Unit 3 Day 7 (Wed 4/29) Flashcards

Question

Severe Persistent Class of Asthma

Answer 1

- continual sx, constant limitation of activity, frequent exacerbations - frequent night sx

Answer 2

• Inappropriate vocal cord motion results in airflow obstruction" • Variable extrathoracic obstructive pattern due to adduction of vocal cords during inspiration" • Symptoms mimic asthma" – Shares similar triggers" • Stridor mistaken for wheezes" • Often coexists with asthma" • Flow-volume loop suggestive • Diagnosed by fiberoptic laryngoscopy" • Bronchoprovocation studies can exacerbate VCD." – VCD may worsen with bronchoprovocation, but will not change FEV1 or PC20 " • Acute treatment is anxiolytics, helium-oxygen mixture" • Long term treatment is speech therapy, underlying triggers" • Avoid over treating asthma"

Answer 3

* COPD is defined by fixed airflow limitation" | * FEV1/FVC

Answer 4

• Productive cough at least 3 months over the past 2 years without other cause" • Increased airways resistance due to changes in airway structure (edema, mucus, fibrosis)" – May have overlapping features with asthma" • Impaired ventilation

Answer 5

- a little up and left of normal curve | - normal shape

Answer 6

• Loss of normal alveolar spaces with enlargement of distal airspaces (acini) • Increased compliance of the lung" – Decreased elastic tissue" – Loss of balance between proteases and anti-proteases in lung (alpha-1-antitrypsin deficiency)" – Increased apoptosis of alveolar cells" – Impaired repair mechanisms" • Impaired gas exchange"

Answer 7

- potential therapy to modify disease by inducing specific allergen tolerance; tends to be more effective in managing allergic rhinitis and conjunctivitis than asthma - requires parenteral (sub Q) administration

Answer 8

``` – Cough" – Rhonchi" – Wheezing" – Prolonged expiratory phase" – Pursed-lip breathing" – Tri-pod position" ```

Answer 9

-limited use due to adverse effect profile • administered by the oral or intravenous route • onset of action: 30 - 60 minutes • metabolism: half-life 7 hours; hepatic metabolism • duration of action: 12 - 24 hours after single dose • mechanism of action: inhibition of phosphodiesterase • beneficial effect: bronchodilator effect and some anti-inflammatory activity • adverse effect: caffeine-like effects such as irritability, gastrointestinal distress. very narrow therapeutic range and requires blood level monitoring to individualize dose. Significant adverse effects can include seizures and irreversible neurologic damage. Multiple DDIs

Answer 10

* Increased cough" * Sputum volume and purulence" * Increased wheezing" * Worsening obstruction on PFT s" * UnchangedCXR" * Precipitated by infection, pollution, PE, unknown factors" * Increased work of breathing due to hyperinflation, increased airway resistance" * Treated with bronchodilators, steroids, antibiotics"

Answer 11

* Respiratory failure" * Right ventricular failure" * Pneumonia" * Spontaneous pneumothorax" • Pulmonary embolism"

Answer 12

* Cough productive of purulent sputum" * Sputum volume often copious—especially during an exacerbation" * Wheezing, hemoptysis " * May be either localized or diffuse" * Mucociliary escalator stops working..."

Answer 13

• Requires a combination of:" – An infectious or inflammatory insult" – Impaired drainage, obstruction or immunodeficiency" • Loss of airway wall integrity with dilation" • May be due to congenital structural anomalies " • Recurrent infections worsen bronchiectasis" • Dilated, collapsible airways result in obstruction" • May be compounded by inflammation"

Answer 14

* Airway clearance – to promote clearance of secretions" * Antibiotics – may be intermittent, chronic, or rotating courses." * Treat reactive airways disease" – Bronchodilators, corticosteroids"

Answer 15

- inhaled glucocorticoids - long acting inhaled beta 2 agonists - leukotriene modifiers - omalizumab (anti-IgE)

Answer 16

-prefferred long term control medication for treatment for persistent asthma

Answer 17

-preferred supplementary long term control agents for use with inhaled glucocorticoids

Answer 18

-biologic response modifier

Answer 19

-potential therapy to modify disease by inducing specific allergen tolerance; tends to be more effective in managing allergic rhinitis and conjunctivitis than asthma

Answer 20

-long acting anticholinergic approved for COPD but not asthma

Answer 21

-limited use due to adverse effect profile

Answer 22

- short acting beta 2 agonists - anticholinergics - systemic glucocorticoids

Answer 23

-preferred tx to relieve sx and prevent exercise induced asthma

Answer 24

- approved for use in COPD but not asthma | - used as secondary reliever for significant asthma exacerbations

Answer 25

-used to manage severe acute asthma exacerbations and occasionally for continued use in managing severe asthma

Answer 26

• Clinical pharmacology: albuterol, terbutaline, salmeterol, formoterol. Used to treat asthma and COPD. – administered by the inhaled, injectable, and oral route – rapid onset of action: minutes for albuterol and formoterol (slightly longer for salmeterol) – duration of action: • quick relievers: 4 - 6 hours (albuterol) • long-term controllers: long acting ß-agonists last approximately 12 hours (salmeterol, formoterol); used to prevent asthma symptoms. • mechanism of action: ß-adrenergic receptor stimulation • beneficial effect: bronchodilation via smooth muscle relaxation; inhibits production of respiratory secretions

Answer 27

• Clinical pharmacology: atropine, ipratropium, tiotropium; approved for use in COPD but not in asthma – administered by the inhaled route – rapid onset of action: minutes • duration of action: – Quick relievers: up to 6 hours (ipratropium) – Long-term controllers: up to 12 hours (tiotropium) • mechanism of action: cholinergic receptor inhibition • beneficial effect - bronchodilation via smooth muscle relaxation – inhibits production of respiratory secretions

Answer 28

Clinical pharmacology: hydrocortisone, prednisone, prednisolone, methylprednisolone. Used to treat acute exacerbations of asthma. • administered by the oral or parenteral route • onset of action: 30 - 60 minutes • metabolism: half-life 2 -3 hours • peak of action: approximately 8 hours • duration of action: – hydrocortisone - 12-24 hours – prednisolone, methylprednisolone - 36-48 hours • mechanism of action: phospholipase inhibition; inhibition of cytokine synthesis • beneficial effect : – anti-inflammatory - reduces cellular infiltration, particularly eosinophils, mast cells, lymphocytes – vasoconstrictor - reduces edema

Answer 29

• Used as the preferred long-acting control agent to treat asthma and for the treatment of COPD, if repeated COPD exacerbations noted. • administered by the inhaled route • onset of action: 30 - 60 minutes • metabolism: half-life 2 -3 hours for most except fluticasone (7 hours) • peak of action: approximately 8 hours for single dose; approximately 4 weeks for continued administration. • duration of action: requires once to twice daily administration to maintain effect • mechanism of action: phospholipase inhibition; inhibition of cytokine synthesis • beneficial effect – anti-inflammatory - reduces cellular infiltration, particularly eosinophils, mast cells, lymphocytes; – vasoconstrictor - reduces edema

Answer 30

– Salmeterol and formoterol - Clinical pharmacology – administered by the inhaled route – onset of action: 15 minutes – duration of action: 8 -12 hours after single dose – mechanism of action: ß-adrenergic receptor stimulation • beneficial effect- bronchodilator effect • Black Box warning due to an observed increase in asthma-related deaths noted in a post-marketing study. Should not be used as monotherapy for asthma since long-acting ß-adrenergic agonists (LABA) do not reduce inflammation. LABA should be combined with an inhaled corticosteroid to control the inflammation component

Answer 31

1-5 um in size allows particles to reach lung

Answer 32

``` • administered by the oral route • onset of action: 30 - 60 minutes • metabolism: half-life 6 hours; hepatic metabolism • duration of action: 12-24 hours • mechanism of action: leukotriene D4 antagonist – montelukast, zafirlukast 5-lipoxygenase inhibition – zileuton • beneficial effect bronchodilator effect anti-inflammatory effect due to leukotriene blocking effect attenuates exercise-induced asthma ```

Answer 33

• administered by the inhaled route • half-life: 20 minutes; excreted unchanged • mechanism of action: inhibition of mast cell mediator release • beneficial effect preventative therapy for exercise-induced asthma can prevent allergen-induced pulmonary response

Answer 34

- GOLD 1: mild, FEV > 80% predicted - GOLD 2: moderate, FEV1 > 50% predicted - GOLD 3: severe, FEV2 > 30% predicted - GOLD 4: very severe. FEV1

Answer 35

§ Smoking cessation has the greatest capacity to influence the natural history of COPD. Health care providers should encourage all patients who smoke to quit. § Pharmacotherapy and nicotine replacement reliably increase long-term smoking abstinence rates. § All COPD patients benefit from regular physical activity and should repeatedly be encouraged to remain active.