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
16
Q
adverse effects beta-adrenoceptor agonists adverse effects -skeletal muscle \_\_\_\_\_ -\_\_\_\_\_ at high doses -\_\_\_\_\_ with excessive use -loss of \_\_\_\_\_ -\_\_\_\_\_ -\_\_\_\_\_: excessive use of short-acting sympathomimetics
A
tremors tachycardia arrhythmias responsiveness tolerance tachyphylaxis
17
Q
beta 2 agonists short acting -\_\_\_\_\_ (Proventil, Ventolin) -\_\_\_\_\_ (bricanyl, brethine) -\_\_\_\_\_ (alupent, metaprel)
pharmacokinetics:
- rapid onset of action 15-30 mins
- peak effect in 30-60 mins
- duration of action: 4-6 hours
A
albuterol
terbutaline
metaproterenol
18
Q
anticholinergics
- _____ (atrovent), _____ (Spiriva)
- blockade of these cholinergic receptors decreases the formation of _____ (_____), resulting in decreased contractility of smooth muscle
- _____
A
ipratropium
tiotropium
cyclic guanosine monophosphate (cGMP)
bronchodilation
19
Q
anticholinergic drugs
muscarinic antagonists
-effects (_____)
–effective in 33% of patients
–not well absorbed into circulation - _____ compounds
–more effective and less toxic than _____ in COPD patients
- pharmacokinetics (_____)
- -_____ delivery, minimally absorbed systemically
- -_____ metabolized, little system action
- -excessive doses - _____ like effects
- -does not cause _____ or _____
A
inhalation quarternary ammonium beta agonists localized rapidly atropine tremor arrhythmias
20
Q
systemic corticosteroids
- used for _____ exacerbations
- _____, _____, _____
- decrease _____ and improve _____ production
- oral or _____
A
moderate-to-severe hydrocortisone prednisone dexamethasone inflammation mucus IV
21
Q
corticosteroids
mechanism of action
-bind to intracellular receptors and activate _____ (GRE) in the cell nucleus
–reduce the activity of _____ and inhibit _____ expression (prostaglandin production) and LOX (lipooxgenase) production
- mechanism of action
- -inhibits _____
- -inhibit expression of _____
- -inhibit expression of _____
- -_____ stabilization
A
glucocorticoid response element phospholipase A 2 COX-2 phospholipase A2 COX-2 LOX membrane
22
Q
controller medications
- inhaled _____
- long acting _____
- _____ modifiers
- slow-release _____
A
corticosteroids
B2 agonists
leukotriene
theophylline
23
Q
inhaled corticosteroids agents -\_\_\_\_\_ (Rhinocort) -\_\_\_\_\_ (belcovent) -\_\_\_\_\_ (Flonase, Flovent) -\_\_\_\_\_ (Nasacort) -\_\_\_\_\_ (omnaris): most recently approved inhaled steroid is an ester prodrug which converts into \_\_\_\_\_ in the lower bronchial epithelium
- adverse effects
- -deposition of drugs in mouth and upper airway lead to _____ (_____)
A
budesonide beclomethasone fluticasone triamcinolone ciclesonide des-isobutyrylciclesonide oral candidiasis (thrush)
24
Q
adverse effects (inhalation)
- occasionally, small degree of _____ (rarely significant)
- _____
- -rinse mouth
- children, mild growth retardation
adverse effects (oral)
- _____, _____, _____
- -_____ suppression, can be reduced by alternate-day therapy
A
adrenal suppression oropharyngeal candidiasis osteoporosis cataract hypertension adrenal
25
Q
long-acting inhaled beta 2 agonists
- _____ (oxeze) and _____ (serevent)
- adjunct therapy to _____
- available alone and as combination therapy with _____
- especially helpful for a night time symptoms and _____ induced asthma
- not to be used to treat acute symptoms or _____
A
formoterol salmeterol inhaled steroids steroids exercise exacerbations
26
Q
leukotriene antagonists
- _____ (5-lipo-oxygenase inhibitor)
- _____
- block _____ receptors that mediate airway _____, edema, _____ and secretion of thick, viscous mucus
- administered _____
- clinical application
- -_____, _____ and treatment
- -NOT useful during _____ attack or _____
A
zileuton zyflo leukotriene inflammation btonchoconstriction orally acute status asthmaticus
27
Q
leukotrienes modifiers
- _____ (Montelukast), _____ (Zafirlukast)
- they prevent binding of _____ to target tissues preventing _____, mucosal edema, bronchial hyper-reactivity
- beneficial in patients with exercise - induced bronchospasm (already on _____) and patients with _____
A
Singulair accolate leukotrienes bronchoconstriction environmental allergies
28
Q
leukotrienes modifiers
- _____ (Singulair) and _____ (accolate)
- selective and competitive leukotriene receptor antagonist
- -_____: LTC4, LTD4, LTE4
- -_____: LTC4, LTD4, LTE4
- clinical application
- -_____, prophylaxis and treatment
- -NOT useful during _____ attack or _____
A
montelukast zafirluast montelukast zafirluast asthma acute status asthmaticus
29
Q
theophylline
- class of _____
- _____, _____ and _____
- mild to moderate _____
- may have mild _____ effects and _____ effects
- enhances _____ secretion
- serum levels measurable
A
methyl-xanthines theophylline theobromine caffeine bronchodilator anti-inflammatory immunosuppressant catecholamine
30
Q
theophylline
- variable t1/2 life- reduced in _____ and _____ age 1 to 9
- metabolism by _____- watch drug interactions
- -_____: severely decreases clearance of theophylline
adverse effects:
- GI (_____), CNS (_____) and cardiac stimulation (_____)
- CNS effects- restlessness, _____, dizziness, _____
- death!!
A
smokers children CYP450 ciprofloxacin diarrhea convulsions arrhythmias insomnia seizures
31
Q
mast cell stabilizers
- _____ (intal)
- stabilize mast cell _____
- not effective during an _____ asthma attack
- prevents mast cells from rupturing and spilling _____ (degranulation) after initial contact with _____
- administered via _____ or _____ spray
- -prevent release of _____
- -has no intrinsic _____ activity
- -has no _____ activity
A
cromolyn sodium membrane acute histamine antigen inhalation intranasal inflammatory mediators bronchodilator antihistamine
32
Q
mast cell stabilizer
-_____ (disodium cromoglycate) and _____
clinical uses:
- _____ (inhalation)
- -especially in children
- _____ (oral)
- _____ (hay fever)
- -_____ irritation
- -_____ irritation
A
cromolyn nedocromil asthma food allergy topical conjunctival nasopharyngeal tract
33
Q
anti-IgE antibodies
- omalizumab (Xolair)
- -_____ developed through molecular biology research (mice)
- -binds to _____ on the surface of _____ and _____ but foes not activate already bound IgE, thus does not _____ cells
- -indicated for moderate to severe cases which are inadequately controlled by _____
- -used in asthma reactive to a specific _____
A
monoclonal antibody IgE mast cells basophils degranulate inhaled corticosteroids allergen
34
Q
anti-IgE antibodies
- omalizumab (Xolair)
- -administered via _____ injection every 3 or 4 weeks
- -lowers _____ to undetectable levels, m reducing early as well as late _____ response
- -adverse effects:
- –injection site reaction (_____)
- –_____; _____; myopathy
- –_____ reaction
A
subcutaneous IgE bronchial thrombophlebitis pharyngitis earache anaphylactic
35
Q
beta blockers
- inducers of _____
- used for Rx _____/_____
- blocking beta 2 receptors in airways with nonselective beta blockers (propranolol)
- selective beta blockers (cardio-selective blockers) preferred: _____
- less _____ than nonselective beta blockers
A
bronchoconstriction
hypertension
arrhythmias
atenolol
36
Q
drug-induced bronchospasm
- ASA and NSAIDs
- -can induce severe _____
- sulfites: _____
- ACE inhibitors
- -can cause cough (_____)
- -cough is due to release of _____
- in asthmatics… since cough is a symptom of asthma and a side effect of _____ use these drugs carefully
A
bronchospasm preservatives lisinopril prostaglandins ACE inhibitors
