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PAS - PHARM > Respiratory > Flashcards

Respiratory Flashcards

(39 cards)

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1
Q

______: chronic inflammatory disease of the bronchial tubes and lung tissue

airway changes:
the muscles surrounding the bronchial tubes ______, airways _____
- the lining of the airway becomes ______ and _____
-there is an increase in ____ production

A

asthma
constrict, narrow
inflamed, swollen
mucus

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2
Q

asthma triggers

  • respiratory infections - ____, _____
  • ______ - pollens, dust mites, animal dander
  • ______
  • work stimuli - ____, farmers hay ____
  • ________ - cold air, tobacco smoke
  • emotions - _____ & ____
  • exercise - especially in ____ ____ climate
  • drugs/preservatives - ___, ____
A 
viral, pneumonia
allergens
GERD
flour, mold
environment
anxiety, stress
cold, dry
ASA, sulfites, beta blockers
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3
Q

signs and symptoms
-use of accessory muscles
(_______, _____ intercostals, and _____ muscles of the neck)
-__________ pulse (weak during _______ and strong at _______)
-over inflation of the ____
-___ color of skin and nails may indicate cyanosis
-responds to standard treatment with _______ and
____
-___________: mortality rate 70%

A 
sternocleidomastoid, external, scalene
paradoxical
inspiration
expiration
chest
blue
bronchodilators, steroids
status asthmaticus
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4
Q

asthma
clinically: recurrent episodic bouts of ______
two phases
-acute-phase (________) response
-within a few minutes to ______ challenge
-________, ________, ________, ______-
-lasts a few hours

late-phase response (_______)

  • ______ wheeze, hyper-responsiveness
  • occurs in _ to _ last up to 12 to 24 hours
A 
bronchospasm
immediate
bronchospasm, SOB, chest tightness, wheezing
inflammation
chronic
2,6
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5
Q 
immediate (acute) phase
bronchial smooth muscle constriction
-mediator release from sensitized \_\_\_\_ cells and other immunologic reponses
-\_\_\_\_\_\_\_\_; eosinophil chemotatic factors
-\_\_\_\_\_\_\_\_\_- (LTB4, LTC4, LTD4, LTE4)
-\_\_\_\_\_- is a chemo-attractant
-\_\_\_\_\_\_\_, neutral \_\_\_\_, \_\_\_\_\_\_\_\_\_ (D2)
-\_\_\_\_\_\_ with treatment
-short term relief with \_\_\_\_\_\_\_
-\_\_\_\_\_\_\_ may help in allaying symptoms
A 
mast
histamine
leukotrienes
LTB4
tryptase
proteases
reversible
prostaglandins
bronchodilators
oral steroids
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6
Q

late phase response
-peak within ___ hours and may last for ____ hrs
-chronic inflammation characterized _________
-mast cells, lymphocytes, GM-CSF (granulocyte, macrophage
CSF)
-release of _______ (IL4, IL5, IL9, 130, TNF, TGF) which activate ________ & _______

A

4-8, 12-24
cellular infiltration
cytokines
eosinophils, neutrophils

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7
Q

goals of asthma therapy

  • prevent troublesome symptojms: cough, breathlessness in night, am, after exercise
  • _______ normal lung func tion
  • maintain normal activity
  • prevent recurrent ________/hosp
  • optimal ____ therapy w no side effects
A

maintain
exacerbations
drug

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8
Q 
quick-relief (rescue) medications:
-agents that directly relaxes bronchial smooth; prompt \_\_\_\_\_ of acute airflow obstruction
-SABA (short acting beta agonist)
-\_\_\_\_\_\_\_\_ (ventolin); \_\_\_\_\_\_\_\_
anticholinergics
-\_\_\_\_\_\_\_\_ (Atrovent); \_\_\_\_\_\_\_\_ (spiriva)
corticosteroids
-\_\_\_\_\_\_\_, prednisone, triamcinolone
A 
reversal
albuterol, terbutaline
ipratropium
tiotropium
fluticasone
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9
Q

pharmacologic agents for asthma

long-term control (controller) medications
-__________, inhaled - beclomethasone, budesonide, fluticasone
-______ (________) - salmeterol (serevent), formoterol; salmeteral/flunisolide
(Advair)
-__________ inhibitors
zileuton (Zyflo)
- ________ stabilizer (also inhibits eosinophi; recruitment)
cromolyn (gastrocom); nedocromil (alocrif)
-________ - theophylline
-________ - omalizumab (xolair)

A 
corticosteroids
LABA (long acting beta 2 agonist)
leukotriene receptor antagonist (LTRA)
5-lipoxygenase inhibitors
mast cell stabilizer
methylxanthines
immunomodulators
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10
Q

types of asthma

  • _______ - patients with episodic illness with extended symptom-free periods
  • _____ or ____ - daily symptoms or symptoms several times/week without extended symptom free periods
  • _____ - daily symptoms during an allergy season (also referred to as seasonal asthma)
A

intermittent
persistent/chronic
allergic

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11
Q

status asthmaticus

  • acute ____ asthma
  • life threatening emergency
  • requires rapid, and aggressive treatment

immediate treatment

  • activate office emergency protocol
  • oxygen by ____
  • humidified air to help _____ mucus
  • _____
  • patients will require hospitilization
A

SEVERE
mask
liquefy
albuterol

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12
Q

symptoms of poorly controlled persistent asthma

  • waking up at night >_/month
  • refilling albuterol (ventolin) > __ time a month
  • _______ bronchoconstriction
  • missing _____
  • missing ___
  • _______
A 
2
1
excercise induced
school
work
hospitilization
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13
Q

quick relief medication reliever/rescue

  • non-selective beta 2 agonist: _______, _________
  • short acting beta2-agonists: ________, _______
  • _________
  • _____________
A

epinephrine, isoproterenol
terbutaline, albuterol
anticholinergics
systemic corticosteroids

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14
Q

beta 2- agonists (albuterol)

  • relax airway smooth or relieve _______
  • used for treatment of ______ episodes of bronchospasm and prevention of _______ d asthma
  • for acute asthmatic attack
  • ________
  • _______ (ma huang)
  • __________
A 
bronchospasm
intermittent
exercise induced
epinephrine
ephedrine
isoproterenol
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15
Q 
beta-2 agonists
-beta-adrenoceptor agonists
mechanism of action
-stimulate \_\_\_ receptor \_\_\_\_\_\_\_\_\_\_ coupled receptor system
-activate \_\_\_\_\_\_\_\_
-increase \_\_\_
-protein \_\_\_\_\_\_\_ activation
-inactivation of \_\_\_\_\_\_\_ kinase
-results in bronchodilator response by relaxation of bronchial smooth muscle
A 
b2
G protein
adenylyl cyclase
cAMP
kinase A
myosin light chain
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16
Q 
beta-adrenoceptor agonists
adverse effects
-\_\_\_\_\_ muscle tremors
-\_\_\_\_\_\_ at high doses
-\_\_\_\_\_ with excessive use
-loss of responsiveness
-\_\_\_\_\_
-\_\_\_\_\_\_\_: excessive use of short acting sympathomimetics
Study These Flashcards
A 
skeletal
tachycardia
arrythmias
tolerance
tachyphylaxis
17
Q 
beta-2 agonists
short acting
-\_\_\_\_\_\_\_ (Proventil, Ventolin)
-\_\_\_\_\_\_\_\_ (Bricanyl, Brethine)
-\_\_\_\_\_\_\_\_ (Alupent, Metaprel)
Pharmacokinetics:
-rapid onset of action 15-30 mins
-peak effect in 30-60
-duration of action:  4-6 hours
Study These Flashcards
A

albuterol
terbutaline
metaproterenol

18
Q

anticholinergics

  • _________(atrovent), _________(spiriva)
  • blockade of these cholinergic receptors decreases the formation of ____, resulting in decreased _______ of smooth muscle
  • ________
Study These Flashcards
A 
ipratropium
tiotropium
cGMP
contractility
bronchodilation
19
Q

anticholinergic drugs
_______ antagonists
-effects (inhalation)
-effective in 33% of patients
-not well absorbed into ________ - quarternary ammonium compounds
-more effective and less toxic than ________ in COPD patients

pharmacokinetics (inhalation)

  • _______ delivery, minimally absored ________
  • rapidly ________, little systemic action
  • excessive doses - ______ like effects
  • does not cause _____ or _______
Study These Flashcards
A 
muscarinic
circulation
beta agonists
localized
systemically
metabolized
atropine
tremor or arrythmias
20
Q

systemic corticosteroids

  • used for _____ to ____exacerbations
  • _________, ________, ________
  • decrease inflammation and improve mucus production
  • ___ or ____
Study These Flashcards
A

moderate, severe
hydrocortisone, prednisone, dexamethasone
oral, IV

21
Q

corticosteroids
mechanism of action
-bind to intracellular receptors. and activate ____ in the cell nucleus
-reduce the activity of ________ and inhibit ____ expression (prostaglandin production) and _____ (lipooxygenase production)

mechanism of action
-inhbits phospholipase A2, COX, LOX and membrane ________

Study These Flashcards
A 
GRE
phospholipase 2
COX-2
LOX
stabilization
22
Q

In COX pathway, what do you give to treat?

Study These Flashcards
A

NSAIDs bc releasing prostaglandins and thromboxanes

and you can give corticosteroids

23
Q

In LOX pathway, what do you give to treat?

Study These Flashcards
A

corticosteroids

24
Q

controller medications

  • _____________
  • _____
  • _________
  • ___________
Study These Flashcards
A

inhaled corticosteroids
LABA
leukotriene modifiers
slow-release theophylline

25
``` controller meds inhaled corticosteroids agents -_________ (rhinocort) -________ (belcovent) -___________ (flonase, flovent) -___________ (nasacort) -________. (omnaris): most recently approved inhaled steroid is an ester ____ which converts into des-isobutryclicesonide in the ______ bronchial epithelium ``` adverse effects -deposition of drugs in mouth and upper airway lead to oral _________ (_____)
``` budesonide beclomethasone fluticasone triamcinolone ciclesonide prodrug lower candidiasis (thrush) ```
26
adverse effects of inhaled corticosteroids inhalation -occasionally, small degree of ______ suppression (rarely significant) -____________ -rinse mouth -children, mild growth _____ adverse effects oral - ________, _______, _______ - _____ suppression, can be reduced by alternate day theapy
``` adrenal oropharyngeal candidiasis retardation osteoporosis, cataract, hypertension adrenal ```
27
controller meds LABA - long acting inhaled eta 2 agonists -________ (oxeze). and _______ (serevent) -adjucnt therapy to inhaled steroids -available ___ and as combination therapy with ______ -espepcially helpful for ___ time symptoms and _____ induced asthma -not to be used to treat ___ symptoms or _______
``` formoterol salmeterol alone steroids night exercise acute exacerbation ```
28
``` controller meds leukotriene antagonists -________ (5-lipo-oxygenase inhibitor) -____ -block leukotriene receptors that mediate airway inflammation, ____, _________, and secretion of thick viscous ____ -administered _____ clinical application -_______, _______ and treatment NOT useful for ____ attack or _________ ```
``` zileuton zyflo edema, bronchoconstriction, mucus orally asthma, propholaxis acute status asthmaticus ```
29
controller meds leukotriene modifiers -________ (motelukast), _______ (zafirlukast) -they prevent _____ of leukotrienes to target tissues preventing bronchoconstriction, mucosal edema, bronchial hyper reactivity -beneficial in patients with _____ induced bronchospasm (already on ______) and patients with ______ allergies ^^ above drugs -______and ______ leukotriene antagonist clinical application - asthma, prophylaxis and treament - NOT useful for accute attack or status asthmaticus
``` singulair accolate binding exercise steroids environmental ``` selective, competitve
30
controller meds theophylline class of __________ - theophylline, ________, and ____ - ___ to ____ bronchodilator - may have mild anti ________ effects and _______ effects - enhances _____ secretion - serum levels measurable - ________ half life - reduced in _______ and children ages 1-9 - metabolism by CYP 450 - watch drug interactions - _______ - severely decreases clearance of theophylline adverse effects GI (______), CNS (_______), and cardiac stimulation (________) -CNS effects - restlessness, insomnia, dizziness, seizures -____!!!
``` methylxanthines mild, moderate inflammatory immunosuppressant catecholamine variable smokers ciprofloxacin diarrheda, convulsions arrythmias death ```
31
``` controller meds mast cell stabilizers _________ (Intal) -stabilize mast cell membrane -NOT effective during acute asthma attack -prevents mast cells from rupturing and spilling _______ (degranulation) after initial contact with antigen -administered via ______ or _______ -prevent release of ___________s -has no ______ bronchodilator activity -has no _______ activity ``` ``` -cromolyn (disodium cromoglycate) & _______ clincical uses -asthma (______), especially in ______ -_____ allergy (oral) -topical (______) -_____ irritation -______ tract irritation ```
``` cromolyn sodium histamine inhalation intranasal spray inflammatory mediators intrinsic antihistamine ``` ``` nedocromil inhalation children food hay fever conjunctival nasopharyngeal ```
32
anti-IgE antibodies - omalizumab (Xolair) - -_____ developed through molecular biology research (mice) - -binds to _____ on the surface of _____ and _____ but foes not activate already bound IgE, thus does not _____ cells - -indicated for moderate to severe cases which are inadequately controlled by _____ - -used in asthma reactive to a specific _____
``` monoclonal antibody IgE mast cells basophils degranulate inhaled corticosteroids allergen ```
33
anti-IgE antibodies - omalizumab (Xolair) - -administered via _____ injection every 3 or 4 weeks - -lowers _____ to undetectable levels, m reducing early as well as late _____ response - -adverse effects: - --injection site reaction (_____) - --_____; _____; myopathy - --_____ reaction
``` subcutaneous IgE bronchial thrombophlebitis pharyngitis earache anaphylactic ```
34
beta blockers - inducers of _____ - used for Rx _____/_____ - blocking beta 2 receptors in airways with nonselective beta blockers (_______) - selective beta blockers (cardio-selective blockers) preferred: _____ - less _____ than nonselective beta blockers
``` bronchoconstriction hypertension arrhythmias propranolol atenolol bronchoconstriction ```
35
drug-induced bronchospasm - ___and ____ - -can induce severe bronchospasm - _____: preservatives - ________ - -can cause cough (_____) - -cough is due to release of _____ - in asthmatics... since cough is a symptom of asthma and a side effect of _____ use these drugs carefully
``` ASA NSAIDs sulfites ACE inhibitors lisinopril prostaglandins ACE inhibitors ```
36
chronic obstructive pulmonary disease (COPD) - COPD is generally used to describe patients with one or more of the following - -_____ - -_____ - -_____
chronic bronchitis emphysema asthma
37
COPD - chronic bronchitis and emphysema - airway _____ - asthma? - 14 million American diagnosed/14 million more - 120,000 deaths annually (COPD +Asthma = 4th) - excessive production and secretion of _____ - _____ smoking is a major factor (80%) - ALL smokers have a decline in lung function - 20% industrial smole, pollutants, airway infections, allergy and hereditary factors
hyper-reactivity mucus cigarette
38
COPD - excessive _____, _____ production and _____ - symptoms have been present for >__ years - destruction of the walls with _____ distortion - loss of _____ - large (central) airways, the small (peripheral) bronchioles and the lung _____ affected - the primary offender: _____ - PMN leukocytes and macrophages release _____ resulting in lung parenchymal destruction
``` cough sputum dyspnea 10 fibrotic elastic recoil parenchyma human leukocyte elastase elastases ```
39
``` copd pathophysiology and natural course -enlarged _____ -dilated _____ -inflammation in _____ -mucus _____ -_____ distortion ```
``` mucus glands bronchial gland ducts bronchioles plugging fibrotic ```

PAS - PHARM (26 decks)

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