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Carroll Pharm Lect 4
Respiratory & GI Pharm
| Question | Answer |
|---|---|
| What is the process of air passage? | 1. Air reaches lungs by passing through the trachea 2. The trachea divides into two bronchi 3. Each Bronchi divides into many bronchioles 4. Bronchioles lead to tiny air sacs of alveoli |
| Does asthma involved the airways or the air sacs | Describe in more detail? |
| What is the parasympathetic pathway from the CNS for the maintenance of normal airway function? | CNS --> (PNS ganglia) ACh to N-N --> ACh to Muscarininc for cholinergic receptors- airways smooth muscle, submucosal glands |
| What is the sympathetic pathway from the CNS for the maintenance of normal airway function? | CNS --> (SNS ganglia) ACh to N-N --> NE to Beta-2 for adrenergic receptors – airway smooth muscle |
| What is the PNS responsible for in the respiratory system? | Bronchial constriction |
| What is the SNS responsible for in the respiratory system? | Little direct innervation, circulating NE, beta-2 dilation (adrenergic receptors causing bronchodilation), also has local control |
| What type of control does the respiratory system have? | Both neural and local control |
| What is different about asthmatic’s airways? | They are hyperreactive and causes constriction much faster |
| What are the mechanisms of bronchospasm? | -Mast cells release bronchoconstrictors substances and inflammatory mediators -degranulation of mast cells -histamine release -inflammatory mediators released -cytokine production |
| Which inflammatory mediators are released? | Prostaglandins & leukotryines |
| What are the net effects of asthma? | Bronchoconstriction and Inflammation & swelling of the airway |
| What does inflammation of the airway lead to? | Leads to hyper-responsive constrictor response of the airway smooth muscle to repeated exposure to allergens and other stimulus (exercise, aspirin) |
| What are some char’cs of asthma? | -Effort to force air through = wheezing -Exhaling difficult leading to decrease in fresh air (less O2 to body, inc [CO2] / lungs blood supply acidic) |
| What are two treatments for asthma? | Bronchodilators or anti-inflammatory agents |
| What do bronchodilators treat? | Treat primary Sx of asthma, Bronchoconstriction |
| What do anti-inflammatory agents treat with regard to asthma? | Reduce level of hyper-responsiveness, and block COX or LOX so no prostaglandins are leukotrienes are contributing to asthma |
| What is an example of a beta-2-adrenergic agonist bronchodilator? | Albuterol (Ventolin, Proventil) |
| What are some char’cs of Albuterol? | Most widely prescribed and most effect agents for Rx of Bronchoconstriction *relaxes smooth muscle |
| When should Albuterol not be used to treat asthma? | In those with CV disease b/c beta agonist causes dilation so get a negative effect |
| What are some anti-inflammatory agents used to treat asthma? | Prednisone, Montelukast (Singulair), and Zafirlukast (Accolate) |
| What are the char’cs of prednisone with respect to asthma? | Glucocorticoid, inhibits prod'n of inflammatory mediators, reduces smooth muscle hyper-reactivity and decreases constriction |
| What is the drug of choice for newly diagnosed asthma? | Prednisone |
| What are the most effective and prescribed agent for inflammation in regards to asthma? | Prednisone |
| What are some char'cs of Montelukast & Zafirlukast? | Leukotrience receptor antagonist, decrease inflammation and bronchoconstriction, effective for treating aspirin-induced asthma (Blocks LOX) |
| Summary of Rx of Asthma: Exposure to asthma trigger? | Avoidance of triggers |
| Summary of Rx of Asthma: Antigen and IgE on Mast Cells? | Cromolyn sodium to keep mast cells together |
| Summary of Rx of Asthma: Mediators released by mast cells & other inflammatory cells? | Anti-inflammatory for late response, or beta-agonist for early response against bronchoconstriction |
| In which COPD cases are bronchospasm often present? | Chronic bronchitis (inflammation of the bronchial tree), and Emphysema (destruction of alveolar walls) |
| What is given to treat COPD? | Beta-2 agonists (Corticosteroids' not shown clear therapeutic benefit) |
| What is cystic fibrosis? | Thick viscous secretions in major exocrine glands |
| What is used to treat CF? | Mucolytic drugs and corticosteroids in cob with reparatory hygiene (postural drainage, breathing exercises) |
| What kind of concerns regarding rehabilitation patients? | Proper resp hygiene, cord. RT with chest PT, Ex may trigger bronchospastic attacks, bronchodilators may cause arrhythmias (probs with meds), weak musculature b/c of corticosteroid Rx |
| What are some char'cs of the GI system? | Food moves through tract, secretion of digestive juices and digestion of food (enzymes), absorption of water and electrolytes, controls fxns by neural and hormonal systems |
| Describe the GI wall? | Smooth muscle layers responsible for motor function, Enteric nervous sysem (located in the walls of GI) |
| What does the GI wall control? | Mov't, secretion, & blood flow further stimulated by the PNS & SNS ganglion |
| How does Enteric Neural Control work? | Myenteric and submucosal plexus receives sensory input from within the wall of the gut |
| How does PNS and SNS control affect the GI? | PNS – enhances GI activity with ACh, SNS decreases GI activity with NE |
| What does cholectstokinin do for enteric hormonal control? | Slows emptying of stomach to allow for fat digestion |
| What does Gastrin do for enteric hormonal control? | Acid secretion – proper pH balance kept |
| What occurs with stomach acid secretion? | Food stimulates gastrin secretion; gastrin stimulates ECL (non-neuronal stores of histamine) causing histamine release & PNS also increasing histamine – Histamine activates the acid-producing parietal cells |
| What is the ECL? | Enterochromaffin-like cells |
| What does Gastrin lead to? | Stimulation of parietal cells (H+ secretion via K+/H+ ATPase secretes acid, Histamine (H2 Receptors) increase acid secretion, PNS also increase acid secretion) |
| What can excess acid secretion lead to? | Ulcers, GERD, Zollinger-Ellison Syndrome |
| What is Zollinger-Ellison syndrome? | Pancreatic tumor that increase gastrin secretion, results in a decr in the acid/base balance |
| What is used to treat excess acid? | K+/H+ ATPase inhibitors or Bismuth compounds + antibiotics, Histamine (H-2) receptor antagonists, Prostaglandin agonists, and Antacids |
| What are two examples of K+/H+ ATPase inhibitors and what does it treat? | Omeprazole (Prilosec) and Lansoprazole (Prevacid) -Treats GERD |
| What is an example and char'cs of a Bismuth compounds + antibiotics? | Bismuth subsalicylate (Pepto Bismol) - forms a protective barrier (weak antacid) and displaces H. pylori for an antibacterial effect |
| What are some Histamine (H2) receptor antagonists used to treat excess acid? | Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid) |
| What is an example of a prostaglandin agonist? Some char'cs and side effects? | Misoprostol (Cytotec) – Helpful in preventing ulcers in pts on NSAIDs – stimulation of bicarbs… SE: Stimulates abortion |
| How do prostaglandin agonists help prevent ulcers? | When NSAIDs inhibit COX, they also inhibit protective prostaglandins which: -Inhibit acid secretion -Stimulation mucous and bicarb production |
| How do antacids work and what are some char'cs? | Neutralize HCl, provide immediate relief, and have a short duration of action |
| What is the side effect of aluminum hydroxide? | An antacid that causes constipation |
| What is the side effect of magnesium hydroxide? | An antacid that is a laxative |
| What is the best antacid? Why? | Maalox = Magnesium + aluminum hydroxide b/c no sideeffects |
| How does inflammatory bowel disease (IBD) occur? What can result? | Occurs with blocked LOX… Ulcerative colitis, and Crohn's disease |
| What is used to treat IBD? | Corticosteroids or salicylate derivatives (NSAIDs) |
| What is the drug of choice for IBD as a corticosteroid? | Prednisone (Deltasone) for acute attacks, inhibits inflammatory mediators, side effects are ulcers |
| What salicylate derivatives are used to treat IBD? | Olsalazine (Dipentum) for reoccurring IBD |
| What is used to treat diarrhea? | Loperamide (Imodium) Best agent….. or Bismuth subsalicylate (Pepto Bismol) |
| What is the term emetic mean? | Vomit |
| What is vomiting caused by? | Chemotherapy, toxic response, infection, motion sickness, & anxiety |
| What are the two control centers of vomiting? | Chemoreceptor trigger zone (CTZ) & the vomiting center in the brainstem |
| What are two anti-emetics? | Dimenhydrinate (for motion sickness) & Lorazepam (for stage fright-induced or anticipatory vomiting) |
| What is a drug to treat constipation? | Magnesium hydroxide (Milk of Magnesia) – water and electrolyte retaining cathartic, may produce dehydration |
| What are some concerns of the GI system with Rehab pts? | Many have damage to stomach mucosa, inactive may suffer from constipation, cancer pts may be on antiemetic drugs, most GI drugs only produce dizziness and fatigue |
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sholl
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