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Pharm 4 > COPD & Allergy > Flashcards

COPD & Allergy Flashcards

1
Q

pathophys of COPD

A

not fully reversible airflow limitation; chronic lung and airway inflammation w mucus hypersecretion and gas exchange abnormalities

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2
Q

Treatment strategies for COPD

A 
B2-R agonist
anti-ACh inhalers
bronchodilators
long-acting inhaled bronchodilators
Combined therapy of bronchodilators
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3
Q

ADR of inhaled corticosteroids in COPD

A

increased risk of osteoporosis with extended use

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4
Q

roflumilast

A

oral PDE4 inhibitor

used in pts with severe COPD with bronchitis and history of exacerbation to dec exacerbations

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5
Q

ADR roflumilast

A

nausea, diarrhea, insomnia, weight loss

interaction with CYP 3A4 inhibitors and inducers

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6
Q

Meds to use for COPD exacerbations

A 
inhaled bronchodilators (B2-ag or anti-ACh), theophylline, systemic corticosteroids, +/- roflumilast
antibiotics if infection present
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7
Q

Tx of COPD

A

stop smoking, bronchodilators, steroids (?), antibacterials (frequent infection)

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8
Q

etiology of allergic rhinitis

A

Seasonal (SAR) - repetitive predictable symptoms in spring/fall, acute and triggered by allergens
perennial (PAR) - chronic, triggered by non-seasonal allergens
*Can have both

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9
Q

Sx of allergic rhinitis

A

ocular: venous congestion -> “allergic shiners”, pruritus, watery red eyes or SAR conjunctivitis
Nasal: clear rhinorrhea, sneezing, congestion, pruritus, post-nasal drip
systemic: fatigue, irritability, cognitive impairment

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10
Q

Drug categories for allergic rhinitis

A

Anti-histamines/ H1-R antagonist
decongestants
corticosteroids

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11
Q

MOA of antihistamines

A

antagonize capillary permeability, wheal and flare formation, pruritus
anti-ACh properties reduced nasal, salivary, lacrimal gland secretions

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12
Q

Brompheniramine

A

1st gen oral antihistamine

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13
Q

chlorpheniramine

A

1st gen oral antihistamine

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14
Q

clemastine

A

1st gen oral antihistamine

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15
Q

diphenhydramine

A

1st gen oral antihistamine

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16
Q

1st vs. 2nd gen oral antihistamines

A

1st gen penetrates CNS -> sedation/ cognitive impairment; OTC
2nd gen Rx and OTC; peripherally selective = “non-sedating”

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17
Q

cetirizine

A

2nd gen oral antihistamine

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18
Q

levocetirizine

A

2nd gen oral antihistamine

19
Q

fexofenedine

A

2nd gen oral antihistamine

*really low CNS penetration

20
Q

loratadine

A

2nd gen oral antihistamine

21
Q

desloratadine

A

2nd gen oral antihistamine

22
Q

ADR of oral antihistamines

A

1st gen: anti-ahc effects = dry mouth/nose/eyes, blurred vision, urinary retention, constipation, tachycardia
CNS depression = sedation, impaired performance

23
Q

azelastine

A

fast-acting intranasal antihistamine, peaks at 3 hours

relieves sneezing, pruritus, rhinorrhea, reduces nasal congestion

24
Q

ADR intranasal antihistamine

A

bitter taste, sedation, local irritation

25
Q

oral decongestant MOA

A

A-adrenergic agonist -> vasoconstriction of vessels in mucosa = temporary relief of nasal congestion

26
Q

phenylephrine

A

direct-acting oral decongestant

also short-acting intranasal decongestant

27
Q

pseudoephedrine

A

indirect-acting/mixed oral decongestant

slower onset, longer duration, more effective than direct acting phenylephrine

28
Q

ADR of oral decongestants

A

more likely in young/old: cardiac stimulation -> increased BP and HR, arrhythmia, palpitations; CNS stimulation -> insomnia, anxiety, tremors; if taken with MAOI increases BP further

29
Q

Precautions with oral decongestants

A

hypersensitivity, idiosyncratic reactions, MAOI use

may exacerbate hyperthyroidism, glaucoma, HTN, BPH

30
Q

naphazoline

A

intermediate acting intranasal decongestant

31
Q

tetrahydrozoline

A

intermediate acting intranasal decongestant

32
Q

oxymetazoline

A

long-acting intranasal decongestant

33
Q

Rhinitis medicamentosa & tx

A

rebound nasal congestion with more than 3 days use of decongestant
Tx: withdraw decongestant 1 nostril at a time, use intranasal corticosteroid, normalizes in 1-2 weeks

34
Q

MOA of intranasal corticosteroid

A

anti-inflammatory action on cells and mediators involved with inflammation

35
Q

DOC for allergic rhinitis & effects

A

intranasal corticosteroid (most effective)
relieves sneezing, rhinorrhea, pruritus, nasal congestion
max benefit in 7 days

36
Q

ADR of intranasal corticosteroid

A

sneezing, stinging with administration
headache
epistaxis

37
Q

beclomethasone

A

intranasal corticosteroid

38
Q

budesonide

A

intranasal corticosteroid

39
Q

flunisolide

A

intranasal corticosteroid

40
Q

fluticasone

A

intranasal corticosteroid

41
Q

mometasone

A

intranasal corticosteroid

42
Q

triamcinolone

A

intranasal corticosteroid

43
Q

Use of inhaled corticosteroids in COPD

A

patients with FEV1 less than 50% expected and exacerbations for 3 years

44
Q

categories of intranasal decongestants

A 
short-acting (less than 4 hr)
intermediate acting (4-6 hr)
long-acting (up to 12 hr)

Pharm 4 (8 decks)

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