Tuesday TBL Flashcards
When should you consider alpha one antitrypsin deficiency?
Emphysema in a young individual (eg, age ≤45 years) ●Emphysema in a nonsmoker or minimal smoker ●Emphysema with predominant basilar lucency on the chest radiograph ●A family history of emphysema and/or liver disease ●Clinical findings or history of panniculitis ●Clinical findings or history of unexplained chronic liver disease
What does a deficiency of alpha-1 antitrypsin result in?
development of early emphysema
In COPD cases, which med can you never use alone? what do you have to couple it with?
can’t use inhaled steroids alone, must couple with LABA
What’s the MOA of β-adrenergic agonists ?
working through Gs to increase ↑ cAMP levels, reducing myosin light chain phosphorylation (and hence contraction), and to open large-conductance calcium-activated potassium channels, hyperpolarizing airway smooth muscle, which further reduces contraction. —Both effects relax airway smooth muscle bronchodilation.
Presence of permanently dilated, damaged major bronchi and bronchioles Response to inflammatory/infectious insult over time =
bronchiectasis this is a manifestation or complication of an underlying disease or condition. need to find cause
What kind of disease is Kartagener syndrome?
primary ciliary dyskinesia
Asthma has a delayed and an immediate response. What brings about the delayed response?
eosinophils and neutrophils are activated by interleukins and other mediators and go on to release additional mediators of bronchoconstriction
Which asthma inhibitors are administered orally, making them beneficial for kiddos?
leukotriene pathway inhibitors
Mutations in any of several genes encoding for proper structure and function of cilia, such as a dynein arm defect =
primary ciliary dyskinesia
What’s the treatment for ABPA (Allergic Bronchopulmonary Aspergillosis)?
prednisone (b/c it’s an inflammatory process, not an infectious process)
Airflow obstruction that is highly reversible/variable in response to medication or spontaneously= ?
asthma
Asthma has a delayed and an immediate response. What brings about the immediate response?
allergens trigger mast cells and T lymphocytes to release, histamine, prostaglandins, and leukotrienes
What’s the MOA of Omalizumab?
monoclonal anti-IgE antibody that binds to IgE and inhibits its binding to mast cells
What triad is seen in Kartagener syndrome?
sinusitis bronchiectasis situs inversus
What chromosome is the CFTR gene on?
chromosome 7
What’s the MOA of corticosteroids?
Corticosteroids decrease the transcription of genes for many pro-inflammatory proteins and increase transcription of genes coding for several anti-inflammatory proteins and the β2-adrenergic receptor.
How do you make a diagnosis of bronchiectasis?
chest imaging; high resolution CT is “gold standard”
What are the most common LABAs?
salmeterol and formoterol
What will you see on chest X-ray that points to bronchiectasis?
“tram tracks”: thickened bronchial walls seen longitudinally -and finger glove sign (mucus filled dilated bronchi)
What are some common exam findings in CF patients?
-Clubbing is almost always seen -Nasal mucosal changes and polyps common -crackles on exam, not wheezes -underweight/malnutrition
What’s the inheritance pattern of cystic fibrosis?
autosomal recessive
What’s the most important drug class in the treatment of asthma?
inhaled corticosteroids
What’s the methylxanthine we have to know?
theophylline
What’s the MOA of methylxanthines?
inhibit phospodiesterases =increase cAMP levels = bronchodilation
What chemical is detected by newborn blood screen that points to cystic fibrosis?
immunoreactive trypsinogen
What is the principal treatment for COPD?
Bronchodilators are the principal treatment for COPD, since corticosteroid treatment fails to relieve the inflammation associated with COPD. Inflammation has already had severe irreversible s/e
How do COPD patients present?
-Gradually progressive dyspnea on exertion -Variable cough & sputum
What’s the MOA of cromolyn?
mast cell degranulation inhibitor (specifically, inhibits chloride transport)
What are the two commonly used anticholinergics used to treat COPD? Which is longer acting?
Ipratropium and tiotropium Tiotropium is long acting
What are the only measures that can reduce mortality for COPD patients?
smoking cessation and supplemental oxygen
What is ABPA (Allergic Bronchopulmonary Aspergillosis)?
-A hypersensitivity to Aspergillus fumigatus (fungus) -Occurs in asthma and cystic fibrosis almost exclusively
What will you see on CT that points to bronchiectasis?
signet ring sign: bronchus is bigger than its accompanying artery.
What’s the MOA of montelukast and zafirlukast?
block leukotriene receptor (CysLT1)
What’s the MOA of Zileuton?
inhibits 5-lipoxygenase, the enzyme that converts arachidonic acid to leukotriene A4
What’s the typical clinical presentation of an asthma patient?
-Intermittent dyspnea, cough, and wheezing. -Cough is sometimes the only sx -Nocturnal symptoms common = clue!!!
In asthma cases, which med can you never use alone? what do you have to couple it with?
never use LABA alone, always couple with inhaled corticosteroids
What are the important steroids used to treat asthma?
beclomethasone, fluticasone, and budesonide (first Aid)
Which are more effective in controlling asthma: anticholinergics or adrenergic agonists?
adrenergic agonists are more effective than anticholinergics
Which type of lymphocytes are particularly involved in the asthmatic immune response?
TH2 lymphocytes
What is the most common mutation in the CFTR gene?
F508 deletion (3 base pair deletion that codes for phenylalanine at position 508)
What’s the most common SABA (ideal for an acute asthma attack)?
albuterol
Which are more effective in controlling COPD: anticholinergics or adrenergic agonists?
anticholinergics are more effective in COPD than are adrenergic agonists. They reduce vagal tone, which may lead to reversal of airway obstruction in narrowed airways of COPD patients.
What’s the function of alpha-1 antitrypsin?
it’s a serine protease inhibitor that Inhibits the enzyme neutrophil elastase from damaging the lung tissue
