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Basic Pharmacology > 4. Drugs used in asthma -hemostasis > Flashcards

4. Drugs used in asthma -hemostasis Flashcards

1
Q

Major risk factor of asthma

A

atopy

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2
Q

relievers

A

short-acting beta2 agonists
muscarinic antagonists
methylxanthines
iv corticosteroids

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3
Q

controllers

A 
corticosteroids 
long acting beta 2 agonists 
mast cell stabilzers
anti-IGE antibodies
leukotriene antagonists
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4
Q

short-acting beta 2 selective agonist

A 
albuterol
levalbuterol
terbutaline
metaproterenol
pirbuterol
procaterol
fenoterol
bitolterol
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5
Q

drug of choice for acute asthma attacks

A

salbutamol (short-acting beta 2 selective agonist)

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6
Q

SE salbutamol

A 
tachycardia
tremors
nervousness 
restlessness
arrhythmias 
tolerance 
tachyphylaxis
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7
Q

short-acting beta 2 selective agonist

usual DOA

A

2-4 hours

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8
Q

short-acting beta 2 selective agonist

that can be given IV

A

terbutaline

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9
Q

short-acting beta 2 selective agonist

that can be given PO

A

salbutamol, terbutaline

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10
Q

beta 2 selective agonist (long acting)

A 
salmeterol
formoterol
cleneterol
bambuterol
arformoterol
vilanterol
indaaterol
olodaterol
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11
Q

beta 2 selective agonist (long acting) used for

A

asthma prophylaxis

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12
Q

muscarinic receptor antagonist for asthma

prevents vagal stimulated bronchoconstriction

A

ipratropium
tiotropium
umeclidinium
glycopyrrhonium

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13
Q

methyxanthine

A

theophyline
aminophyllien
pentoxyfylline
doxofylline

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14
Q

MOA theophylline

A

phosphodiesterase inhibition
adenosine receptor antagonist
causes bronchodilation

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15
Q

use of methylxanthine

A 
asthma (prophylaxis for nocturnal attacks)
intermittet claudication (pentoxyfylline only)
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16
Q

this muscarinic receptor antagonist

does not cross BBB

A

glycopyrronium

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17
Q

muscarinic receptor antagonist
used as monotherapy for COPD
antispasmodic and reduce salivation with anesthetics

A

glycopyrronium

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18
Q

theophylline antidote in overdosage

A

beta blockers

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19
Q

mast cell stabilizer
prevents calcium influx, stabilizes mast cells ,
preventing degranulation and release of histamine, leukotrienes, and other mediators

A

cromolyn B

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20
Q

uses of cromolyn B

A

asthma prophylaxis

allergies (eyes,nose,GI)

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21
Q

SE cromolyn B

A

cough

airwasy irritation

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22
Q

corticosteroid for asthma

A 
fluticasone
beclomethasone
budesonide 
ciclesonide 
flunisolide 
mometasone
triamcinolone
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23
Q

inhibitor of phospholipase A2, reduces expression fo COX

A

corticosteroid

fluticasone
beclomethasone
budesonide 
ciclesonide 
flunisolide 
mometasone
triamcinolone
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24
Q

DOC asthma prophylaxis

A

corticosteroid

fluticasone
beclomethasone
budesonide 
ciclesonide 
flunisolide 
mometasone
triamcinolone
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25
SE fluticasone
oropharyneal candidiasis minimal steroid toxicity (adrenal suppression) mild growth retardation
26
for status asthmaticus | tx
IV prednisolone and hydrocortisone
27
lowest systemic steroid toxicity
ciclesonide
28
leukotriene synthesis inhibitor
zileuton
29
Uses of zileuton
asthma prophylaxis | exercise-, antigen-, aspirin induced bronchospasm
30
SE of zileuton
``` flulike syndrome headache drowsiness dyspepsia hepatitis elevation of liver enzymesq ```
31
leukotriene receptor antagonist
montelukast zafirlukast pranlukast
32
blcoks cysteinyl leukotriene-1 receptor for leukotrienes C4,D4, and E4 prevents airway inflammation and bronchoconstriction
Montelukast
33
Uses of monteukast
asthma prophylaxis | exercise-, antigen-, aspirin induced bronchospasm
34
anti - IgE antibody | Binds IgE antibodies on mast cells. Reduces rxn to inhaled antigen
Omalizumab
35
Uses of omalizumab
prophylaxis of severe refractory asthma not responsive to all other drugs
36
SE Omalizumab
``` Fever angioedema anaphylactic rxns Idiopathic severe thrombocytopenia nasopharyngitis upper abdominal pain ```
37
these drugs prevent release /action of mediators such as leukotrienes, cytokines
cromolyn steroids zileuton omalizumab
38
This drugs inhibit acute symptoms of asthma
beta agonists theophylline muscarinic antagonists leuktriene antagonists
39
This drugs inhibit inflammation | bronchial hyperreactivity
steroids cromolyn leukotriene antagonists
40
Drugs used for cough
``` Mucolytic N-acetylcysteiene Carbocisteine Ambroxol Bromhexine Erdosteine ``` Expectorant Guaifenesin ``` Antitussives Dextromethophan codeine Butamirate citrate Levodropropizine ``` Inhibits PDE and calcium entry Vitex negundo
41
mucolytic
``` N-acetylcysteiene Carbocisteine Ambroxol Bromhexine Erdosteine ```
42
Expectorant`
Guaifenesin
43
centrally acting Antitussives, opiod antitussive
Dextromethophan | codeine
44
Inhibits PDE and calcium entry
Vitex negundo
45
reduce disulfide bridges that bind glycopreotins to other proteins such as albumin also act as antioxidants and may reduce airway inflammation
mucolytic
46
NAC used for
cough
47
SE of NAC
``` chest tightness disagreeable odor drowsiness fever hemoptysis inc volume of bronchial secretions irritatin of tracheal and bronchial tract nausea rhinorrhea stomatitis vomiting ```
48
act as an irritat to gastric vagal receptors and recruit afferent parasympathetic reflexes that cause glandular exocytosis of a less viscous mucus mixture
guiafenesin
49
SE of guiafenesin
``` drowsiness incomplete or infrequent bowel movements inducing of a relaxed easy state stomach cramps dizziness headache rash nausea vomiting stomach upset ```
50
antitissives CI in
bacterial lung infections asthma bronchiectasis chronic bronchitis (suppurating bronchial inflammation) antitussives cause harmful sputum thickening and retention
51
dec sensitivity of medullary/CNS cough centers to peripheral stimuli and dec mucosal secretion
dextromethorphan
52
when is morphine indicated for cough?
intractable cough from bronchial asthma
53
this antitussive has no addictive potention, no analgesic effect, produces less constipation and inhibition of mucociliary clearance
dextromethorphan
54
centrally acting antitussive,non-opioid antitussive
butamirate citrate
55
peripherally acting antitussive
Levodropropizine
56
act through receptors in the brainstem to inhibit cough
butamirate citrate
57
SE butamirate
``` somnolence nausea vomiting diarrhea dizziness hypotension ```
58
non-opioid drug with a peripheral action by inhibiting the apprent pathways that generate cough reflex (modulates C-fibre activity)
Levodropropizine
59
SE of levodropropizine
``` nausea vomiting heartburn diarrhea fatigue weakness drowsiness dizziness headache palpitations ```
60
inhibits PDE III and inhibits Ca entry (acts as a CCB) which explain bronchodilatory effect inhibits COX 2
vitex negundo
61
most common type of anemia
microcytic hypochromic anema caused by iron deficiency
62
lab pic of iron deficiency anemia
dec iron dec ferritin inc TIBC
63
megaloblastic anemias are caused by deficiency of
vitamin B12 | folic acid
64
most common type of megaloblastic aneia
pernicious anemia
65
storage protein of iron
ferritin
66
iron bound to this transport protein
transferrin
67
unexplained presence of iron deficiency anemia in any adult with exception of premenopausal, multiparous woman mandates
throrough endoscopic/ radiographic visualization of entire large bowel
68
hematopoietic growth factor
oral Ferrous sulfate ferrous gluconate ferrous carbinate parenteral iron dextran sodium ferric gluconate complex iron sucrose Cyanocobalamin Hydroxocobalamin Methylcobalamin Folic acid Folacin (pteroylglutamic acid) Folinic acid/ Leukovorin Methylfolate Epoietin Alfa FIlgrastim Oprelvekin (IL-11) Eltrombopag Plerixafor Romiplostim
69
ferrous sulfate | SE
black stools (obscure GI loss) Acute overdosage - necrotizing gastroenteritis , abdominal pain, metabolic acidosis , bloody diarrhea, shock, lethargy, dyspnea chronic iron overload - hemochromatosis , organ failure (heart, liver, pancreas), death
70
iron content of iron preparations
``` Fe carbonate 100% fe fumarate 33% Fe sulfate, dried 30% Fe sulfate, hydrated 20% Ferric ammonium sulfate 18% Fe gluconate 12% ```
71
acute iron intoxication most common in
children - accidental ingestion of iron supplementation
72
tx of acute iron intoxication
removal of unabsorbed tablets from the gut correction of acid base and electrolyte abnormalities parenteral administration of deferoxamine which chelates circulating iron
73
triad of hemochromatosis
cirrhosis DM skin pigmentation CDS
74
hemochromatosis | occurs
inherited abnormality in iron absorption persons who receive frequent transfusions for tx of hemolytic disorders (thalassemia major)
75
tx of hemochromatosis
phlebotomy chronic administration of deferoxamine or derasirox
76
heavy metal chelator
deferoxamine deferasirox deeriprone
77
uses of deferoxamine
acute iron poisoning | hemochromatosis not adequately tx by phlebotomy
78
SE of deferoxamine
hypotension ARDS neurotoxicity inc susceptibility to infections
79
acute iron poisoning | tx
IV deferoxamine
80
hemochromatosis | tx
oral deferasirox | deferiprone
81
cobalt containing vitamin
vitamin B12
82
cofactor in the transfer of 1-carbon units | for synthesis of DNA
Vitamin b12
83
megaloblastic anemia, neurologic defects
vit b12
84
neurologic manifestations of vit b12 defieciency
ataxic gait impaired position and vibratory sense spasticity
85
Vit b12 absorbed in
distal ileum | with intrinsic factor
86
plasma transport of vit b12 is accomplished by binding to this protein
transcobalamin II
87
storage of vit b12
liver, 5 year supply
88
2 forms of vit b12
cyanocobalamin | hydroxocobalamin
89
essential 2 rxn of vit b12
(1) conversion of methylmalonyl CoA to succinyl CoA | (2) conversion of homocystein to methionine
90
in vit b12 deficiency, folate accumulate as
N-methyltetrahdrofolate
91
deficiency inc risk of neutral tube defects in fetus
folic acid
92
folic acid is absrobed by the
proximal jejunum
93
dec in dietary intake of folic acid within ____ is followed by megaloblastic anemia
1-6 months
94
cofactor required for essential enzymatic rxns that form tetrahydrofolate convert homocystein to methionine metabolize methylmalonyl CoA
cyanocobalamin
95
vit b12 SE
no significant toxicity
96
this route is used for pernicious anemia
parenteral form
97
has longer t1/2 than cyanocobalamin
hydroxocobalamin
98
MOA | precursor of an essential donor of methyl groups used for synthesis of amino acids , purines, and deoxynucleotide
folic acid
99
uses of folic acid
megaloblastic anemia prevention of neural tube defects (spina bifida) prevention of coronary artery disease
100
agonist of erythropoietin receptors by red cell progrenitors
epoetin alfa darbepoetin alfa methoxypolyethylene glycol-epoetin beta
101
Uses of epoetin alfa darbepoetin alfa methoxypolyethylene glycol-epoetin beta
anemia esp associated with chronic renal failure HIV infection cancer prematurity prevention of the need for transfusion in patients undergoing certain types of elective surgery
102
SE of epoietin alfa
htn thrombosis pure red cell aplasia
103
dabepoietin is given
once a week
104
methoxy PEG epoietin beta is given
1-2 x a month
105
myeloid growth factor
Filgrastim (G-CSF) Pegfilgrastim Plerixafor Lenograstim
106
Binds receptors on myeloid progenitors and stimulates cell maturation and proliferation Accelerates neutrophil recoverya dn reduces incidence of infection
Filgrastim (G-CSF) Pegfilgrastim Plerixafor Lenograstim
107
Uses of Filgrastim (G-CSF) Pegfilgrastim Plerixafor Lenograstim
Neutropenia associated with chemotherapy myelodysplasia aplastic anemia mobilization of peripheral blood cells in preparation for hematopoetic stem cell transplantation
108
SE of filgrastim
bone pain (arthralgia ) fever edema splenic rupture
109
megakaryocyte growth factor
oprelvekin (IL-11) thrombopoietin eltrombopag romiplastim
110
MOA of oprelvekin
acitvates IL-11 receptors
111
uses of oprelvekin (IL-11) thrombopoietin eltrombopag romiplastim
secondary prevention of thrombocytopenia in ptx undergoing cytotoxic chemo for nonmyeloid cancers
112
SE oprelvekin (IL-11) thrombopoietin eltrombopag romiplastim
``` Fatigue headache dizziness anemia fluid accumulation in the lungs transent atrial arrhythmias ```
113
oprelvekin (IL-11) thrombopoietin eltrombopag romiplastim given
SC OD
114
use for tx of thrombocytopenia in adults and pedia >/= 6 yrs old with chronic ITP with insufficient response with corticosteroids ,Ig , or splenectomy
eltrombopag
115
blocks bindig of stromal cell derived factor 1 alpha in bone marrow stromal cells , to the CXCR4. -> mobilization of progenitor and hemotopoeitic stem cells from one marrow into peripheral blood for collection and subsequent autologous transplantation in patients with non-hodgkinds lymphoma and multiple myeloma
plerixafor
116
fusion antibody-peptode that is thrombopoietin receptor agonist;
romiplostim
117
mechanisms of hemostasis
1. vasoconstriction 2. platelet plug formation 3. formation of clot via coagulation 4. fibrous organization
118
1st step of vasoconstiction | autocoid factors
thromboxane A2 - platelet activator | Endothelin
119
Primary hemostasis involves formation of
platelet plug
120
platelet plug formation factors | is mediated by
exposed subendothelial collagen -> thrombogenic platelet adhesion - vWF (released by endothelium) by GpIb receptor in platelet surface platelet release rxn 1. ADP - platelet aggregation 2. TXA2 - platelet activator and vasoconstriction 3. serotonin - platelet aggregation and vasoconstriction
121
intrinsic pathway of hemostasis factors
PTT Factor V,8,9,10,11,12 prothrombin (2) fibrinogen (1)
122
extrinsic pathway of hemostasis factors
PT | Factor V,7,10, prothrombin (2) , fibrinogen (1)
123
net result of coagulation pathways
prothrombin activator
124
Antiplatelet drugs
Aspirin Salsalate Sodium salicylate Abciximab Eptifibatide Tirofiban Clopidogrel Ticlopidine Prasugrel Ticagrelor Dipyridamole Cilostazol
125
Anticoagulants
Indirect thrombin inhibitors 1. heparin 2. enoxaparin (LMWH) 3. coumarin derivatives (warfarin Direct thrombin inhibitors 1. lepirudin 2. rivaroxaban
126
Chemical antagonist of heparin | reverses excessive anticlotting activity of unfractionated heparin
protamine sulfate
127
thrombolytic
``` alteplase anistreplase reteplase streptokinase tenectelase urokinase ```
128
tissue plasminogena activator analog | converts plasminogen to plasmin which degrades fibrin and fibrogen -> thrombolysis
``` alteplase anistreplase reteplase streptokinase tenectelase urokinase ```
129
Uses of ``` alteplase anistreplase reteplase streptokinase tenectelase urokinase ```
Acute MI Ischemic stroke pulmonary embolism
130
SE of alteplaste
bleeding cerebral hemorrhage reperfusion arrhythmias
131
this thombolytic has loss of effectiveness on 2nd use and allergic rxns
streptokinase
132
antidote to thrombolytic drugs
aminocaproic acid
133
most critical to a positive outcome for stroke treatment is the window period. The recommended window period for stroke intervention
6 hours
134
Intravenous fibrinolytic therapy at the cerebral circulation dose within the first ____ hours of ischemic stroke onset offers substantial net benefits for virtually all patients with potentially disabling deficits.
3 hours
135
Intravenous fibrinolytic therapy at the cerebral circulation dose within ____ hours offers MODERATE net benefits when applied to all patients with potentially disabling deficits.
3-4.5
136
Intra-arterial fibrinolytic therapy in the ____hour window offers moderate net benefits when applied to all patients with potentially disabling deficits and large artery cerebral thrombotic occlusions.
3- to 6-hour
137
CI to thrombolysis
hx of cerebrovascular hemorrhage at any time nonhemorrhagic stroke or other cerebrovascular event within apst yr marked htn >180/110 mmHg at ANY TIME during the acute presentation suspicion of aortic dissection active internal bleeding (excluding menses)
138
prothrombotics
1. tranexamic acid 2. vit k. 3. desmopressin 4. aprotinin
139
antiplasmin drug | aminocaproic acid
tranexamic acid
140
competitively inhibits plasminogen activation by inhibiting tPA
tranexamic acid
141
CI of tranexamic acid
disseminated intravascular coagulation
142
uses of tranexamic acid
prevention and tx of acute bleeding episodes in ptx with high risk of bleeding (hemophilia, intracranial aneurysms, menstrual, obstetric, postop)
143
SE tranexamic acid
hypotension myopathy diarrhea thrombosis
144
endogenous vitamin | for synthesis of fx vitamin K dependent clotting and anticlotting factors
Vitamin K1 (phytonadione) Vit K2 menaquinone vit k3 menadione phytomenadione
145
antidote to warfarin
Vitamin K1 (phytonadione) Vit K2 menaquinone vit k3 menadione phytomenadione
146
uses of vit k
prevention of hemorrhagic diathesis in newborns vit k deficiency antidote to warfarin
147
SE vit K
severe infusion rxn when administered too fast (dyspnea, chest and back pain)
148
this vit k is ineffective
vit k3 menadione
149
ADH agonist V2 receptor agonist inc factor 8 activity of ptx with mild hemophilia A or von willebrand disease
Desmopressin vasopresin terlipressin
150
serine protease inhibitor | antiplasmin drug
aprotinin
151
inhibits plasmin and plasmin streptokinase complex in ptx who receibed streptokinase
aprotinin
152
aprotinin uses
post op or intra op bleeding
153
SE of aprotinin
inc risk of renal failure heart attack and stroke removed from market due to mortality
154
this is the most common acuse of acute myocardial infarction , ischemic stroke, and limb gangrene
arterial thrombosis | - predominance of platelets in aterial thrombi
155
Antiplatelet drug antiinflammatory drug COX INHIBITOR , non-selective, irreversible reduce production of TXA2
ASPIRIN, SALSALATE SODIUM SALICYLATE
156
aspirin | uses
``` prevention of aterial thrombosis (MI, TIA, CVD) Inflammatory disorders (rheumatic fever, kawasaki disease, juvenile rheumatoid arthritis ) ```
157
SE of aspirin
``` GI toxicity nephrotoxicity tinnitus hypersensitivity hyperventilation HAGMA inc bleeding time nephrotoxicity (AKI and interstitial nephritis) ```
158
toxic dose of aspirin
150 mg/kg | 70 kg, 21 tabs
159
lethal dose of aspirin
500 mg /kg | 70 kg, 70 tablets
160
triad of aspirin hypersensitivity
Samter triad 1. asthma 2. aspirin sensitivity 3. nasal polyps
161
what is the expected acid base abnormality in salicylate poisoning
respiratory alkalosis with HAGMA inc resp drive -> hyperventilation-> resp alkalosis uncoupling of oxidative phosphorylation leads to inc anaerobic metabolis via LACTIC ACIDOSIS and high-anion gap metabolic acidosis
162
difference in presentation of ASA intoxication in children and adults
adults = mixed acid base disorder respiratory alkalosis with HAGMA children = pure acid base disorder (HAGMA)
163
what is the diff between INHIBITOR and UNCOUPLER of oxidative phosphorylation?
inhibitors: completely halt ETC uncouplers: dissipate proton gradient without interrupting ETC
164
antiplatelet drug | GP IIa/IIIa inhibitor
Abciximab Eptifibatide Tirofiban
165
Uses of abciximab
used during PCI to prevent thrombosis adjunct to thrombolysis, acute coronary syndromes (unstable angina, NSTEMI)
166
SE abciximab
bleeding | thrombocytopenia
167
antiplatelet drug thienopyridine ADP inhibitor
Clopidogrel Ticlopidine Prasugrel Ticagrelor
168
Uses of clopidogrel
prevention and tx of arteral thrombosis (stroke, TIA, UA) prevention of restenosis after PCI ACS
169
SE clopidogrel
``` bleeding nausea dyspepsia hematologic -neutropenia -leukopenia - thromotic thrombocytopenic purpura (Ticlopidine) ```
170
Clopidogrel + aspirin
additive
171
this drug specifically inhibits ADP subtype P2Y | allosteric antagonist
Clopidogrel
172
antiplatelet drug | PDE inhibitor
dipyridamole | cilostazol
173
MOA inhibit PDEIII -> inc. cAMP (platelets and BV) -> aggregation and vasodilation inhibit adenosine uptake by endothelial cells and RBC -> inc adenosine -> inhibition of platelet aggregation
dipyridamole | cilostazol
174
uses of dipyridamole cilostazol
1. prevention of thromboembolic complications of cardiac valve replacement 2. 2ndary prevention of ischemic stroke (with aspirin) 3. Cilostazol -intermittent claudication
175
SE of dipyridamole cilostazol
headache | palpitations
176
cilostazole is CI in
HF
177
drugs which inhibit formation of fibrin clots | mainly used for prevention and tx of venous thrombosis (pulmonary embolism, deep vein thrombosis )
anticoagulants
178
activates antothrombin III (inactivates thrombin or Factor IIa, Factor IXA and factor Xa) by forming stable complexes
hepatin
179
impairs post translation modification of factors II, VII, IX, and X vit K dependent factors 2,7,9,10
warfarin
180
monitoring of heparin effect
PTT
181
warfarin | monitoring
PT
182
antidote for hepation
protamine
183
antidote for warfarin
vit k, ffp
184
this lab test will assess extrinsic pathway
PT extrinsic = PeT
185
this lab test will assess intrinsic pathway
PTT Brad PiTT
186
DOC for anticoagulation during pregnancy
heparin
187
a heparinoid 80% hepatin 20% dermatan sulfate
sulodexide
188
ROUTE | hepatin
IV , SC
189
uses of heparin
``` DVT PE UA MI adjuvant to PCI and thrombolytics AF ``` DOC for anticoagulation during pregnancy angioplasty and stent placement : (+) with GPIIb-IIIa inhibitors (abciximab) revascularization procedures: (+) thrombolytics
190
binds and potentiates effect of antithombin III on factor Xa (more selective) less effect on factor IIa/thrombin
``` enoxaparin dalteparin tinzaparin danaparoid fondaparinux nadroparin ```
191
SE enoxaparin
``` DVT PE UA MI adjuvant to PCI and thrombolytics AF ```
192
SE heparin
bleeding heparin induced thrombocytopenia osteoporosis with chronic use
193
advantage of enoxaparin
do not require aPTT monitoring | higher bioavailability, longer t1/2
194
binds to thrombin’s active and inhibits its enzymatic action
``` lepirudin desirudin bivalirudin argatroban dabigatran ```

Basic Pharmacology (15 decks)

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