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Pharmacology > Deja Ch 7 Pulmo > Flashcards

Deja Ch 7 Pulmo Flashcards

1
Q

What are the classifications of asthma severity?

A

Mild intermittent; mild persistent; moderate persistent; severe persistent

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2
Q

What are the main classifications of drugs for asthma?

A

Bronchodilators; anti-inflammatory agents

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3
Q

Name the drug class for each of the following medications: Albuterol

A

Short-acting _2-adrenergic agonist

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4
Q

Name the drug class for each of the following medications: Epinephrine

A

Short-acting _2-adrenergic agonist

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5
Q

Name the drug class for each of the following medications: Terbutaline

A

Short-acting _2-adrenergic agonist

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6
Q

Name the drug class for each of the following medications: Salmeterol

A

Long-acting _2-adrenergic agonist

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7
Q

Name the drug class for each of the following medications: Formoterol

A

Long-acting _2-adrenergic agonist

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8
Q

Name the drug class for each of the following medications: Isoproterenol

A

Short-acting _-adrenergic agonist

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9
Q

Name the drug class for each of the following medications: Metaproterenol

A

Short-acting _-adrenergic agonist

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10
Q

Name the drug class for each of the following medications: Fluticasone

A

Inhaled corticosteroid

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11
Q

Name the drug class for each of the following medications: Flunisolide

A

Inhaled corticosteroid

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12
Q

Name the drug class for each of the following medications: Beclomethasone

A

Inhaled corticosteroid

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13
Q

Name the drug class for each of the following medications: Triamcinolone

A

Inhaled corticosteroid

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14
Q

Name the drug class for each of the following medications: Budesonide

A

Inhaled corticosteroid

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15
Q

Name the drug class for each of the following medications: Methylprednisolone

A

Systemic corticosteroid

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16
Q

Name the drug class for each of the following medications: Prednisone

A

Systemic corticosteroid

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17
Q

Name the drug class for each of the following medications: Cromolyn

A

Mast cell stabilizer

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18
Q

Name the drug class for each of the following medications: Nedocromil

A

Mast cell stabilizer

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19
Q

Name the drug class for each of the following medications: Ipratropium

A

Inhaled anticholinergic

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20
Q

Name the drug class for each of the following medications: Tiotropium

A

Inhaled anticholinergic

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21
Q

Name the drug class for each of the following medications: Theophylline

A

Phosphodiesterase inhibitor; adenosine antagonist; methylxanthine

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22
Q

Name the drug class for each of the following medications: Zileuton

A

5-Lipoxygenase inhibitor

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23
Q

Name the drug class for each of the following medications: Zafirlukast

A

Leukotriene receptor antagonist

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24
Q

Name the drug class for each of the following medications:Montelukast

A

Leukotriene receptor antagonist

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25
Q

How do _2-agonists help treat asthma?

A

Bronchodilation via _2-adrenoceptor-mediated smooth muscle relaxation

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26
Q

How do corticosteroids help treat asthma?

A

Decrease production and release of proinflammatory cytokines; decrease inflammatory cell activation, recruitment, and infiltration; decrease vascular permeability; decrease mucous production; increase number and sensitivity of _2-adrenergic receptors

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27
Q

How do mast cell stabilizers help treat asthma?

A

Prevent mast cell degranulation, thereby decreasing release of histamine, platelet activating factor, leukotrienes, and other mediators that cause bronchoconstriction. Therefore only useful before exposure to allergen.

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28
Q

How do inhaled anticholinergics help treat asthma?

A

Competitively inhibit muscarinic receptors, thereby inhibiting vagal-mediated bronchoconstriction; reduce mucous production

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29
Q

How do phosphodiesterase inhibitors help treat asthma?

A

Increase cAMP which causes bronchodilation

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30
Q

How do 5-lipoxygenase inhibitors help treat asthma?

A

Inhibits production of leukotrienes (LTC4, LTD4, LTE4) from arachidonic acid, thereby preventing bronchoconstriction

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31
Q

What _2-adrenergic agonist is commonly used as a tocolytic agent (stops premature labor by relaxing uterine smooth muscle)?

A

Terbutaline

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32
Q

What cation can be used as a tocolytic agent?

A

Mg2+ (Magnesium ion)

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33
Q

Is cromolyn used for treatment or prevention of an asthma attack?

A

Prevention

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34
Q

Is nedocromil effective during an acute asthma attack?

A

No

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35
Q

What are the side effects of mast cell stabilizers?

A

Bitter taste; throat irritation

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36
Q

What are the side effects of _2-adrenergic agonists?

A

Tachycardia; muscle tremors; anxiety; arrhythmias; hyperglycemia; hypokalemia; hypomagnesemia (systemic side effects are minimized when drug is delivered via inhalation)

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37
Q

What are the side effects of 5-lipoxygenase inhibitors and leukotriene antagonists?

A

Increased liver function tests (LFTs); headache; Churg-Strauss syndrome

38
Q

What is the main nonsystemic side effect of inhaled corticosteroids?

39
Q

What is thrush?

A

Oropharyngeal candidiasis

40
Q

How can you prevent thrush when using inhaled corticosteroids?

A

Use of a spacer device; rinse mouth with water after medication use

41
Q

What is a possible systemic side effect of inhaled corticosteroids in children?

A

Decreased growth of long bones

42
Q

If using an inhaled corticosteroid and _2-adrenergic agonist together, which do you use first?

A

_2-adrenergic agonist (bronchodilates the airways, thereby increasing amount of corticosteroid that is delivered to its site of action)

43
Q

What are the side effects of theophylline?

A

Tachycardia; arrhythmias; nausea; diarrhea; central nervous system (CNS) excitation (narrow therapeutic index)

44
Q

Give an example of a methylxanthine other than theophylline:

A

Caffeine; theobromine; aminophylline

45
Q

Why do inhaled anticholinergics have a minimal side effect profile?

A

Quaternary ammonium derivatives of atropine, therefore, do not leave the pulmonary system and cannot cross the blood-brain barrier

46
Q

What are examples of systemic anticholinergic side effects?

A

Dry mouth; dry eyes; constipation; urinary retention; blurred vision; mydriasis; drowsiness; tachycardia

47
Q

How do you treat _-blocker-induced bronchospasm?

A

With anticholinergics such as ipratropium and tiotropium

48
Q

Name two drugs used to treat an acute asthma attack:

A
  1. Epinephrine 2. Albuterol
49
Q

What is the IV form of theophylline called?

A

Aminophylline (2:1 complex of theophylline and ethylenediamine)

50
Q

What is the term used to describe a severe asthma attack that does not respond to usual asthma therapy?

A

Status asthmaticus

51
Q

How is status asthmaticus treated?

A

Oxygen; inhaled albuterol; intravenous or oral corticosteroids; inhaled anticholinergics

52
Q

What is the drug of choice for mild asthma?

A

Short-acting _2-adrenergic agonist

53
Q

What is the maintenance drug of choice for chronic asthma?

A

Inhaled glucocorticoid

54
Q

How is theophylline primarily metabolized?

A

Hepatic cytochrome P-450 enzymes (CYP 1A2 and CYP 3A4)

55
Q

Give examples of medications that can lead to increased theophylline levels when used concomitantly:

A

Cimetidine; erythromycin; fluoroquinolones

56
Q

What drug can cause asthma, nasal polyps, and rhinitis?

A

Aspirin (“aspirin triad”); seen in the rare case of aspirin sensitivity where inhibition of cyclooxygenase (COX) leads to a buildup of leukotrienes

57
Q

What disease processes fall under the category of chronic obstructive pulmonary disease (COPD)?

A

Asthma; chronic bronchitis; emphysema

58
Q

State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Forced expiratory volume in 1 second (FEV1)

59
Q

State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Forced vital capacity (FVC)

A

Unchanged or increased

60
Q

State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: FEV1/FVC

A

Decreased (

61
Q

State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Total lung capacity (TLC)

A

Unchanged or increased

62
Q

What agents are used to treat COPD?

A

Inhaled anticholinergics; _2-adrenergic agonists; theophylline; inhaled corticosteroids

63
Q

What are the first-line agents for treatment of COPD?

A

Inhaled anticholinergics (ipratropium)

64
Q

Give examples of drugs that can suppress the CNS cough reflex:

A

Morphine; codeine; hydrocodone; hydromorphone; dextromethorphan

65
Q

Which has greater antitussive (anticough) action, morphine or codeine?

66
Q

When using opioids for cough suppression, are the doses required less than, equal to, or greater than the doses required for analgesic activity?

67
Q

Which opioid is the drug of choice for cough suppression?

A

Dextromethorphan (no analgesic activity, no addiction risk)

68
Q

What is a cough expectorant?

A

An agent that thins respiratory tract mucus and promotes its expulsion from the tracheobronchial system

69
Q

Give an example of a cough expectorant:

A

Guaifenesin

70
Q

What is/are the signs and symptoms of allergic rhinitis?

A

Inflammation of the nasal mucous membrane which is characterized by nasal itching, sneezing, rhinorrhea, and congestion

71
Q

What causes allergic rhinitis?

A

Allergens interacting with IgE-coated mast cells leading to release of histamine, leukotrienes, and chemotactic factors

72
Q

How do you treat allergic rhinitis?

A

Antihistamines; _-adrenergic agonists; intranasal corticosteroids; intranasal cromolyn; 5-lipoxygenase inhibitors; leukotriene antagonists

73
Q

Give examples of antihistamines used in the treatment of allergic rhinitis:

A

Diphenhydramine; chlorpheniramine; loratadine; desloratadine; fexofenadine; cetirizine; astemizole

74
Q

Name three nonsedating antihistamines:

A
  1. Loratadine 2. Desloratadine 3. Fexofenadine
75
Q

Why are loratadine, desloratadine, and fexofenadine nonsedating?

A

No CNS entry

76
Q

Where are H1 histamine receptors located?

A

Smooth muscle; endothelial cells; heart; CNS

77
Q

Histamine acting at H1 receptors does what to the following? Bronchiolar smooth muscle

A

Contraction

78
Q

Histamine acting at H1 receptors does what to the following? Capillaries

A

Dilation; increased permeability

79
Q

Histamine acting at H1 receptors does what to the following? Peripheral nociceptive receptors

A

Activation which leads to increased pruritus and pain

80
Q

What are the major side effects of diphenhydramine?

A

Anticholinergic side effects, such as sedation, dry mouth, dry eyes, constipation, urinary retention, blurred vision, mydriasis, and tachycardia

81
Q

Give examples of _-adrenergic agonists (nasal decongestants) used in the treatment of allergic rhinitis:

A

Phenylephrine; pseudoephedrine; oxymetazoline

82
Q

How do _-adrenergic agonists help relieve signs and symptoms of allergic rhinitis?

A

Vasoconstriction of dilated arterioles in nasal mucosa; decrease airway resistance

83
Q

What can happen when you discontinue use of long-term intranasal decongestants?

A

Rebound nasal congestion (only use these types of medications for short-term relief)

84
Q

What causes neonatal respiratory distress syndrome?

A

Insufficient maturation of type II pneumocytes leading to decreased production of surfactant

85
Q

What is the purpose of lung surfactant?

A

Reduce alveolar surface tension which allows alveoli to remain open for proper gas exchange

86
Q

What medications can be used to accelerate fetal lung maturation?

A

Glucocorticoids; thyrotropin-releasing-hormone (TRH)

87
Q

What is a marker of fetal lung maturity?

A

Lecithin to sphingomyelin ratio of at least 1.5:1

88
Q

What pharmacologic options are available for treating neonatal respiratory distress syndrome?

A

Surfactant replacement therapy; nitric oxide (NO)

89
Q

What can be used to reduce small airway accumulation of viscous mucus in cystic fibrosis patients?

A

N-acetylcysteine; DNase

90
Q

How does N-acetylcysteine work in cystic fibrosis?

A

Acts as a mucolytic agent through its free sulfhydryl group which breaks disulfide bonds in mucoproteins, thereby lowering mucus viscosity

91
Q

How does DNase work in cystic fibrosis?

A

Deoxyribonuclease that selectively cleaves polymerized DNA in pulmonary secretions, thereby reducing mucus viscosity

92
Q

Patients receiving which radiologic enhancing compound can be given concomitant N-acetylcysteine to protect renal function?

A

Computed tomography (CT) contrast

Pharmacology (25 decks)

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