respiratory Flashcards
1
Q
what is asthma?
- chronic inflammatory disease of the _____ and _____ tissue
- airway changes:
- -the muscles surrounding the bronchial tubes _____, airways _____
- -the lining of the airway becomes _____ and _____
- -there is an increase in _____ production
A
bronchial tubes lung constrict narrow inflamed swollen mucus
2
Q
asthma triggers
- respiratory infections-viral, _____
- allergens-pollens, _____, animal dander
- _____ (_____)
- work stimuli-flour, farmers hay mold
- environment–_____ air, _____ smoke
- emotions- _____, _____
- _____- especially in _____ climate
- drugs/preservatives- _____, _____, _____
A
pneumonia dust mites gastroesophageal reflux (GERD) cold tobacco anxiety stress exercise cold dry ASA sulfites beta blockers
3
Q
signs and symptoms
- use of _____ muscles (_____, _____ and _____ of the neck)
- _____ pulse (weak during _____ and strong during _____)
- over inflation of the _____
- _____ color of skin and nails may indicate _____
- responds to standard treatment with _____ and _____
- _____: mortality rate 70%
A
accessory sternocleidomastoid external intercostals scalene muscles paradoxical inspiration expiration chest blue cyanosis bronchodilators steroids status asthmaticus
4
Q
asthma
- clinically: recurrent episodic bouts of _____
- two phases:
- –acute-phase (_____) response
- –within a _____ to _____ challenge
- –_____, _____, _____ tightness, _____
- –lasts a few hours
- -late phase response (_____)
- –chronic _____, _____
- –occurs in 2 ot 6 hours and lasts up to _____ to _____ hours
A
bronchospasm immediate few mins antigen bronchospasm shortness of breath chest wheezing inflammation wheeze hyper-responsiveness 12 24
5
Q
immediate (acute) phase
- bronchial smooth muscle constriction
- -mediator release from _____ cells and other immunologic responses
- –_____; _____ factors
- –_____ (LTB4; LTC4; LTD4; LTE4)
- —LTB4- is a _____
- –_____, neutral _____, _____ (D2)
- –reversible with treatment
- –short term relief with _____
- –_____ may help in allaying symptoms
A
sensitized mast histamine eosinophil chemotactic leukotrienes chemo-attractant tryptase proteases prostaglandins bronchodilators oral steroids
6
Q
late phase response
- peak within 4-8 hours and may last for 12-24 hours
- _____ characterized by cellular _____
- -_____, _____, GM-CSF (_____ CSF)
- –releases of _____ (IL4, IL5, IL9, I30, TNF, TGF) which activate _____ and _____
- -activated _____ and _____
A
chronic inflammation infiltration mast cells lymphocytes granulocyte macrophage cytokines eosinophils neutrophils eosinophils neutrophils
7
Q
goals of asthma therapy
- prevent troublesome symptoms- _____, _____ in night, am, after _____
- maintain normal _____ function
- maintain normal activity
- prevent recurrent _____/_____
- optimal drug therapy with no side effects
A
cough breathlessness exercise exacerbations hosp
8
Q
pharmacologic agents for asthma
- quick-relief (rescue) medications
- -agents that directly relaxes _____; prompt reversal of acute airflow obstruction
- -_____ (short acting _____)
- -_____ (Ventolin); _____
- anticholinergics
- -_____ (atrovent); _____ (Spiriva)
- corticosteroids:
- -_____, _____, _____
A
bronchial smooth muscles SABA beta agonist albuterol terbutaline ipratropium tiotropium fluticasone prednisone triamcinolone
9
Q
pharmacologic agents for asthma long-term control (controller) medications: -corticosteroids, inhaled: --\_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_ -LABA (long acting beta2 agonist) --\_\_\_\_\_ (serevent); \_\_\_\_\_; \_\_\_\_\_/\_\_\_\_\_ (Advair) -leukotriene receptor antagonist (LTRA) --\_\_\_\_\_ (Singulair); \_\_\_\_\_ (Accolate) -5-lipoxygenase inhibitors --\_\_\_\_\_ (Zyflo) -mast cell stabilizer (also inhibits \_\_\_\_\_; recruitment) --\_\_\_\_\_ (Gastrocrom); \_\_\_\_\_ (Alocril) -methylxanthines --\_\_\_\_\_ -immunomodulators -\_\_\_\_\_ (Xolair)
A
beclomethasone budesonide fluticasone salmeterol formoterol salmeteral/flunisolide montelukast zirfarlulast zileuton eosinophi cromolyn nedocromil theophylline omalizumab
10
Q
types of asthma
- _____: patients with episodic illness with extended symptom-free periods
- _____ or _____: daily symptoms or symptoms several times/week without extended symptom free periods
- _____: daily symptoms during an allergy season (also referred to as “seasonal”) asthma
A
intermittent
persistent
chronic
allergic
11
Q
status asthmaticus acute severe asthma -life threatening emergency -requires rapid, aggressive treatment -immediate treatment: --activate office emergency protocol --\_\_\_\_\_ by mask ---\_\_\_\_\_ to help liquefy mucus --\_\_\_\_\_ --patients will require \_\_\_\_\_
A
oxygen
humidified air
albuterol
hospitalization
12
Q
symptoms of poorly controlled persistent asthma
- waking up at night > _____/month
- refilling _____ (_____) >1/month
- exercise-induced _____
- missing _____
- missing _____
- _____
A
2 albuterol ventolin bronchoconstriction school work hospitalization
13
Q
quick relief medication RELIEVER/RESCUE
- non-selective beta-2 agonist: _____, _____
- short-acting beta2-agonists: _____, _____
- _____
- systemic _____
A
epinephrine isoproterenol terbutaline albuterol anticholinergics corticosteroids
14
Q
beta 2-agonists (albuterol)
- relax airway _____ or relieve _____
- used for treatment of _____ episodes of _____ and prevention of _____-induced asthma
- for _____ asthmatic attack
- _____
- _____ (Ma Huang)
- _____
A
smooth muscle bronchospasm intermittent bronchospasm exercise acute epinephrine ephedrine isoproterenol
15
Q
beta 2 agonists beta-adrenoceptor agonists -mechanism of action --stimulate B2 receptor \_\_\_\_\_ ---activate \_\_\_\_\_ ---increase \_\_\_\_\_ ---\_\_\_\_\_ activation ---inactivation of \_\_\_\_\_ -result in \_\_\_\_\_ response by relaxation of bronchial smooth muscle
A
G protein coupled receptor system adenylyl cyclase cAMP protein kinase A myosin light chain kinase bronchodilator
