Asthma/DVT/PE Flashcards Preview

CRRAB 2 > Asthma/DVT/PE > Flashcards

Flashcards in Asthma/DVT/PE Deck (24):
1

Symptoms of Asthma

Chronic cough, Dyspnea, Wheezes
diminished FEV/FVC ratio, improves with administration of beta-2 agonist (PEFR also increases)

2

Atopic Asthma

Excessive Th2 response
type 1 IgE-mediated hypersensitivity; evidence of allergen sensitization, often in a patient with a history of allergic rhinitis, eczema

3

Non-atopic Asthma

often adult-onset/more severe disease: triggers can be: aspirin/other drugs, exercise, cold air, stress, inhaled irritants

4

Diphenhydramine, chlorpheniramine

1st generation anti-histamines
block H1, muscarinic, cholinergic receptors
not recognized by P-glycoprotein efflux pump --> sedation
side effects from other receptors

5

Fexofenadine, cetirizine, loratidine

2nd generation anti-histamines
block H1 receptor
recognized by P-glycoprotein efflux pump --> no sedation or side effects from other receptors

6

Theophylline

mechanism not fully elucidated
PDE inhibitor --> results in increase in cAMP levels --> results in broncho dilation
Toxic side effects --> don't use

7

Normal dilation pathway of broncho smooth muscle

Epi binds beta-2 receptors --> GPCR --> adenylyl cyclase --> increased cAMP --> bronchodilation

8

Cromolyn Sodium

anti-inflammatory and mast cell stabilizer
blocks release of histamine and SRS-A

9

Albuterol

SABA --> binds beta-2 receptors causing broncho dilation

10

Salmeterol, formoterol

LABA --> binds beta-2 receptors causing broncho dilation
NEVER use by themselves!!!

11

Zileuton

5-lipoxygenase inhibitor --> inhibits synthesis of LTB4
may decrease the need for beta agonists
require monitoring for hepatic toxicity

12

Monteleukast, Zafirleukast

reversible leukotriene receptor antagonists (LTD4 receptor and Cyst-LTR1)
Safe and once daily administration

13

Phenylephrine

potent, direct acting alpha agonist with no beta activity --> vasoconstriction --> nasal decongestion

14

Pseudoephedrine

Directly stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction; directly stimulates beta-adrenergic receptors causing bronchial relaxation

15

Inhaled corticosteroids

bind steroid response element --> alter transcription --> decreased NF-kB, and other inflammatory cytokines and mediators
Nasal sprays: enhanced uptake in lungs, prolonged tissue binding in the lungs, nearly complete first pass inactivation

16

Omalizumab

- binds to free IgE in circulation → inhibits IgE binding to mast cells & basophils→ decreases mediator release→ decreases free IgE & down-regulates IgE receptors
- Given as injection sub-q, expensive
- Anti-IgE treatment might be recommended if you have allergic asthma and you keep experiencing persistent symptoms despite taking your controller medications.

17

Treatment of different severities of asthma

Step 1 - SABA as needed
Step 2 - Low dose ICS and SABA as needed
Step 3 - Low dose ICS and LABA/medium ICS w/ SABA as needed
Step 4 - Medium dose ICS and LABA
Step 5 - High dose ICS and LABA
Step 6 - High dose ICS, LABA, oral corticosteroid

18

Severity of Asthma symptoms

1. Intermittent: infrequent symptoms (less than twice a week) use albuterol
2. Persistent: more than twice a week - waking up with cough/ not able to breath, Treat these people with daily inhaled corticosteroids. If someone has persistent asthma you will use the least effective dose. When they have an exacerbation you still use the albuterol just like everyone else.
3. Severe: add a long acting, increase the dose, add a leukotriene inhibitor, never use theophylline
4. Super severe: daily oral steroids!!

19

Nonpharmacologic treatment of asthma

Allergen/environment control
Patient Education
Recognition of symptoms and measurements of lung function

20

Inverse Agonist

binds same receptor but induces pharmacological response opposite to that of agonist

21

Competitive Agonist

receptor antagonist that binds receptor but does not activate the receptor

22

Virchow's Triad

Stasis
Hypercoaguability
Endothelial Damage

23

PE and V/Q mismatch?

V/Q ratio goes to infinity (essentially no perfusion)

24

D-dimer test

Good sensitivity but LOW specificity
Negative test --> NO CLOT
Positive test --> can't say there is a clot