Respiratory Flashcards
Asthma: extrinsic atopic type 1
immediate response by IgE, histamine is released, usually family hx of allergies (think children)
prognosis for Asthma extrinsic atopic type 1
good
Asthma: Intrinsic (non-atopic) idiopathic type2
adult onset (>30yr old), chronic bronchitis, poor prognosis
Asthma: exercised induced triggers
cold, hypocapnia
early asthma response occurs within how many minutes, recovery time? cause?
s/s within 20 mins, recovery 60 mins, caused by IgE on mast cells
Late asthma response occurs how soon? duration? cause?
3-5 hours after exposer, lasts days or weeks, caused by release of chemical mediators from mast cells, macrophages and epithelial cells
Beta 2 Adrenergic agonist, Mexthylxanthine, Anticholinergics are all what class of drugs?
bronchodilators
Beclometasone [Qvar], Fluticasone propionate [flovent]
inhaled steriod
how do inhaled steroids work?
they bind to cytosolic glucocorticoid receptors and reduce eosinophils/mast cells in airway, they reduce histamine responsiveness
are inhaled steroids long-term or short-term?
long term
systemic corticosteroids mechanism of action
prevent cytokine and mediator release, inhibit IgE release, suppreses airway inflammation
are systemic corticosteroids short term? long term?
short term
Leukotriene modifier example
Montelukast [singulair]
Leukotriene: MOA
block bronchconstriction by preventing leukotrienes from binding to receptor sites
Leukotriene modifiers: Contraindications
acute bronchospasm, lactation, liver impairment
Leukotriene modifiers: ADRs
neurophychiatric (stop if you see this), muscle pain, elevated LFTs
when would you put someone on Montelukast [Singulair]? (Leukotriene modifier)
maintenance therapy for asthma >1 year, prevention of EIA>15 years old, allergic rhinitis
what do Leukotriene modifiers (Montelukast [Singulair]) bind to?
plasma proteins
Mast cell Stabilizers are used for acute or chronic phases?
chronic
Mast cell Stabilizers: MOA
stop calcium influx across cell membrane from mast cell mediators, suppresses inflammatory cells
How are mast cell stabilizers (Cromolyn) given?
nebulizer
Mast cell stabilizer example
Cromolyn
Beta-Adrenergic Agonists examples
Albuterol
Salmeterol (not given alone)
Beta-Adrenergic Agonists MOA
stimulate B receptors in smooth muscle which dilated bronchi (they stimulate B1 receptors in the heart which increases HR)
Beta-Adrenergic Agonists Contraindications
ischeminc heart disease, hypertension, arrhythmias, seizures, hyperthyroidism
Beta-Adrenergic Agonists ADRs
increased HR, tremor, hypokalemia, hyperglycemia
Methylxanthines
cause direct muscle relaxation, induce diuresis, gastric acid secretion
Methylaxanthines exaples
Theophylline, Aminophylline
how doMethylaxanthines effect the heart
increased cardiac output, decreased venous pressure
Anticholinergic drug examples
Atrovent, spiriva
Anticholinergic drugs (Atrovent, spiriva) are used for?
COPD
Anticholinergic drugs (Atrovent, spiriva) mechanism of action and how fast does it work
it drys everything, blocks muscarinic cholinergic receptors in bronchi, works quickly
Combivent, advair diskus, breo Ellipta, Symbicort, Dulera are all what?
combo products
what is ok for mild asthma attacks?
inhaled bronchodilators (albuterol)
what is ok for frequent attacks?
oral or inhaled steroids and an inhaled bronchodilator
what is ok for EIB?
inhaled bronchodilators, inhaled mast cell stabilizer (Cromolyn)
intermittent asthma
symptoms <2/week, <2/month at night
mild persistent asthma
symptoms >2/week but <1/day, >2/month at night, Its effecting their acitivity
moderate persistant asthma
daily episodes, effects activities >2/week, >1/week at night
severe persistant asthma
continual s/s, frequent episodes, limits activity, frequent night episodes
When should a steroid be introduced for pt with asthma?
if patient is having episodes >2/week even with beta2 agonist
