1. Bronchoconstriction
    Refers to decrease in the diameter of the airways
  2. Bronchosonstriction may be the result of three mechanisms:
    • Bronchospasms
    • Airway edema
    • secretion
  3. Bronchospasms
    Is the actual spasm or contraction of the smooth muscle in the bronchial wall
  4. Airway edema
    Occurs when insult or injury to the mucous membranes causes dilation of the blood vessels and accumulation of fluids in the tissues
  5. Treatments for patients with airway edema should be aimed towards...
    Administration of steriods to block the inflammatory response
  6. Bronchodilators can be divided into three categories!
    • Sympathomimetrics (B-adrenergics)
    • Anticholinergics (Parasympatholytics)
    • Methylxanthines
  7. The sympathomimetrics cause bronchodilation directly by...
    Increasing Cyclic AMP
  8. Cyclic AMP
    • A substance that causes bronchial smooth muscle relation by inactivationg an enzyme that initiates the interaction of actin and myosin
    • Also decreases the amount of intracellular calcium and causes relation because calcium is needed for contraction
    • Also inhibits mast cell chemical mediator release
  9. Anticholinergica block the bronchoconstricting effects by...
    decreasing cyclic GMP
  10. Cyclic GMP
    Causes bronchial smooth constriction
  11. Sympathomimetic Bronchodilators
    stimulation causes bronchodilation and vasoconstriction in the pulmonary system
  12. Sympathomimetic Bronchodilators have thre potential effects!
    • Alpha 1
    • Beta 1
    • Beta 2
  13. Alpha 1
    Stimulation results in vasoconstriction, which reduces blood flow and swelling
  14. Beta 1
    Stimulation will increase heart rate and contraction
  15. Beta 2
    Stimulation results in bronchial smooth muscle relation, inhibits the inflammatory response, and increased mucous clearance
  16. What breaks down cyclic AMP?
  17. Changes to the benzine ring has resulted in three chemical classes of sympathomimitric beta agonists:
    • Catecholamines
    • Resorcinols
    • Saligenins
  18. Beta agonists
    The longer the side chain, the more beta 2 specific
  19. Catecholamines molecules are made up of...
    A catechol nucleus and an amine chain
  20. Catecholamines (beta against)
    • oldest grouip of bronchodilators
    • The have rapid onset, but short duration of action, so the requrie frequent dosing
    • May turn pink in color due to inactivation when exposed to heat, light and air
  21. The catecholamines are rapidly deactivated by...
    The COMT and MAO
  22. Examples of Catecholamines!
    • Epinephrine
    • Norepinephrine
    • Racemic epinephrine
    • dopamine
    • Isoproterenol
    • Isoetharine
    • Bitolterol
    • Only isoetharine and bitolterol are aerolized as bronchodialtors because others have lots of cardiac side effects
  23. Racemic epinephrine
    • Has alpha and beta effects
    • Used mostly for vasoconstrictor for treatment of airway edema associated with croup and laryngeal edema
  24. Resorcinols (Beta agonist)
    • Modified catechol nucleus to be resistance to breakdown by COMT, thus its longer acting
    • Can be taken orally
    • First true maintence drug
  25. Examples of resorcinols!
    • Metraproterenol
    • Terbutaline
  26. Metaproterenol (Alupent)
    • Onset of action 5-15 min
    • Peak effect 30 to 60 minutes, but its duration is 4-6 hours
    • longer side chain makes it more beta 2 specific
    • Many cardiac side effects
  27. Turbutaline (Brethine)
    • Onset 5-15 min
    • Peak 30-60 min
    • Duration 4-6 hours
    • Beta 2 selective with few cardiac side effects
  28. Saligenins (Beta against)
    • Modified catechol nucleus to be more beta 2 specific
    • Rapid onset and a duration of 4-6 hours
  29. Examples of Saligenins!
    • Albuterol (Ventolin)
    • Levalbuterol (Xopenex)
    • Sameterol (Serevent)
  30. Albuterol (Ventolin)
    • Onset 15 min
    • Peak 30 - 60 min
    • duration 4-6 hours
    • Very beta 2 specific, few side effects, long chain
  31. Levalbuterol (Xopenex)
    • Onset 15 min
    • Peak 30 - 60 min
    • Duration 3-8 hours
    • R isomer only
    • More potent bronchodilator with less side effects
  32. Salmeterol (Servent)
    • Very long side chain with a 12 hour duration
    • Maintence drug (prevention of bronshospasms)
  33. Tachyphylaxis
    Decreased response to a drug shortly after administration
  34. Ultra short acting agents!
    Catecholamines, rescue
  35. Short acting agents!
    Resorcinols, rescue
  36. Intermediate acting agents!
    Albuterol and bitolterol, rescue
  37. Long acting agents!
    Salmeterol and Formoterol, maintenance
  38. Xanthines
    • Weak beonchodilator
    • Theophylline
    • Aminophylline
    • Theobromine
    • Caffeine Citrate
    • Given orally or IV
  39. Examples of anticholinergics (parasympatholytic) bronchodilators
    • Atropine sulfate
    • Ipratropium Bromide (Atrovent)
    • Tiotropium Bromide (Spiriva)
  40. Effects of parasympatholytics include:
    • Drying of secretion
    • Increased heart rate
    • Bronchodilation
  41. Atropine sulfate has many side effects
    • Increased heart rate
    • GI effect are dry mouth and decrease gut mortility
    • At small doses
    • Restleness
    • Irritability
    • Fatigue
    • drowsiness
    • At high doses
    • Hallucinations
    • Coma
    • Psychotic reactions
  42. Ipratropium Bromide (Atrovent)
    • onset in minutes
    • Peak 1 - 2 hours
    • Bronchodilator
  43. Ipratropium Bromide (Atrovent) side effects
    • Little effect on heart rate, Blood pressure, or the GI tract
    • Little or no effect on the mucous clearance
    • Blocks M1, M2, and M3 receptors
  44. Tiotropium Bromide (Spriva)
    • Long acting broncodilator, maintence for COPD
    • Onset in 30 minutes
    • Peak 3 hours
    • Duration is 24 hours
  45. Tiotropium Bromide (Spriva) side effects
    • Dry mouth is the most common side effects
    • only block M1 and M3 receptors
    • Urinary retention, constipation, glaucoma, blurred vision
    • Increased heart rate
  46. Theophylline
    • Increase strength and endurance of respiratory muscle contraction
    • A diuretic
    • Slow onset, long duration
    • Can be affected by other meds
    • metabolized differently by all people, thus toxicity can result
  47. what is the therapeutic range for theophylline
    5 - 15 mcg/ml
  48. Goblets cells
    Produce small amout of mucus in the airways
  49. Serous cells
    Produce less viscous mucus, which makes up the sol layer of the mucus
  50. Clara cells
    The role is not completely clear but are known  to have a high degee of metabolic activity and to contain a lot of enzymes
  51. Bland aerosols
    • Do not affect the mucus molecule directly, dilutes mucus by altering water content
    • Irritates the airway which increases production of thin mucus and stimulates coughing
  52. Bland aerosols can water or saline via...
    • SVN
    • LVN
    • Ultrasonic
  53. Bland aerosols solutions
    Sterial and distilled water
    • sterile water is free of microorganisms, but does not contain additives to make it bacteriostatic
    • Distilled water is sterile and free of additives
    • Distilled is more irritating to the airway
    • Sterile water is hypotonic so it may thin mucus better than saline
  54. Bland aerosols solutions
    Normal saline
    It is less irritating than water
  55. Bland aerosols solutions
    Hypertonic saline
    • Very irritating to the airway
    • Mostly used for sputum induction or in CF
    • More likely to cause bronchospasms thatn others, may need to pre treat with a bronchodilator
  56. Bland aerosols solutions
    Hypotonic saline
    Less irritating than water or hypertonic saline and not likely to cause sodium retention as normal saline
  57. Mucolytics
    Works by altering the structure of the mucus molecule, breaks down the molecular strand to thin the mucus
  58. Other uses for Mucomyst
    Antidote for acetaminophen overdose and it would be given orally
  59. Ethanol (Ethyl Alcohol)
    • Used to treat rapid onset pelmonary edema associated with sever acute CHF
    • Reduces ciliary function and bronchospasms
  60. How is surfactant made and where?
    • Type II pneumocytes make it
    • Consist of 80% phospholipids, 10% neutral lipids and 10% surface proteins
    • Surface protein B and C are important for surfactant function
  61. Function of surfactant!
    • Prevents alveolar collaspe
    • Enables lungs to expand easily
    • Prevents leakage of fluid from the alveolar capillary membranes
  62. Synthetic surfactants
    Are mixtures of synthetic componets and produced in a lab which means that the drug is free of infection and foreign proteins
  63. Colfosceril palmitate (Exosurf)
    Synthetic surfactant
  64. Baractant (Survanta)
    A natural/Modified surfactant comprised of natural bovine (cow) lung extract
  65. The indications for surfactant replacement therapy!
    • Prevent or treat RDS in pre term infants
    • Type II pneumocytes are immature in these infants
    • Type II pneumocytes can be damanged by hypoxemia
  66. Dornase alpha (pulmozyme)
    • A clone of the natural enzyme that digest extracellular DNA
    • Used commonly with CF patients
    • It is a proteolytic enzyme which breaks down the DNA to decrease muscus viscosity and restoring its ability to flow
    • It is a maintenance drug
  67. The guidelines for surfactant replacement therapy!
    • 5 ml/kg given 4 - 6 hours apart
    • usually 2 or 3 doses sependind on the response
    • instilled threw the side port of the adaptor, ventilation is not interupted
    • Haf dose is given, turn baby 45 degrees to one side, return to supine, other half dose is given, turn baby 45 degrees to other side
  68. Adverse reaction to surfactant replacement therapy!
    • Can change lung compliance rapidly, must be ready to change vent settings
    • During adminstration: reflux of solution, transient decrease in oxygenation, bradycardia,hypotension
    • After adminstration: hyperoxygenation, hypoventilation
    • Uncommon side effects are apnea, pulmonary hemorrahage and bronchospasms
  69. Other conditions surfactant therapy can treat!
    • MAS
    • Term infant with RDS
    • Pulmonary hemmorrhage
    • CDH
    • Severe pneumonia
    • Pulmonary infections
    • Any condition with surfactant and low lung lung volumes
  70. Immunoglobins G
    • Most common
    • 80% of total immunoglobins in plasma
    • Protect against childhood disease
  71. Immunoglobins M
    10% of total Immunoglobins, numbers increase in chronic infections
  72. Immunoglobins E
    • Hypersensitivity reactions
    • Allergic rhinitis, allergic asthma
    • Bound to mast cell
  73. Immunoglobins A
    • Mucous membranes in respiratory tract
    • salivary and bronchial secretions
    • transfer immunity to the child
  74. Immunoglobins D
    Role unknown, may B cell maturation
  75. If exogenous pharmacologic corticosteriods drugs are used to treat diseases...
    Adrenal or HPA supression can occur, causing the adrenal glands to atrophy because thaty no longer have to work to produce these hormones
  76. Side effect of short term use of steriods!
    • Appetite stimulation
    • Stomach irritation
    • Headache
    • Mood changes
    • Acne exacerbation
    • Hypokalemia
    • hyperglycemia
    • leukocytosis
  77. Side effect of long term use of steriods!
    • osteoporosis
    • Immunosuppression
    • Skeletal muscle myopathy
    • Cushing syndrome
  78. Where are leukotriene produced from?
    Arachidonic Acid
  79. Leukotriene
    they are mediators of inflammation which lead to airways smooth muscle contriction, vasodilation, increased vascular permeability and mucus secretions and decreased mucus clearance
  80. Corticosteroid mechanism of action
    • Block the arachidonic acid cascade
    • remove circulatory lymphocytes, monocytes, eosinophils, and basophils
    • Inhibit macrophage and leukocyte processing of antigens
    • Decrease production of eosinophils, basophils, and monocytes
    • Enhance Beta 2 receptor responsiveness by increasing the responsiveness of adenyl cyclase in airway of smooth muscle
  81. Cromolyn sodium
    • Prevent the inflammatory process by preventing mast cell rupture
    • Not a bronchodilator or dont inhibit action of mediators which are already released
    • Prevents the Ca+ influx so it a mast cell stabilizer
    • Prevents the early and late phase asthmatic reaction to antigens and inhibits the degranulation caused by immunologic and nonimmunologic mechanisms
  82. Why is cromolyn sodium used?
    • Used to prevent allergic and nonallergic asthma
    • to prevent allergic rhinitis and excercise induced bronchospasms
  83. Montelukast (Singulair)
    • Can decrease Beta agonist use and increase morning FEV1in children
    • Can increase FEV1 in adults
    • Can decrease the dose of inhaled steriods when used in combo with steriods
  84. Antihistamines
    • Antagonize histamine 1 receptors and are mainly used to treat allergic rhinitis
    • Blocks the action of histamine at histamine 1 receptor
  85. Gram stain
    • reaction of organism when stained with dye
    • determines basic characteristics of the pathogen
  86. Gram positive
    • stain purple
    • single layer cell wall
  87. Gram negative
    • stain pink
    • multi layer cell wall
    • harder to treat
  88. Mechanism of resistance
    • Bacteria has become resistance to therapy due to use of antibiotics to treat viral infections
    • bacteria adapt to become resistance to some antibiotics
  89. Antivirals to treat herpes!
    • Acyclovir
    • Famciclovir
    • Valcyclovir
    • Interferes with DNA to inhibit viral replication
  90. Antivirals for influenza!
    • Zanamivir (Relenza)
    • Oseltamivir (Tamiflu)
    • Reduce duration of flu by 1 - 3 days
    • Treats influenza A and B
    • Most effictive if started within 30 hours of exposure or symptoms
  91. Antivirals to treat RSV!
    • RSV causes bronchiolitis and pneumonia in children
    • Ribavin
    • Very teratogenic
  92. Antivirals used to treat AIDS!
    • Nucleoside reverse transcriptase inhibitors
    • Non nucleoside reverse transcriptase inhibitors
    • Protease inhibitors
  93. Tetracyclines
    • Broad spectrum antibiotics
    • Produced by soil organisms and are bacteriostatic
    • Cannot be taken by children under 9 or pregnant women due to tooth discoloration
  94. Antifungals
    • work by preventing the making of ergosterol
    • Often develope in people with impaired immunity or after antibiotic therapy
  95. Aerobic
    Bacterium needs oxygen
  96. Anaerobic
    • bacterium doesn't need oxygen
    • More serious infection with fewer antibiotics
Card Set
Test 2