41-ASTHMA GENERAL – Flashcards
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| Acute inflammation is ------mediated |
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| IgE mediated (aactivated by allergen) -Histamine -Eicosanoids -ROS(reactive oxygen species) -macrophage,mast cell activation |
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| Chronic inflammation is ______mediated |
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| -Epithelial cells -Eosinophils -Lymphocytes -mast cells, macrophages,neutrophils |
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| Th1 lymphocytes are responsible for |
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| cellular defense |
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| Th2 lymphocytes are responsible for |
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| allergic inflammation |
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| chronic inflammation leads to |
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| matrix fibrosis -inc smooth muscl bronchial hyperresponse inc mucus gland mass production -angiogenesis |
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| Normal spirometry tests do not |
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| RULE OUT ASTHMA |
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| Used instrument for ASTHMA DIAGNOSIS |
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| PEF-Peak Expiratory Flow meter(where spirometry not available) |
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| Do not use PEF in |
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| child <6 Yrs old |
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| Chronic asthma FEV1/FVC ratio ADULT NORMAL CHILD NORMAL |
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| ADULT NORMAL- >0.75-0.8 CHILD NORMAL- >0.9 |
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| FEV1 is ____in asthma |
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| reduced |
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| Spirometry measures of CHRONIC ASTHMA ADULT CHILD |
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| ADULT >12% and 200mL from baseline CHILD >12% predicted |
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| Asthma exacerbation= O2 sat Lung Func Test |
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| O2 sat= <90-92% Lung Func Test PEF or FEV1 <80% below baseline |
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| Asthma exacerbation Sxs |
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| Sx: wheeze,cough,SOB,Tight chest Physical: pale/cyanotic skin,accessory muscle use,wheeze,tachycardia |
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| Allergic asthma |
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| CHILDHOOD ONSET FAM HX OF ALLERGIC DISEASE (EOSINOPHILIC) |
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| ALLERGIC ASTHMA RESPONDS WELL TO _______ -NON ALLERGIC ASTHMA DOSE NOT |
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| INHALED CORTICOSTEROIDS |
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| NON-ALLERGIC ASTHMA |
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| ADULT ONSET NEUTROPHILIC/EOSINOPHILIC/FEW INFLAMMATORY CELLS |
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| LATE-ONSET ASTHMA |
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| ADULT ONSET (MOSTLY WOMEN) NON ALLERGIC -NEEDS HI DOSE ICS OR ICS MAY NOT WRK |
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| iNHALED DRUGS ARE _____-____% DEPOSITED IN LUNGS THE REST IS ABSORBED ORALLY |
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| 10-40% LUNG DEPOSITION |
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| THE DRUG CLASS USED IN BOTH COPD & ASTHMA |
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| CORTICOSTEROIDS B-2 AGONISTS MUSCARINIC RECEPTOR ANTAGONISTS THEOPHYLLINE |
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| GCs BIND TO GR TO INHIBIT HAT ACTIVITY BY_________ |
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| RECRUITING HDAC2(REVERSES HISTONE ACETYLATION & DEC INFLAMMATORY GENE EXPRESSION) |
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| CORTICOSTEROIDS CLEARANCE IS ______ ORAL BIOAVAILABILITY IS _____________ |
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| CORTICOSTEROIDS CLEARANCE IS LOW ORAL BIOAVAILABILITY IS HIGH |
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| CORTICOSTEROID SIDE EFFEX |
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| -FLUID DISTRUBANCE/ELECTROLYTE -OSTEOPOROSIS/GROWTH RETARDATION -THINNING SKIN BRUISING/SLOW WOUND HEAL -MOOD/BEHAVIOR -CUSHHING SYNDROME(SUPRESSED HPA AXIS--CORTISOL SUPPRESSION) |
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| SMALLEST RRA |
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| HYDROCORTISONE |
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| LARGEST RRA |
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| MOMETASONE FUROATE (75%ORAL BIO) |
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| LARGEST ORAL GC RRA |
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| METHYLPREDNISOLONE (99% ORAL BIO) |
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| RRA IS________ |
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| RADIORECEPTOR ASSAY= DRUGS AFFINITY FOR GC RECEPTOR |
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| CORTICOSTEROIDS ARE METABOLIZED THRU |
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| CYP3A4 (KETOCAONAZOLE-->>POTENT INHIBITOR OF CYP3A4.INC PLASMA CONC OF ICS) |
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| BETA-2 AGONIST EFFECTS |
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| INCREASE IN -GLUCONEOGENESIS -HR -RELAXATION IN LUNGS/UTERUS -SKEL MUSC POTASSIUM UPTAKE/CONTRACTABILITY |
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| SHORT ACTING BETA 2 ADRENERGIC RXs |
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| EPINEPHRINE (SELECTIVITY low) ISOPROTERENOL (SELECTIVITY low) TERBUTALINE (SELECTIVITY high) ALBUTEROL |
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| LONG ACTING BETA 2 AGONISTS |
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| -SALMETEROL -FORMOTEROL -OLODATEROL -INDACATEROL -VILANTEROL |
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| RESCUE INHALER MEDS |
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| -ALBUTEROL -LEVALBUTEROL -TERBUTALINE |
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| BETA 2 SIDE EFFECTS |
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| TREMOR TACHYCARDIA HYPERGLYCEMIA HA,PAIN,DIZZINESS |
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| beta 2 intrxn with |
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| CYP3A4(KETOCONAZOLE/RITONAVIR) MOAs BETA BLOCKERS (PRODUCE SEVERE BRONCHOSPASM BY BLOCKING BETA AGONIST EFFECTS) DIGOXIN (MAY DEC DIGOXIN LEVELS) DIURETICS(POTENTIATES HYPOKALEMIA) |
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| THEOPHYLLINE(METHYLXANTHINES) BRONCHODILATION DUE TO |
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| -PDE INHIBTIOION |
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| iNC CL OF THEOPHYLLINE BY |
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| -SMOKING -INDUCING CYP1A2 -CHILDHOOD -HI PROTEIN,LOW CARB DIET -BARBECUED MEAT |
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| DEC CL OF THEOPHYLLINE |
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| CYP1A2 INHIBITON(CIMETIDINE,ERYTHROMYCIN,ALLOPUR, ZAFRILUKAST) |
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| THEOPHYLLINE SIDE EFFECTS |
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| NV HA DIURESIS CARDIAC ARRYTHMIAS BEHAVIOR DISTURBANCE/SEIZURES |
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| PDE4 ROFLUMILAST |
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| TX OF PT WITH SEVERE COPD AND HX OF EXACERBATION |
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| PDE4 INHIBITION DOES |
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| -INC cAMP -SMOOTH MUSCLE RELAX -DEC INFLAMM -DEC BRONCHOCONSTR -DEC NEUROPEPTIDE RELEASEIN PULM SENS NERVES |
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| ROFLUMILAST SIDE EFFECTS & PK |
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| ND HA WEIGHT LOSS PK:CYP1A2 & CYP3A4 CONTRA IN MOD-SEVERE HEPATIC IMPRMENT |
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| LEUKOTRIENE MEDIATORS |
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| ACT AT LTD2,LTE4,LTC4 TO HALT PROD OF BRONCHOCONSTRCT,MUCUS SECRET,PLASMA EXUD,EOSINOPHIL RECRUITMENT ZAFRILUKAST MONTELUKAST ZILEUTON |
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| ANTI CHOLINERGICS(MUSCARINIC RECEPTOR ANTAGONISTS) |
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| TIOTROPIUM,IPATROPIUM,ACLIDINIUM,GLYCOPYRROLATE (IPATROPIUM HAS A BAD TASTE) NEBULIZED CAUSES GLAUCOMA CAN CAUSE DRY MOUTH -URINARY RETENTION -BRONCHOCONSTRCTION WHEN USED WITH BENZALKONIUM |
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| ANTI IgE ANTIBODIES |
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| OMALIZUMAB,MEPOLIZUMAB,DUPILUMAB -DONT USE IN ASTHMA -DONT STOP CORTICOSTEROIDS ABRUPTLY -STOP IF FEVER,RASH,JOINT PAIN DEVELOPS |
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| ADRB2 DEALS WITH |
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| BETA AGONISTS |
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| CRHR1 GENE DEALS WITH |
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| INHALED CORTICOSTEROIDS |
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| GLY16GLY GENE IN ADRB2 SHOWS |
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| BETTER RESPONSE THAN ARG16ARG GENE TO SABA |
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| ADRB2 DOES NOT SHOW DIF BETWEEN GLYGLY AND ARGARG FOR _________ |
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| LABA RESPONSE |
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| CRHR1 SHOWS BETTER LUNG FUNC IN ADULTS AND PEDS W/ HOMOZYGOUS |
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| T/T & A/A (RS242941 & RS1876828) WITH INHALED CORTICOSTEROIDS |
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| SNPs IN CRHR1 DECREAS ______________ |
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| ENDOGENOUS CORTISOL AND IMPROVES PT SENSITIVITY TO ICS |
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| GUIDELINES AND LABEL UPDATES FOUND WHERE???? |
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| PHARMGKB CPIC DUTCH GUIDELINES FDA |
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| TRANSLATE LAB GENOTYPE RESULTS |
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| GENETIC TESTING REGISTRY PHARMGKB CLINVAR PUBMED |
