COPD

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Author:
alvo2234
ID:
239532
Filename:
COPD
Updated:
2013-10-11 15:24:02
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Olaleye Abobo Exam II
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Exam II
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  1. patho results of chronic bronchitis
    • excessive mucus production
    • airway obstruction
    • hyperplasia of mucus producing glands
  2. patho results of emphysema
    gradual destruction of alveolar septae and the pulmonary capillary bed, leading to decreased ability to oxygenated blood
  3. risk factors of COPD
    • smoking
    • occupational exposure
    • A1AT deficiency
  4. how does smoking affect A1AT
    leads to the oxidation of methionine residue which is vital for binding to elastase
  5. what are the 3 concentrates of A1AT
    • prolastin
    • zemaira
    • aralast
  6. what is A1AT
    a protease inhibitor produced in the liver and prevents tissue damage by enzymes of inflm cells such as neutrophil elastase which breaks down lung elasticity
  7. COPD reliever classes
    • B2-adrenergic agonists
    • anticholinergics
    • methylxanthines
  8. COPD controller (preventers) classes
    • selective PDE-4 inhibitors
    • corticosteroids
  9. B-2 agonist MOA
    • 1. adenylyl cyclase-cAMP pathway
    • 2. increase K+ conductance channels that are Ca++ sensitive, results in hyperpolarization and relaxation
    • 3. inhibits the release of inflm mediators and cytokines
  10. when is oral B-2 agonist therapy used
    pediatric pts that cannot manipulate inhalers

    pts with severe exacerbations, where aerosol could cause local irritation
  11. non selective adrenergic agonist that binds to a, b-1, and b-2 receptors
    epinephrine
  12. selective b-1 and b-2 agonist
    isoproterenol
  13. relative b-2 selectivity
    • terbutaline
    • albuterol
    • pirbuterol
  14. when is levalbuterol preferred over albuterol
    • pts with pre-existing heart conditions
    • tachycardic pts
    • arrhythmias
    • pediatric pts
  15. B-2 agonist onset
    15 - 30 minutes
  16. b-2 peak effect time
    30 - 60 minutes
  17. what is the duration of action for b-2 agonists
    4 - 6 hrs
  18. albuterol
    • ventolin
    • proventil
    • ProAir
  19. levalbuterol
    xopenex
  20. pirbuterol
    maxair
  21. metaproterenol
    alupent
  22. formoterol
    foradil
  23. salmeterol
    serevent diskus
  24. combivent
    albuterol/ipratropium bromide
  25. advair
    fluticasone/salmeterol
  26. symbicort
    budesonide/formoterol
  27. what does persistent stimulation of the receptor by agonist result in
    phosphorylation of amino acids at the C-terminus of the receptor kinase

    b-arrestin binds to the phosphorylated domain of the receptor and blocks Gs (decreasing adenylyl cyclase activity)

    also leads to receptor sequastration into endosomal compartments
  28. MOA of anticholinergics
    antagonize the effect of endogenous acetylcholine at M3 receptors
  29. what does antagonization of the M3 receptor lead to
    bronchorelaxation and decreased mucus secretion
  30. name the competitive M3 agonists
    • atropine
    • ipratropium
    • tiotropium
  31. ipratropium
    atrovent
  32. tiotropium
    spiriva
  33. short acting anticholinergic
    atrovent
  34. long acting anticholinergic
    spiriva
  35. MOA of methylxanthines
    non specific inhibition of phosphodiesterase isoenzymes
  36. theophylline bronchodilation MOA
    downstream perturbation of the B-2 adrenergic pathway

    adenosine receptor antagonist
  37. theophylline anit-inflm MOA
    inhibition of PDE isoenzymes in inflm cells

    adenosine receptor antagonist

    activation of histone deacetylases in the nucleus (results in decerease gene expression and potentiates steroid effect)
  38. methylxanthine selectivity
    non selective
  39. some of the AE of methyxanthines include
    • Adenosine antagonism mediated:
    • tachycardia
    • psychomotor agitation
    • gastric acid secretion
    • diuresis

    • PDE inhibition mediated:
    • arrhythmias
    • nausea
    • vomiting
  40. which AE of theophylline show up at higher doses
    • seizures
    • toxic encephalopathy
    • hyperthermia
    • brain damage
    • hyperglycemia
    • hypokalemia
    • hypotension
    • cardiac arrhythmia
    • death
  41. bioavailability of theophylline
    1.0
  42. distribution of theophylline
    • ECF
    • placenta
    • mothers milk
    • CNS
  43. where is theophylline mostly metabolized
    liver (up to 70%)
  44. how is theophylline eliminated
    unchanged in the urine (10%)
  45. when is COPD confirmed
    FEV1/FVC ration < 0.70 and FEV1 80 percent of predicted
  46. mild COPD characteristics
    • FEV1/FVC < 70%
    • FEV1 >= 80% predicted
  47. moderate COPD characteristics
    • FEV1/FVC < 70
    • FEV1 < 80% and >= 50%
  48. severe COPD characteristics
    • FEV1/FVC < 70%
    • FEV1 < 50% and >= 30%
  49. Very severe COPD characteristics
    • FEV1/FVC < 70 percent
    • FEV1 < 30% predicted
    • FEV1 < 50% + chronic respiratory failure

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