Respiratory Disorder Flashcards
RS Disorder
Cough
Asthma
COPD
Cough activated by
Mechanical stimuli - Foreign body, dust, talking
Chemical stimuli - Smoke, perfume
Thermal stimuli - Cold air, hot air, cold water
Cough Categories
Acute 3 week
Subacute 3-8 week
Chronic 8 week
COPD symptom
Same as asthma
COPD caused by
chronic bronchitis
Emphesema
Smoking
COPD Feature
Irreversible - Present of fibrosis
Progressive
Abnormal inflammatory response
Asthma Characteristic
Recurrent attack of airway obstructive
Chronic inflammatory
Airway hyper-reactivity
Asthma Phase
Early Phase: Bronchospasm
Late Phase: Inflammation
Asthma Clinical Indication
Recurrent attack Coughing Short of breath(SOB) & Dyspnea Chess tighness Wheezing
Asthma Type
Extrinsic-Allergic
Intrinsic- Infection, Stress
Cold Air Exercise
Drug-induced(latrogenic) Aspirin
Asthma Pathological feature
Contraction of airway sm
Mucosal thickening
Plug of mucus
Asthma Treatment
Sympathomimetic agents Methylxantine drug Antimuscuranic agent Corticosteroids Cromolyn & Nedocromil Leukotriene pathway inhibitor Other
Asthma Therphy
Dilate bronchi
Reduce inflamation & mucus
Other Asthma Therphy using
Anti-IgE monoclonal antibodies
Calcium Channel blocker
Nitric Oxide Donor
First Line Bronchodilator
B2-sympathomimetic (Adrenoceptor
stimulant) agent
Methylxantine Group
Anticholinergic(Muscarinic) Agent
Why not B1
may induce hypertension,
tachycardia, mi
B2-sympathomimetic class
Short acting agent(PIO)
Long acting agent(Inhalation)
Albuterol(Salbutamol), Terbutaline
B2-sympathomimetic
T1/2: 2-3 hour
Short acting agent(PIO)
Relieve bronchi
Salmeterol, Formoterol
B2-sympathomimetic
Long acting agent(Inhalation)
T1/2: 12 hour
Maintain dilation
B2-sympathomimetic ADR
Tachycardia- In large dose,B1 receptor
Skeletal Muscle tremor-B2 receptor, Large dose
Theophylline
Methylxantine Group, Tea On sm: bronchodilation On ske.m: contraction of diaphragm Narrow therapeutic index- Careful patient already on oral theophylline
Precaution when using Theophylline
Never give rapidly Avoid heart complication
Never given IV On tp treatment, measure tp blood level
Caffeine & Theobromine
Methylxantine Group
Coffee & Cocoa
General effect of Methylxantine Group
On sm: bronchodilation
On ske.m: improve contractility
GIT: secretion of gastric acid &
digestive enzyme
Atropine
Anticholinergic=bronchodilator Non selective Many side effect Block all; body, gland, heart, sm Not used anymore
Ipratropium Bromide
Anticholinergic=bronchodilator
Poorly absorb=Inhalation
Act directly Dilate & Selective
Low con in circulation, Not much systemic adr, Not cross BBB, no cns fx
Effect less than B2 agonist, Longer action than B2 agonist
Effective in COPD
Reduce inflamation & mucus
Antiinflamatory(long term controller)
Antiinflamatory classes
Corticosteroid Cromolyn or Nedocromil Leukotriene Antagonist (oraly)
Corticosteroid; Derived from Glucocorticoid
Prednisone
Cortisone
Hydrocortisone
Avoided in chronic, mode adr
Prednisone(Prodrug)
Oral
»Prednisolone
Severe(systemic)
Corticosteroid
Beclomethasone, Fluticasone
Inhale
Lipid soluble
Local action
Corticosteroid
Corticosteroid Systemic(PO) adr
Adrenal suppresion-Taper dose gradually Give time to function back
Osteoporosis
Cataract
Avoid by using inhale
Corticosteroid inhale adr
Orapharyngeal / Oral Candidiasis
Hoarseness
Avoid by washing mouth
Cromolyn or Nedocromil characteristic
Mast cell stabilizer
Less effective than
steroid/glucocorticoid
Inhalation, poorly absorbed
Mast cell stabilizer used in
Prophylaxis
Reduce symptom
Rhinoconjunctivitis
Cromolyn or Nedocromil MOA
Mast cell - Inhibit early response to antigen
Eosinophil - Inhibit inflamatory response to allergen
Airway nerve - Inhibit cough
Leukotriene(we use anti)
derive from lipooxygenase
Bronchoconstrictor & chemotactic agent
Stop LT stop constriction
Zileuton
anti- Leukotriene
Block synthesis of LT
5-lipooxygenase Inhibitor
Zafirlukast, Montelukast
anti- Leukotriene
Inhibit action of leukotrine D4
Inhibit binding of LTD4 to receptor
Asthma classification
Mild - 1x in a week
Moderate - 2-3x
Severe - Daily
