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Pharmo for medic school > Astham COPD > Flashcards

Astham COPD Flashcards

(55 cards)

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1
Q

Asthma results from

A

Combo of inflammation and bronchoconstriction

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2
Q

COPD overview

A

Chronic, progressive, largely irreversibly characterized by airflow restrictions and inflammation

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3
Q

S&S COPD

A 
Chronic cough
Excessive sputum
Wheezing
Dyspnea
Poor exercise tolerance
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4
Q

COPD 2 main conditions

A

Chronic bronchitis

Emphysema

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5
Q

Chronic bronchitis

A

Chronic cough, excessive sputum which results in hypertrophy of mucus secreting glands in epithelium of large airways

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6
Q

Emphysema

A

Enlargement of air space within bronchioles and alveoli brought on by deterioration of the walls of the airspaces

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7
Q

Two main pharmacologic classes for asthma COPD

A

Anti-inflammatory agents
Glucocorticoids (pred, dex)
Bronchodilators
Beta 2

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8
Q

Three main routes for asthma meds

A

MDI, DPI (dry powder), neb

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9
Q

MDIs

A

Start inhaling before activating, only 10% of drug reaches lungs (21% with spacer)

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10
Q

Short acting B2s - PRN

A

Salbutamol

Levalbuterol

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11
Q

Long acting B2

A 
Aclidinium bromide
Arformoterol
Formoterol
Indacaterol
Salmeterol
Taken on fixed schedule
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12
Q

Ventolin contras

A

Hypersensitivity

Tachydysrhythmias

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13
Q

Ventolin dose

A

10 puffs MDI q 5 prn (kids under 20kg max 15, over 20kg max 30)
Neb 5mg prn
Bronchospasm and anaphylaxis
Peds half it if under 20kg, over 20kg same dose, max 3 doses

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14
Q

Atrovent class

A

Parsympatholytic
Anticholinergic
Bronchospasm, anaphylaxis

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15
Q

Dose

A

500mcg or 10 puffs if pt hasn’t received 3 doses of neb

Less than 20kg half it

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16
Q

Events leading to asthma

A

Allergen binds to IgE
Mast cells release histamine, leukotriends, prostaglandins and interleukins which cause broncho constriction and release more inflamm cells (eosinophils, leukocytes, macrophages) which release their on mediators

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17
Q

Chronic bronchitis defined by

A

Chronic cough and excessive sputum production

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18
Q

Emphysema defined as

A

Enlargement of air space within bronchioles and alveoli brought on by deteriotion of walls in these air spaces

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19
Q

Patho of COPD

A

From frequent irritation and inflammation bronchial edema and increase mucus secretion. Also, inflammation inhibits protease inhibitors and protease enzymes break down elastin which destroys alveolar wall

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20
Q

Two main classes of drugs for asthma and COPD

A

Antiinflammatory agents and bronchodilators

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21
Q

Three advantages of inhalation

A

Enhanced effect by direct drug delivery
Systemic effects minimized
Relief is rapid

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22
Q

Four types of inhalation devices

A

MDI, respimat, dry powder, nebs

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23
Q

Respimats

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A

Deliver drug as a fine mist

24
Q

Spacers

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A

Increases amount to lungs (21% vs 10%) and eliminates depositing of drug in mouth

25
MOA gluccorticoids in asthma
Decreased synthesis and release of inflammatory mediators (leukotriends, histamine, prostaglandins) Decreased activtation of inflammatory cells (eosinophils, leukocytes) Decreased edema of airway mucosa (secondary to decreased vasc perm) may increase B2 receptors (# and responsiveness)
26
Inhaled glucocorticoids
Largely devoid of serious tox, most serious is adrenal suppression - usually minimal.
27
Candidiasis
Thrush in the mouth, any infection from candida (yeast)
28
Bone loss
From long term steroids. To address this use lowest dose possible, insure adequate calcium and D, lift weights
29
Oral steroids sides
Adrenal suppression, hyperglycemia, peptic ulcer, growth suppression
30
Leukotrien modifiers
Suppress leukotrienes which promote smooth muscle constriction and increase vessel perm, also potentiate inflamm reaction
31
Beta 2
Bronchodilation but also somewhat suppress histamine and increase ciliary motility
32
LABAs (long acting B2)
Preferred over SABAs in COPD, need steroids in asthma to go with it, LABA alone increase risk of death - increase risk of severe asthma
33
When is SABA not enough
rescue inhaler use twice a week
34
THeophylline
MOA relaxing smooth muscle, probably by blocking adenosine receptors, enhance calcium perm in sarcoplasmic reticulum, inhibit cyclic nucleotide phosphodiesterase (increase in cAMP) Use only after B2 and antichols Tox - N/V diarrhea insomnia restlessness dysrhythmias Other methylxanthis are aminophylline and dyphylline
35
Iptratropium bromide
Approved for COPD, off label asthma Blocks muscarinic receptors 30 seconds effect, 50% in effect in 3 minutes, persist for 6 hours
36
Adverse effects atrovent
Quaternary (carries positive charge) keeps drug in lungs | May raise intraoccular pressure
37
Glucocoricoid combos
Fluticasone/salmeterol (advair) -DPI Budesonide/formoterol (symbicort) -MDI Steroid/B2 in that order for those ones
38
FEV1
Forced expiratory volume in 1 second. Single most useful asthma test 75% of predicted value in asthmatics
39
FVC
Measured with spirometer. Total volume of air pt can exhale Also FEV1/FVC ratio 5% lower than normal in asthma 70-85% depending on age
40
PEF
Peak expiratory flow. Maximal rate of airflow during expiration. Check every morning, monitor if drops to 80% of personal best
41
Classes of asthma
Intermittent, mild persistent, moderate persistent, severe persistent Impairment (day to day) and Risk (risk of adverse event)
42
EIB exercised induced bronchospasm
Loss of heat and or water from lung. B2 prophylatically immediately before
43
COPD measurement
Post bronchodilator FEV1/FVC of less than 0.7 indicates COPD
44
Classes of COPD - 4
Mild, moderate, severe, very severe
45
Tx for stable COPD
Bronchodilators, glucocorticoids, PDE 4 inhibitors
46
PDE 4 inhibitor
PDE inactivates cAMP, keeping cAMP up results in decreased inflammation, cough, mucus production Adverse effects include diarrhea, reduced appetite, weight loss, nausea, headache and back pain, insomnia, depression
47
half of asthma triggered by
Allergens
48
Ventolin contras
Hypersens and tachydysrhythmias | Repeat PRN
49
Prednisone
Contras severe SOB, already taking pred, pneumonia or SIRS criteria
50
Dex
Contras hypersens, systemic fungal infections, hypersens to benzyl alchohol or sodium sulfite, pneumonia or SIRS met
51
Methylpred contras
Hypersens Systemic fungal infection Pneumonia or SIRS 100-250mg IV over 1 min or diluted in 50-100mL NS over 15 minutes
52
Mag contras
Heart block, renal failure
53
Mag dose
2g IV in 50mL NS over 10 for bronchospasm
54
Methylxanthines MOA
Block adenosine receptors Enhance calcium perm of sarcoplasmic reticulum Increase cAMP
55
Theophylline dose
400mg/250mL 5-15mcg/mL (wtf?)

Pharmo for medic school (26 decks)

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