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pathways to airflow limitation in asthma - 🧠 ANSWER ✔✔*airflow limitation
in asthma is caused by bronchospasm and/or inflammation*
- allergen > mast cell reaction > inflammatory mediators > bronchospasm
- allergen > mast cell reaction> infiltration of inflammatory mediators and
inflammatory cells > inflammation
,- bronchial hyperreactivity > triggers > bronchospasm
bronchitis (COPD) pathway to airflow limitation - 🧠 ANSWER ✔✔-
continuous irritation from smoke/pollution > inflammation > bronchial
edema/hyper secretion of mucus > airway obstruction
emphysema (COPD) pathway to airflow limitation - 🧠 ANSWER ✔✔-
continuous irritation from smoke/pollution > inflammation > increased
protease activity > destruction of alveolar walls > airway obstruction
considerations for metered dose inhalers (MDIs) - 🧠 ANSWER ✔✔- most
commonly prescribed
- must coordinate between activation and inhalation
- notorious for incorrect use: patient education necessary
- more drug reaches lungs with use of spacer (21% vs 9%)
considerations for dry powder inhaler (DPIs) - 🧠 ANSWER ✔✔- activated by
inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
considerations for nebulizers - 🧠 ANSWER ✔✔- fine mist droplets
,- no coordination necessary
- powered equipment (not portable, needs battery or plug)
considerations for respimats - 🧠 ANSWER ✔✔- better than other drug
inhalation delivery devices
- activated by inhalation (no coordination)
- fine mist droplets (better delivery to lower respiratory tract)
- portable
Uses for pulmonary glucocorticoids - 🧠 ANSWER ✔✔asthma and COPD
routes for pulmonary glucocorticoids - 🧠 ANSWER ✔✔- oral
- parenteral
- inhalation
mechanism of pulmonary glucocorticoids - 🧠 ANSWER ✔✔- anti-
inflammatory
- immunosuppressant
pulmonary glucocorticoid prototypes (and their routes) - 🧠 ANSWER ✔✔-
fluticasone/budesonide (inhalation)
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3
, - prednisone/prednisolone (oral)
- methylprednisolone (IV)
indications for pulmonary glucocorticoids - 🧠 ANSWER ✔✔*prophylaxis for
obstructive airway diseases*
- inhaled
- on a fixed schedule
- controller medication
*temporary use for severe obstructive disease when unable to deliver drug
via inhalation*
- oral or parenteral
- ex: no airway movement during status asthmaticus finch
side effects for pulmonary glucocorticoids - 🧠 ANSWER ✔✔- thrush (oral
candidiasis): rinse mouth after usage of inhaled agents to prevent this
- hyperglycemia
- peptic ulcer disease