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Pharm Exam 6 > Resp 2 > Flashcards

Resp 2 Flashcards

1
Q

asthma

A

variable airflow obst - often reversible with meds

bronchial hyper-responsiveness which has various triggers (chronic airway inflammation - airway remodeling)

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2
Q

asthma epidemiology

A

most common chronic dx in kids
5,000 deaths/yr (80-90% are preventable)
most deaths occur out of hospital bc of inadequate therapy

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3
Q

asthma pathophys

A

eosinophils and mast cells

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4
Q

mediators

A

prostaglandins, thrombaxanes and leukotrienes

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5
Q

pharm targets for asthma

A

bronchodilators
anti-inflamm’s
leukotriene rec antagonists
anti-interleukin ABs

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6
Q

bronchodilators

A

B2 agonists (rescue med for acute exacerbations)
anticholinergics (less so with asthma, more COPD)
theophyline

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7
Q

anti-inflamm agents

A

inhaled GS (suppression of underlying inflammation)

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8
Q

frequency of asthma symptoms

A

intermittent (step 1) or persistent (step 2-4)

severity is mild, mod or severe

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9
Q

dx tests for asthma

A

abnormal PFTs that improve by >/= 15% after bronchodilator therapy

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10
Q

general approach to tx of asthma

A

education to pt’s/caregives
pharmacotherapy
individualization
2 main options (bronchodilators or inhaled CS)

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11
Q

strep 1

A

no long term control

SABA for quick relief PRN

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12
Q

step 2

A

long term: low-dose ICS or LTRA (montelukast)

quick relief: SABA

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13
Q

step 3

A

long term: low-dose ICS + LABA or medium dose ICS or low-dose ICS + LTRA
quick relief with SABA

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14
Q

step 4

A

long term: medium or high dose ICS + LABA
or medium/high dose ICS + LABA and/or LAMA or high dose ICS + LTRA/theophylline
quick relief with SABA

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15
Q

ICS’s asthma

A 
high dose systemic steroids are used for status asthmatics or severe asthma unresponsive to Beta agonists 
minimal toxicity at low-mod dose 
BID dosing reduces oral thrush 
1st line for persistent asthma 
doses not interchangeable
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16
Q

cholinergic antagonists asthma

A

not as potent as B2-ag’s
quaternary NH4 agents have poor abs
limits systemic abs and systemic effects
anticholinergics inhibit constrictive tone

17
Q

asthma pharmacotherapy summary

A

agents are either quick-relief or long term
anti-inflam’s are preferred for long-term control
a step-wise tx approach is preferred
SABA is used for rescue

18
Q

COPD

A

chronic bronchitis or emphysema
RF is cig smoking
inflam differs from that of asthma
has exacerbations

19
Q

chronic bronchitis

A

chronic or recurrent excessive mucus sec into bronchial tree
cough occurring most days > 3 months/yr for at least 2 consecutive yrs
blue bloaters dur to CO2 retention
percussion is resonant
BS distant to auscultation

20
Q

emphysema

A 
defined by anatomic pathology 
permanent/enlarged air spaces
destruction of alveolar walls
minimal cough
pink puffers due to tachypnea 
pursed lips compensates for loss of elastic recoil 
sitting forward to minimize E of breathing 
uses accessory mm for breathing 
hyper resonant on percussion
21
Q

COPD exacerbation

A

worsening beyond normal day-to-day variation and leads to change in meds
1-2 a yr
>80% managed outpt
severe exacerbation in hospital (accessory mm use, cyanosis, peripheral edema)
life-threatening exacerbation in ICU (AMS, worsening respiratory status, hemodynamic unstable)

22
Q

abx in COPD

A

abx for exacerbations, not prophylaxis
only effective in setting of info
used for 7-10 days

23
Q

O2 in COPD

A

low dose long-term (cont O2 has been shown to dec mortality, improves QOL and dec’s time in hospital)
nasal canal at 2-3 L/min
raise PaO2 to > 60 mm Hg is goal
avoid flames
high dose O2 inhibits resp drive so COPD pt’s may die in sleep

24
Q

stepwise drug therapy in COPD

A 
short acting inhaled bronchodilator for acute symptoms 
long acting inhaled bronchodilator 
combo anticholinergic + B-agonist 
consider theophylline 
combo inhaled CS + long acting B-agonist
25
Q

B2 agonists for asthma

A

most effective bronchodilators
indicated for intermittent bronchospasm of asthma
drug of choice for acute asthma and exercise induced bronchospasm
bronchoselectivity is inc’ed by inhalation

26
Q

Methylxanthines

A

potency is limited by narrow therapeutic index
toxic effects appear at > 15 mg/L
therapeutic range: 10-20 mg/L (note overlap!)
MOA: phosphodiesterase III and IV inhibition

27
Q

anti-interleukin

A

dec exacerbations by ~50%

possible anaphylaxis

28
Q

cholinergic antagonists COPD

A

1st line in stable COPD

fewer SE’s than with sympathomimetics (B2 agonists)

29
Q

B2 agonists for COPD

A

2nd line after anticholinergics
drug of choice in acute exacerbation
begin a trial pf B2 Ag’s if response to ipratropium is unsatisfactory

30
Q

ICS COPD

A

DO NAOT modify lung fxn decline or improve mortality
recommended for severe-v severe freq exacerbations
long term use of systemic CS is discouraged due to adverse effects

31
Q

adverse effects of ICS in COPD

A

oropharyngeal candidiasis

hoarse voice

Pharm Exam 6 (3 decks)

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