Respiratory Flashcards
______: chronic inflammatory disease of the bronchial tubes and lung tissue
airway changes:
the muscles surrounding the bronchial tubes ______, airways _____
- the lining of the airway becomes ______ and _____
-there is an increase in ____ production
asthma
constrict, narrow
inflamed, swollen
mucus
asthma triggers
- respiratory infections - ____, _____
- ______ - pollens, dust mites, animal dander
- ______
- work stimuli - ____, farmers hay ____
- ________ - cold air, tobacco smoke
- emotions - _____ & ____
- exercise - especially in ____ ____ climate
- drugs/preservatives - ___, ____
viral, pneumonia allergens GERD flour, mold environment anxiety, stress cold, dry ASA, sulfites, beta blockers
signs and symptoms
-use of accessory muscles
(_______, _____ intercostals, and _____ muscles of the neck)
-__________ pulse (weak during _______ and strong at _______)
-over inflation of the ____
-___ color of skin and nails may indicate cyanosis
-responds to standard treatment with _______ and
____
-___________: mortality rate 70%
sternocleidomastoid, external, scalene paradoxical inspiration expiration chest blue bronchodilators, steroids status asthmaticus
asthma
clinically: recurrent episodic bouts of ______
two phases
-acute-phase (________) response
-within a few minutes to ______ challenge
-________, ________, ________, ______-
-lasts a few hours
late-phase response (_______)
- ______ wheeze, hyper-responsiveness
- occurs in _ to _ last up to 12 to 24 hours
bronchospasm immediate bronchospasm, SOB, chest tightness, wheezing inflammation chronic 2,6
immediate (acute) phase bronchial smooth muscle constriction -mediator release from sensitized \_\_\_\_ cells and other immunologic reponses -\_\_\_\_\_\_\_\_; eosinophil chemotatic factors -\_\_\_\_\_\_\_\_\_- (LTB4, LTC4, LTD4, LTE4) -\_\_\_\_\_- is a chemo-attractant -\_\_\_\_\_\_\_, neutral \_\_\_\_, \_\_\_\_\_\_\_\_\_ (D2) -\_\_\_\_\_\_ with treatment -short term relief with \_\_\_\_\_\_\_ -\_\_\_\_\_\_\_ may help in allaying symptoms
mast histamine leukotrienes LTB4 tryptase proteases reversible prostaglandins bronchodilators oral steroids
late phase response
-peak within ___ hours and may last for ____ hrs
-chronic inflammation characterized _________
-mast cells, lymphocytes, GM-CSF (granulocyte, macrophage
CSF)
-release of _______ (IL4, IL5, IL9, 130, TNF, TGF) which activate ________ & _______
4-8, 12-24
cellular infiltration
cytokines
eosinophils, neutrophils
goals of asthma therapy
- prevent troublesome symptojms: cough, breathlessness in night, am, after exercise
- _______ normal lung func tion
- maintain normal activity
- prevent recurrent ________/hosp
- optimal ____ therapy w no side effects
maintain
exacerbations
drug
quick-relief (rescue) medications: -agents that directly relaxes bronchial smooth; prompt \_\_\_\_\_ of acute airflow obstruction -SABA (short acting beta agonist) -\_\_\_\_\_\_\_\_ (ventolin); \_\_\_\_\_\_\_\_ anticholinergics -\_\_\_\_\_\_\_\_ (Atrovent); \_\_\_\_\_\_\_\_ (spiriva) corticosteroids -\_\_\_\_\_\_\_, prednisone, triamcinolone
reversal albuterol, terbutaline ipratropium tiotropium fluticasone
pharmacologic agents for asthma
long-term control (controller) medications
-__________, inhaled - beclomethasone, budesonide, fluticasone
-______ (________) - salmeterol (serevent), formoterol; salmeteral/flunisolide
(Advair)
-__________ inhibitors
zileuton (Zyflo)
- ________ stabilizer (also inhibits eosinophi; recruitment)
cromolyn (gastrocom); nedocromil (alocrif)
-________ - theophylline
-________ - omalizumab (xolair)
corticosteroids LABA (long acting beta 2 agonist) leukotriene receptor antagonist (LTRA) 5-lipoxygenase inhibitors mast cell stabilizer methylxanthines immunomodulators
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)
intermittent
persistent/chronic
allergic
status asthmaticus
- acute ____ asthma
- life threatening emergency
- requires rapid, and aggressive treatment
immediate treatment
- activate office emergency protocol
- oxygen by ____
- humidified air to help _____ mucus
- _____
- patients will require hospitilization
SEVERE
mask
liquefy
albuterol
symptoms of poorly controlled persistent asthma
- waking up at night >_/month
- refilling albuterol (ventolin) > __ time a month
- _______ bronchoconstriction
- missing _____
- missing ___
- _______
2 1 excercise induced school work hospitilization
quick relief medication reliever/rescue
- non-selective beta 2 agonist: _______, _________
- short acting beta2-agonists: ________, _______
- _________
- _____________
epinephrine, isoproterenol
terbutaline, albuterol
anticholinergics
systemic corticosteroids
beta 2- agonists (albuterol)
- relax airway smooth or relieve _______
- used for treatment of ______ episodes of bronchospasm and prevention of _______ d asthma
- for acute asthmatic attack
- ________
- _______ (ma huang)
- __________
bronchospasm intermittent exercise induced epinephrine ephedrine isoproterenol
beta-2 agonists -beta-adrenoceptor agonists mechanism of action -stimulate \_\_\_ receptor \_\_\_\_\_\_\_\_\_\_ coupled receptor system -activate \_\_\_\_\_\_\_\_ -increase \_\_\_ -protein \_\_\_\_\_\_\_ activation -inactivation of \_\_\_\_\_\_\_ kinase -results in bronchodilator response by relaxation of bronchial smooth muscle
b2 G protein adenylyl cyclase cAMP kinase A myosin light chain
beta-adrenoceptor agonists adverse effects -\_\_\_\_\_ muscle tremors -\_\_\_\_\_\_ at high doses -\_\_\_\_\_ with excessive use -loss of responsiveness -\_\_\_\_\_ -\_\_\_\_\_\_\_: excessive use of short acting sympathomimetics
skeletal tachycardia arrythmias tolerance tachyphylaxis
beta-2 agonists short acting -\_\_\_\_\_\_\_ (Proventil, Ventolin) -\_\_\_\_\_\_\_\_ (Bricanyl, Brethine) -\_\_\_\_\_\_\_\_ (Alupent, Metaprel) Pharmacokinetics: -rapid onset of action 15-30 mins -peak effect in 30-60 -duration of action: 4-6 hours
albuterol
terbutaline
metaproterenol
anticholinergics
- _________(atrovent), _________(spiriva)
- blockade of these cholinergic receptors decreases the formation of ____, resulting in decreased _______ of smooth muscle
- ________
ipratropium tiotropium cGMP contractility bronchodilation
anticholinergic drugs
_______ antagonists
-effects (inhalation)
-effective in 33% of patients
-not well absorbed into ________ - quarternary ammonium compounds
-more effective and less toxic than ________ in COPD patients
pharmacokinetics (inhalation)
- _______ delivery, minimally absored ________
- rapidly ________, little systemic action
- excessive doses - ______ like effects
- does not cause _____ or _______
muscarinic circulation beta agonists localized systemically metabolized atropine tremor or arrythmias
systemic corticosteroids
- used for _____ to ____exacerbations
- _________, ________, ________
- decrease inflammation and improve mucus production
- ___ or ____
moderate, severe
hydrocortisone, prednisone, dexamethasone
oral, IV
corticosteroids
mechanism of action
-bind to intracellular receptors. and activate ____ in the cell nucleus
-reduce the activity of ________ and inhibit ____ expression (prostaglandin production) and _____ (lipooxygenase production)
mechanism of action
-inhbits phospholipase A2, COX, LOX and membrane ________
GRE phospholipase 2 COX-2 LOX stabilization
In COX pathway, what do you give to treat?
NSAIDs bc releasing prostaglandins and thromboxanes
and you can give corticosteroids
In LOX pathway, what do you give to treat?
corticosteroids
controller medications
- _____________
- _____
- _________
- ___________
inhaled corticosteroids
LABA
leukotriene modifiers
slow-release theophylline
controller meds inhaled corticosteroids agents -\_\_\_\_\_\_\_\_\_ (rhinocort) -\_\_\_\_\_\_\_\_ (belcovent) -\_\_\_\_\_\_\_\_\_\_\_ (flonase, flovent) -\_\_\_\_\_\_\_\_\_\_\_ (nasacort) -\_\_\_\_\_\_\_\_. (omnaris): most recently approved inhaled steroid is an ester \_\_\_\_ which converts into des-isobutryclicesonide in the \_\_\_\_\_\_ bronchial epithelium
adverse effects
-deposition of drugs in mouth and upper airway lead to oral _________ (_____)
budesonide beclomethasone fluticasone triamcinolone ciclesonide prodrug lower candidiasis (thrush)
adverse effects of inhaled corticosteroids
inhalation
-occasionally, small degree of ______ suppression (rarely significant)
-____________
-rinse mouth
-children, mild growth _____
adverse effects oral
- ________, _______, _______
- _____ suppression, can be reduced by alternate day theapy
adrenal oropharyngeal candidiasis retardation osteoporosis, cataract, hypertension adrenal
controller meds
LABA - long acting inhaled eta 2 agonists
-________ (oxeze). and _______ (serevent)
-adjucnt therapy to inhaled steroids
-available ___ and as combination therapy with ______
-espepcially helpful for ___ time symptoms and _____ induced asthma
-not to be used to treat ___ symptoms or _______
formoterol salmeterol alone steroids night exercise acute exacerbation
controller meds leukotriene antagonists -\_\_\_\_\_\_\_\_ (5-lipo-oxygenase inhibitor) -\_\_\_\_ -block leukotriene receptors that mediate airway inflammation, \_\_\_\_, \_\_\_\_\_\_\_\_\_, and secretion of thick viscous \_\_\_\_ -administered \_\_\_\_\_ clinical application -\_\_\_\_\_\_\_, \_\_\_\_\_\_\_ and treatment NOT useful for \_\_\_\_ attack or \_\_\_\_\_\_\_\_\_
zileuton zyflo edema, bronchoconstriction, mucus orally asthma, propholaxis acute status asthmaticus
controller meds
leukotriene modifiers
-________ (motelukast), _______ (zafirlukast)
-they prevent _____ of leukotrienes to target tissues preventing bronchoconstriction, mucosal edema, bronchial hyper reactivity
-beneficial in patients with _____ induced bronchospasm (already on ______) and patients with ______ allergies
^^ above drugs
-______and ______ leukotriene antagonist
clinical application
- asthma, prophylaxis and treament
- NOT useful for accute attack or status asthmaticus
singulair accolate binding exercise steroids environmental
selective, competitve
controller meds
theophylline
class of __________
- theophylline, ________, and ____
- ___ to ____ bronchodilator
- may have mild anti ________ effects and _______ effects
- enhances _____ secretion
- serum levels measurable
- ________ half life - reduced in _______ and children ages 1-9
- metabolism by CYP 450 - watch drug interactions
- _______ - severely decreases clearance of theophylline
adverse effects
GI (______), CNS (_______), and cardiac stimulation (________)
-CNS effects - restlessness, insomnia, dizziness, seizures
-____!!!
methylxanthines mild, moderate inflammatory immunosuppressant catecholamine variable smokers ciprofloxacin diarrheda, convulsions arrythmias death
controller meds mast cell stabilizers \_\_\_\_\_\_\_\_\_ (Intal) -stabilize mast cell membrane -NOT effective during acute asthma attack -prevents mast cells from rupturing and spilling \_\_\_\_\_\_\_ (degranulation) after initial contact with antigen -administered via \_\_\_\_\_\_ or \_\_\_\_\_\_\_ -prevent release of \_\_\_\_\_\_\_\_\_\_\_s -has no \_\_\_\_\_\_ bronchodilator activity -has no \_\_\_\_\_\_\_ activity
-cromolyn (disodium cromoglycate) & \_\_\_\_\_\_\_ clincical uses -asthma (\_\_\_\_\_\_), especially in \_\_\_\_\_\_ -\_\_\_\_\_ allergy (oral) -topical (\_\_\_\_\_\_) -\_\_\_\_\_ irritation -\_\_\_\_\_\_ tract irritation
cromolyn sodium histamine inhalation intranasal spray inflammatory mediators intrinsic antihistamine
nedocromil inhalation children food hay fever conjunctival nasopharyngeal
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 _____
monoclonal antibody IgE mast cells basophils degranulate inhaled corticosteroids allergen
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
subcutaneous IgE bronchial thrombophlebitis pharyngitis earache anaphylactic
beta blockers
- inducers of _____
- used for Rx _____/_____
- blocking beta 2 receptors in airways with nonselective beta blockers (_______)
- selective beta blockers (cardio-selective blockers) preferred: _____
- less _____ than nonselective beta blockers
bronchoconstriction hypertension arrhythmias propranolol atenolol bronchoconstriction
drug-induced bronchospasm
- ___and ____
- -can induce severe bronchospasm
- _____: preservatives
- ________
- -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
ASA NSAIDs sulfites ACE inhibitors lisinopril prostaglandins ACE inhibitors
chronic obstructive pulmonary disease (COPD)
- COPD is generally used to describe patients with one or more of the following
- -_____
- -_____
- -_____
chronic bronchitis
emphysema
asthma
COPD
- chronic bronchitis and emphysema
- airway _____
- asthma?
- 14 million American diagnosed/14 million more
- 120,000 deaths annually (COPD +Asthma = 4th)
- excessive production and secretion of _____
- _____ smoking is a major factor (80%)
- ALL smokers have a decline in lung function
- 20% industrial smole, pollutants, airway infections, allergy and hereditary factors
hyper-reactivity
mucus
cigarette
COPD
- excessive _____, _____ production and _____
- symptoms have been present for >__ 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 10 fibrotic elastic recoil parenchyma human leukocyte elastase elastases
copd pathophysiology and natural course -enlarged \_\_\_\_\_ -dilated \_\_\_\_\_ -inflammation in \_\_\_\_\_ -mucus \_\_\_\_\_ -\_\_\_\_\_ distortion
mucus glands bronchial gland ducts bronchioles plugging fibrotic
