DRUGS Flashcards
1
Q
Fluticasone [Flovent HFA]
Class/Indications
A
Class: Glucocorticoid
Indications: Asthma, COPD
2
Q
Fluticasone MOA
A
MoA: anti-inflammatory, immunosuppressive & anti-proliferative activity
3
Q
Fluticasone SE/ADR
A
SE/ADRs: headache, oral thrush, URI, throat irritation, cough
4
Q
Fluticasone Contra
A
Contra: Hypersensitivity, acute bronchospasm, latent TB, glaucoma, cataracts
5
Q
Fluticasone Fun Fact
A
PG- C, lactation caution Inhalation long-term prophylaxis of bronchospasm; Children possible growth slowing but “catch up”; rinse mouth after use; Budesonide [Pulmocort inhalers]
6
Q
Prednisone
Class/Indications
A
Class: Glucocorticoid
Indications: Adjunct therapy in exacerbation of bronchospasm; multiple others
7
Q
Prednisone MOA
A
MoA: Anti-inflammatory early after administration by decreasing migration of WBCs, reversal capillary permeability, immunosuppressant; later onset of inhibition of protein synthesis
8
Q
Prednisone SE/ADR
A
SE/ADRs: In short term use minimal; longer than 10-14 days multiple systemic
9
Q
Prednisone Contra
A
Contra: Hypersensitivity, acute bronchospasm (unless as adjunct), latent TB, glaucoma, cataracts
10
Q
Prednisone Dx-Dx
A
Dx-Dx: tNSAIDS, anti-diabetic meds, anti-HTN meds
11
Q
Prednisone Fun Fact
A
Other: Short-term oral “burst” therapy in exacerbation bronchospasm; Asthma & COPD; avoid long-term oral use; Oral or IV routes; PG: Caution, Lact: Caution
12
Q
Cromolyn Na [Crolom MDI]
Class/Indications
A
Class: Anti-inflammatory – Mast Cell Stabilizer
Indications: Childhood asthma
13
Q
Cromolyn MOA
A
MoA: Stabilizes mast cell membrane to prevent degranulation and release of histamine, leukotrienes, slow-reacting substance of anaphylaxis
14
Q
Cromolyn SE/ADR
A
SE/ADRs: Headache, unpleasant taste, hoarseness, cough
15
Q
Cromolyn Fun Fact
A
Other: Generally works better in children than adults; inhalation route; PO route investigational for food allergy, IBD; PG: B
16
Q
Zafirlukast
Class/Indications
A
Class: Oral leukotriene receptor antagonist
Indications: Asthma
17
Q
Zafirlukast MOA
A
MoA: selective and competitive antagonist of leukotriene receptors D4 & E4, SRSA
18
Q
Zafirlukast SE/ADR
A
SE/ADRs: Headache, nausea, diarrhea; Hepatitis
19
Q
Zafirlukast Contra
A
Contra: Hypersensitivity; acute exacerbation of asthma; caution in alcoholic cirrhosis
20
Q
Zafirlukast Dx-Dx
A
Dx-Dx: Concomitant food decr availability by 40%
21
Q
Zafirlukast Fun Fact
A
Other: Can continue but not start Zafirlukast during acute exacerbation asthma; PG: B; lact: not rec
22
Q
B- exercise induced asthma dose
A
2 puffs 5 mins before
23
Q
B- fluticasone SE
A
oral thrush, rinse mouth
24
Q
B- pg ICS
A
yes but diskus preferred
25
B- chantix MOA
partial nicotine agonist
26
Albuterol (Salbutamol) [Ventolinz]
| Class/ Indication
Class: Beta2 agonist, short acting bronchodilator
Indications: Bronchospasm in asthma & COPD, EIB
27
Albuterol MOA
MoA: Bronchial smooth muscle Beta2 (sympathetic) receptor stimulation; racemic mixture w/ R isomer active & S isomer inactive (?side effects)
28
Albuterol SE/ADR
SE/ADRs: Angina, incr or decr BP, arrhythmias, palpitations, CNS stimulation, angioedema, restlessness, wakefulness
29
Albuterol CONTRA
Contra: Caution with HTN, CHF, arrhythmias, seizure d/o, diabetes, glaucoma, hyperthyroidism, low serum K+
30
Albuterol DX-DX
Beta-Blockers
31
Albuterol Monitoring
Spirometry
32
Albuterol Fun fact
Other: Treatment or prophylaxis; multiple formulations MDI, oral tablet & solution, Neb sol; IV in Canada; use of spacer/VHC with MDI; use in conjunction with anti-inflammatory agent for long term use for other than mild asthma; Tolerance develops with long term use of Beta2 agonists; PG: C, Lact: caution
33
Levalbuterol [Xopenex HFA]
| Class/ Indication
Class: Beta2 Adrenergic Agonist, short acting bronchodilator
Indications: treatment or prevention of bronchospasm in reversible airway disease (Asthma, EIB, COPD)
34
Levalbuterol MOA
MoA: rapid acting selective Beta2 receptor agonist counteracts bronchospasm; pure R- isomer of drug
35
Levalbuterol SE/ADR
SE/ADRs: tremor, rhinitis, viral infection, headache, pharyngitis
36
Levalbuterol Contra
active cardiac disease
37
Levalbuterol Dx-DX
Dx-Dx: incr levels of loop diuretics, sympathomimetics; levels decr by Beta Blockers, combination Alpha/Beta Blockers
38
Levalbuterol Monitor
Spirometry, HR, BP
39
Levalbuterol Fun fact
Other: MDI & nebulizer solution available; use in conjunction with anti-inflammatory agent for long term use for other than mild asthma or EIB; PG: C, Lact: caution
40
Salmeterol [serevent diskus]
| Class/Indications
Class: Beta2 Adrenergic Agonist, long acting bronchodilator
Indications: long term control of COPD, asthma control; EIB
41
Salmeterol MOA
MoA: selective, long-acting Beta2 adrenergic agonist
42
Salmeterol SE/ADR
SE/ADRs: headache, muscle pain, anxiety, insomnia
43
Salmeterol Contra
Contra: acute asthma or acute COPD; seizure d/o, CVD, diabetes, hyperthyroidism
44
Salmeterol DX-DX
Dx-Dx: incr levels of loop diuretics, sympathomimetics; levels incr by CYP3A4 inhibitors ; impact decr by Beta blockers
45
Salmeterol Monitor
Spirometry, HR,BP, glucose
46
Salmeterol Fun fact
Other: Black Box Warning re: asthma deaths, CVD outcomes; use in Exercise induced bronchospasm (EIB) discouraged; DPI rinse mouth after use; DPI 50mcg/inh; PG: C, Lact: caution
47
Formoterol Class/ Indication
Class: Beta2 Adrenergic Agonist, long acting bronchodilator
Indications: long term control COPD, asthma with steroid MDI
48
Formoterol MOA
long acting beta 2 agonist
49
Formoterol SE/ADR
SE/ADRs: tremor, chest pain, palpitations, anxiety, insomnia, muscle cramps
50
Formoterol Contra
Contra: acute asthma or COPD; active CVD
51
Formoterol Dx-DX
Dx-Dx: incr levels of loop diuretics, sympathomimetics; effect decr by Beta blockers
52
Formoterol Monitor
Spirometry, HR, BP, glucose
53
Formoterol Fun Fact
Other: Black Box Warning re: asthma deaths, CVD; discourage use for EIB; DPI 12mcg/inh and neb sol: PG: C, Lact: caution
54
Theophylline Class/Indication
Class: PDE inhibitor or Methylxanthine bronchodilator
Indications: reversal of bronchospasm
55
Theophylline MOA
MoA: PDE blockade causes incr levels cAMP which produces bronchodilation, diuresis, CNS and cardiac stimulation, release of epinephrine
56
Theophylline SE/ADR
SE/ADRs: tachycardia, headache, insomnia, seizures
57
Theophylline Contra
Contra: CVD, HTN, hyperthyroidism, peptic ulcers, seizure d/o
58
Theophylline Dx-Dx
Dx-Dx: levels incr by multiple CYP1A2, 3A4 inhibitor drugs
59
Theophylline Monitor
Theophylline level, spirometry, HR,BP,glucose
60
Theophylline Fun Fact
Other: narrow therapeutic index; target level 10-19.9mcg/mL serum; Sn & Sm toxicity include persistent vomiting, agitation; oral, IV formulations; PG: C, Lact: “compatible”
61
Roflumilast Class/Indication
Class: PDE-4 Inhibitor anti-inflammatory agent
Indications: Adjunct therapy in COPD (chronic bronchitis)
62
Roflumilast MOA
MoA: Drug and active metabolite inhibit PDE4 increasing cAMP in inflammatory and structural cells; suppress cytokine release; inhibit lung infiltration by WBC’s; decreases pulmonary remodeling
63
Roflumilast SE/ADR
SE/ADRs: Headache, weight loss, diarrhea, nausea
64
Roflumilast Contra
Contra: Mod- to severe liver impairment
65
Roflumilast DX-DX
Dx-Dx: CYP3A4 inducers decr serum conc Roflumilast; Cipro incr conc; Rifampin decr conc
66
Roflumilast Monitor
Spirometry
67
Roflumiast Fun Fsact
Other: Adjunct to bronchodilator therapy only; with or without food; not for acute exacerbation; PG-avoid use and not in nursing; 500mcg tablet once daily
68
Ipatropium Class/Indication
Class: Anticholinergic bronchodilator, short acting
Indications: acute and maintenance Tx of bronchospasm in COPD, asthma
69
Ipatropium MOA
MoA: blocks acetylcholine cholinergic receptors in bronchial smooth muscle to reduce bronchospasm
70
Ipatropium SE/ADR
SE/ADRs: URI, chest pain, palpitations, dyspepsia, xerostomia, dyspnea, flu-like syndrome
71
Ipatropium Contra
Contra: narrow angle glaucoma, paradoxical bronchospasm; acute asthma except in conjunction with SABA drug; urinary tract outflow obstruction
72
Ipatropium Dx-DX
Dx-Dx: decr effect of acetylcholinesterase inhibitors
73
Ipatropium Fun Fact
Other: MDI, neb sol; First line COPD; adjunct in asthma; tolerance not seen with long term use; PG: C
74
Tiotropium class/indication
Class: Anticholinergic bronchodilator, long acting
Indications: maintenance Tx bronchospasm in COPD, asthma
75
Tiotropium MOA
MoA: blocks acetylcholine at parasympathetic receptors in bronchial smooth muscle producing bronchodilatation
76
Tiotropium SE/ADR
SE/ADRs: URI, chest pain, palpitations, dyspepsia, xerostomia, dyspnea, flu-like syndrome
77
Tiotropium Contra
Contra: paradoxical bronchospasm, acute bronchospasm, narrow angle glaucoma, urinary tract outflow obstruction
78
Tiotropium Montior
spirometry HR
79
Tiotropoim DX-DX
Dx-Dx: decr effect of acetylcholinesterase inhibitors
80
Tiotropium Fun Fact
Other: First line COPD; adjunct in asthma; DPI; ~10x effect of ipratropium; PG: C; Lact: caution
81
Omalizumab [Xolair] class/indication
Class: Anti-IgE antibody; Immunomodulator
Indications: maintenance Tx allergic asthma not controlled by inhaled steroids
82
Omalizumab MOA
MoA: binds to IgE antibody receptors on mast cells, blocking attachment of IgE antibody and preventing degranulation release of histamines, leukotrienes
SE/ADRs: headache, injection site reaction, URI, pain; Anaphylaxis
83
Omalizumab Contra
Contra: acute asthma, status asthmaticus
84
Omalizumab dx-dx
impairs vaccines
85
Omalizumab monitor
Monitor: Spirometry; [IgE]rises with Tx and may be elevated up to 1 year after cessation Tx
86
Omalizumab Fun Fact
Other: 2nd line drug; expensive ($740/150mg); SQ admin in office due to possible anaphylaxis; dosed by pre-Tx [IgE] and weight; inject every 2 to 4 weeks; Black box Warning re anaphylaxis; PG: B, Lact: caution
87
Fluticasone/Salmeterol[Advair HFA/Advair Diskus]
| Class/ indication
Class: Combination Glucocorticoid and Long acting Beta 2 Agonist
Indications: Asthma (maintenance of bronchodilation), Asthma
88
Fluticasone/Salmeterol (advair) MOA
MoA: anti-inflammatory action of steroid and bronchodilitation activity of Beta2 agonist
89
Fluticasone/Salmeterol (advair) SE/ADR
SE/ADRs: Combo of SE/ADRs of both ingredients; increased risk death
90
Fluticasone/Salmeterol (advair) Contra
Contra: Acute exacerbation of bronchospasm; status asthmaticus
91
Fluticasone/Salmeterol (advair) dx-dx
Dx-Dx: Combo both ingredients
92
Fluticasone/Salmeterol (advair) Monitor
Monitor: Spirometry, HR, BP, CNS stimulation; frequency of use of SABA; growth velocity in children
93
Fluticasone/Salmeterol (advair) Fun fact
Other: MDI [Advair HFA] 45/21mcg/inh; 115/21mcg; 230/21mcg; Inhaled powder [Advair Diskus] 100/50mcg/inh; 250/50mcg, 500/50mcg; Black Box Warning re asthma-related deaths: PG: C, Lact: caution
94
Budesonide/Formoterol [Symbicort MDI] class/ indication
Class: Combination Glucocorticoid and Long acting Beta 2 Agonist
Indications: Asthma (maintenance of bronchodilation); COPD
95
Budesonide/Formoterol [Symbicort MDI] MOA
MoA: anti-inflammatory action of steroid and bronchodilitation activity of Beta2 agonist
96
Budesonide/Formoterol [Symbicort MDI] SE/ADR
SE/ADRs: Combo of SE/ADRs of both ingredients; increased risk death
97
Budesonide/Formoterol [Symbicort MDI] Contra
Contra: Acute exacerbation of bronchospasm; status asthmaticus
98
Budesonide/Formoterol [Symbicort MDI]DX-DX
combo both
99
Budesonide/Formoterol [Symbicort MDI] Monitor
Monitor: Spirometry, HR, BP, CNS stimulation; frequency of use of SABA; growth velocity in children
100
Budesonide/Formoterol [Symbicort MDI] Fun Fact
Other: MDI 80/4.5 or 160/4.5 at 2 inh BID; in 60 and 120 inh MDI’s; Black Box Warning re asthma-related deaths; PG: C, lact: not
101
Ipratropium/Albuterol [Combivent] class indications
Class: Short acting Anticholinergic & short acting Beta2 agonist
Indications: COPD pts requiring two bronchodilators
102
Umeclidinium/Vilanterol [Anoro Elipta] class/ indication
Long-acting anticholinergic/Long-acting Beta Agonist Combo
| Indications: COPD
103
Umeclidinium/Vilanterol [Anoro Elipta] MOA
Combination of two agents with different bronchodilating action (anti-muscarinic and beta2 agonism)
104
Umeclidinium/Vilanterol [Anoro Elipta] SE/ADR
Paradoxical bronchospasm, chest pain, limb pain, pharyngitis
105
Umeclidinium/Vilanterol [Anoro Elipta] Contra
Severe milk protein allergy; caution with glaucoma; co-morbid thyrotoxicosis, seizure disorder, prostatic hyperplasia, low K+, diabetes
106
Umeclidinium/Vilanterol [Anoro Elipta] dx-dx
Multiple but lower risk of occurrence
107
Umeclidinium/Vilanterol [Anoro Elipta] Monitor
FEV1, peak flow, BP, HR, CNS stimulation, eye changes
108
Umeclidinium/Vilanterol [Anoro Elipta] Fun Fact
: PG ‘C’, Lact caution; t1/2 = 11 H; 1 inh once daily
109
Nicoderm class/indication
Class: Nicotine replacement agents
Indications: tobacco cessation aid
110
Nicoderm MOA
MoA: biphasic CNS & ANS nicotine receptor stimulant; low dose -> stimulation ANS ganglia; large dose -> stim followed by blockade of transmission
111
Nicoderm SE/ADR
SE/ADRs: headache, mucosal irritation, cough, rhinitis; toxicity -> tremors, respiratory excitation, convulsions, respiratory failure
112
Nicoderm Contra
Contra: varies with formulation; recent AMI, life threatening arrhythmias; severe angina, TMJ d/o, hyperthryroidism, T1DM, bronchospastic d/o
113
Nicoderm DX-DX
Dx-Dx: conc incr by Cimetadine
114
Nicoderm Monitor
HR,BOP,Insomnia
115
Nicoderm Fun Fact
Other: can use more than one formulation; PG: D (nasal formulation), Lact: unk
116
Bupropion [Zyban] Class/indication
Class: Dopamine-reuptake inhibitor antidepressant
Indicatins: tobacco cessation [Zyban]; depression [Wellbutrin]
117
Bupropion [Zyban] MOA
unknown
118
Bupropion [Zyban] SE/ADR
SE/ADRs: tachycardia, headache, insomnia, nausea, xerostomia, weight loss, palpitations, agitation, constipation, diarrhea
119
Bupropion [Zyban] Contra
Contra: Bipolar disorder, seizure disorder; active CVD, uncontrolled HTN
120
Bupropion [Zyban] Dx-DX
Dx-Dx: MAO inhibitors, ethanol
121
Bupropion [Zyban] Monitor
Monitor: psychiatric symptoms, tobacco use, BP
122
Bupropion [Zyban] Fun Fact
Other: Black Box Warning: may precipitate or worsen depression, suicidal thoughts, suicide; dosing differences -> Zyban 150mg daily to twice daily for 12 weeks; Wellbutrin forms IR, SR, ER variable; PG: C, Lact: ??
123
Varenicline [Chantix] class/indications
Class: Partial nicotine agonist
Indications: tobacco cessation aid
124
Varenicline [Chantix]MOA
MoA: prevents nicotine stimulation of the mesolimbic dopamine system
125
Varenicline [Chantix] SE/ADR
SE/ADRs: insomnia, headache, abnormal dreams, nausea
126
Varenicline [Chantix] Contra
Contra: psychiatric disorders, decreased renal function, active CVD
127
Varenicline [Chantix] dx-dx
unknown
128
Varenicline [Chantix]monitor
Monitor: Psych changes; tobacco use
129
Varenicline [Chantix] other
Other: Black Box Warning re: pscyhiatric events depression, suicidal thoughts, suicide, agitation; titrate dose up (0.5mg once daily to 1mg twice daily for 11 weeks w/ additional 12 weeks if needed); PG: C, Lact: not
