Pulmonary

Question 1

What are the goals of treating pulmonary Disorders?

Answer 1

• relief of bronchoconstriction
• Remove secretions
• improve alveolar ventilation/oxygynation
• improve breathing pattern

Question 2

Chronic inflammatory disorder which bronchi become hyper-reactive from allergens, chemicals, exercise, cold air

Answer 2

Asthma

Question 3

how does asthma work?

Answer 3

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.

Question 4

Criteria to Dx asthma

Answer 4

• 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)

Question 5

MOA of short acting Beta 2 Agonists SABAs

indication?

dose?

Answer 5

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.

Question 6

Long acting Beta 2 agonist MOA

Answer 6

Bind to beta 2 and activate glucocorticoid receptors and enhance transcription of antiinflammatory mediators.

Question 7

indication for LABAS?

Answer 7

• reduce frequency of asthma episode.
• ARDs in COPD
• inhaled steroids not enough to control symptoms or plateau.
• NOT FOR ACUTE Tx.

Question 8

Dose of LABAs

Answer 8

2x/day from powdered inhaler. onset 15 min last 12 hrs. used with other controller (steroid)

Question 9

MOA of Cromolyn/nedocromi:

Answer 9

inhibit mast cell degranulation preventing eosinophil activation.

Question 10

What are other long term Tx for asthma?

Answer 10

cromolyn/nedocromil
corticosteroids
leukotriene antagonists
xanthine derivative

Question 11

Main drug used to reduce frequency of attacks?

MOA?

dosing?

Answer 11

corticosteroids:

dec. mast cells, eosinophils,t lymphocytes.
dec mRNA expression of interleukins.

inhaled/oral/IV with LABAS

Question 12

Leukotriene antagonist MOA?

indication

dose?

Answer 12

Blocks binding of leukotriene to receptor
inhibit release of leukotriene

long term control of asthma, allergy

1x a day

Question 13

Xanthine derivative MOA?

Answer 13

inhibit phosphodiesterase which inc cAMP. inhibit bronchoconstricting prostaglandins/

Question 14

indication for Xanthine

Answer 14

bronchodilator
inc diaphragmatic strength/endurance
inc min ventilation
inc tase exchange/ex tolerance.
anti inflammatory

Question 15

ADR of Xanthine?

Answer 15

narrow window insomnia
nervous
tachycardia
HTN
arrhythmia
inc gastric secretion.

Question 16

Approach to Tx asthma?

Answer 16

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.

Question 17

what is a metered dose inhaler?

Answer 17

puffer containing CFC that was damaging Ozone. moved to CFC free/dry powder inhaler

Question 18

inhaler method?

Answer 18

shake
inhale 3-5 seconds while pressing in
hold for 10 seconds. repeat after 1 min.

Question 19

new devices show lung deposition of ____ meaning what

Answer 19

55%

more effective at lower doses . particles suspended longer.

Question 20

electric or battery compressor connected to cup holding liquid medication. making air mixed medication

Answer 20

nebulizer.

Question 21

involves acute airway construction during or after exercise.

triggers?

Answer 21

exercise induced asthma

cold air
chlroine
CO2 emissions (ice rink)

take beta 2 15 min before or warmup/get warm.

Question 22

Tx for acute status asthmatics?

Answer 22

IV steroids: takes 4-6 hrs
Monitoring glucose/electrolyte
IV theophylline
Magnesium sulfate: relax smooth muscle
Sedative
Ketamine: Anesthetic
Mechanical Ventilation
He+O2

Question 23

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?

Answer 23

COPD

Bullae.

Question 24

Drugs for COPD?

Answer 24

anticholinergics
steroids
Antibiotics
B2 agonist. 
Xanthines for diaphragm
Mucoltic drugs.

Question 25

COPD Short acting anticholinergics MOA

Answer 25

competitively inhibit effect of Ach at muscarinic receptors. block contraction of airway and mucus secretion..
for COP obvi.

Question 26

Dosing and ADR of short acting anticholinergics?

Answer 26

SAMA/SABA
combivent

dry mouth
pharangeal irritation
systemic side effects.

Question 27

2 long acting muscarinic antagonists? (LAMAs)

Answer 27

tiotropium: 1x/d to prevent bronchospasm (spriva)

Aclidinium bromide: dry powder inhaler 2x/d long acting muscarinic antagonist. can cause paradoxical bronchospasm doe.

Question 28

First LABA approved for COPD? whats effects?
ADR?
Trade name?

Answer 28

Indacaterol (ultra laba)

bronchodilates in 5 mins last 24 hr.

adr: cough/ nasopharyngitits

arcapta neohaler

Question 29

enzymes that metabolize cAMP. what does inhibition of this have?

name?

ADR?

Answer 29

PDE/phosphodiesterase

inhibiting PDE-4 has anti-inflammatory effect.

(roflumilast)

ADR: diarrhea/weight loss

Question 30

Therapy concerns for Anticholingergics?

Answer 30

tachycardia
HTN
urinary retention
dry mouth.

Question 31

steroid therapy concerns?

Answer 31

bruising
OP
infection risk
HTN
atrophy

Question 32

Beta 2 agonist therapy concerns

Answer 32

tremor
tachycardia
hypokalemia
hyperglycemia
angina.