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58 Cards in this Set
- Front
- Back
Define ashtma?
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an inflammatory disease with associated bronchospasm
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What are the clinical signs of asthma?
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wheezing, breathlessnes, cough, mucosal edema dn the production of mucoid sputum and plugs
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What happens to expiratory flow in asthma?
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expiratory flow decreases
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What is the goal of treating ashtma?
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modificatin of airway inflammation - not just achieving brochodilation
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What are the 4 types of quick-relief medications?
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1. inhaled β₂ agonists, 2. anticholinergic, 3. systemic corticosteroids, 4. oxygen
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What are 4 inhaled β₂ agonists used to treat ashtma?
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1. abuterol, 2. levalbuterol, 3. terbutaline, 4. pirbuterol
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What is the drug of choice of the β₂ agonists for treating asthma?
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levalbuterol
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What effects do inhaled β₂ agonists have on asthma?
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relief of acute symptoms/bronchospasm and preventative treatment prior to exercise induced asthma
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What is the M.O. of inhaled β₂ agonists?
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bronchodilation via adenylate cyclase activation and increased cAMP
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Do inhaled β₂ agonist impact any changes on airway inflammation
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No, they do not
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What are two anticholinergic drugs used to treat asthma?
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ipratropium and tiotropium (longer half life)
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When are anticholinergic drugs used to treat asthma?
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to achieve relief of acute bronchospasm, in patients who are intolerant to β₂ agonist
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What is the M.O. of anticholinergic drugs?
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bronchodilation by competitive inhibition of muscarinic cholinergic receptors; reduction in vagal tone to airways and may block reflex bronchoconstriction secondary to irretants or to reflux esophagitis
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What are the adverse effects of anticholinergic drugs?
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dry mouth and decreased respiratory secretions and increased wheezing in some pts
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Can anticholinergic drugs be used with exercise induced bronchospasms?
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No, they do not block exercise induced bronchospasm nor does it modify reactions to allergens
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What are two systemic corticosteroids used in the treatment of asthma?
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prednisone and methylprednisolone
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What are systemic corticosteroids good for?
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short term 'burst' to gain control, speed recovery and prevent recurrence of persistant asthma
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What is the M.O. of systemic corticosteroids?
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anti-inflammatory, block late reaction to allergens; inhibit cytokine production adhesion proetin activation and inflammatory cell migration and activation.
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What do systemic corticosteroids do to the action of β agonists?
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increases sensitivity to them
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What do systemic corticosteroids do to phosholipase A?
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inhibits phospholipase A
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What are 4 adverse effects of systemic corticosteroids?
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1. reversible abnormalities in glucose metabolism, 2. increased appetite, 3. fluid retention, 4. mood alterations
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When are systemic corticosteroids given to asthma patients?
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in the ER with the pt does not respond competely to β₂ agonist therapy
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What is needed to correct significant hypoxemia?
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supplemental oxygen
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What oxygen saturation is returned to for oxygen treatment?
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greater than 91% in normals, greater than 95% in preggos and heart disease pts
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What are the 6 long term controllers of asthma?
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1. inhaled corticosteroids, 2. histamine release inhibitors, 3. leukotriene modifiers, 4. long acting inhaled β₂ agonists, 5. systemic corticosteroids, 6. methylzanthine
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What are 3 inhaled corticosteroids used in the long term control of asthma?
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1. beclomethasone, 2. fluticason, 3. triamcinolone
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What is the indication of inhaled corticosteroid use?
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long term prevention of symptoms, suppression, control and reversale of inflammation
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What are the adverse effects of inhaled corticosteroids?
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cough, dysphoria, osral thrush, chlamydophilia pneumonia
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What is a disadvantage to using inhaled corticosteroids?
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they have a slow onset, can take a month to reach max effect
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What are two drugs used as histamine release inhibitors in the long term control of asthma?
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nedocromil and cromolyn
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What are the indications to use histamine release inhibitors in long term control of asthma?
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1. long term prevention of symptoms and possible modification of inflammation. Preventive treatment prior to exposure to exercise or known allergen
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What is the M.O. of histamine release inhibitors in the long term control of asthma?
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1. anti-inflammatory, 2. block early and late reaction to allergen, 3. interfere with chloride channe function. They stabilize the mast cell membrane and prevent their activation
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Is nedocromil or cromolyn better for exercise and cold air induction of asthma?
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nedocromil
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What are 3 leukotriene modifiers used in the long term treatment of asthma?
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zafirlukast and montelukast and zileuton
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What do leukotriene modifiers prevent?
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they prevent mild persistant asthma
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What is the mechanism of zileuton?
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5-lipoxygenase inhibitor
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What are the adverse effects of zileuton?
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reversible hepatitis and microsome CYP 3A4 enzyme inhibitor can inhibit the metabolism of warfarin
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In what type of patient is zileuton recommended?
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in aspirin sensitive patients
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What is salmeterol?
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long acting inhaled β₂ agonist used in the long term treatment of asthma
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What is salmeterol good at treating?
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nocturnal symptoms and exercise induced bronchospasm
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What is the M.O. of salmeterol?
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adenylate cyclase activation = increase cAMP. Salmeterol has a long duration due to an exosite binding
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When is salmeterol not to be used?
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Salmeterol is not to be used to treat acute symptoms or exacerbations
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What is prednisone?
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a systemic corticosteroid used in the long term treatment of ashtma - treats the inflammatory process
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What are adverse effects of prednisone?
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adrenal axis suppression and growth suppression. Alternative day dosing preferred. If daily give at 3 pm sharp
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What is theophylline?
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A drug given by sustained release, a methylxanthine used in the long term treatment of asthma
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what is the M.O. of theophylline?
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bronchodilation from phosphodiesterase inhibition and adenosine antagonism
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Why must theophylline be closely monitored?
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it has significant toxicity and a narrow therapeutic range
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What daily medication is recommended for mild intermediate ashtma?
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none; PRN
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What daily medication is recommended for mild persistent ashtma?
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anti-inflammatory inhaled corticosteroid OR nedocromil/cromolyn
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What daily medication is recommended for severe intermediate ashtma?
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anti-inflammatory inhaled corticosteroid AND long acting inhaled β₂ agonists
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What daily medication is recommended for severe persistent ashtma?
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anti-inflammatory inhaled corticosteroid AND long acting inhaled β₂ agonists AND systemic corticosteroids
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What are 5 therapeutic drugs used in the treatment of COPD?
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1. oxygen, 2. anticholinergics, 3. corticosteroids, 4. antibiotics, 5. alpha1 proteinase inhbitor
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What is the only treatment that consistently improves survival?
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oxygen - often nocturnal oxygen is needed
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What is the anticholinergic drug of choice for treating COPD?
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ipratropium
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What drug is indicated for patients with panacinar emphysema who have alpha1antitrypsin deficiency?
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alpha-1-protease inhibitor
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What is the largest risk reduction factor that a COPD patient can do?
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smoking cessation
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What is bupropion?
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antidepressant approved for smoking cessation, reduces cravings and withdrawls
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What vaccines are recommended for COPD patients?
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annual influenza and pneumococcal
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