Term
| How do corticosteroids help in asthma? |
|
Definition
| block many key steps in the inflammatory process |
|
|
Term
| NO is increased/decreased in asthma. |
|
Definition
|
|
Term
| NO is elevated/reduced after corticosteroid treatment. |
|
Definition
|
|
Term
| ___________ is also a bronchodilator which is activated by NO. |
|
Definition
|
|
Term
| goals of asthma treatment |
|
Definition
1. directly relax bronchiolar smooth muscle
2. reduce inflammation by inhibiting inflammatory mediators |
|
|
Term
| Why are asthma drugs administered by aerosol? |
|
Definition
have potentially serious adverse side effects when administered systemically
Aerosol application is used to produce high local concentrations of drug in the lungs and limit systemic absorption. |
|
|
Term
| The best respiratory drugs have... |
|
Definition
| poor absorption from GI tract and/or first-pass metabolism in the liver |
|
|
Term
| factors influencing effectiveness of aerosol drug |
|
Definition
1. particle size
2. rate of breathing and breath holding |
|
|
Term
| drug of choice for rapid relief of bronchospasm (asthma, COPD) |
|
Definition
|
|
Term
| What are short acting beta 2 stimulants used for? |
|
Definition
| intermittent use on an as-needed bases for relief of acute, severe bronchospasm |
|
|
Term
| What must you be careful about with use of beta agonists? |
|
Definition
| overuse (side effects, worsening symptoms that you keep self-treating) |
|
|
Term
| beta agonist mechanism of action |
|
Definition
-beta 2 receptor couples to Gs protein and increases cAMP
-cAMP stimulates phosphorylation cascade that leads to decreased intracellular Ca and smooth muscle relaxation
-inhibit mediator release from mast cells |
|
|
Term
| selectivity of beta agonists |
|
Definition
| higher affinity for beta 2 receptors than beta 1 receptors (less cardio side effects) |
|
|
Term
|
Definition
short-acting beta 2 agonist
onset <15 min
duration 2-4 hrs |
|
|
Term
|
Definition
long-acting beta 2 agonist
useful to control nighttime asthma symptoms
NOT suitable for treatment of acute bronchospastic attacks |
|
|
Term
|
Definition
| less/non-selective beta agonist |
|
|
Term
|
Definition
| less/non-selective beta agonist |
|
|
Term
| Oral administration of beta agonists... |
|
Definition
| increases incidence of adverse side effects |
|
|
Term
| appropriate situation for oral beta agonist therapy |
|
Definition
-children with URI who cannot manipulate inhaler
-severe asthma exacerbations where inhaler cannot be used or when aerosol is irritating
-elderly who can't figure out inhaler |
|
|
Term
| Who are at higher risk of having adverse effects from beta agonists? |
|
Definition
| pts with cardiovascular disease and/or diabetes |
|
|
Term
| What do beta agonists do to diabetics? |
|
Definition
|
|
Term
| beta agonist drug interactions |
|
Definition
| thyroid, digitalis, methyxanthines |
|
|
Term
| drug of choice for anaphylactic reactions |
|
Definition
|
|
Term
|
Definition
bronchodilation
vasoconstriction (maintain BP, dec. edema)
inhibition of mediator release |
|
|
Term
| second therapy for anaphylaxis |
|
Definition
H1 agonist (diphenhydramine)
corticosteroid (hydrocortisone)
aminophylline (IV form of theophylline) |
|
|
Term
|
Definition
quaternary muscarinic receptor antagonist
bronchodilator |
|
|
Term
| If ipratropium bromide is given parenterally, the effects are like __________. But, it is only given as _________ _________. |
|
Definition
|
|
Term
| ipratropium bromide indications |
|
Definition
-COPD
-combined with albuterol (Combivent)
-intranasally to reduce secretions in URT and LRT in allergic rhinitis and chronic postnasal drip syndrome |
|
|
Term
|
Definition
Spiriva
newer long-acting agent used for maintenance therapy in chronic bronchitis and emphysema |
|
|
Term
|
Definition
| methylxanthine broncodilator |
|
|
Term
| theophylline mechanism of action |
|
Definition
block cAMP and cGMP degradation by phosphodiesterase inhibition
(increase cAMP and cGMP) |
|
|
Term
|
Definition
formerly 1st line agent for asthma
now far less prominent role
nocturnal asthma (can cause insomnia) |
|
|
Term
| corticosteroid mechanism of action |
|
Definition
inhibit the production and release of cytokines, vasoactive and chemoattractive factors, lipolytic and proteolytic enzymes, decrease mobilization of leukocytes to areas of injury, and decrease fibrosis
enhance actions of beta agonists |
|
|
Term
| Asthmatics who require inhaled beta agonist therapy ________ times weekly are candidates for inhaled steroid therapy. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
inhaled corticosteroid
with salmeteral (Advair Diskus) |
|
|
Term
|
Definition
|
|
Term
| potential side effects of inhaled corticosteroids |
|
Definition
-candidiasis (use spacer and rinse mouth)
-hoarseness
-HPA suppression
-bone resorption
-carbohydrate and lipid
-cataracts and skin thinning
-purpura
-growth retardation |
|
|
Term
|
Definition
cromolyn sodium
nedocromil |
|
|
Term
| cromolyn compound mechanism of action |
|
Definition
| decrease degranulation of mast cells and prevent infiltration with WBCs |
|
|
Term
| Cromolyn compounds do/do not directly relax smooth muscle. |
|
Definition
do not
(not useful for control of acute bronchospasm) |
|
|
Term
| Cromolyn compounds are primarily... |
|
Definition
|
|
Term
| nedocromil is approved for use in asthmatic patients ____ years old; cromolyn is approved for _______ |
|
Definition
|
|
Term
|
Definition
| leukotriene (LTD4) receptor antagonist |
|
|
Term
| Leukotriene inhibitors are approved for children as young as... |
|
Definition
|
|
Term
| Leukotriene inhibitors are not as effective as corticosteroids on _______ and _______, but nearly equal in _________. |
|
Definition
| bronchiole reactivity and airway inflmmation; reducing asthma exacerbations |
|
|
Term
| FDA investigating what about leukotriene inhibitors |
|
Definition
|
|
Term
| Corticosteroids do/do not work well on COPD pts. |
|
Definition
do not
They do better on albuterol + ipratropium bromide. |
|
|
