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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)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
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, 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
theoretical side effects
- immunosuppression