Respiratory Disorders: Wk 3 Flashcards
asthma definition
-Hyper responsiveness to stimuli that produce bronchoconstriction
-Stimuli include cold air, exercise, allergens and emotional stress
-Airway inflammation and edema
-Resulting from release of various mediators from mast cells, eosinophils, macrophages, etc.
-Mediators include histamine, adenosine, bradykinin, leukotrienes and prostaglandins
-chronic inflammatory disorder
asthma causes of obstruction and sx
-Airway obstruction results from:
- bronchial inflammation
- smooth muscle constriction
- obstruction of the lumen with mucus, inflammatory cells and epithelia debris
-Symptoms of obstruction: dyspnea, coughing, wheezing, headache, tachycardia, syncope (fainting), diaphoresis (excessive sweating), pallor (paleness) and cyanosis
COPD
COPD
-General symptoms: dyspnea on exertion (DOE), cough, acute exacerbations w/ wheezing and dyspnea
-Types of COPD:
-Chronic Bronchitis: chronic productive cough x 3 months (in 2 successive years)
-Emphysema: abnormal enlargement of airspaces; destruction of airspace walls -> barrel chest
asthma vs COPD
-asthma: sensitizing agent -> asthmatic airway inflammation, CD4+ T lymphocytes, eosinophils -> -completely reversible
-COPD: noxious agent -> COPD airway inflammation, CD8+ T lymphocytes, macrophages, neutrophils
-completely irreversible
asthma: bronchodilators
-beta agonists
-Epinephrine
-Anticholinergics
-Theophylline (xanthine dervatives)
“you can BEAT asthma - its reversible”
asthma: anti-inflammatory agents
-Omalizumab (Xolair)
-Glucocorticosteroids **
-Mast cell stabilizers
-Leukotriene inhibitors
“OMG Luca(R)io has asthma”
COPD: bronchodilators
-Beta 2 agonists
-Anticholinergics
-Theophylline – for refractory cases
“you can’t BEAT COPD -> irreversible so its just a BATtle”
COPD: anti-inflammatory
-Systemic glucocorticosteroids – for acute exacerbations
-Inhaled glucocorticosteroids – for chronic management
-Roflumilast (Daliresp) – PDE 4 inhibitor (new class of drug)
“SIR -> Lucario’s boss”
What are the only agents that can counteract an acute asthmatic attack?
-Short acting beta2 agonists : SABA
________are less useful in asthma, better for COPD
Anticholinergics: better for COPD and emphysema/chronic bronchitis
Theophylline
used on long term basis to prevent bronchoconstriction in asthma and emphysema
metered dose inhaler (MDI)
Correct use: shake, full exhale, start inhaling slowly and then press MDI, hold breath for 5-10
seconds
-Need to wait 1 minute between doses, 5 minutes between different drugs so drug can take
effect and 2nd dose can get deeper
-simple MDI- hard to use
-with aerochamber- easier to use
-MDI, aerochamber, facemask - mask pieace
-portable
dry powder inhaler
-Inside there is a capsule that is punctured when you press, then breathe in
-Need to breathe in quickly (compared to MDI where you breathe in slowly) -> BAD for COPD pts that have bad inspiratory effort
Nebulizer machine
- easy to use
- It atomizes the drug, makes it smaller so it can get deeper into the lung for better treatment
mixed non-selective bronchodilators
-Epinephrine (alpha1- increased BP, beta1- increase HR, B2 - bronchodilation)
-Uses: Can be used for asthma, but B2 agonists are preferred
-Examples:
-Epinephrine (SQ, IM, IV) (C)
-Epinephrine inhaled (Primatene mist)
-Racemic epinephrine (nebulized) – more for bronchospasms, croup cough)
bronchodilators: non-selective beta agonists
-Have some effect on beta1 receptors also
-Cardiac effects
-drug examples:
-Isoproterenol
-Pirbuterol
“daniel IP is non-selective -> thats why he went to USC instead of UCLA”
bronchodilators: beta 2 selective agonists
-Specific for beta2 receptors
-less cardiac stimulation
-selectivity is limited as doses become higher, resulting in HR and contractility
-albuterol: MC*
-Terbutaline
-Levabuterol
bronchodilators: beta 2 selective agonists: short acting SABA
-acute attack, use PRN
-Uses: Asthma, exercise induced asthma (EIA), COPD
-Examples: albuterol, levalbuterol, terbutaline
-Albuterol
-MDI, neb, PO (tabs or solution)
-Combined w/ ipratropium (Combivent inhaler, Duoneb nebulizer)
-Levalbuterol - kids
-Terbutaline (Brethine) (C) PO, INJ -> Inhaler form (Bricanyl) – not available in US
bronchodilators: beta 2 selective agonists- longer acting LABA
-maintenance medication
-Uses: Asthma, COPD
-Given BID or q12h , NOT PRN, NOT for acute attacks
-Examples: Salmeterol, Formoterol, Arformoterol
-Salmeterol (Serevent) (C) DPI -> w/ fluticasone (Advair DPI(MY MOM), MDI)
-Formoterol
-Arformoterol (neb - new drug for COPD)
LAba = SF(A)
LA and SF are cool cities to go to
-salmon
-fomo
-alfomo
ADRs for all beta agonists
-Local: dry irritated throat, cough, bad taste
-Systemic:
- CNS stimulation (insomnia, excitability, tremor)
- cardiac stimulation
- hypotension (depending on degree of beta 2 stimulation in vasculature)
- Hyperglycemia and hypokalemia also occur secondary to beta 2 agonist activity
bronchodilators: anticholinergics asthma vs COPD use
Asthma: use in combo w/ beta 2 agonists -> NOT PRN
For COPD – may be used as PRN (per GOLD guidelines), and can be used as monotherapy
Rhinitis tx as well
bronchodilators: anticholinergics agents
-Ipratropium:
-short acting anticholinergic
- asthma:use in combo with beta 2 agonist (albuterol); NOT PRN
-For COPD: PRN or monotherapy
-ADRs – CNS, palps, bitter taste, cough
-Tiotropium:
-long acting anticholinergic – QD = better compliance
-Longer DOA
-Very expensive
