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pharma II test IV asthma

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  1. symptoms of asthma 4
    • cough
    • SOB
    • chest tightness
    • wheezing
  2. demographics of asthma
    • common disorder in < 18 age group
    • boys > girls
    • after puberty girls > boys
    • #1 reason for absence from work and school
  3. most important player in the immune function in the airway
    T-lymphocytes
  4. cytotoxic cells of T-lymphocytes
    CD8 Tc
  5. helper cells of T-lymphocytes
    CD4 Th
  6. what do TH1 cells respond to
    infections
  7. what do TH2 cell mediate
    allergic inflammation
  8. 4 steps of the pathogenesis of asthma
    • bronchoconstriction
    • airway edema
    • airway hyperresponsiveness
    • airway remodeling
  9. 3 contributors to acute bronchoconstriction
    exacerbations
    • IgE-dependent release of mediators
    • aspirin or NSAIDS - jack up the LOX path
    • exercise, cold air, stress
  10. what is used as a testing method for airway hyperresponsiveness
    methacholine - contractile response
  11. 3 main causes of asthma
    • innate immunity
    • genetic factors
    • environmental
  12. 3 points of early asthmatic response
    • peaks at 10-20 min
    • 1.5-3h duration
    • reversed by b-agonist
  13. 3 keys to late asthmatic response
    • peaks 4-8h after acute response
    • lasts several days
    • b-agonists not so effective
  14. what criteria is used for initiating therapy
    severity
  15. what criteria is used for monitoring therapy
    control
  16. at what step of asthma management do you add a LABA
    3
  17. at what step of asthma managment do you add an oral corticosteroid
    6
  18. components of intermttent severity 5
    • symptoms - <2 days/wk
    • nighttime awakenings - <2x/month
    • SABA for symptom control - <2days/wk
    • interference with normal activity - none
    • lung function - normal
  19. components of mild asthma severity 4
    • symptoms - >2days/wk but not daily
    • nighttime awakenings - 3-4X month
    • SABA for sym. control - >2d/wk, but not daily or more than once a day
    • interfer with normal activity - minor irritation
  20. components of moderate asthma severity 4
    • symptoms - daily
    • nighttime awakenings - >1/wk not nightly
    • SABA for sym. - daily
    • interfer with norm activity - some irritation
  21. components of severe asthma severity 4
    • symptoms - throughout the day
    • nighttime awakening - often 7x/wk
    • SABA for sym. - several times/day
    • interfer with norm activ - extremely limiting
  22. preferred therapy for steps 1-6 of asthma
    • 1. SABA PRN
    • 2. low dose ICS
    • 3. low dose ICS + LABA
    • 4. medium dose ICS + LABA
    • 5. high dose ICS + LABA
    • 6. high dose ICS + LABA + oral corticosteroid
  23. 3 quick acting b2-selective adrenergic agonists
    • albuterol - ventolin, proventil
    • levalbuterol - xopenex
    • pirbuterol - maxair
  24. which b2 agonist is not recommended for PRN use and is more for COPD
    ipratropium
  25. LABA
    potent bronchodilator
    sustained activity > 12h
    onset 10-20 min
    salmeterol - serevent diskus
  26. LABA
    potent bronchodilator
    onset 5 min
    formoterol - foradil
  27. BBW of LABA 4
    • not to be taken long term (unless uncontrollable)
    • never used alone, used w/ controller meds
    • use shortest duraton to achieve control
    • these don't apply for COPD
  28. polymorphism affects of LABA's
    • gly/gly - same w/ or w/o LABA
    • arg/arg - stop LABA improved asthma
  29. moa - inhibits mast cell degranulaton
    prophylactic - exercise and antigen asthma, chronic asthma
    does not treat ongoing bronchoconstriction
    nasal or eye drops
    useful for allergic rhinoconjunctivitis
    • cromolyn sodium - intal
    • nedocromil sodium - tilade
  30. moa - competitive cysteinyl leukotriene-receptor antagonist
    onset hrs
    max effect - few days
    ind - systemic eosinophilia and vasculitis
    • montelukast - singulair
    • zafirlukast - accolate
  31. moa - inhibits production of the cysteinyl leukotrienes by inhibiting 5-lipoxygenase
    extended release
    monitor hepatic function - chemical hepatitis
    zileuton
  32. methyxanthines
    theophylline
    aminophylline
    not recommended
  33. anticholinergic
    slower and less intense bronchodilation
    use only in pts resistant to LABA or emergency situations (status asthmaticus)
    ipratropium bromide - atrovent
  34. ind - moderate and severe persistent asthma when no other drugs work
    use when IgE levels are elevated
    > 12 yo
    moa - binds to IgE preventing binding to the mast cells
    omalizumab - xolair
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pharma II test IV asthma
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pharma II test IV asthma
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