Respiratory 2 Flashcards
chronic obstructive pulmonary disease (COPD)
- COPD is generally used to describe patients with one or more of the following
- -_____
- -_____
- -_____
chronic bronchitis
emphysema
asthma
COPD
- excessive _____, _____ production and _____
- symptoms have been present for >10 years
- destruction of the walls with _____ distortion
- loss of _____
- large (central) airways, the small (peripheral) bronchioles and the lung _____ affected
- the primary offender: _____
- PMN leukocytes and macrophages release _____ resulting in lung parenchymal destruction
cough sputum dyspnea fibrotic elastic recoil parenchyma human leukocyte elastase elastases
pathophysiology and natural course
- enlarged _____
- dilated _____
- inflammation in _____
- mucus _____
- _____ distortion
mucus glands bronchial gland ducts bronchioles plugging fibrotic
COPD treatment goals
- improve a patients _____ status and QOL
- preserve optimal _____
- prevent the recurrence of _____
- treatment is guided by severity
- -reduction of risk factors: _____ cessation; _____ vaccine (vaccination)
- -_____ rehabilitation: graded aerobic physical exercise programs
- -_____ agents
- -_____
- -_____
- -_____ options
functional lung function exacerbations smoking influenza cardiopulmonary pharmacologic oxygen antibiotics surgical
COPD pharmacological agents
- beta 2 agonists: SABA; LABA
- anticholinergic agent: _____; _____
- methylxanthines: _____ (nonspecific PDE inhibitor)
- PDE Type 4 inhibitors: _____ (Ariflo) and _____ (Daxas, Daliresp)
- _____
- mucolytic agents: _____, _____
- _____
- _____ therapy
ipratropium tiotropium theophylline cilomilast rofulmilast corticosteroids guaifenesin acetylcysteine antibiotics oxygen
medications
- bronchodilators:
- -_____
- -_____
- -_____
- glucocorticoids
- _____
- oxygen
- respiratory stimulants
- _____
- vaccinations
- lifestyle modification
anticholinergics B2 agonists methyxanthines mucolytics antibiotics
anticholinergics
- _____ (atrovent)
- -relaxation of _____ by inhibition of _____
- -bronchodilating effects are equal to or more than _____
- _____ (Spiriva) once daily
- combivent = _____ + _____
ipratropium bronchial smooth muscle cGMP beta agonists tiotropium salbuterol ipratropium
long acting B2 agonists
_____ (serevent)
-approved for use in _____ I997
-_____ puffs _____ vs. ipratropium _____ puffs _____
–equivalent or superior to _____, greatest benefit in those with _____ response
salmeterol COPD 2 BID 2 QID ipratropium bronchodilator
corticosteroids
- controversial in COPD
- only appropriate for symptomatic patients with _____ and _____
- long-term treatment with oral steroids is not recommended
moderate
severe COPD
mucolytics
- _____ (Mucomyst)
- pharmacotherapeutics:
- -break up thick, _____ in patients whose physical condition makes it difficult to cough up these secretions
- -antidote for severe _____ (_____) overdosage
- most frequently given by _____
- fast-acting drug, with onset of action within _____
acetylcysteine tenacious sputum acetaminophen tylenol nebulizer 1 minute
expectorants
- _____ (mucinex, Buckleys)
- decreases the _____ of secretions
- _____ can be more easily coughed up
- available in many _____ preparations
guaifenesin
viscosity
serous secretions
OTC
antitussives \_\_\_\_\_ (DM) -used to suppress the \_\_\_\_\_ when chronic nonproductive coughing accompanies a disorder of the respiratory tract -\_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_ -\_\_\_\_\_ containing -side effects: \_\_\_\_\_
dextromethorphan cough reflex benylin robitussin coricidin morphine constipation
antihistamines
sedating: _____ (Benadryl)
- non-sedating: _____ (Claritin)
- block the _____ receptor sites, preventing histamine action when an antigen is encountered
- restores normal air flow through the _____
- many available OTC
diphenhydramine
loratadine
H1
upper respiratory system
histamine (autacoid-local hormone)
- mediates a range of cellular responses
- -_____
- -_____ reactions
- -_____ secretions
- -_____ in CNS
- has no clinical application
- clinically we block its actions
- -_____
allergies inflammatory gastric acid neurotransmission antihistamines
histamine receptors
-two receptor types: H1 and H2
H1 receptors:
- _____ reactions:
- -_____, _____, _____, etc
- smooth muscle and _____
- -_____ (hypotension); _____, _____; redness, hives and inflammation
- sensory nerve endings: _____, _____
H2 receptors:
-gastric mucosa: _____ gastric secretion
allergic dermatitis rhinitis conjunctivitis endothelium vasodilation bronchoconstriction edema itching pain increase
histamine antagonist
- antihistamines
- -are effective if they are able to block receptors _____ histamine release can occur:
- -_____ use provides optimum benefit
- -_____: refers to classis H1 receptor blocked
- –as compare to _____
before
prophylactic
antihistamine
H2 antagonist
histamine antagonist
- receptor antagonists- _____ at the _____ receptor
- H1 receptor antagonist (_____)
- -_____ (Benadryl)
- -_____ (atarax)
- H2 receptors antagonist (ulcers)
- -_____ and _____
competitive antagonists histamine antihistamines diphenhydramine hydroxyzine cimetidine ranitidine
H1 receptor antagonists
- first generation
- -chloropheniramine
- dimenhydrinate
- -_____
- -_____
- -_____
- -meclizine
- -distributed in CNS
- –_____
second generation
- astemizole
- cetirizine
- loratadine
- terfenadine
- do not cross _____
intra-nasal
-_____
diphenhydramine promethazine hydroxyzine sedation BBB azelastine
H1 receptor antagonists
first generation
pharmacological effects:
-_____: block central H1 receptors
-most sedating are _____, _____, _____
-clinical uses: _____ and _____, _____, vertigo
-clinical uses (more sedating agents): _____ inducing agent, _____, _____
sedation diphenhydramine hydroxyzine promethazine nausea vomiting motion sickness sleep preoperative sedative anti-anxiety
H1 receptor antagonists first generation effects: -anticholinergic --anti-\_\_\_\_\_ effect by blocking the \_\_\_\_\_ center) - \_\_\_\_\_ (Benadryl)
local anesthetics
-mechanism: in part block _____ influx to _____
motion sickness vomiting diphenhydramine Na nerve
H1 receptor antagonists first generation clinical uses: -\_\_\_\_\_ --allergies but not asthma --\_\_\_\_\_ as adjunctive to oxygen and epinephrine ---\_\_\_\_\_ ---\_\_\_\_\_
antihistaminic
anaphylaxis
diphenhydramine
chlorpheniramine
H1 receptor antagonists first generation clinical uses: -\_\_\_\_\_: --diphenhydramine has direct effect on the cough center in the medulla of the brain
- _____:
- -used in Parkinson patients, blocks central muscarinic receptors (_____)
- _____:
- -diphenhydramine by inhibiting the central chemoreceptor trigger zone (CTZ)
- dimenhydrinate (dramamine, gravol)
antitussives
antidyskinetic
procyclidine
antiemetic
all antihistamines: torsade de pointes
- prolonged _____ interval on the ECG
- drug interactions
- -drugs that increase serum concentration of _____
- –inhibition of _____
- –macrolide antibiotics (_____)
- –_____ (azole anti fungal)
QT anti-histamine cytochrome P450 erythromycin ketoconazole
antihistamines- drug interactions
- CNS depressants
- -_____, _____
- anticholinergics: _____
- drugs prolonging QT intervals
- -macrolide _____, azole _____, _____ agents
- -_____ juice
- -increase plasma drug concentration
- _____ (MAOI)
alcohol antidepressants atropine antibiotics antifungals calcium channel blocking grapefruit monoamine oxidase inhibitors
H2 receptor antagonists
- _____ (Tagamet)
- _____ (Zantac, tritec)
- _____ (Pepcid)
cimetidine
ranitidine
famotidine
