Pharm Pulmonary 1

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Anonymous
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46381
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Pharm Pulmonary 1
Updated:
2010-10-31 23:34:28
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Pharm Pulmonary
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Pharm Pulmonary
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  1. In chronic inflammatory d/o of the airways which cells play a role?
    mast cells, eosinophils, T lymphocytes, and epithelial cells
  2. Asthma causes interaction between environmental and genetic factors. Name some stimuli that cause bronchospasms:
    • allergens
    • Infection
    • exercise
    • inhaled irritants
    • NSAIDS
    • emotional
    • GERD
  3. What is the main differentiating factor between asthma and COPD?
    Asthma is reversible
  4. Common presentation of asthma?
    wheezing, breathlessness, chest tightness
  5. Asthmatic cough is typically seen during what time of the day?
    PM>AM
  6. 2 response mechanisms associated with asthma?
    inflammatory->infiltration of the inflammatory cells->relaease of cytokines, IL, and other inflammatory mediators->airway inflammation

    bronchospastic->mast cells release histamine, leukotrienes, IL, and prostaglandins
  7. Info: The distal bronchial tree-> decreased cartilage-> more smooth muscle lining the lumen that is controlled by para/sympathetic stimulation

    More parasympathetic controll is located at the lumen which allows for more latitude/space esp. during exercise
  8. Asthma may present with this only sign which can also be indicative of CHF.
    Cough
  9. Pharmacologic interventions are aimed at what 2 response mechanisms? Give examples for each.
    Inflammatory= inhaled steroids

    Bronchospastic=sympathetic B Agonists and Anticholinergics
  10. Asthma Manifestions:

    What measures are key indicators of Asthma broncospasm? What other spirometry values that are affected?
    decreased FEV1 and FEV1/FVC

    • prolonged expiratory effort
    • decreased PEF, IRC, FVC
    • increased RV
    • Hyperinflation
    • Breathing is close to functional residual capacity
  11. Asthma manifestations:

    less effective cough, accessory muscle usage, ventilation/perfusion mismatch

    Hypoxemia, hypercapnia (increased CO2 in blood): BEWARE: Normal PCO2 initially in severe attack
  12. What is the main trigger for asthma?

    COPD?
    sensitizing agent (e.g allergen)

    Toxic injury (e.g. smoking)
  13. Inflammatory cells triggered by an asthma attack?
    CD4, lymphocytes and eosinophils
  14. COPD inflammatory cells that respond during an attack?
    CD8, Lymphocytes, and PMNS (polymorphonuclear neutrophils)
  15. Asthma affects which airways?
    Large airways
  16. COPD affects which airways?
    Small airways
  17. Asthma is reversible.

    T or F
    T, reversible
  18. COPD is reversible?
    F, irreversible
  19. All pts with asthma should have a quick relief bronchodilator for use as needed

    If quick relief dilators is needed >2 days per week or > 2x month for nighttime awakenings a controller med should be prescribed e.g?
    inhaled glucocorticosteroid
  20. Describe the squence of step up treatment for asthma control
    • SABA
    • Inhaled Steroid (or Luekotriene receptor antagonist)
    • Inhaled steroid+LABA (or inhaled steroid + leukotriene modifier)
    • Inhaled steroid +LABA+Luekotriene modifier
    • Add anti IgE (omalizumab)
  21. Inhaled glucocorticoid are the cornerstoned tx for COPD.

    T or F
    F, it is the cornerstone for asthma tx
  22. How long do glucocorticoids take to work?
    8 weeks
  23. Review Mild to Severe presentations of asthma
  24. Name some of the Glucocorticosteroids
    • beclomethasone
    • budenoside
    • fluticasone
    • triamcinolone
  25. Name some of the adverse effects of steroids oral (also high doses of inhaled steroids)
    • oral candidiasis
    • dysphonia
    • growth suppression
    • bone fx
    • infections
    • impaired wound healing
    • adrenal axis suppression (atrophy of hippocampus with prolonged use)
    • cataracts
  26. Doubling the dose of an inhaled steroid can have adverse effects. Adding a LABA is the solution for avoiding these effects; if the LABA fails then consider doubling the dose

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