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Pharmacology > Chap 8, 9, 11 > Flashcards

Chap 8, 9, 11 Flashcards

1
Q

Xanthines

A

Weak Bronchodilator, Exact method of action is unknown, Additive affect with Beta Agonist (albuterol), Non-bronchodilator effects on respiration

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2
Q

Non-bronchodilator effects on respiration

A

Respiratory muscle strength (diaphragm), Respiratory muscle endurance, Central ventilatory drive, Anti-inflammatory, Cardiovascular Improvement

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3
Q

Theophyline

A

Used on wheening process. Diaphragm contracts better, stimulates prem to breath

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4
Q

Xanthines Used in asthma

A

Maintenance therapy for long term step 2 (essential replaced by antileuotrienes now), 2nd line drug if steroids, mast cell inhibits, or antileukotriene do not work

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5
Q

Xanthines used in COPD

A

Indicated for moderate to severe maintenance (not rescue drug), Used in acute exacerabations for I.V route

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6
Q

Xanthines Physiologic effects

A

Stimulation of CNS, Cardiac muscle stimulation, tremor, diureses-rehydrate, smooth muscle relaxation-bronchodilator effect, Peripheral and coronary vasodilation

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7
Q

Dosing Routes

A

Oral: Theophyline and IV: Aminophylline

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8
Q

Oral Xanthines

A

Theophyline

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9
Q

IV Xanthines

A

Aminophylline

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10
Q

Metabolized by the ___ and excreted by the ____

A

Liver; Metabolized, Kidneys; Excreted

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11
Q

Dosing is monitored by

A

Blood Serum Levels, 2-3 hours after AM dose, Must keep in therapeutic ranges to be effective… Metabolized and excreted differently by each individual

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12
Q

Caution of giving Theophylline

A

Worry about organ disfunction (Liver/Kidney)

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13
Q

Xanthines Ranges

A 
<5ug/ml no effect
10-20 ug/ml safe therapeutic range
Asthma ideal 5-15 ug/ml
COPD ideal 10-12 ug/ml
>20 ug/ml Nausea
> 30ug/ml Cardiac Arryhthmias
>40 ug/ml Seizure, cardiac arrest
Some patients may experience adverse effects even in therapeutic range- use as little as possible
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14
Q

Safe therapeutic range

A

10-20 ug/ml

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15
Q

Asthma ideal range

A

5-15 ug/ml

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16
Q

COPD ideal range

A

10-12 ug/ml

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17
Q

Nausea range

A

> 20ug/ml

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18
Q

Cardiac Arrhythmias range

A

> 30 ug/ml

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19
Q

Seizure, cardiac arrest ranges

A

> 40ug/ml

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20
Q

Factors Affecting blood levels

A

Steroids (increase), CHF(increase), Liver Failure (increase), Kidney failure (increase), Beta Agonists (decrease), Cig smoking (decrease), Diuretics (decrease)

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21
Q

Routes of Corticosteroids

A

IV: Solumedrol, Solucortef
Oral: Methlyprednisone (prednisone)
Inhaled: Administration controls side effects

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22
Q

IV

A

Solumedrol, Solucortef

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23
Q

Oral

A

Methlyprednisone (prednisone)

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24
Q

Inhaled

A

Beclomethasone, Triamcinolone (mdi/dpi), Flunisolide, Budesomide, Fluticasone, Fluticasone/Salmeterol

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25
Q

Beclomethasone

A

Beclovent, Vanceril, QVAR

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26
Q

Triamcinolone (DPI/MDI)

A

Azmacort, Kenalog

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27
Q

Flunisolide

A

Aerobid

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28
Q

Budesomide

A

pulmicort

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29
Q

Fluticasone

A

Flovent

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30
Q

Fluticasone/ Salmeterol

A

Advair

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31
Q

Corticosteriods come from the

A

adrenal cortex (kidney), also known as adrenal cortical hormones

32
Q

The adrenal gland is above the ____ and is composed of two parts….

A

Kidney… The inner zone is the adrenal medulla and produces epinephrine. The outer zone is the cortex and produces corticosteroids.

33
Q

Inner zone is the___ and produces___

A

Adrenal medulla and produces epinephrine

34
Q

Stimulation of the hypothalamus causes

A

impulses to the median eminence

35
Q

Median eminence releases

A

corticotrophin releasing factor (CRF)

36
Q

CRF released and goes to the ___ ___ ___ which releases ___ ___

A

Anterior pituitory gland, which releases adrenocorticotropic hormone (ATH)

37
Q

Cortisol and glucocorticoids regulate metabolism of

A

Carbohydrates, fats, and protein, increase levels of glucose for body energy

38
Q

When exogenous glucocorticoids are given the body

A

cannot tell the difference between them and the endogenous type. The body then stops producing their own glucorticoids because there is enough in the system. Much like a thermostat

39
Q

Diurnal steroid cycle or circadian rhythm

A

Level of glucocorticoids goes up and down over a 24 hour period. The highest level in the AM to prepare for the work day. It tapers off during the day and then it kicks in and builds up over night

40
Q

Alternate day therapy

A

It is not uncommon for oral steroids to be given on an every other day schedule. This allows the body to produce its own steroids every other day

41
Q

Inflammation

A

The response of vascularized tissue to injury, Redness and swelling, with heat and pain (Corticosteroid treats inflammation)

42
Q

The bodys response to an injury

A
  • Reness: local dilation of blood vessels, occuring in seconds
  • Flare: reddish color several centimeters from the site, occurs within 15-30 seconds
  • Wheal: local swelling, occurring in minutes
43
Q

Wheal

A

local swelling, occurring in minutes

44
Q

Flare

A

reddish color several centimeteres from the site, occurs within 15-30 seconds

45
Q

Redness

A

local dilation of blood vessels, occuring in seconds

46
Q

Same thing happens in the lungs as in an injury when an allergen is inhaled, the causes the

A

release of many chemical mediators

47
Q

Early response

A

inflammation (15 minutes). One mediator is histamine which causes release of prostaglandins and leukotrienes leading to inflammation and bronchospasm

48
Q

Late Response

A

(6-8 hours) - Mucosal swelling from increased vascular permeability, Release of eosinophils and neutrophils into the airway, shedding of airway cells and hyperplasia of goblet cells

49
Q

Glucocorticoids inhibit inflammatory response (6)

A
  1. Blocks prostaglandin release
  2. Decreases monocytes, eosinophils and basophils increased eosinophils common with asthma but this will decrease with steroids
  3. Decreases lymphocytes
  4. Inhibits late-phase response
  5. Increases beta receptor response
    Respores responsiveness to beta adrenergics, the sooner the steroid are given the sooner the response to beta drugs improves. Effects can be seen 1-4 hours after steroids are started
    6.Redistributes Neutrophils- white cell counts in blood can go up in pts taking steroids
50
Q

Respores responsiveness to beta-adrenergics,

A

the sooner the steroid are given the sooner the response to beta drugs improves. Effects can be seen 1-4 hours after steroids are started

51
Q

Increased eosinophils common with athma, but this will ___ with steroids

A

decrease

52
Q

White cell counts in blood can

A

go up in pts taking steroids

53
Q

Advantages of topically (inhaled) delivered steroids

A

decreases systemic effects, delivered directly to site

54
Q

Glucocorticoids on the market

A

Beclomethasone, Triamcinolone, Flunisolide, Fluticasone

55
Q

Beclomethasone

A

most potent drug

56
Q

Triamcinolone

A

longer duration

57
Q

Flunisolide

A

Similar to triamcinolone

58
Q

Fluticasone

A

high potency

59
Q

Corticosteroids all are ___ ___ of hydrocortisone

A

synthetic anlogues

60
Q

Most corticosteroids are available in

A

nasal spray

61
Q

Hazards and side effects: systemic side effects of corticosteroids

A

Suppression of adrenal cortex, Immunosuppression, Psychiatric reaction, Cataract, Myopathy, Osteoporosis, Peptic ulcer, Fluid retention, Hypertension, Increased WBC count, Fat redistribution (moon face and hump back), Retard growth in children, Steroid diabetes

62
Q

Immunosuppression

A

Watching for inflammatory infection

63
Q

Pyschiatric reactions

A

bipolar/ depression/ diffusions

64
Q

Myopathy

A

Brake down muscular bone

65
Q

Osteoporosis

A

muscle

66
Q

Fluid retention / Fat distribution

A

moon face and hump back

67
Q

Steroid diabetes

A

check blood sugars every 2 hours

68
Q

Aerosolized side effects

A

Systemic side effects of inhaled drugs, Adrenal insufficiency-mainly when changing from systemic, Recurrence of other problems under control while on systemic, Acute episodes of asthma may occur when changing from systemic, Suppression of adrenal cortex (very rare), Reduced growth in children, Topical side effects from inhaled drugs, Oropharyngeal fungal infections (should use space with MDI and rinse mouth after taking ), Dysphonia (hoarseness and changes in voice), cough and bronchoconstriction, incorrect use of MDI

69
Q

Oropharyngeal fungal infections

A

should use spacer with MDI and rinse mouth after taking, avoid thrush

70
Q

Dysphonia

A

hoarseness and changes in voice

71
Q

Clinical uses of corticosteroids

A

Asthma, Efficacy is dose dependent, Aerosolized steroids are not indicated in emergency management, Aerosols should be given in several doses throughout the day, COPD, Androgenous (Anabolic)

72
Q

Asthma

A

Bronchospasm from inflammation of airways, moved to first line therapy for maintenance of asthma

73
Q

Inhaled steroids in asthma

A
  1. Inhaled steroids should replace oral steroids when possible
  2. Aerosol therapy may need an initial clearing of airways by using oral steroids
  3. Increase dose of inhaled steroids to see if can avoid oral steroids
  4. Inhaled steroids may benefit all asthmatic patients
  5. Inhaled steroids and beta agonists reduce morbidity
  6. Should still try cromlyn sodium
74
Q

Efficacy is dose dependent

A

Higher dose the more relief, also the more systemic effects, higher inhale dose may be better than oral steroids.

75
Q

COPD with corticosteroids

A

Debatable use, each pt should be evaluated for benefit and if none shown be discontinued

76
Q

Adregenous (anabolic) in corticosteroids

A

sports use, increases testosterone increasing muscle mass

Pharmacology (10 decks)

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