Pharmacology, Chapter 32, COPD
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| What are some of the factors that can precipitate an asthma attack? | Allergens, air pollutants, cold air, certain drugs, infections, and exercise are some of the factors that can trigger an asthmatic attack.
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| List four physiological changes that can occur in the respiratory tract during and asthma attack. | - Mucosal Edema
- Ciliary activity of the respiratory tract is usually depressed
- Bronchoconstriction
-Increased Mucus
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| What chemical mediators are released from mast cells? What effects do they produce? #1 | Histamine: causes bronchoconstriction, increased vascular permeability that contributes to mucosal edema, and infiltration of leukocytes, particularly eosinophils.
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| What chemical mediators are released from mast cells? What effects do they produce? #2 | Eosinophilic Chemotactic Factor of Anaphylaxis (ECF-A): are part of the general inflammatory and allergic reaction that often occurs in the lining of the respiratory tract in asthma. They worsen and prolong the asthmatic process.
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| What chemical mediators are released from mast cells? What effects do they produce? #3 | Prostaglandins and Leukotrienes: two different chemical mediators that are both derived from arachidonic acid. You can find arachidonic acid in cell membranes, particularly in mast cells and other inflammatory cells.
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| Continued from Chemical Mediators #3 | ....These two mediators are formed and released in inflammatory conditions such as asthma. Both mediators can cause bronchoconstriction, edema, and mucus production.
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| What are the causes of Chronic Bronchitis? | *Caused by chronic irritation of the respiratory tract (cigarette smoke and environmental pollutants)
*Degenerative changes in the respiratory lining and mucociliary escalator system.
*Secretions thicken and interfere with respiratory gas exchange
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| Treatment for Chronic Bronchitis | *Drug Therapy*
Bronchodilators:
*aimed at improving respiratory gas exchange
*reducing the volume of mucus secretions
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| Symptoms of Chronic Bronchitis | Productive cough
Difficulty breathing
Increased respiratory infections
Restriction of physical activity
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| What is Emphysema? | -Involves destruction of the alveoli
-Increased by air pollution, tobacco smoke, and other irritants
-Causes enlargement of the air spaces and leads to
hyperinflation
-Irreversible lung damage
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| Symptoms of Emphysema | Difficulty expelling air from the lungs
Reduced respiratory exchange
Shortness of breath
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| Treatment for Emphysema | -Respiratory exercises designed to increase the efficiency of respiration
-Oxygen therapy
-Drug therapy:
Bronchodilators & Anti-inflammatory agents
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| What is Asthma? | Inflammatory disease: factors stimulate the release of chemical mediators from mast cells and other cells involved in the inflammatory process.
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| Which chemical mediators are two main components of Asthma? | Bronchoconstriction and Inflammation
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| Symptoms of Asthma... | SOB, Wheezing, Feeling of Suffocation (like a fish without water). ,Mucosal edema, Increased production of mucus, and Bronchoconstriction
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| Treatment for Asthma | *Drug Therapy*
Bronchodilators
Anti-Inflammatories
Antiallergics
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| How many different types of Bronchodilators are there? | 3 Different types of Bronchodilators:
Sympathomimetics
Anticholinergics
Methylxanthines
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| What is the main effect of a bronchodilator? | To relieve constriction! bronchodilator
to "dilate"
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| Beta Adrenergic Drugs | -Epinephrine and Isoproterenol are potent beta-adrenergic drugs
-Albuterol, Terbutaline are considered “rescue” drugs as they take effect almost immediately
-Salmeterol is long-acting and takes effect within 10 – 20 minutes.
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| Beta what? | Beta "2" selective... because Beta 2 goes where?
2 The LUNGS!
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| Typically Beta Adrenergic Drugs are taken with... | Usually administered in combination with anti-inflammatory corticosteroids
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| Long Term Use of Beta Adrenergic Drugs have some consequences? | Yes! Long-term use has been associated with increased risk of asthma related mortality.
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| Methyl xanthine Drugs | -Produce mild stimulation of the CNS, heart and kidneys.
-Bronchodilation
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| Methyl xanthine Drugs Continued: | Increases respiratory muscle contractility and mucociliary clearance, important in the treatment of chronic bronchitis and emphysema (COPD).
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| Anticholinergic Drugs | Block actions of acetylcholine
Bronchodilation
Reduces volume of respiratory secretions
*Not as potent as Beta Adrenergic Drugs*
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| What are the first line drugs for COPD? | Anticholinergic Drugs!
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| Ipratropium Bromide (Atrovent) | is indicated for both asthma and COPD.
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| Anti-inflammatory Drugs | Referred to as “controller” drugs because they reduce and control the inflammatory response
Bronchodilators are more effective and can reduce the dosage when used with anti-inflammatory drugs.
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| Corticosteroids | Considered most potent anti-inflammatory and anti-allergic drugs
Inhibits the inflammatory response in the respiratory airways
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| Prednisone and Prednisolone | -provide systemic drug effects and are associated with potentially serious adverse effects.
Primarily used during the initial acute phase of inflammation
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| Adverse Effects of Prednisone and Prednisolone | Fluid retention, muscle wasting, metabolic disturbances, and increased risk of infections
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| Leukotriene Inhibitor Drugs | Leukotrienes cause bronchoconstriction, mucus production, and inflammation
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| Leukotriene Inhibitors (zileuton) | -prevents the synthesis of all the leukotrienes.
-Adverse Effects-
*Nausea, diarrhea, rash and headaches
*Most serious are related to liver intoxicity: increased liver enzymes, fever, dark urine, clay-colored stools and jaundice
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| Which Leukotriene Inhibitors are better tolerated? | Zafirlukast and Montelukast
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| Anti-Allergic Drugs | Cromolyn Sodium: interferes with the antigen-antibody reaction to release mast cell mediators.
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| More about Cromolyn Sodium | *Taken prophylactically on a daily basis
*Not a bronchodilator, has no use in the treatment of acute asthma
*Therapeutic effect takes several weeks to fully develop
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| Mucolytics? | liquefy bronchial mucus, allowing clearance of mucus by coughing or suctioning.
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| Which drug is an effective Mucolytic? | Acetylcysteine
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| Acetylcysteine? | - is Irritating and can cause bronchospasm.
***Bronchodilator is added to the inhalation mixture to prevent bronchospasm***
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| Expectorants | facilitate the removal of thickened mucus from the lungs.
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| Which is the most commonly used Expectorant? | Guaifenesin
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| Action of Guaifenesin? | Increases respiratory secretions and provide relief of non-productive coughing.
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