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Asthma Flashcards

(48 cards)

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1
Q

What area of the lungs is affected by asthma?

A

Bronchioles

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2
Q

What happens to the bronchioles during asthma?

A

Airway becomes inflammed and narrows
Smooth muscle contracts
Mucous production increases

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3
Q

What stimuli provokes asthma?

A

allergens

airflow obstruction

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4
Q

What are the physical signs of asthma?

A

1) inflammation of the lining of the airways (primary)
2) Bands of muscle tighten
3) mucus thickens

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5
Q

What happens on the cellular level during asthma following the introduction of stimuli?

A

Mast cells and IgE (immunoglobulin E) complex causes degranulation of mast cells

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6
Q

What is degranulation?

A

the emptying of the contents of the Mast cells

Mast cells release eosinophils and histamine

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7
Q

What are eosinophils?

A

cytokines, leukotrienes, and major basic protein that causes INFLAMMATION

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8
Q

What does histamine do?

A

Causes bronchoconstriction

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9
Q

What are the symptoms of asthma?

A

1) shortness of breath - cyanosis, anxiety, sweating
2) wheezing
3) chest tightness, pain, pressure
4) increased sputum production, chronic cough
5) fatigue

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10
Q

How are respiratory functions measured?

A 
PEFR (Peak expiratory flow rate)
FEV (forced expiratory volume)
Tidal volume
Vital capacity
Residual capacity
Total lung capacity
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11
Q

What is Peak expiratory flow rate?

A

highest velocity of expired air obtained, starting with fully inflated lungs - measured with peak flow meter

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12
Q

What is FEV?

A

Forced expiratory volume - measured with a spirometer

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13
Q

What does tidal volume measure?

A

normal breathing

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14
Q

What is vital capacity?

A

volume of air expired after maximal inhalation

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15
Q

What is residual capacity?

A

volume of air left in lungs AFTER MAXIMAL INHALATION AND EXPIRATION

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16
Q

What is total lung capacity?

A

Vital and residual capacity combined - asthmatics have decreased Vital capacity, increased Residual

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17
Q

What characterizes a MILD asthmatic?

A

Frequency of symptoms: 1/week
Nocturnal symptoms: none
Condition between episodes: asymptomatic
PEFR: 80%+

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18
Q

What characterizes a Moderate asthmatic?

A

Frequency of symptoms: 2/week
Nocturnal symptoms: 1/week
Condition between episodes: none besides wheeze
PEFR: 60-80% of non-asthmatic

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19
Q

What characterizes a Severe asthmatic?

A

Frequency of symptoms: daily
Nocturnal symptoms: >2/week
Condition between episodes: hospitalized w/in year
PEFR: <60% normal

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20
Q

What are the two types of inhalers?

Study These Flashcards
A

Preventive and Rescue

21
Q

What are the 4 types of Preventative inhalers?

Study These Flashcards
A

1) cromolyns
2) methlyxanthines
3) Leukotriene inhibitors
4) Corticosteroids

22
Q

What is the MOA for Cromolyn inhalers?

Study These Flashcards
A

Mast cell stabilizer - prevents mast cell degranulation

23
Q

When should cromolyns be used?

Study These Flashcards
A

4 weeks before allergy season, 4xday

24
Q

What are side effects for cromolyn inhalers?

Study These Flashcards
A 
nasal congestion
coughing
sneezing
nose bleeds
dry throat
25
What is the MOA for methlyxanthine tablets?
relaxation of smooth muscle - mostly COPD emphysema
26
Why do methlyxanthine tablets relax smooth muscle?
they are related to coffee, so caffeine causes dilation, but can be toxic and has side effects of caffeine
27
What are leukotrienes?
They are produced by the immune system and have a major role in asthma by inducing prolonged, slow contraction of smooth muscle in lungs to prevent allergens
28
What is the MOA for leukotriene inhibitors?
antagonize leukotrienes and decreasing inflammation in the lungs as a result
29
What are the three common leukotriene inhibitor tablets?
1) Accolate: BID dose on empty stomach - hepatic toxicity 2) singulair - no toxicity - taken before bed 3) zyflo - liver toxicity
30
What is a corticosteroid?
Strong anti inflammatory
31
What are the common inhaled corticosteroids?
1) fluticasone (flovent) 2) budesonide (pulmicort) dry powder inhaler 3) triamcinolone (azmacort) 4) flunisolide (aerobid & aerobid-M)
32
What is the MOA for inhaled corticosteroids?
1) inhibition of phospholipase A2, which decreases AA cleavage, prevents COX2, decreases inflammation 2) decreases WBC infiltration into lungs
33
What are side effects of inhaled corticosteroids?
dry mouth, hoarseness, candiasis (yeast infection)
34
What are the adverse effects of high doses of corticosteroids?
``` HPA suppression (adrenal insufficiency) Hyperglycemia Joint/cartilage damage Osteoporosis Decreased immune system Child retardation Poor healing ```
35
What are the oral steroids for asthma?
Prednisone, prednisolone, methylprednisolone
36
When are oral steroids used?
in short bursts after hospitalization due to potency
37
What is the result of HPA suppression?
hypothalamus stops releasing cortisol
38
What can happen when transferring from oral to inhaled steroid?
HPA suppression - could lead to death due to adrenal insufficiency...common after transfer-gastroenteritis due to campylobacteria (electrolyte imbalance)
39
What is the use for rescue inhalers?
used for acute attacks to dilate bronchioles immediately
40
What is the MOA for rescue inhalers?
mimics epinephrine at the beta receptors
41
Why must rescue inhalers hit the B2 receptors and not the B1 receptors?
beta receptors are epinephrine receptors... | B2 in lungs, B1 in heart - hitting B1 can cause severe tachycardia
42
What are the common B2 receptor agonist rescue inhalers?
1) Albuterol (most common) 2) Bitolterol 3) Pirbuterol (maxair) 4) Salmeterol (severent) long acting 5) Levo-albuterol (xopenox) pure albuterol 6) Foradil - long acting
43
What are the side effects of B2 inhalers?
skeletal muscle tremors
44
Why are B2 inhalers used in combination with inhaled corticosteroids?
B2 primes lungs by opening up bronchioles quickly
45
What is the MOA for anti-cholinergic inhalers?
prevents autonomic nervous system from keeping lungs constricted - cholinergic effect
46
What are the therapy regimens for Mild asthmatics?
B2 agonist rescue inhalers for acute episodes
47
What are the therapy regimens for Moderate asthmatics?
B2 agonist Long acting bronchodilator (severent) Corticosteroids or Leukotriene antagonists
48
What are the therapy regimens for severe asthmatics?
all of the above, with oral corticosteroids added

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