Medicam antiinfl

Question 1

Tipuri

Answer 1

Glucocort
Modif de leucotriene
Inhib degranulare mastocitara
-terapie anti IgE
-alte terapii-antihistaminice H1,inh de fosfodiesteraza4,imuniter specifica

Question 2

Glucocort mecan act

Answer 2

-act pe recep intracitoplasmatici
-sunt transloc in nucleu
-influenteaza codificare gene pt mediatori infl

Question 3

Glucocort efecte

Answer 3

-inh formare citokine proinfl
-inh migrare mediatori infl
-apoptoza eozinofile
-scad secr exocrine
-cresc ef beta 2 agonisti
-scad desensibilizare recel beta 2 Agonisti
-pe termen lung scad hiperreactivit bronsica (ef antiinfl)
-scad edem(scade permeab vasc)
-scad sinteza PG,LT

Question 4

Glucocort indicatii

Answer 4

-astm-monoter sau cu beta 2 agonisti de lumga dur sau cu modif de leucotriene
-exacerbari se da oral/iv(3-7 zile)

-BPOC-eficienta mai redusa,dar se da la fel ca si la astm

Question 5

Glucocort ef adv

Answer 5

Locale(depunere orofaringe)
-diafonie
-candidoza bucala
-iritatie

Sistemic
-insuf corticosuprarenala
-intarziere crestere copii(beclometazona)
-osteoporoza(femei menopauza)
-r adv cut(varstnici)
-glaucom,cataracta
-probl metab

Question 6

Glucocort inh

Answer 6

-lipofili
-10-40% e retinut in plaman, restul e inghitit/depozitat in orofaringe-dar prim pasaj hep si doar putin ajunge sistemic
-au mai mare afin to recep pulm decat cei adm oral
-ciclesonid-promedicam
-1-2 adm cei de generatie noua
-3-4 adm cei de gen veche(beclometazona)

Question 7

Glucocort inh exemple

Answer 7

Bectlometazona dipropionat
Fluticazona propionat(FLIXOTIDE) +Salmeterol(Seretide)/Formoterol
Fluticazona furoat
Budesonide(PULMICORT)
+Formoterol(Symbicort)
Mometazona
Ciclesonid

Question 8

Glucocort oral

Answer 8

-pe term lung se prefera metilprednisolon(ef minime mineralocorticoid si pe ms striat)
-doza intreaga se ia dimineata in jurul orei 7
-adm la 2 zile nu confera control bun

Prednison
Metilprednisolon

Question 9

Glucocort iv

Answer 9

-hemisuccinat de hidrocortizon se prefera(ef rapid si de scurta dur)-acelasi ef ca si prednison oral

-se poate da si metilprednisolon

Question 10

Leucotriene efecte

Answer 10

-bronhoconstr(de 1000 de ori mai tare ca HIS)
-creste secr mucoasa
-creste edem
-atrage neutrofile si eozinofile(LTB4)

Question 11

Mediatori de leukotriene mecan act

Answer 11

-inh sinteza lor-inh 5 lipooxigenaza(ZILEUTON)
-antag recep pt Cys-LT(ZAFIRLUKAST,MONTELUKAST-afin pt LTR1,PRANLUKAST)

Question 12

Modif de LT-efecte

Answer 12

-reduc bronhoconstr
-antiinfl(reducere eozinofile-mai putin decat glucocort)
-reduc util beta2 agonisti in criza

Question 13

Modif LT -indicatii

Answer 13

-astm ca alternativa la glucocort la pac care nu pot utiliza(forme usoare)
-+ glucocort la cei ce nu pot utiliza beta 2 agonisti
-astm indus alergic,efort,asociat cu rinita alergica

NU SE UTIL IN BPOC

Question 14

Modif de LT-r adv

Answer 14

-cresc enzime hep(zileuton,zafirlukast)
-sdr Churg-Strauss-vasculita cu eozinofilie sistemica,astm,afect cardiaca,renala,nv perif(zafir,montelukast)
-interactiuni(citocrom P450) ale zileuton,zafirlukast cu antiepileptice,anticoag orale,teofilina

Question 15

Inh degranulare mastocite-Cromone
Efecte

Answer 15

-inhib elib subst proinfl(HIS,PGD)
-inhib form Cys-LT
-inhib functia limfocite(eoz)
-inh chemotactism eoz,neutrofile,monocite
-inh form IgE
-inh reflexele nv implicate in simpt astmului

Scad hiperreactivit bronsica in adm cronica

Question 16

Cromone indicatii

Answer 16

-astm -cu glucocort
-rinita alergica
-conjunctivita alergica
-alergii alim(pt simpt gastrice cu 15-30 inainte de ingerare)
-mastocitoza sistemica

Question 17

Cromone medicam

Answer 17

Cromoglicat disodic

Question 18

Antihistaminice H1

Answer 18

-produc sedare,crestere in G
-antihistaminic si inh si degranulare mastocite
-acum se recomanda cele de gen 2 pr ca au ef sedativ minim

Ketotifen

Question 19

Anti IgE mec act

Answer 19

-se leaga de IgE si nu lasa se le cupleze pe bazofile si mastocite
-scade si recep pt IgE in bazofile si mastocite
-in timp scade markeri infl (NO,IL-13)
si cel infl cronice(limbB, eozinofile)

OMALIZUMAB

Question 20

Anti IgE indicatii

Answer 20

-astm sever daca nu merge combinatia
(Se da sc cam 2 ani)-treapta 5
-urticarie cronica idiopatica(6 luni)
-pt reducere anafilaxie

Question 21

Anti IgE -r adv

Answer 21

-la loc injectare-eritem,edem,durere
-inf virale
-r anafilactice rar
-cefalee,febra

Question 22

Imunoter alergen specifica

Answer 22

-activeaza limf T(limiteaza rasp la alergen-o sa fie ca la un pac non-atopic)
-merge pe rinita bine
-se mai foloseste si la astm dar trb selectionati pac
-mai efic la copii si tineri
-recomandat pt polen,acarieni,par de animale
-trat 3-5 ani
-adm oral,sublingual,subcut

R adv
-local dupa inj
-anafilactic
-agravare simpt astm chiar dupa injectare

Question 23

Modif de citokine,chemokine

Answer 23

Doar cel anti IL-5 s a dovedit eficient(scad nr exacerbari si nr eozinofile)

Question 24

Inh de fosfodiesteraza 4

Answer 24

-scad eozinofile
-scad rasp alergen in astm
-scad exacerbari in BPOC(ROFLUMILAST)
-dad multiplex ef adv si nu e prea folosit