Pulmonary Flashcards
What are the goals of treating pulmonary Disorders?
- relief of bronchoconstriction
- Remove secretions
- improve alveolar ventilation/oxygynation
- improve breathing pattern
Chronic inflammatory disorder which bronchi become hyper-reactive from allergens, chemicals, exercise, cold air
Asthma
how does asthma work?
destruction of mast cells release histamine, leukotrienes and prostaglandins release from damaged cells.
T+B lymphocytes and others cause inflammatory response.
1 in 12 adults. 11 children have it.
Criteria to Dx asthma
- episode of airway obstruction partially reversible by:
- increase in FEV >12% from baseline
- increase predicted FEV >10%
- increase in PEV of >20%
- variation in PEV of 10% (2x a day)
MOA of short acting Beta 2 Agonists SABAs
indication?
dose?
Bind to beta 2 to relax airway smooth muscle causing dilation
short term relief of acute asthma attack
2 puff 4-6 hr. not more than 12/24hr.
Long acting Beta 2 agonist MOA
Bind to beta 2 and activate glucocorticoid receptors and enhance transcription of antiinflammatory mediators.
indication for LABAS?
- reduce frequency of asthma episode.
- ARDs in COPD
- inhaled steroids not enough to control symptoms or plateau.
- NOT FOR ACUTE Tx.
Dose of LABAs
2x/day from powdered inhaler. onset 15 min last 12 hrs. used with other controller (steroid)
MOA of Cromolyn/nedocromi:
inhibit mast cell degranulation preventing eosinophil activation.
What are other long term Tx for asthma?
cromolyn/nedocromil
corticosteroids
leukotriene antagonists
xanthine derivative
Main drug used to reduce frequency of attacks?
MOA?
dosing?
corticosteroids:
dec. mast cells, eosinophils,t lymphocytes.
dec mRNA expression of interleukins.
inhaled/oral/IV with LABAS
Leukotriene antagonist MOA?
indication
dose?
Blocks binding of leukotriene to receptor
inhibit release of leukotriene
long term control of asthma, allergy
1x a day
Xanthine derivative MOA?
inhibit phosphodiesterase which inc cAMP. inhibit bronchoconstricting prostaglandins/
indication for Xanthine
bronchodilator inc diaphragmatic strength/endurance inc min ventilation inc tase exchange/ex tolerance. anti inflammatory
ADR of Xanthine?
narrow window insomnia nervous tachycardia HTN arrhythmia inc gastric secretion.
Approach to Tx asthma?
mild SABA low corticosteroid/Leukotriene (LTRA) + SABA med steroid/LTRA/LABA + SABA med LABA and steroid high steroid laba/ med steroid LTRA High steroid+laba+oral steroid.
what is a metered dose inhaler?
puffer containing CFC that was damaging Ozone. moved to CFC free/dry powder inhaler
inhaler method?
shake
inhale 3-5 seconds while pressing in
hold for 10 seconds. repeat after 1 min.
new devices show lung deposition of ____ meaning what
55%
more effective at lower doses . particles suspended longer.
electric or battery compressor connected to cup holding liquid medication. making air mixed medication
nebulizer.
involves acute airway construction during or after exercise.
triggers?
exercise induced asthma
cold air
chlroine
CO2 emissions (ice rink)
take beta 2 15 min before or warmup/get warm.
Tx for acute status asthmatics?
IV steroids: takes 4-6 hrs Monitoring glucose/electrolyte IV theophylline Magnesium sulfate: relax smooth muscle Sedative Ketamine: Anesthetic Mechanical Ventilation He+O2
Airway obstruction and destruction of lung tissue due to smoking . caused by luminal narrowing and constant irritants making excess mucus and SOB.
cant breathe out.
also whats a small air pocket?
COPD
Bullae.
Drugs for COPD?
anticholinergics steroids Antibiotics B2 agonist. Xanthines for diaphragm Mucoltic drugs.
COPD Short acting anticholinergics MOA
competitively inhibit effect of Ach at muscarinic receptors. block contraction of airway and mucus secretion..
for COP obvi.
Dosing and ADR of short acting anticholinergics?
SAMA/SABA
combivent
dry mouth
pharangeal irritation
systemic side effects.
2 long acting muscarinic antagonists? (LAMAs)
tiotropium: 1x/d to prevent bronchospasm (spriva)
Aclidinium bromide: dry powder inhaler 2x/d long acting muscarinic antagonist. can cause paradoxical bronchospasm doe.
First LABA approved for COPD? whats effects?
ADR?
Trade name?
Indacaterol (ultra laba)
bronchodilates in 5 mins last 24 hr.
adr: cough/ nasopharyngitits
arcapta neohaler
enzymes that metabolize cAMP. what does inhibition of this have?
name?
ADR?
PDE/phosphodiesterase
inhibiting PDE-4 has anti-inflammatory effect.
(roflumilast)
ADR: diarrhea/weight loss
Therapy concerns for Anticholingergics?
tachycardia
HTN
urinary retention
dry mouth.
steroid therapy concerns?
bruising OP infection risk HTN atrophy
Beta 2 agonist therapy concerns
tremor tachycardia hypokalemia hyperglycemia angina.
