q

Combination therapy for b2 agonists

A

+ inhaled corticosteroids, which upregulates beta 2 receptors
b2 agonists thought to downregulate beta2 receptors

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16
Q

Anticholinergic prototype

A

Long-acting muscarinic antagonist: tiotropium (greater selectivity for M3)

17
Q

MOA of anticholinergics

A

antagonism at M1, M3 (major) - bronchoconstriction/bronchial secretion

18
Q

PK of anticholinergics

A

quaternary compound; systemic absorption low
mostly swallowed, but not absorbed
peak effect 30-90 min, duration 6 h

19
Q

SE of anticholinergics

A

dry mouth
nasal irritation
nosebleeds

20
Q

Leukotriene receptor antagonist prototype

A

montelukast

21
Q

MOA of LTRAs

A

antagonist receptors in the lipoxygenase pathway
LT1 receptor = mediate bronchoconstriction / inflammation
leukotrienes = biologically active FAs derived from arachidonic acid
- bronchoconstriction
- hyperactive airways
- inflammation
- mucus hypersecretion

22
Q

SEs of LTRAs

A

headache, vomiting diarrhea

rare: Churg-Strauss syndrome

23
Q

Methylxanthine prototype

A

theophylline

24
Q

MOA of methylxanthines

A 
inhibit phosphodiesterase, which breaks down cAMP
adenosine antagonist (contributes more to SE)
25
Q

SE and contraindications of theophylline

A

narrow margin of safety
absorption unpredictable
nausea, vomiting, headache, insomnia, tremor, seizures, restlessness, arrhythmias

CI: active/symptomatic CAD (increased inotropy, HR)

26
Q

Inhaled corticosteroid prototype

A

Budesonide, fluticasone

27
Q

MOA of inhaled corticosteroids

A 
affects nuclear gene expression
anti-inflammatory
inhibit expression of pro-inflammatory cytokines and COX-2
immunosuppression
catabolic
anti-mitotic
water retention
28
Q

SEs of inhaled corticosteroids

A

oral candidiasis
dysphonia
sore throat

29
Q

Monoclonal antibody prototype

A

omalizumab

sc injection

30
Q

Combination therapy for obstructive airway disease

A

inhaled corticosteroids + LABA
- fluticasone + salmeterol
- budesonide + formoterol
corticosteroid upregulation of b2 to counteract downregulation by BA

31
Q

Inducer of asthma in a previously non-asthmatic individual

A

western red cedar sap

32
Q

Mechanism of alveolar breakdown due to smoking

A

Neutrophil and macrophages recruited to alveolar space, release elastase-containing granules
Chemotaxis
Inactivating alpha-1-antritrypsin
Impairs elastin resynthesis

33
Q

Non-obstructive causes of bronchiectasis

A 
CF
Kartagener's syndrome (ciliary dysfunction)
immune deficiencies
necrotizing pneumonias (TB, Staph)
34
Q

Obstructive causes of bronchiectasis

A

foreign bodies
neoplasms
inspissated mucus
congenital abnormalities

35
Q

Complication of emphysema

A

cor pulmonale

Pulmonary (22 decks)

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