antiasthmatic and bronchodilators

Question 1

what is an anticholinergic inhaler?

Answer 1

(or muscarinic receptor antagonists) block the parasympathetic nerve reflexes that cause the airways to constrict, so allow the air passages to remain open

Question 2

what are the examples of anticholinergic inhalers?

Answer 2

ends in -tropium

• ipratropium (atrovent, combivent)
• tiotropium (spiriva)

Question 3

what is the primary action of anticholinergic inhalers?

Answer 3

bronchodilation

Question 4

when would anticholinergic inhalers be used?

Answer 4

bronchospasms associated with COPD

Question 5

what are the side effects of anticholinergic inhalers?

Answer 5

A - agitation 
B - blurred vision
C - constipation, coughing, confusion
D - dry mouth (most common)
S - stasis of urine

Question 6

what is different about tiotropium (Spiriva)?

Answer 6

it is a long-acting anticholinergic inhaler (bronchodilator)

• dry powder
• combined with albuterol

Question 7

what are beta 2 agonists?

Answer 7

a group of drugs prescribed to treat asthma

Question 8

what ending is seen with beta 2 agonist?

Answer 8

• terol

Question 9

what are examples of beta 2 agonists?

Answer 9

short-acting - albuterol

long-acting - formoterol (foradil) and salmeterol (serevent)

Question 10

what is the name of the beta 2 agonist shorting acting inhaler (rescue inhaler)?

Answer 10

albuterol

Question 11

what routes are beta 2 agonists given?

Answer 11

• PO (rare)

- inhaler

Question 12

what is the action of beta 2 agonists?

Answer 12

selective stimulation of bronchodilation, suppresses histamine, and increases cillary motion

Question 13

what are the side effects of beta blockers

Answer 13

• tachycardia and chest pain (related to beta 1)

- tremor (beta 2 in extremities)

Question 14

how often is albuterol given?

Answer 14

typically PRN but for frequent attacks, it can be given on a fixed schedule

Question 15

how often is formoterol (Foradil) or salmeterol (Serevent) given?

Answer 15

fixed schedule, typically 2 times a day

Question 16

what black box warning is seen with formoterol (Foradil) and salmeterol (Serevent)?

Answer 16

increased mortality (mostly with incorrect use - not really seen much anymore)

Question 17

what are glucocorticosteroids?

Answer 17

used as treatment for pts with frequent asthma symptoms (more than a couple of times a week)

Question 18

would a pt still need a bronchodilator with glucocorticosteroids?

Answer 18

yes

Question 19

what routes are used for glucocorticosteroids?

Answer 19

usually inhaled, but also PO and IV

Question 20

what are the examples of glucocorticosteroids?

Answer 20

• beclomethasone
• budesonide (pulmicort)
• fluticasone (flovent)
• triamcinolone (azmacort)

Question 21

what endings are used with glucocorticosteroids?

Answer 21

• one

- ide

Question 22

what are the adverse effects of inhaled glucocorticosteroids?

Answer 22

• oropharyngeal candidiasis (thrush of the mouth)

- dysphonia (hoarseness)

Question 23

why would you want to rinse your mouth out after inhaling glucocorticosteroids?

Answer 23

to prevent thrush in the mouth (oropharyngeal candidiasis)

Question 24

what are the side effects of oral glucocorticosteroids?

Answer 24

typically occurs in times of sickness when the dose is increased

• adrenal suppression
• osteoporosis
• hyperglycemia
• PUD (peptic ulcer disease)
• growth suppression in young

Question 25

what is the main use of glucocorticosteroids?

Answer 25

prophylaxis of chronic asthma (given on a fixed schedule)

Question 26

are glucocorticosteroids given PRN or on a fixed schedule?

Answer 26

fixed schedule

Question 27

what is cromolyn (Intal) used for?

Answer 27

prophylactically - prior to allergen exposure - exercise-induced bronchospasms

Question 28

what is the action of cromolyn (Intal)?

Answer 28

suppress inflammation by stabilizing cytoplasmic membranes PREVENTING THE RELEASE OF HISTAMINE (allergic reaction response)

Question 29

is cromolyn (Intal) used long-term or as a rescue method?

Answer 29

long-term use

Question 30

what adverse effects are seen with cromolyn (Intal)

Answer 30

cough - otherwise well tolerated

Question 31

what is methylxanthines (theophylline) used for?

Answer 31

2nd line treatment for asthma and COPD

Question 32

is methylxanthines (theophylline) a first-line treatment or second-line treatment

Answer 32

2nd line

Question 33

what is the mechanism of action for methylxanthines (theophylline)?

Answer 33

- relax bronchial smooth muscle | - nonsystemic action

Question 34

what are the adverse effects of methylxanthines (theophylline)?

Answer 34

cardiac arrest

Question 35

what antiasthmatic drug has a side effect of cardiac arrest?

Answer 35

methylxanthines (theophylline)

Question 36

what is the therapeutic range for methylxanthines (theophylline)? what is toxic?

Answer 36

therapeutic range - 5-15 | toxicity - greater than 20

Question 37

what are the signs and symptoms of toxicity with methylxanthines (theophylline)?

Answer 37

- nausea and vomiting - dysrhythmias - restlessness - confusion

Question 38

what education is needed with methylxanthines (theophylline)?

Answer 38

it is a stimulant so avoid caffeine cause that can lead to tachycardia which can then lead to dysrhythmias which then could lead to cardiac arrest

Question 39

what group of people would need a higher dose with methylxanthines (theophylline)?

Answer 39

children of smokers

Question 40

where is methylxanthines (theophylline) metabolized?

Answer 40

P450 system

Question 41

what kind of drug is a leukotriene modifier?

Answer 41

montelukast (singular)

Question 42

what is the action of leukotriene modifiers?

Answer 42

suppress effects of leukotrienes which promote bronchoconstriction and eosinophil infiltration

Question 43

what are leukotrienes?

Answer 43

they are associated with histamines and tightening of airway muscles

Question 44

what is the use for leukotriene modifiers?

Answer 44

maintenance of bronchodilation and allergies | - not relief of current symptoms

Question 45

what forms do leukotriene modifiers come in?

Answer 45

- daily PO absorption - rapid absorption - chewable tablets for kids

Question 46

what is a concern seen with leukotriene modifiers?

Answer 46

neuropsychiatric effects in kids

Question 47

what drug is an example of IgE agonists?

Answer 47

omalizumab (Xolair)

Question 48

what does the ending -mab indicate?

Answer 48

immunosuppressant medication which increases the risk for anaphylaxis

Question 49

are IgE agonists a first-line treatment or a second-line treatment for allergy-induced asthma?

Answer 49

2nd line

Question 50

what are IgE agonists used for?

Answer 50

allergy-induced asthma

Question 51

what is the action of IgE agonists?

Answer 51

- combines with IgE molecules to decrease the amount of IgE that can bind to MAST cells - work early in the allergy cascade

Question 52

what are the adverse effects of IgE agonists?

Answer 52

- increased risk for cancer | - anaphylaxis

Question 53

what route can IgE agonists be given

Answer 53

subcutaneous (administered every 2-4 weeks in a providers office)

Question 54

what teaching is needed with IgE agonists?

Answer 54

it is given subcutaneously every 2-4 weeks in a providers office

Question 55

what drugs are allergic rhinitis treatment?

Answer 55

``` first generation - diphenhydramine (benadryl) second generation - loratadine (claritin) - cetirizine (zyrtec) - fexofenadine (allegra) ```

Question 56

what is the mechanism of action for allergic rhinitis treatment?

Answer 56

histamine antagonist

Question 57

what is an adverse effect of allergic rhinitis treatment?

Answer 57

drowsiness

Question 58

what can allergic rhinitis treatment also be given with?

Answer 58

- intranasal corticosteroids | - decongestants

Question 59

why would diphenhydramine (Benadryl) be given in a hospital?

Answer 59

could be given through an IV if using an allergin in a hospital, like dye

Question 60

what is the common ending for allergic rhinitis treatment?

Answer 60

-ine