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47 Cards in this Set
- Front
- Back
Mild asthma suffer has about ____ attacks per week?
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2/week
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airway narrowing is treated by ?
Thickening mucus plug is treated by ? |
bronchodilator
anti-inflammatory drug |
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TH1 or TH2?
usually a persons response to infection. Body has immune response to positively fight an infection what we see in asthma. Usually release cytokines or inflammatory mediators. |
TH1
TH2 |
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cAMP is produced from the enzyme ___?___ and will cause bronchodilation
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adenylate cyclase
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___?___ breaks down cAMP
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phospodiesterases
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Muscarinic antagoist will block action of ACh and Theophylline will block adenosine in order to ___?___ bronchoconstriction
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stop
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When an inhaler is used, only ___?___ of drug reaches airways. The best particle size is ___?___ micrometers in diameter
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2-10%
2-5 |
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Typically .3-.5 mg ___?___ given IM used to treat anaphylactic shock. Don’t give it SubQ b/c the hypotension associated with shock will decrease blood flow to skin and it won’t get into the systemic circulation.
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epinephrine
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Longer duration than epi
Less potent than epi Orally active (25 mg capsules) Parenteral (50 mg/mL for injection) Central side effects Now not used in asthma Crosses BBB and can cause HA |
ephedrine
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Preparations:
Inhalant 0.5, 1% for nebulization; 80, 131 mcg/puff aerosols b1/b2 agonist: Maximal bronchodilation within 5 min 60-90 min duration Side effect: cardiac arrythmia |
Isoproterenol
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Short acting Beta 2 agonists
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Albuterol (Proventil, Ventolin)
Terbutaline (Brethine) Metaproterenol (Alupent) Pirbuterol (Maxair) |
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SABA differ from epinephrine by having a ?
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large substitution on the -OH group
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Inhalant: 90 mcg/puff aerosol,
solution for nebulization Oral: 2,4 mg tab; 2 mg/5mL syrup Oral sustained release 4, 8 mg tab R and S preparation Most popular SABA |
albuterol
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Only one available for s.c. (0.25 mg)
Used similar to epi in emergency ttt of asthma when aerosolized therapy is not available or has become ineffective Note that it has a long duration of action(cumulative effect) |
terbutaline
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Oral SABA include:
These have no advantages over inhalation and often cause side effects of:Skeletal muscle tremor Tachycardia (note patients with CV diseases) Nervousness, headache HYPOkalemia (Na/K ATpase activation, gluconeogenesis, and insulin secretion) |
albuterol and terbutaline
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Most effective bronchodilators
First choice for severe acute asthma Frequent administration (q20min) |
SABA (B2 agonists)
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Usually __?__ doses of 2.5 mg nebulized albuterol are needed for adults
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3
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Long acting Beta agonist include:
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salmeterol and formoterol
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Uses:
Combined with inhaled corticosteroids Prophylactic against exercise-induced asthma Nocturnal asthma (combine with corticosteroid, not more than twice a day) |
long acting beta 2 agonist (salmeterol and formoterol)
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When do you use oral beta 2 agonists?
Toxicities: Decreased arterial oxygen tension (PaO2) …. Supplemental oxygen Cardiac arrythmias Tachyphylaxis / genetic polymorphism |
Children <5years old
Severe asthma exacerbations when aerosols may worsen cough or bronchospasm |
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Methylxanthines include:
Not used much after Beta 2 agonist discovered. Main source is beverages |
Theophylline, aminophylline
Theobromine Caffeine |
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MOA:
PDE(4) inhibition: Bronchodilation Inhibition of cytokine release Decreased immune cell migration and activation Adenosine receptors inhibition Enhancement of histone acetylase |
Methylxanthines
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___?___ may restore corticosteriod responsiveness
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theophylline
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Uses: improves long term asthma control, alone or combined with corticosteroids .. Still not recommended by NIH for management of hospitalized asthma patients
Relieves acute asthma, controls chronic has narrow therapeutic index and clearance is based on hepatic metabolism |
Methylxanthines (most effective is theophylline)
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Antimuscarinic agents include:
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ipratropium, tiotropium, and atropine
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delivered by inhalaltion, poorly absorbed into the circulation, and does not enter the CNS
Care when using a nebulizer (eye deposits) Less effective bronchodilators than beta agonists, however, the addition of ___?___ enhances the bronchodilation action of nebulized albuterol in acute severe asthma never use these as rescue inhalers |
ipratropium
muscarinic antagonists |
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Effective in patients with COPD, using the long acting selective antimuscarinic agent ___?___.
It binds with equal affinity to M1, M2, and M3, but dissociates rapidly from M2, so it does not inhibit M2-mediated inhibition of the release of ACh (offers selectivity to M1 and M3) |
tiotropium
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common side effect of antimuscarinic agents are:
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dry mouth and bitter taste
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If you use a B2 agonist more than 2x/weekly you need to add __?__ to therapy
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inhaled corticosteriod
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MOA of what drug?
Inhibit production of inflammatory cytokines Reduce bronchial reactivity Reduce frequency of asthma exacerbations Potentiate the effects of b2-agonists |
corticosteriods (antiinflammatory agents)
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Systemic corticosteriods include?
Urgent treatment: 30-60 mg prednisone /day or methylprednisone 1 mg/kg i.v. every 6 h, decrease daily dose after improvement Usually discontinue systemic corticosteroids in 7-10 days |
prednisolone, methylprednisolone, and prednisone
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Systemic corticosteriods should be given __?__
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early in the morning
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To prevent nocturnal asthma, oral or inhaled corticosteroid is given ?
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late
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If corticosteriods are taken long term, adrenal suppression can occur and the body will stop producing __?__
you must ? |
cortisol
wean the pt off the corticosteriod so the body can catch back up |
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inhaled corticosteriods include?
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Beclomethasone, Budesonide, ciclesonide, flunisolide, fluticasone, mometsone, triamcinolone
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if patient isn't responding to corticosteriods the dose can be __?__
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steadily increased
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prodrug that is an inhaled corticosteriod, bound to pp, no evidence of reduced side effects
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Ciclesonide
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Act on delayed Cl- channels in
membranes, inhibit cell activation leading to: Mast cell stabilizers (inhibit early response to Ag challenge by inhibiting histamine release Act on airways nerves, inhibit cough Inhibit release of inflammatory mediators from eosinophils Effect seems to be cell and organ specific |
Cromolyn and Nedocromil
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mast cell stabilizer administered MDI ?
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nedocromil
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Effective as aerosols in inhibiting Ag and exercise-induced asthma (EIA)
Chronic use slightly reduces bronchial hyper-Reactivity No effect on bronchospasm, only used prophylactically |
Cromolyn and Nedocromil
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Prophylactic against exercise or allergen-induced asthma
2-4 puffs 2-4x / day, most effective in young patients with extrinsic asthma |
Cromolyn and Nedocromil
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adding __?__ to inhaled corticosteriods improves asthma control
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Nedocromil
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Side effects:
throat irritation, dry mouth, cough, rarely, wheezing, tight chest Symptoms can be prevented by inhaling b2 agonist before the __?__ |
Cromolyn or Nedocromil inhalation
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They improve asthma control and reduce frequency of exacerbations.
Advantage: taken orally, especially for children Montelukast is approved for children as young as 6 years of age Important in managing aspirin induced asthma |
leukotriene pathway inhibitors
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is the least prescribed because of occasional liver toxicity.
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Zileuton (5-LO inhibitor)
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Churg-Strauss syndrome (systemic vasculitis leading to worsening of asthma, pulmonary infiltrates, and eosinophilia) coincidental when prednisone dosage is reduced and adding
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zafirlukast or montelukast
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Anti IgE antibody that comes as a powder for sc injection, 202.5 mg
Used for severe asthma not controlled by other therapies Helps reduce frequency and severity Especially for patients with high corticosteroid requirement |
Omalizumab (Xolair)
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