Respiratory Disorder

Question 1

RS Disorder

Answer 1

Cough
Asthma
COPD

Question 2

Cough activated by

Answer 2

Mechanical stimuli - Foreign body, dust, talking
Chemical stimuli - Smoke, perfume
Thermal stimuli - Cold air, hot air, cold water

Question 3

Cough Categories

Answer 3

Acute 3 week
Subacute 3-8 week
Chronic 8 week

Question 4

COPD symptom

Answer 4

Same as asthma

Question 5

COPD caused by

Answer 5

chronic bronchitis
Emphesema
Smoking

Question 6

COPD Feature

Answer 6

Irreversible - Present of fibrosis
Progressive
Abnormal inflammatory response

Question 7

Asthma Characteristic

Answer 7

Recurrent attack of airway obstructive
Chronic inflammatory
Airway hyper-reactivity

Question 8

Asthma Phase

Answer 8

Early Phase: Bronchospasm

Late Phase: Inflammation

Question 9

Asthma Clinical Indication

Answer 9

Recurrent attack
Coughing
Short of breath(SOB) & Dyspnea
Chess tighness
Wheezing

Question 10

Asthma Type

Answer 10

Extrinsic-Allergic
Intrinsic- Infection, Stress
Cold Air Exercise
Drug-induced(latrogenic) Aspirin

Question 11

Asthma Pathological feature

Answer 11

Contraction of airway sm
Mucosal thickening
Plug of mucus

Question 12

Asthma Treatment

Answer 12

Sympathomimetic agents
Methylxantine drug
Antimuscuranic agent
Corticosteroids
Cromolyn & Nedocromil
Leukotriene pathway inhibitor
Other

Question 13

Asthma Therphy

Answer 13

Dilate bronchi

Reduce inflamation & mucus

Question 14

Other Asthma Therphy using

Answer 14

Anti-IgE monoclonal antibodies
Calcium Channel blocker
Nitric Oxide Donor

Question 15

First Line Bronchodilator

Answer 15

B2-sympathomimetic (Adrenoceptor
stimulant) agent
Methylxantine Group
Anticholinergic(Muscarinic) Agent

Question 16

Why not B1

Answer 16

may induce hypertension,

tachycardia, mi

Question 17

B2-sympathomimetic class

Answer 17

Short acting agent(PIO)

Long acting agent(Inhalation)

Question 18

Albuterol(Salbutamol), Terbutaline

Answer 18

B2-sympathomimetic
T1/2: 2-3 hour
Short acting agent(PIO)
Relieve bronchi

Question 19

Salmeterol, Formoterol

Answer 19

B2-sympathomimetic
Long acting agent(Inhalation)
T1/2: 12 hour
Maintain dilation

Question 20

B2-sympathomimetic ADR

Answer 20

Tachycardia- In large dose,B1 receptor

Skeletal Muscle tremor-B2 receptor, Large dose

Question 21

Theophylline

Answer 21

Methylxantine Group, Tea
On sm: bronchodilation
On ske.m: contraction of diaphragm
Narrow therapeutic index- Careful patient
already on oral theophylline

Question 22

Precaution when using Theophylline

Answer 22

Never give rapidly Avoid heart complication

Never given IV On tp treatment, measure tp blood level

Question 23

Caffeine & Theobromine

Answer 23

Methylxantine Group

Coffee & Cocoa

Question 24

General effect of Methylxantine Group

Answer 24

On sm: bronchodilation
On ske.m: improve contractility
GIT: secretion of gastric acid &
digestive enzyme

Question 25

Atropine

Answer 25

``` Anticholinergic=bronchodilator Non selective Many side effect Block all; body, gland, heart, sm Not used anymore ```

Question 26

Ipratropium Bromide

Answer 26

Anticholinergic=bronchodilator Poorly absorb=Inhalation Act directly Dilate & Selective Low con in circulation, Not much systemic adr, Not cross BBB, no cns fx Effect less than B2 agonist, Longer action than B2 agonist Effective in COPD

Question 27

Reduce inflamation & mucus

Answer 27

Antiinflamatory(long term controller)

Question 28

Antiinflamatory classes

Answer 28

``` Corticosteroid Cromolyn or Nedocromil Leukotriene Antagonist (oraly) ```

Question 29

Corticosteroid; Derived from Glucocorticoid

Answer 29

Prednisone Cortisone Hydrocortisone Avoided in chronic, mode adr

Question 30

Prednisone(Prodrug)

Answer 30

Oral >>Prednisolone Severe(systemic) Corticosteroid

Question 31

Beclomethasone, Fluticasone

Answer 31

Inhale Lipid soluble Local action Corticosteroid

Question 32

Corticosteroid Systemic(PO) adr

Answer 32

Adrenal suppresion-Taper dose gradually Give time to function back Osteoporosis Cataract Avoid by using inhale

Question 33

Corticosteroid inhale adr

Answer 33

Orapharyngeal / Oral Candidiasis Hoarseness Avoid by washing mouth

Question 34

Cromolyn or Nedocromil characteristic

Answer 34

Mast cell stabilizer Less effective than steroid/glucocorticoid Inhalation, poorly absorbed

Question 35

Mast cell stabilizer used in

Answer 35

Prophylaxis Reduce symptom Rhinoconjunctivitis

Question 36

Cromolyn or Nedocromil MOA

Answer 36

Mast cell - Inhibit early response to antigen Eosinophil - Inhibit inflamatory response to allergen Airway nerve - Inhibit cough

Question 37

Leukotriene(we use anti)

Answer 37

derive from lipooxygenase Bronchoconstrictor & chemotactic agent Stop LT stop constriction

Question 38

Zileuton

Answer 38

anti- Leukotriene Block synthesis of LT 5-lipooxygenase Inhibitor

Question 39

Zafirlukast, Montelukast

Answer 39

anti- Leukotriene Inhibit action of leukotrine D4 Inhibit binding of LTD4 to receptor

Question 40

Asthma classification

Answer 40

Mild - 1x in a week Moderate - 2-3x Severe - Daily