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Pulmonology > Drugs > Flashcards

Drugs Flashcards

1
Q

What are the names of the 2 long acting beta agonists?

A

Salmeterol, Formoterol

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2
Q

Can long acting beta agonists be used in mono therapy for asthma?

A

NO - increased risk of asthma death if you do!

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2
Q

What’s a common substance that one should avoid/limit when using beta agonists?

A

caffeine

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2
Q

What is considered the long-term control drug of choice in patients with any degree of asthma?

A

Inhaled corticosteroids

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3
Q

What are the names of 3 systemic corticosteroids used in respiratory disorders?

A

dexamethasone, prednisone, solumedrol

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4
Q

If a patient has asthma and COPD, which drug class is indicated?

A

Anticholinergics. Not for asthma, unless COPD is also present.

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5
Q

How does cromolyn work? Based on this, what indications does it have?

A

Inhibits release of histamine. Can be effective when taken before an exposure or exercise but do not relieve asthmatic symptoms once present.

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6
Q

This medication is no longer recommended for asthma due to its narrow therapeutic window?

A

Theophylline

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7
Q

What can happen with a theophylline overdose?

A

seizures or potentially fatal arrhythmias

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9
Q

Which drug class increases liver enzymes, and therefore requires periodic monitoring of LFTs?

A

Leukotriene antagonists - zafirlukast, montelukast, zileuton

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10
Q

What are two non-asthma indications for the use of theophylline?

A

erectile dysfunction and pulmonary hypertension

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12
Q

What patient education is required for taking Zafirlukast?

A

Food impairs absorption

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13
Q

What drug class do Leukotriene antagonists interact with?

A

CYP450 drugs - i.e. warfarin

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14
Q

What is the indication for use of a leukotriene antagonist?

A

Prophylaxis of asthma, Montelukast can also be used for prevention of exercise-induced bronchospasm

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15
Q

What symptoms are associated with an overdose of theophylline?

A

nausea/vomiting, tremor, anxiety, possible seizure,

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16
Q

Besides emergency management, what therapeutic management can be used to treat theophylline overdose?

A

Propranolol and activated charcoal

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17
Q

How does Buproprion, an anti-depressant, help people quit smoking?

A

By boosting levels of dopamine and NE, it mimics nicotine and reduces cravings

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18
Q

How does nicotine gum, patch, etc help people quit smoking?

A

has about half the peak level of smoking, so it can help people stop and reduce withdrawal symptoms

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19
Q

Varenicline (Chantix) is a partial agonist of nicotinic receptors so it produces less euphoric effect, but can help with

A

withdrawal symptoms

20
Q

It is very important to monitor patients on Chantix for:

A

suicidal thoughts and mood changes

21
Q

A woman wants to quit smoking but is concerned about gaining weight when she does, what medication could help her?

A

Naltrexone (Revia)

22
Q

Name some benefits of prescribing dabigatran over warfarin? down sides?

A

Few interactions, no routine monitoring required. But, it is way expensive and can’t be used if have mechanical heart valves.

23
Q

Drugs used to prevent embolism and stroke in patients with Afib?

A

Warfarin and dabigatran

24
Q

What medication significantly improves outcome and ability to perform ADLs after a stroke?

A

Alteplase (Activase) - has to be given within 3 hours

25
Q

What other indications does Alteplase (Activase) have?

A

It is a thrombolytic so can be used in MI, massive PE, acute arterial occlusion of a limb

26
Q

What drug is indicated after an acute stroke in patients not eligible for thrombolytic therapy and hemorrhage has been excluded?

A

Aspirin, followed by anticoag drugs

27
Q

How should you instruct a patient to administer a MDI?

A

slowly and deeply inhale before and during

28
Q

How should you instruct a patient to administer a DPI?

A

quickly and deeply

29
Q

T/F. Twice-daily dosing of inhaled corticosteroids provides adequate control of asthma in most patients.

A

true. Once-daily dosing can be sufficient in some patients

30
Q

What time frame can be expected before we notice the maximum response from inhaled corticosteroids?

A

months

31
Q

What are systemic effects of high-dose inhaled corticosteroid therapy? And how can this be reduced?

A

adrenal suppression, skin thinning, osteoporosis, easy bruising, cataracts.

Use of inhalation chamber coupled with mouth washing after MDI use can decrease local (cough, dysphonia, candidiasis) and systemic side effects.

32
Q

Use of SABA more than how many days a week indicates inadequate control and the need to step up treatment?

A

> 2 days/week

33
Q

Describe the stepwise order of medications for persistent asthma:

A

Step 1: SABA prn
Step 2: low dose ICS
Step 3: low dose ICS + LABA (or medium ICS)
Step 4: medium ICS + LABA
Step 5: high ICS + LABA
Step 6: high ICS + LABA + oral corticosteroid

34
Q

At what step should referral to an asthma specialist be warranted?

A

If step 4 or more higher is needed

35
Q

T/F. Once asthma is controlled for >3 months, patients should stay on current medication regimen.

A

False. Step down if possible

36
Q

At which steps should subcutaneous allergen immunotherapy for patients with allergic asthma be considered?

A

Steps 2-4

37
Q

Patients on systemic corticosteroid treatment (oral or parenteral), concurrent treatment with what supplements are needed?

A

calcium and vitamin D to prevent steroid-induced bone mineral loss (osteoporosis)

38
Q

What syndrome has been diagnosed in a small number of patients who have taken montelukast or zafirlukast?

A

Churg-Strauss

39
Q

Contraindication to Buproprion?

A

at risk for seizures, eating disorders

40
Q

What are the names of the inhaled corticosteroids?

A

-ONE

beclomethasone, fluticasone, triamcinolone, mometasone

41
Q

Which steroid administration route is indicated for acute symptomatic sarcoidosis?

A

Systemic

42
Q

First line long-term therapy in persistent asthma:

A

ICS

43
Q

If you’re using your SABA more than 2 days/week for symptom relief, what is the next step?

A

Indicates inadequate control and time to step up to an inhaled corticosteroid!

44
Q

What are considered “long-term” control med:

A
  1. anti-inflammatory agents (steroids)
  2. LABA - salmeterol and formoterol OR
    bronchodilators - cromolyn, tiotropium, theophylline
  3. Leukotriene modifiers
45
Q

What are considered “quick-relief” meds:

A
  1. SABA
  2. Ipratroprium bromide
  3. steroids (if don’t respond to SABA)
46
Q

Which types of asthma exacerbations do you treat with supplemental oxygen?

A

Moderate and severe!

Pulmonology (17 decks)

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