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Flashcards in Respiratory Deck (45)
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1

Asthma meds are aimed at

flattening the response to inflammatory mediators

2

Why is it that steroids that work in asthma have minimal response in COPD?

Because the inflammation in COPD is of a different pathway than that of asthma

3

Inhaled _________ can help reduce the frequency of COPD exacerbations

corticosteroids

4

This type of medication has only a modest ole in increasing air outflow in a patient with COPD with chronic breathlessness that is worsened by exercise

Bronchodilators

So basically in COPD, bronchodilators don't really help and the steroids used in asthma don't really work either. People with COPD are placed on corticosteroids.

5

R sided heart failure with COPD

Those with CB experience R HF and cor pulmonale as part of the disease process

Those with emphysema experience R heart problems during acute infections

6

Pink puffers refer to __1___
Blu bloaters refer to __2__

1= emphysema
2= CB

7

PaCO2 in COPD

High in CB
Normal in emphysema

8

Types of bronchodilators used

Beta agonists
Anti-cholinergics
Methyxanthines

9

Problem with using epi for treatment of bronchoconstriction

It has B1 and alpha effects as well, which can cause tachycardia, palpitations, and vasoconstriction

10

Selective B2 agonists
(Short and long acting)

Short acting:
- Terbutaline
- Albuterol
- Levalbuterol (the most B2 selective!)
- Salbumatol
^^ We go for the first three of these because we can repeat the dose multiple times

Long-acting
- Salmeterol (pts on this at home and use albuterol for acute attacks)
- Formoterol

All of these B2 selective agents have an affinity for B2 200-400 times stronger than that for B1.

11

What happens at high doses of B2 selective agents?

They become less selective and start affecting other receptors

12

Effect of B2 agonists on electrolytes

Hypokalemia**- increased uptake by skeletal muscle. Also there is release of glucose, causing an insulin spike, driving K+ into cells. Also, B2 stimulates the Na/K pump, further driving K+ into cells.

Hypomagnesemia

Hyperglycemia

13

3 beneficial effects of B2 on the bronchi

Smooth muscle relaxation / bronchodilation
Decreased release of histamine from mast cells
Increased ciliary clearance of mucus

14

Onset of action of B2 agonists

15-30 minutes

Levalbuterol may act as soon as 5 minutes

15

How are B2 agonists given?

Inhaled, nebulized, aerosolized, powder, orally, SQ

16

Only B2 agonist that can be given SQ

Terbutaline

17

Side effects of B2 agonists

Muscle tremor (B2)
Increased HR (B1)
Vasodilation (B2)
Metabolic changes (B2)- hypokalemia, hyperglycemia, and mypomagnesemia

18

How can B2 side effects be minimalized?

Inhalation delivery (decreases systemic effects by keeping it in the lungs)

19

Albuterol dosing

100cmg/puff
2 puffs Q4-6 hours
Nebulizer dose: 2.5-5 mg in 5mL of saline

20

Albuterol DOA

4-8 hours

21

Albuterol has an additive effect with _______ on bronchomotor tone

Anesthetics

22

2 Isomers of albuterol

R- This is Levalbuterol and is more B2 selective

S- This type of albuterol has more affinity for B1

23

How to blunt airway hyperresponsiveness prior to anesthesia

4 puffs of albuterol

or

2 puff albuterol + 1mg/kg of lidocaine IV

24

Bitolterol

B2 selective agent that resembles albuterol but is longer lasting.
CV side effects are rare
Dose is 270mcg/puff
Max of 16-20 puffs/day

25

SQ use of terbutaline

SQ use resembles the effects of epinephrine.
Used for status asthmaticus or pre-term labor
Dose for adults in .25mg SQ Q 15 min
Dose for peds is .01mg/kg SQ

26

Terbutaline inhaler dose

200mcg/puff
Max of 16-20 puffs/day

27

How can terbutaline be administered?

Inhalation
SQ
Oral

28

How do long-acting B2 agonists work?

They have a lipophilic side chain that resists degradation. Results in a DOA of 12-24 hours. These are not used for acute attacks.

29

How can the amount of time between asthma flare-ups be avoided?

Combined therapy of a long-acting B2 agonist and a steroid

30

Methylxanthines are also called ______

Phosphodiesterase inhibitors

31

What is the MAJOR PREVENTATIVE treatment for patients with asthma?

Inhaled corticosteroids

32

This is the most important type of drug in the management of asthma

Inhaled corticosteroids

33

Do corticosteroids cure asthma?

No. They are used as a supportive therapy, not a cure.

34

The degree of bronchoconstriction and hyperresponsiveness in asthma paralleles _____

the degree of inflammation

35

Asthma is characterized by these two features

Inflammation and hyperresponsiveness

36

Effect of using corticosteroids with a B2 blocker

It increases the DOA of the B2 blocker

37

Effect of eosinophil degranulation

Interferes with the activity of M2 receptor, causing bronchoconstriction

38

Salmeterol is given as a combination of

Salmeterol and fluticasone

39

These are the most important drugs in asthma management

Corticosteroids

40

These are the most important drugs in COPD management

anticholinergics (tiotropium is best --> only FDA approved anticholinergic for COPD).

Tiotropium has minimal SE because it doesn't cross the respiratory epithelium

41

Methylxanthines (phosphodiesterase inhibitors) interact with this anesthetic

Halothane

42

How long does it take for cromolyn to take effect? How does cromolyn work? What are the SEs?

It is a mast cell stabilizer (inhibits antigen-induced histamine release). It is for preventative therapy only!!! Takes 7 days for effect to kick in.

43

Montelukast (Singulair) can interact with ____ and cause ______

Warfarin
Prolonged PT

44

The Anti-IgE antibody we know if called

Omalizumab

45

Nerves that aren't part of the ANS can release these substances to induce bronchiole dilation

NO and VIP