Asthma, GI Drugs, Analgesics, RA + OA, Diabetes Flashcards
What’s the treatment rationale for asthma?
Bronchodilators
Anti-inflammatories
Three classes of bronchodilators
β2 Agonists
Anticholinergics
Methylxanthines
Types of β2 agonists used for asthma
Slow acting (Prophylactic)
Rapid acting ("Rescue" Agent)Albuterol (Proventil) is in a class of _ called _
Bronchodilators, β2 agonists
Salmeterol (Advair) is in a class of _ called _
Bronchodilators, β2 agonists
With regards to timeliness of use, Albuterol (Proventil) is _ while Salmeterol is _
rapid acting, slow acting
Albuterol is used as a _ while salmeterol is used as a _
Rescue Agent, Prophylactic
Ipratropium (Atrovent) is in a class of _ called _
Bronchodilators, Anticholinergics
Tiotropium (Spiriva) is in a class of _ called _
Bronchodilators, Anticholinergics
Theophylline (Theo-24, Theolair, Uniphyl) is in a class of _ called _
Bronchodilators, Methylxanthines
Three classes of anti-inflammatory drugs
Corticosteroids
Antileukotrienes
Mast cell stabilizers
Fluticasone (Advair, Flonase) is in a class of _ called _
Anti-Inflammatories, Corticosteroids
Montelukast (Singulair) is in a class of _ called _
Anti-Inflammatories, Antileukotrienes
Cromolyn sodium (NasalCrom) is in a class of _ called _
Anti-Inflammatories, Mast cell stabilizers
How do Corticosteroids work?
Mimic the anti-inflammatory effects of cortisol
How do Antileukotrienes work?
Block LTB4 receptors, reducing leukotriene effect
How do mast cell stabilizers work?
Prevent the degranulation of mast cells
Why are methylxanthines not as common nowadays?
Small therapeutic index
Ipratropium (Atrovent) is commonly used in the maintenance of
COPD
How do methylxanthines work?
Bind directly to and relaxes bronchial smooth muscles
Why is Albuterol (Proventil) inhaled?
To target the airways and reduce systemic side effects
What’s the most commonly used bronchodilator?
β2 Agonists
What are leukotrienes?
Inflammatory mediators that enhance the inflammatory response
Active ingredients in Advair
Fluticasone & Salmeterol
What’s the treatment rationale for constipation?
Increase GI (colonic) motility
What’s the treatment rationale for diarrhea?
Decrease GI (colonic) motility
What’s the treatment rationale for GERD?
Reduce HCl secretion
What’s the treatment rationale for Peptic Ulcer Disease?
Reduce HCl secretion + Increase mucosal protection
Two classes of laxatives
Stimulants
Bulk forming agents
Phenolphthalein (X-Lax) is in a class of _ called _
Laxatives, Stimulants
Psyllium (Metamucil) is in a class of _ called _
Laxatives, Bulk forming agents
How do bulk-forming agents work?
Expand when exposed to water, distending GI wall, stimulating peristalsis (gastro colic reflex)
Possible side effects of long term use of laxatives
Bowel atony
Diphenoxylate (Lomotil) is in a class of _ called _
Anti-diarrheals, Opiods
Loperamide (Immodium) is in a class of _ called _
Anti-diarrheals, Opiods
When should diarrhea not be treated with antimotility agents?
Antimotility agents should not be used when it’s infectious diarrhea
How do PPI’s work?
Inhibit proton pumps, reducing HCl secretion
Omeprazole (Prilosec) is in a class of drugs called _
PPI’s
Esomeprazole (NEXium) is in a class of drugs called _
PPI’s
How do H2 receptor antagonists work?
block H2 (histamine) receptors, indirectly reducing HCl secretion
Ranitidine (Zantac) is in a class of drugs called _
H2 receptor antagonists
Cimetidine (Tagamet) is in a class of drugs called _
H2 receptor antagonists
Omeprazole (Prilosec), Esomeprazole (NEXium), Ranitidine (Zantac), and Cimetidine (Tagamat) all
Reduce HCl secretion
How does sucralfate (Carafate) work?
In an acidic environment forms protective mucosal layer that coats ulcer
When should sucralfate (Carafate) not be used?
Sucralfate (Carafate) should not be used with an antacid
Two classes of analgesics
Opiods
Non-opiods
Most common non-opiod subclass
NSAIDs
With regards to pain intensity, opiods are used for
moderate to severe pain
Two classes of opiods
Strong agonists
Moderate agonists
What do opiods bind to?
μ opiod receptors
How do opiods reduce pain?
change brain’s perception of pain
inhibit ascending pain transmission
stimulate descending pain-relieving transmission
What are the side effects of opiods?
Constipation
Respiratory depression
Most common non-opiod non-NSAID
Acetaminophen
Acetaminophen has no anti-inflammatory effect; it is an _ and _
analgesic, antipyretic
How do NSAID’s work?
inhibit enzymes, usually COX-1 and COX-2, in the cyclooxygenase pathway, reducing the synthesis of anti-inflammatory mediators
What products depend on the COX-1 pathway
TXA2, which promotes platelet aggregation
PG, which increase mucosal protection in GI tract
What products depend on the COX-2 pathway
PGI’s associated with pain, inflammation, and fever production
PGI’s, which decrease platelet aggregation
Aspirin (Ecotrin) is in a class of _ called _
Non-opiod analgesics, NSAID’s
Ibuprofen (Advil, Motrin) is in a class of _ called _
Non-opiod analgesics, NSAID’s
Naproxen (Aleve) is in a class of _ called _
Non-opiod analgesics, NSAID’s
Celecoxib (Celebrex) is in a class of _ called _
Non-opiod analgesics, NSAID’s
Celecoxib (Celebrex) specifically inhibits what pathway
COX-2
In addition to being an analgesic, Aspirin is also a _, _, _
antipyretic, anti-inflammatory, anti-platelet
_ has the most advanced anti-platelet effect of the NSAID’s
Aspirin
What are the side effects of NSAID’s
May promote ulcer formation
May promote stomach bleeding
What are the side effects of celecoxib (Celebrex)?
Increase risk of adverse cardiovascular effects, mostly heart attack
Where do the side effects for celecoxib (Celebrex) come from?
Unimposed COX-1’s TXA2 effect on platelet aggregation
Where does the side effect for NSAID’s come from?
Removing COX-1’s PG’s mucosal protection in GI tract
Generally, knocking out the COX-1 pathway has what effect on the body?
decreases platelet aggregation
decreases mucosal protection in GI tract
Generally, knocking out the COX-2 pathway has what effect on the body?
reduces pain, inflammation, and fever
increases platelet aggregation
What’s the treatment rationale for rheumatoid arthritis?
Reduce pain and inflammation
Halt disease progression
Rheumatoid arthritis is an _ disease that usually affects _ joints
autoimmune, smaller
_ are used to treat the disease progression of rheumatoid arthritis
DMARD’s-disease modifying antirheumatic drugs
Two classes of DMARD’s
Nonbiologic
Biologic
1st line of defense for rheumatoid arthritis
DMARD’s- Reduce immune activity
Methotrexate (Trexall) is in a class of drugs called _ _
Nonbiologic DMARD’s
Leflunomide (Arava) is in a class of drugs called _ _
Nonbiologic DMARD’s
How does methotrexate (Trexall) work?
Methotrexate (Trexall) is a folate inhibitor which reduces T-cell proliferation, reducing autoimmune activity
How does leflunomide (Arava) work?
Leflunomide (Arava) reduces T cell activation, reducing autoimmune activity
Adalimumab (Humira) is in a class of drugs called _ _
Biologic DMARD’s
How does adalimumab (Humira) work?
Adalimumab (Humira) binds tumor necrosis factor α, the chemical, not the receptor, to prevent proinflammatory effect
What are the side effects of DMARD’s
Increased risk of life-threatening infection
Osteoarthritis is a _ disease that usually affects _ joints
progressive, large
What’s the treatment rationale for osteoarthritis?
Reduce pain
Visco-supplementation
Chondroitin sulfate is a _ intended to _
viscosupplement, replace material in cartilage
Hyaluronan injections do what for osteoarthritis?
Hyaluronan injections minimize degenerative effects
What’s the treatment rationale for Type I diabetes mellitus?
Replace insulin
What’s the treatment rationale for Type II diabetes mellitus?
increase insulin sensitivity/decrease insulin resistance
increase insulin secretion in β cells
What’s the potential sideeffect of all antidiabetic drugs?
hypoglycemia
Glipizide (Glucotrol) is in a class of _ called _
antidiabetics, Sulfonylureas
Exenatide (Byetta) is in a class of _ called _
antidiabetics, Incretin analogues
Sitagliptin phosphate (Januvia) is in a class of _ called _
antidiabetics, DPP-IV Inhibitors
Three classes of drugs to increase insulin secretion for Type II Diabetes mellitus
Sulfonylureas
Incretin analogues
DPP-IV Inhibitors
How do sulfonylureas work?
directly stimulates β cells to produce more insulin
How do incretin analogues work?
mimics effect of incretin (GLP-1), stimulating β cells to produce more insulin
How do DPP-4 inhibitors work?
inhibits DPP-4, the enzyme that inactivates GLP-1, prolonging GLP-1’s β cell stimulating effect, producing more insulin
Class of drugs that increases insulin sensitivity for Type II Diabetes mellitus
Biguanides
Metformin is in a class of _ drugs called _
antidiabetics, biguanides
How does dapagliflozin (Farxiga) work?
blocks sodium-glucose transport proteins, reducing glucose reabsorbed from filtrate, reducing blood sugar
How does metformin work?
increases peripheral glucose uptake by cells &
lowers hepatic glucose production, reducing blood sugar
