Question Answer
What are the causes of lung inflammation? Diseases Infections Inhalation of toxic substances Trauma
What is the immune response? The bodies natural defense mechanism.
What is the function of the immune response? To neutralize, destroy and eliminate antigens.
What are antigens? Any foreign substance
How does humoral immunity work?(circulating immunity) B-lymphocytes produce antibodies (IgG, IgM,IgA,IgD)
How do T-lymphocytes work? They remove or destroy directly or indirectly. (cell mediated immunity)
What does the antibody IgG do? It is the most common 80% of immunoglobulins in plasma. Protects against childhood diseases
What does IgM do? 10% of immunoglobulins; numbers increase in chronic infections.
What does IgE do? It’s involved in hypersensitivity reactions, allergic rhinitis, allergic asthma; bound to mast cells
What does IgA do? Mucous membranes in the respiratory tract; Transfer immunity to the child.
Describe Mast Cell Chemical Mediator Release. Mast cells are found throughout the body. Antigens attatch to mast cells Mast cells become sensitized. Await re-exposure. Upon re-exposure antigen-antibody reaction occurs causing rupture of mast cell. Histamine/Chemotactic factors are released.
What are the two types of asthma? Allergic Asthma and non-allergic asthma
Describe allergic Asthma. Most common. Caused by external agents Treated with allergy shots.
Describe non-allergic asthma caused by infection, cold air, exercise, stress. No immune response occurs (mast cells degranulate and burst)
How is non-allergic asthma treated? With prophylactic antiashtmatic agents that prevent mast cells from bursting.
Describe the early phase inflammatory response. Local vasodilation, increased vascular permeability, redness and wheal formation. Immediate response is bronchial contraction, wheezing, cough dyspnea, hypoxemia
What almost always reverses the early phase inflammatory response? Bronchodilators
Describe the late phase response. Slow imflammatory process that develops 6-8 hours later. Can be serious Treatment is aimed at stopping the inflammatory progression before it occurs at this stage
What happens during the late phase response? Hypersecretion of mucus and mucus swelling occurs. Traffic jam of cellular debris piles up
What class is geared towards the late phase response? Corticosteroids.
What does the endocrine system do? Secretes hormones into the blood stream.
What does the adrenal medulla secrete? Norepinephrine Epinephrine
What does the adrenal cortex secrete? steroids
What are the two classes of corticosteroids? Mineralcorticoids Gluccocorticoids
What are mineralcorticoids? Corticosteroids with salt-retaining activity that are important for electrolyte balance and fluid volume
What are gluccocorticoids? affect carbohydrate, protein and fat metabolism. Have anti infmallatory activity and supress immune response.
What does the hypothalamic Pituitary Adrenal Axis do? (HPA) Controls corticosteroid release. Responsible for normal fluctuation in steroid blood levels
Describe HPA. Hypothalamus stimulated. CRF (corticotropin releasing factor) released by anterior pitutiary gland. ACTH (Adrenocorticotropic Hormone released. Causes steroids to be released by adrenal cortex. This is a biofeeback mechanism.
Three mechanisms of action of the HPA. Block or diminish late-phase asthma response. Remove circulatory lymphocytes. Inhibit macrophage and leukocyte processing of antigens.
What are three more mechanism of actions of the HPA. Enhance responsiveness of B2 receptors. Time dependent (cellular biochemical effects are immediate, clinical response takes longer.)
What are corticosteroid effects on inflammation? Block arachidonic acid metabolites (leukotrienes and prostoglandins) Decrease monocytes, eocinophils and basophils. Decrease lymphocytes and macrophages Inhibit late-phase inflammation Increase Beta 2 receptors and responsiveness.
What are the immunologic side effects of corticosteroids. immunosupression, increased susceptibility to infections
What are the cardiovascular side effects to corticosteroids? Edema hypertension
What are the CNS side effects to corticosteroids? Euphoria Insomnia
What are dermatologic side effects to corticosteroids? Thin Skin impaired wound healing bruising altered fat distribution
What are endocrinolgic side effects to corticosteroids? diabetes cushingoid state
What are metabolic side effects to corticosteroids? electrolyte imbalance negative nitrogen imbalance
what are musculoskeletal side effects to corticosteroids? muscle weakness, osteoporosis, growth suspension
What are opthalmic side effects to corticosteroids? glaucoma
What is the oral corticosteroid. prednisone
What is the parenteral corticosteroid. Hydrocortisone (cortef) Methylprednisolone (solumedrol)
Cusing syndrome? Oral-yes Aerosol-No
Steroid dependence? Oral-High risk Aerosol-Low risk
Local theraputic effects? Oral-No Aerosol-yes
Risk to growth development in children oral-yes aerosol-no
Ease of use oral- yes aerosol-no
Cost oral-inexpensive aerosol-expensive
local airway reaction oral-no aerosol-Yes
beclamethasone dipropionate Beclovent Vanceril
Budesonide turbuhaler Pulmicort
Ciclesonide HFA Alvesco
Flunisolide Aerobid
Fluticasone Flovent
Triamcinolone acetonide Azmacort
Mometasone furoate Asmanex
Diproprionate HFA Qvar
budesonide, formoterol Symbicort
Advair low-150 mcg Medium 250 mcg High- 550 mcg
Fluticasone (MDI) low 44 mcg/puff medium 100 mcg/puff high 220 mcg per puff
Benefits of daily use. (corticosteroids) fewer symptoms Fewere severe exacerbations Reduced use of B2 agonist Reduction in airway remodeling. improved lung function. reduced airway inflammation
What are the two types of steroid dependency? psychological desire. physiologic steroid suppression of HPA
What are the withdrawal symptoms of steroids Anorexia Nausea Vomiting Lethargy Headache Hypotension
What are antiasthmatics? Mast cell stabilizers
How do antiasthmatics work? Impair or prevent the inflammatory response from ever beginning. Prevents mast cells from rupturing.
What are antiasthmatics used for? Allergic, nonallergic asthma, allergic rhinitis, and EIB.
What is EIB? Exercise induced bronchospasm
What else does antiasthmatics do? inhibit LAR and prevent BHR
What is LAR Late Asthma reaction
What is BHR bronchohyperresponsiveness
Cromolyn Sodium Intal
How does Cromolyn Sodium come? Solution/DPI
Facts about Intal. Compatible with B2 agonist Prophylactic effect in 4-6 weeks May be an alternate for children with side effects to theophylline
Nedocromil Sodium Tilade
How does Tilade come? MDI
Facts about Tilade. Theraputic effect in 4-6 weeks Side effects (1 in 1000) Non-toxic cough wheeze headache bad taste
Prostoglandin facts. Present in almost all tissues Modulate airway function can alter V/Q classified by chemical structure Very short half life.
PgF2 (most common) bronchoconstriction
PgE1, PgE2 Bronchodilation
What are Leukotrine modifiers? A recent group medication. inhibits leukotriene mediator cascade.
What are the two leukotrine modifiers? Accolate Singulair (maintenance therapy)
What agents treat upper airway congestion? Intranasal Medications, Intranasal corticosteroids, antihistamines, decongestants.
Intranasal medications. Cromolyn (prevents mast cell from degredation). Nasalcrom.
Intranasal corticosteroids Nasocort Nasonex Flonase Rhinocort Beconase
Antihistamine Benadryl Claritin Zyrtec ALlegra
Decongestants Sudafed Afrin (alpha 1 properties)