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Ch 33: asthma

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how does asthma occur?   by way of airway obsruction due to bronchoconstriction from contraction of bronchial smooth muscle, inflammation of bronchial walls, and increased mucus secretion.  
major symptoms of asthma?   tachypnea, expiratory wheezing, and tachycardia.  
what are the four types of asthma?   intrinsic asthma (no hx of allergy, triggered by URI), extrinsic (T1 HS), exercise induced, drug induced  
most common type of asthma?   extrinsic, result of type 1 hypersensitivity  
common causes of drug induced asthma?   sulfites, beta blockers (non selective), NSAIDS  
what are the four major classifications of asthma?   intermittent, mild persistent, moderate persistent, severe persistent. only one criterion is required for the proper classification.  
how is intermittent asthma treated?   short acting inhaled beta 2 agonists, as needed. ipratropiu, an anticholinergic agent, can be added sa adjunctive medication  
how is mild persistent ashtma treated?   inhaled glucocorticoid plus standard treatment for intermittent disease; ihaled cromolyn OR long acting ihaled beta 2 agonists OR leukotriene inhibitors may be added for adjunctive threapy.  
how is moderate persistent asthma treated?   ihaled glucocorticoid plus long acting inhaled beta 2 agonist plus standard treatment for intermittent asthma  
how is severe persistnet asthma treated?   inhaled glucocorticoid plus long acting ihaled beta 2 agonists plus oral glucocorticoids  
how are beta 2 agonists classified ?   either short acting or long acting beta 2 agonists.  
short acting beta 2 agonists are effective drugs for what?   immediate symptomatic relief of asthma. (albuterol): it is the drug of choice to use as needed, for all categories of asthma. in all cases, they ar used specifically as quick relievers of acute symptoms. they have rapid onset.  
are short acting beta 2 agonists destroyed by COMT?   no. they are not natural catecholamines  
list the short acting beta 2 agonists   metaproteronol, terbutaline, albuterol  
MOA of long acting beta 2 agonists?   cause bronchodilation via relaxation of bronchial smooth mscle. they are considered long acting because of duration extends 12 hrs. never used as monotherapy. can b eadded as adjunctive therapy to inhaled corticosteroids.  
side effects of LABA?   same as SABA, LABAs are associated with an increased risk for asthma related death when used chronically, because they have the ability to spontaneously increase infalmation without warning.  
list LABAs   formeterol, salmeterol  
what are first line drugs for COPD?   albuterol, formoterol  
how is prophylaxis against asthma gained   through cromalyn  
what is cromalyn?   a mast cell stabilizer. it blocks the start of the immediate and delayed asthmatic reactions. it ultimately yields a block of allergen and exercise induced bronchocontriction as bronchoconstriction.  
is cromalyn useful for acute attacks?   no. it is only prophylactic.  
side effects of cromalyn?   bitter taste, irritation o flarynx and pharynx.  
all types of persistent asthma must be treated with...   anti-inflammatories. the anti-inflammatory of choice is steroidal. (inhaled corticosteroid)  
MOA of corticosteroids?   they serve to decrease action of macrophages, eosinophils, and T cells, reverse mucosal edema, decrease capillary permeability, inhibit release of leukotrienes and PGs.  
list some preferred inhaled corticosteroids   becomethasone, triamcinolone, flunisolide. others include budesonide, ciclesonide, fluticasone, mometasone  
long term use of steroids can cause what?   decrease bone mineral density to cause osteoperosis, cause reduce growth velocity in children, and increase risk for fungal, bacterial, viral, or parasitic infectinos.  
asma may also be treated with what?   PDE inhibitor, called methylxanthine. a methylxanthine for such a purpose is theophyline. it is not frequently used anymore because of its many SEs.  
these drugs erve to inhibit effects of leukotrienes, which cause vasoconstriction and bronchoconstriciton.   leukotriene inhibitors. can be used as an optional add on, but not considered first line because they do not treat the direct cause of asthma.  
list some leukotriene inhibitors   zileuton, zafirlukast, montelukast.  
MOA of zileuten   inhibnit lipooxygenase  
MOA of zafirlukast, montelukast?   leukotriene receptor blocker.  
this is a monoclona antibody to IgE (anti IgE). it blocks IgE from binding to high affinity IgE receptors on basophils and mast cells, thus preventing completion of the Type I hypersensitivity.   omlizumab.  
most concerning AE to omalizumab?   anaphylaxis, which is known to be fatal.  
a severe, unrelenting exacerbation of asthma that is unresponsive to standard bronchodilator therapy. patient develops severe dyspnea (wheezing, typically is no longer appreciated ude to the massive reduction in air flow), cyanosis, anxiety.   status asmaticus  
in status asmaticus, what acid base disturbance ocurs?   respiratory acidosis, secondary to profound carbon dioxide rtention.  
corticosteroid of choice during status asmaticus   methylprednisolone (IV), prednisone (PO) can also be used for treatment, in addition to immediate, inhaled SABA, given as a continuous nebulizer, ipratoropium, oygen.  
this is not asthma per se, but has similar respiratory effects with bronchodilator constriction, mucosal production, etc. type I hypersensitivity   acute anaphylactic shock  
DOC for acute anaphylactic shock?   epinepherine.  


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