10271603
Description
Flashcards by Elizabeth Then, updated more than 1 year ago
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Created by Elizabeth Then
about 7 years ago
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| Question | Answer |
| Asthma definition | Chronic inflammatory disorder of the airways Reversible airflow obstruction inflammation causes increase in bronchial hyper responsiveness |
| Onset of asthma | Early onset- childhood late onset- adulthood |
| 2 phases of asthma attack | Early- bronchospasm, treated with bronchodilators (B2 adrenoreceptor agonists) Late- Inflammation, treated with anti-inflammatory agents (glucocorticosteroids, cromoglicate |
| Risk factors for asthma | environments, dust, allergens, genetics |
| Respiratory efferent pathways | smooth muscle of respiratory tract innervated by parasympathetic nerves mediate bronchoconstriction and mucus binding (binding to ACH and muscarinic M3 receptors in SM Is NOT innervated by sympathetic nerve |
| Bronchodilators | used in early phase B2 adrenoreceptor agonists anticholinergic drugs (muscarinic receptor antagonists) |
| Anti-inflammatory agents | directed in early and late phase glucocorticosteriods cromoglicate |
| B2 receptor agonists | bronchodilator smooth muscle relaxation-inhaled aerosol short acting drugs-salbutamol long acting drugs-salmeterol G-protein coupled receptor on smooth muscle of bronchioles, causes bronchodilation cAMP activation side-effects: tremor, tachycardia, nervousness, insomnia |
| Anticholinergic drugs (muscarinic receptor antagonists/antimuscarinic agents) | bronchodilator(early phase) competitively inhibit Ach affect on muscarinic receptor SM relaxation- inhaled aerosol Ipatropium side effects: minimal due to low systemic absorption, urinary retention, pupil dilatation, glaucoma |
| Anti-inflammatory agents | directed against both early and late phase glucocorticoids cromoglicate |
| Glucocorticoids | NOT bronchodilators NOT effective against early phase e.g. beclomethasone action: prevent immune cell activation, inhibit activation of chemotaxins by leucocytes reduce cytokines, produce anti-inflammatory effect side effects: oral candidiasis (need antifungal) adrenal suppression |
| cromoglicate | NOT bronchodilator action: inhaled aerosol, poor absorption inhibit release of histamine, depresses bronchial SM hyper reactivity side effects: few, safe drug for asthma, irritation of upper resp tract |
| Xanthine derivatives: | theophylline aminophylline xanthine alkaloids-coffee, tea, cocoa SM relaxation, cAMP increase, inhibit breakdown of mast cells Side effects: narrow therapeutic range, insomnia, headache, GI disturbance, tachcardia |
| Leukotriene receptor antagonist | e.g. accolate, montelukast mechanism: antagonism of LTD4 receptor bronchoconstriction, mucus secretion increase side effects: few, headache, GI disturbance |
| New Drugs (Omalizumab) | NOT effecttive against early phase targets IgE antibodies with mast cellls SC injection side effects: reduce immune response, anaphylactic reaction, increase in malignancies |
| New drugs (5-lipoxygenase inhibitors) | NOT effective against early phase inhibit enzyme 5-lipoxygenase, responsible for formation of leukotriens from arachidoic acid side effects: headache, GI disturbance |
| Stepwise approach to asthma management | Once sustained control is achieved, a step down reduction therapy is considered long term aim is to promote minimum therapy-maintain controal |
| COPD | chronic bronchitis and emphysema not fully reversible airflow obstruction, progressive decline in lung function breathlessness, cough, airway inflammation, symptoms overlap, difficult to diagnose, ongoing decline in FEV1 |
| COPD-treatment | bronchial SM relaxation with short and long b2 adrenoreceptor agonists, anticholinergics, monitor FEV1 short b2=salbutamol long b2=salmeterol |
| COPD- treatment (anti-inflammatory) | less effective due to adverse effects but effectively control inflammation used to prevent lung function deterioration oral glucocorticosteriods- short term inhaled glucocorticosteriods- advanced stages of COPD adverse effects: infections, osteoporosis, psychological disturbances |
| Inhaler medication advantages | drug delivery to site of action immediate effect for bronchodilators small doses required to be effective with few side effects |
| Types of inhalers | MDI- delivery of specific amount in aerosol form Breath Actuated MDI- less propellant than MDI DPI- breath actuated no propellants nebulisr- converts liquid medication to fine mist for inhalation |
| inhaler assessment and education | must be explained and demonstrated select most suitable device match device with capability regular review of technique |
| Asthma allergic/extrinsic | triggered by allergen, release of histamin and leukotrienes, causes SM spasm, mucous, bronchoconstriction, inflammmation |
| Asthma non-allergic/intrinsic | -altered autonomic nervous system function, release of histamine and leukotrienes, bronchoconstriction, mucous |
| Histamine in asthma | cause sm spasms, inflammation, oedema, stimulate larger bronchi |
| Ach in asthma | increase vagal tone, cause bronchoconstriction, increase mucous secretions |
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