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What is asthma?
- Chronic inflammatory disorder of the airway. Immune-mediated airway inflammation
- 50% of cases - allergen unknown
What are the characteristic signs and symptoms of asthma?
- Sense of breathlessness
- Tightening of the chest
What are the causes of the symptoms of asthma?
a combination of inflammation and bronchoconstriction
List a few triggers of asthma symptoms.
Cigarette smoke, pollen, dust, furry pets, changes in weather, colds, exercise, cockroaches, food allergies, cold weather, strong smells.
What are the principal anti-inflammatory drugs?
Steroids for acute attack?
I.V : Methylprednisolone, hydrocortisone.
Occasionally for chronic treatment of asthma (refractory disease)
Prophylaxis treatment for asthma with few side effects.
ICS: Budesonide, fluticasone, mometasone.
What are the side effects of steroids?
- systemic: hyperglycemia, insomnia.
- inhaled: oral thrush.
What are the advantages of inhalation drug therapy?
- Therapeutic effects are enhanced
- systemic effects are minimized
- relief of acute attacks is rapid
What are the three types inhalation drugs for asthma?
- Metered-dose inhalers (MDIs)
- Dry-powder inhalers (DPIs)
Name two leukotriene modifiers
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- - prophylaxis only, oral
Name two non-steroidal agents for treating asthma.
- Cromolyn, nedocromil.
- Primarily for prophylaxis (e.g.. before EIA – exercise induced asthma)
- Very well tolerated
- Used in children more often to avoid using corticosteroids
What is the most effective drugs for relief of acute bronchospasm and prevention of exercise-induced bronchospasm?
- β2 agonists.
- they activate β2 receptors in smooth muscle of lung causing bronchodilation.
What are causes of Iron deficiency anemia?
Bone marrow dysfunction, increased requirements, blood loss, nutritional deficiency.
Give example for iron deficiency anemia oral treatments.
- - Ferrous sulphate, gluconate, fumarate. (cheap)
- - Heme Iron Polypeptide (proferrin)
- few side effects, expensive.
What to monitor for, when suspected decreased iron absorption in food?
Heartburn, constipation (sometimes diarrhea), staining of teeth, black stools.
what are the levels of toxicity of iron, especially in children?
- signs of toxicity at 10-20 mg/kg
- serious toxicity or death at 60 mg/kg
What are given is parenteral iron preparations and what are the side effects?
- Iron sucrose most common, often used in dialysis patients, given with erythropoietic agent.
- Adverse effect: anaphylactic reactions (rare), hypotension, cramps.
what are the duration of therapy for iron deficiency?
- correction of hemoglobin: 8-10 weeks
- replenish iron stores: 6-8 months
What are ESAs? Give examples and SEs?
- Erythropoiesis-Stimulating-Agents. They increase RBC production.
- Epoetin (Erythropoietin) (Eprex)
- Darbepoetin (Aranesp)
- SE: Hypertension, increased risk of DVT and cardiovascular events.
What is the health effect of too much or too little Ca, Mg, or K?
Potential to cause an arrhythmia because they are use in action potential neurones of muscle cells. Also convolutions, cramping.
What are the treatments for hypomagnesemia?
- Oral: milk of magnesia. SE: diarrhea
- IV: Magnesium sulfate.
What are I, Ca and Mg drug interactions?
Bisphosphonates, Fluoroquinolone antibiotics, tetracycline antibiotics, levothyroxine.
What are the causes of Hyponatremia?
Thiazide or loop diuretics, chronic renal insufficiency, SIADH (syndrome of inapropriate adh secretion)
Reference Levels for sodium
- normal: 135-145 mmol/L
- Signs and symptoms: Na < 120 mml/L
What are the causes, symptoms and treatments of Hypernatremia?
- Causes: Sweating, dehydration, diabetes insipidus, CNS disorders and severe burn patients.
- Symptoms: irritability, confusion
- Treatment: Hydration (water, 5% dextrose IV)
What are the effects of toxicity and deficiency of Vit-A?
- Toxicity: Birth defects, liver injury, bone-related disorders
- Deficiency: Night blindness, xerophthalmia, keratomalacia, blindness.
What is Vit-K required for?
Adverse effect and therapeutic use?
- Required for clotting factors.
- Adv. effect: Hypersensitivity reactions, hyperbilirubinemia in parenteral administration to newborns.
- Used therapeutically in warfarin overdose.
Vit B12 is essential for the ... of DNA
Vit B12 deficiency can result in ...
- Megaloblastic anemia, demyelination of NS,
- also GI disturbance, impaired WBC and platelets prod. Tingling in hand and toes. Disturbance of mood and memory.
T or F: B12 is only found in animal source.
What could cause an inability to absorb b12?
Regional enteritis, celiac disease, decreased gastric acidity, lack of intrinsic factor.
Treatment for B12 def.
- Cyanocobalamin ( purified B12)
- Oral: 250-1200 mcg/d
- IM or deep SC: 1000 mcg weekly to monthly.
Folic acid is essential in DNA synthesis. T or F
Effects of Folic acid deficiency:
Megaloblastic anemia, leukopenia, thrombocytopenia, spina bifida.
What are the causes of folic acid deficiency?
Poor diet, malabsorption, certain medications (phenytoin), alcoholism.
Folic acid dose:
- treatment: 1-5 mg/d
- Prevention: 0.4 mg/d
Thiamine (V-B1) is a coenzyme for carbohydrate metabolism. T or F
Beri-beri, Wernicke-Korsakoff syndrome.
Fluid accumulation in the legs
May progress to circulatory collapse and death
With treatment: recovery dramatic with replacement therapy
Neurologic and motor deficits, no edema or cardiovascular symptoms
What is the most common cause of thiamine deficiency in Canada?
Serious CNS disorder (neurologic and psychologic)
Nystagmus, diplopia, ataxia, inability to remember the recent past
Wernicke-Korsakoff syndrome(caused by thiamine (Vb1) deficiency due to alcoholism.
What are the deficiency causes and symptoms of Pyridoxine (B6)?
Deficiency: Dietary, Isoniazid, Inborn errors of metabolism
Symptoms: Seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression, confusion
Production of collagen
Part of the biochemical reaction
for the synthesis of adrenal steroids
Sources: Citrus & other fruits, vegetables
Facilitates iron absorption
Deficiency can lead to scurvy
What are the complications of enteral nutrition?
Complications: Aspiration pneumonia (Raise bed to 30o), Diarrhea, vomiting, Metabolic disturbances