CP Pharmacologic Interventions

Question 1

What are 3 drug classes used to increase contractility

Answer 1

beta 1 agonists
phosphodiesterase Inhibitor
digitalis (foxglove)

Question 2

what are 3 drug classes that decrease the heart’s workload via decreased contractility?

Answer 2

calcium channel blockers
centrally acting agents (also decrease HR)
beta 1 antagonists

Question 3

what are 3 drug classes that decrease the heart’s workload via decreased afterload?

Answer 3

alpha 1 blockers
direct vasodilators
aldosterone blockers

Question 4

what are 3 drug classes that decrease the heart’s workload via decreased preload?

Answer 4

diuretics (loop,thiazide, k-sparing)
ACE inhibitors
Angiotensin II Receptor Antagonists

Question 5

what class of drugs increases myocardial bloodflow? What are the 3 types?

Answer 5

nitrates
-venodilators (preload), arteriodilaros (afterload) , organic nitrates (both)

Question 6

what 2 classes manage hemostasis?

Answer 6

thrombolytics (clot busters-reactive) ) and anticoagulants (blood thinners-proactive)

Question 7

Name the antiarrhythmic drug classes

Answer 7

I. Sodium Channel blockers (decrease excitability)
II Beta blockers-increase latency (decrease HR)
III-prolong repolarization (decrease HR)
IV- Calcium Channel Blockers (decreased excitability)

Question 8

What is the most common treatment for hyperlipidemia? What are the PT considerations?

Answer 8

Statins
Myalgias + RHABDO!!
liver damage, intolerance, HA. GI and loass of CoenzymeQ10
+ increased risks of chronic conditions (cancers, DM, stroke, etc)

Question 9

bronhi and bronchioles have an outer layer of cartilage and an inner layer of ___-hence pathologies related to these structures usually involve some sort of ____

Answer 9

smooth muscle, brohnchoconstriction

Question 10

what are the 3 primary causes of bronchoconstriction?

Answer 10

abnormal tone (bronchospasms)
inflammation
mechanical obstruction

Question 11

general characteristics of an acute brochospasm include:
smooth muscle _____
____ production
vascular _______

Answer 11

smooth muscle constriction, mucous production and vascular engorgement

Question 12

T/F: Stimulation of the nucleotide cyclic AMP activates our beta-TWO receptors and produces bronchoconstriction as a parasympathetic response.

Answer 12

FALSE.
cAMP> beta 2 receptor stimulation> bronchodilation as adrenergic response

Question 13

Stimulation of the nucleotide cyclic GMP activates ___ receptors causing parasympathetic ______.

Answer 13

muscarinic, bronchoconstriction

Question 14

since cAMP and cGMP influence the ANS in opposite ways, meds interact with them differently to achieve the same goal.
____ promote bronchodilation via increasing cAMP, while ____ and ____ achieve brochodilation via inhibiting cGMP

Answer 14

beta- adrenergic agonists,

alpha-adrenergic antagonists + muscarinic antagonists

Question 15

beta adrenergic agonists, are most commonly admistered via ____due to rapid onset and decreased concern about AEs related to receptor specificity.

Answer 15

inhalation

oral less common (HR/HTN AEs)
subcutaneous rare (many AEs)

Question 16

why might a nebulizer be easier to administer than a metered dose inhaler? Why might someone prefer the latter?

Answer 16

the nebulizer req less coordination and the meds are mixed with saline for easy inhale

they are convenient and quick as compared to the neb that takes 10-15 min.

Question 17

list the 3 primary side effects related to beta adrenergic agonists.

Answer 17

receptor overreach (think BBB and cardiac irregularities from also hitting b1 recptors)

also
-developed tolerance
-airway irritation from excessive use

Question 18

T/F: Albuterol is an example of a short acting beta agonist and is thus most effectively used in rescue inhalers while LABAs are usually taken daily for maintenence.

Answer 18

true

Question 19

Why would aticholinergic/antimuscarinic drugs be prioritized for someone with COPD vs someone with asthma if both involve vasoconstriction?

Answer 19

these drugs target parasympathetic vagal tone/ACh release-not inflammation.

Question 20

SAMAs are ____ for COPD while LAMAs are for ____. Atropine is another option that is easily absorbed but rarely used due to AEs.

Answer 20

rescue inhalers, maintenance

Question 21

you remember our anticholinergic rhyme from pharm??

+ tachycardia and confusion

Answer 21

can’t see, can’t spit, can’t pee, can’t shit :)

Question 22

glucocorticoids by reversing what aspect of the inflammation cycle?

Answer 22

increase in vascular permeability

Question 23

T/F: An advantage of glucocorticoids for pulmonary pts is that they aren’t administered systemically but are inhaled instead–thus typical corticosteroid AEs are avoided.

Answer 23

false-AEs are decreased but not eliminated.

Question 24

____ (ex. theophylline, caffeine and theobromine) inhibit phosphodiesterase> increase cAMP> bronchodilation+antiinflammation.

found in coffee, chocolate and tea

Answer 24

Xanthine derivatives

Question 25

while xanthine derivatives allow for extended release, ____MUST be monitored in these pts as it has a low toxicity index.

Answer 25

blood pressure (HYPOtension)

++ other related AEs (confusion, restlessness,nausea,etc)

Question 26

Drug classes used to control respiratory secretions and treat respiratory tract irritations include: (4)

Answer 26

antitussives, decongestants, antihistamines, and mucolytics

Question 27

How do antitussives work? When would they NOT be indicated?

Answer 27

They either block receptors as topical anesthetics or increase the medulla’s cough threshold; they are not indicated for active and productive coughs.

Question 28

decongestants are usually from what class? What other effects might we expect?

hint: there is a reduction of bloodflow/outflow from capillaries

Answer 28

alpha 1 adrenergic agonists;
sympathetic responses (ex. CNS, CV excitation, rebound effects)

avoid long term use!!

Question 29

antihistamines are indicated for

Answer 29

sensorineurally-stim sneezing
increased mucous and congestion from vascular engorgement

Question 30

where are histamine receptors located?

hint: think about how the antihistamines impact the user

Answer 30

vascular smooth muscle and endothelial cells (vasodilation+ permeability)
CNS tissue throughout body

Question 31

this subclass of antihistamines does not cross the BBB, has fewer side effects and is preferred for asthma pts since it doesn’t dry out and further irritate their airways .

Answer 31

2nd generation

Question 32

T/F: Leukotriene Inhibitors (ex Singulair) are not safe for asthmatics because they trigger bronchial smooth muscle contractions.

Answer 32

false. leukotrienes trigger these and inhibition of these molecules is commonly used for seasonal allergies.

Question 33

what dynamic duo works best for mobilizing and removing secretions from the respiratory tract?

think Robitussin and Mucinex

Answer 33

mucalytics + expectorants

Question 34

what is a typical qualifier for supplemental O2?

Answer 34

SpO2 during a 6MWT</=90%

Question 35

what are some general complications of O2? for special populations?

Answer 35

general: skin irritation, fatigue, a.m. HA, explosion risk
COPD: hypoxic drive- don’t overdo it
infants: scarring in developing lungs

Question 36

list the 4 long term medications for asthma

Answer 36

LABAs
leukotriene modifiers
mast cell stabilizers
theophylline (xanthine derivative)

Question 37

list the 3 short term medications for asthma

Answer 37

SABA
anticholinergics
systemic corticosteroid