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Advanced Pharmacology > Endocrine/ENT > Flashcards

Endocrine/ENT Flashcards

1
Q

__________________ have a relatively quick onset of action ~15 minutes to 30 minutes

A

1st generation antihistamines

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2
Q

With regular use, tolerance or drug failure occurs after several weeks to months of taking 1st generation antihistamines….Why?

A

This is because antihistamines can induce the production of hepatic enzymes that actually break them down (they help with their own destruction)

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3
Q

Cautions for ____________:
Narrow-angle Glaucoma (increases intraocular pressure)
BPH (decrease UOP)
Elderly (anticholinergic effects)

A

1st generation antihistamines

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4
Q

Why can’t the 2nd generation antihistamines cause sedation?

A

Because they are large-molecule, low lipid-solubility causing them to be unable to cross BBB
And because they have low affinity for histamine receptors in the brain

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5
Q 
\_\_\_\_\_\_\_\_\_\_ effects:
dry mouth
blurred vision
urinary hesitancy
constipation
mental confusion
A

anticholinergic

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6
Q

these drugs have low receptor specificity and interact with both peripheral and central histamine receptors and readily cross the blood-brain barrier

A

1st generation antihistamines

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7
Q

___________ have CNS SE including:

sedation, drowsiness, somnolence, fatigue, cognitive decline, psychomotor effects, and loss of coordination.

A

1st generation antihistamines

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8
Q

__________ are potent muscarinic receptor antagonists too which leads to anticholinergic side effects, such as sinus tachycardia, dry skin, dry mucous membranes, dilated pupils, constipation, ileus, urinary retention, and agitated delirium.

A

1st generation antihistamines

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9
Q

________ is considered a 2nd generation antihistamine, but it is mildly sedating. Be cautious recommending in those that sedation could impair their functioning (e.g., pilots

A

cetirizine (Zyrtec)

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10
Q

2nd generation antihistamine onset time/steady state

A

1-2.5 hrs…1-3 days for steady state

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11
Q

_____ can impair absorption of 2nd generation antihistamines

A

food

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12
Q 
SE of \_\_\_\_\_\_\_\_\_\_:
Headache
dry mouth
dyspepsia
nausea
fatigue
A

2nd generation antihistamines

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13
Q

Interactions of __________:
Antifungals- causes concentration of this drug to increase
CAN PROLONG QT INTERVAL!!!

A

Fexofenadine (Allegra)

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14
Q

vasoconstrictor drugs that relieve nasal congestion by constricting the blood vessels of nasal mucosa that has been dilated by histamine
–sympathomimetics amines, chemically similar to norepinephrine

A

Nasal decongestants

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15
Q

_________ are available over-the-counter, but often combined with other agents (antihistamines, pain relievers, caffeine

A

Nasal decongestants

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16
Q

__________ improve nasal congestion associated with allergic rhinitis by acting on adrenergic receptors, which causes vasoconstriction in the nasal mucosa, decreasing inflammation.

A

Nasal decongestants

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17
Q

Nasal decongestants are not recommended for more than _____ days

A

3

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18
Q

SE of _______:
Elevate blood pressure & heart rate
Insomnia
Palpitations

A

Oral Decongestants

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19
Q

drugs such as codeine, dextromethorphan, and diphenhydramine are agents that prevent or relieve a nonproductive cough

A

Antitussives

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20
Q

__________ should be used only when the client has a nonproductive cough or for rest at night (and only if needed)

A

Antitussives

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21
Q

________ antitussives should be avoided in patients with COPD and a history of substance abuse

A

opioid

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22
Q

may be prescribed for minor nonproductive cough for individuals for whom dextromethorphan does not work or for whom opioids may not be prescribed.
–it is an expensive method of cough suppression.

A

Benzonatate (Tessalon Perles)

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23
Q

Education for ___________:
many are combination products and many are combined with a decongestant, antihistamine, expectorant, and sometimes even acetaminophen or ibuprofen products (sometimes expectorants and suppressants are combined)!!

A

OTC products

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24
Q

________ is a 3 pronged approach:
Trigger avoidance
Pharmacology
Immunotherapy

A

Allergic Rhinitis Treatment

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25
Q

mainstays of medication for ________ symptoms are antihistamines, nasal corticosteroids, and decongestants

A

allergy/allergic rhinitis

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26
Q

For severe allergic reactions, PO, IM or IV __________ (depending on the severity) are utilized.

A

corticosteroids

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27
Q

______________ reduce rhinitis, sneezing, and itching, but minimal effect on nasal congestion.

A

PO antihistamines

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28
Q

_____________ are used to treat allergic disorders and to relieve histamine-induced symptoms but do not treat the underlying cause

A

H1 antagonists / Antihistamines

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29
Q

drugs that provide relief of urticaria and angioedema in about 70% of patients and are more effective for prevention than reversal of histamine effects

A

H1 antagonists / Antihistamines

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30
Q 
Avoid \_\_\_\_\_\_\_\_\_\_ in the elderly due to potential SE:
arrhythmias
dizziness
sedation
hypotension
difficulty with urination
A

1st generation antihistamines

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31
Q

____________:

loratadine, cetirizine and levocetirizine

A

2nd generation antihistamines

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32
Q

drugs that are more selective for peripheral H1 receptors and cause less sedation

A

2nd generation antihistamines

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33
Q

____________, an H2 antagonist, may be useful in treating refractory urticaria that has not responded to an H1 antagonist. However, there is no evidence that it is useful alone or as a first line measure….and it is alot of drug-drug interactions

A

cimetidine (Tagamet)

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34
Q

this drug that has several drug-drug interactions is best to avoid in patients who are on multiple medications…EX: drug interactions with antifungals and erythromycin and may cause dysmenorrhea,

A

Fexofenadine (Allegra)

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35
Q

Rapid onset of action drug that may aid in reducing nasal congestion offered (in patients > 5 years old) as an alternative or additional first-line therapy for allergic rhinitis

A

Intranasal Antihistamines

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36
Q

Consider a combination of intranasal ________ and intranasal _________ for moderate to severe nasal symptoms of seasonal allergic rhinitis

A

corticosteroids + antihistamines

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37
Q

SE of ________:
Sedation
bitter taste
CNS depression- impair physical or mental abilities

A

Intranasal Antihistamines

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38
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_:
agitation
aggression
anxiousness
dream abnormalities
hallucinations
depression
insomnia
irritability
restlessness,
suicidal thinking and behavior (including suicide)
tremor
A

Montelukast (Singulair)

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39
Q

Approved U.S. _________:
Montelukast (Singulair)
Zafirlukast (Accolate)

A

Leukotriene Modifiers

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40
Q

Drugs that inhibit the action of leukotrienes (inflammatory compounds) that are released by eosinophils and mast cells
By suppressing these inflammatory compounds, they:
-Decrease smooth muscle constriction –vasodilation
-Decrease blood vessel permeability
-DecreasMost effective when taken at bedtimee inflammatory response

A

Leukotriene Modifiers

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41
Q

Drugs that inhibit the action of leukotrienes (inflammatory compounds) that are released by eosinophils and mast cells
By suppressing these inflammatory compounds, they:
-Decrease smooth muscle constriction –vasodilation
-Decrease blood vessel permeability
-DecreasMost effective when taken at bedtimee inflammatory response

A

Leukotriene Modifiers

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42
Q

Leukotriene Modifiers onset of action

A

several days to see benefit

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43
Q

Great add-on after second-generation antihistamines and intranasal steroid sprays; also, can be used in asthma

A

Leukotriene Modifiers

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44
Q

two U.S. approved medicines for treatment of allergies

A

Montelukast (Singulair) and zafirlukast (Accolate)

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45
Q

Consider prescribing these alone or in combination with antihistamines; b/c they are less effective than intranasal steroids

A

Leukotriene Modifiers

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46
Q

approved for the chronic treatment of asthma, acute prevention of exercise-induced bronchial constriction, and relief of both perennial and seasonal allergic rhinitis symptoms. Singulair is approved in adults and children 6 months of age and older. Educate patients about this risk and document. It can be very effective, but we must educate our patients.
(*This is different than the age of approval for this drug in asthma. For asthma, approval is for 12 months and older. This can also vary by resource used).

A

Montelukast (Singulair)

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47
Q

these drugs interrupt inflammation by suppressing the synthesis of histamineand must be used daily in order to build up the barrier to block the allergic cascade

A

Intranasal Corticosteroids

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48
Q 
EX of \_\_\_\_\_\_\_\_\_\_:
beclomethasone [Beconase] 
fluticasone [Flonase], 
budesonide [Rhinocort], 
beclomethasone [Beconase], 
mometasone [Nasonex], 
triamcinolone [Nasacort
A

Intranasal Corticosteroids

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49
Q

most effective treatment for allergic rhinitis.

A

Intranasal Corticosteroids

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50
Q

ery effective in preventing allergy symptoms

They do not treat symptoms but prevent symptoms.

A

Intranasal Corticosteroids

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51
Q

Because it takes approximately five days for intranasal steroids to develop the effective barrier in the nares to prevent allergy symptoms, choose to recommend an ________________ for the first five days

A

oral antihistamine

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52
Q

the patient has seasonal or perennial allergic rhinitis, then _________ of a nasal steroid should prevent allergy symptoms.

A

daily use

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53
Q

Some providers may give the patient a five-day course called a ____________ (i.e., the same dose once a day for five days) for immediate relief if the patient has tried multiple antihistamines without success and is miserable

A

prednisone burst

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54
Q

Unless absolutely essential, oral __________ should not be given if the patient is diabetic due to steroids elevating blood sugar

A

prednisone

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55
Q

Drugs that activate alpha1-adrenergic receptors, leading to vasoconstriction of the nasal blood vessels which may relieve congestion
—vasoconstriction results in decreased blood flow and fluid exudate, which relieves nasal congestion

A

Nasal Decongestants

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56
Q

EX of_________: Oxymetazoline, Sudafed

A

Nasal Decongestants

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57
Q

primary difference between OTC decongestants and prescription decongestants

A

dosing frequency

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58
Q 
\_\_\_\_\_\_\_\_\_\_ stimulate alpha-adrenergic receptors, this may lead to CNS stimulation:
tremors
elevated heart rate
arrhythmias
elevated blood pressure
insomnia
A

Nasal Decongestants

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59
Q

PO ___________ are discouraged and the topical (intranasal) should be used for a brief period of time (for only up to 3 days)

A

decongestants

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60
Q

Contraindications of __________:
uncontrolled HTN
caution in well-controlled HTN

A

Nasal Decongestants

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61
Q

this is helpful for clearing the nares of mucous and reducing the time that allergens come in contact with the nasal mucosa, thereby preventing the allergic cascade.

A

Saline spray

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62
Q

_____________:
Less effective than intranasal corticosteroids
Inhibits histamine release
Good alternative for patients who are not candidates for corticosteroids.
Most effective when used regularly prior to the onset of allergic symptoms.
Requires frequent dosing, 3-4 times/day

A

Intranasal Cromolyn

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63
Q

*Consider _________________ to improve allerigic rhinitis symptoms, especially for patients with a preference for not using medication

A

nasal saline irrigation

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64
Q

Eye symptoms can be treated _______ with eye drops (e.g., ant-histamines, mast cell stabilizers, corticosteroids, decongestants, NSAIDs

A

directly

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65
Q

Eye symptoms can be treated __________ with oral antihistamines, sublingual immunotherapy, or subcutaneous immunotherapy

A

Systemically

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66
Q

Ocular administration of mast cell stabilizers, antihistamines, or dual-action medications is the ________ therapy for allergic conjuctivitis

A

first-line

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67
Q

Medicines for __________:
Naphazoline/pheniramine (Naphcon-A, Opcon-A) -Naphazoline (decongestant)
Pheniramine (anti-histamine)- OTC ***do not give to children <6
Olopatadine (Patanol/Pataday) (Antihistamine)- Rx only/ expensive!
Patanol–for children 3 years of age and older
Pataday–for children 2 years of age and older.

A

allergic conjunctivitis

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68
Q

FDA is now requiring safety labeling changes for prescription opioid cough and cold medicines containing _________ or ___________

A

codeine or hydrocodone

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69
Q

these products will be labeled for use only in adults aged 18 years and older and will no longer be indicated for the treatment of a cough in any pediatric population.

A

codeine or hydrocodone opioid cough/cold meds

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70
Q

recommendations for URI in __________:

rest, hydration, a diet high in fruits and vegetables, and saline nasal spray or washe

A

pregnancy women

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71
Q

Also note that many sore throat sprays and lozenges contain soothing agents, antiseptics, and anesthetics—some of which are contraindicated in both ___________ and __________

A

pregnancy and breastfeeding

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72
Q

______________ are likely the most effective agent for allergic rhinitis and are often considered first-line during pregnancy

A

Nasal corticosteroids

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73
Q

_____________ is the only corticosteroid that is pregnancy category B

A

Budesonide [Rhinocort]

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74
Q

___________ are overall are considered safe in pregnancy due to their high first-pass hepatic uptake and low maternal systemic absorption—amounts absorbed into the bloodstream are probably too small to affect a fetus

A

Nasal corticosteroids

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75
Q

Beclomethasone (Beconase AQ) and intranasal cromolyn sodium (NasalCrom) also have good evidence for effectiveness and safety with use during ___________ and ___________ because systemic availability is low after maternal inhalation

A

pregnancy and lactation

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76
Q

Beclomethasone, Flonase, and Nasonex are all category _____ and safety in lactation is unknown but characteristics such as poor oral bioavailability and rapid first-pass hepatic uptake will likely result in low to insignificant amounts of infant exposure.

A

C

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77
Q

Oxymetazoline may reduce _________

A

milk supply

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78
Q

Oxymetazoline (Afrin and an active ingredient in common OTC nasal preparations), xylometazoline (Novorin, Sinutab nasal spray), and naphazoline are all Pregnancy Category ___

A

C

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79
Q

Chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), and doxylamine (Unisom SleepTabs) do not have ___________ effects and can relieve symptoms of both watery eyes and rhinorrhea. Begin with chlorpheniramine—this drug has a high safety profile and has been on the market the longest of any antihistamine.

A

teratogenic

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80
Q

If used in small, occasional doses, small amounts of diphenhydramine or chlorpheniramine are considered safe with ___________

A

breastfeeding

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81
Q

It is preferable to start with the ___________ for allergic rhinitis with breastfeeding, especially with a newborn or premature infant
***instruct to take at bedtime or before infant’s longest sleep period

A

2nd generation, non-sedating antihistamines

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82
Q

___________, a 2nd generation antihistamine, has not been associated with teratogenicity in any trimester and small, occasional doses are likely harmless with breastfeeding

A

Cetirizine (Zyrtec)

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83
Q

Similar to loratadine, __________ may decrease milk supply, especially if combined with a sympathomimetic (such as pseudoephedrine/Sudafed)

A

Cetirizine (Zyrtec)

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84
Q

____________ is a newer 2nd generation antihistamine safe for 2nd trimester use

A

Loratadine (Claritin)

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85
Q

Doxylamine (similar structure to Benadryl) is a tried and true medication known for its safety in __________, however is possibly unsafe in _____________

A

pregnancy; breastfeeding

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86
Q

_________ likely passes into breast milk and may cause sedation and paradoxical CNS stimulation

A

Doxylamine

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87
Q

_________ likely passes into breast milk and may cause sedation and paradoxical CNS stimulation
*** Use with caution, especially for infants with respiratory disorders.

A

Doxylamine

88
Q

there is mixed information on the fetal effects associated with _________Codeine (category C). Some sources claim safe use during pregnancy, while others report first trimester use is associated with fetal malformations

A

codeine

89
Q

Antitussives guaifenesin and dextromethorphan are pregnancy category ____

A

C

90
Q

Guaifenesin in the first trimester may be associated with _________

A

birth defects

91
Q

Education for _________ with breastfeeding:
Monitor infant behavior closely
Time dosages and feedings for the least exposure possible. Instruct the mother to monitor weight gain and warning signs of sedation such as drowsiness, breathing difficulties, and decreased interest in feeding

A

Codeine

92
Q

_________ are given to infants as young as 2 months (Guaifenesin) and 1 month (Dextromethorphan) so a much smaller amount is passed through breastmilk

A

antitussives

93
Q

_________ are not considered first-line for rhinitis in pregnancy. However, if non-pharmacologic and other methods are ineffective, they may be used for acute congestive episodes (**use less than ___ days)

A

Decongestants less than 3 days

94
Q

Start with ________ forms of decongestants first in pregnancy

A

nasal

95
Q

Oxymetzaoline nasal spray (Afrin®), category ____ (good first-line but only less than ____ days)

A

C; 3 days

96
Q

________is associated with an increased risk of gastroschisis with first trimester use, but is considered safe in the 2nd and 3rd trimesters; avoid use in the first trimester

A

Sudafed

97
Q

Data is mixed on Phenylephrine (Neo-Synephrine, Sudafed PE, AH-CHEW D, Rhinall): some sources consider this class safe in pregnancy, while others claim these meds may cause fetal _______

A

hypoxia

98
Q

The safety of oxymetazoline (Afrin®) and pseudoephedrine use during lactation is _________

A

unknown

99
Q

Consider use of _______ oxymetazoline before oral systemic decongestants (such as Sudafed).

A

nasal

100
Q

The addition of an ____________ to the short-acting beta-agonists (SABA) is now as soon as the asthma symptoms progress past mild intermittent. No longer do we use a SABA alone!

A

inhaled corticosteroid

101
Q

The evidence for the diagnosis of asthma should be documented before starting _________ treatment, as it is often more difficult to confirm a diagnosis afterward (if possible).

A

controller

102
Q

Sx of _________:
Wheezing (polyphonic, musical or whistling sounds, predominantly expiratory)
Cough
Chest tightness
Dyspnea
Worsening of symptoms at night or in the presence of environmental stimuli

A

Asthma

103
Q

Treatment for _____________ asthma:
All adults and adolescents with ________ should receive either symptom-driven (in mild) or daily low dose ICS-containing controller treatment!!!

A

mild intermittent asthma

104
Q

GINA now recommends that every adult and adolescent with asthma should receive _____________ medication to reduce their risk of serious exacerbations, even in patients with infrequent symptoms.
AND Every patient with asthma should have a ________

A 
ICS-containing controller 
reliever inhaler (SABA)
105
Q

Treatment for _____________ asthma:

long-acting beta-agonist inhaler plus inhaled steroids to suppress the overactive immune response in the lungs.

A

mild persistent asthma

106
Q

Treatment for _____________ asthma:
Either a low-dose inhaled steroid and a long-acting beta-agonist.
Alternatively, medium-dose inhaled steroids may be used in addition to a short-acting beta-agonist such as albuterol

A

moderate persistent asthma

107
Q

Treatment for _____________ asthma:
High-dose inhaled steroids and a long-acting beta-agonist.
If that does not control the symptoms, oral steroids are added.
Alternative drugs are available at all stages, as are allergy shots if the asthma is a result of general allergies.

A

severe persistent asthma

108
Q

The presence of one severe feature is sufficient to diagnose _____________.

A

severe persistent asthma

109
Q

Reducing ___________ is a critical element of treatment in asthma

A

airway inflammation

110
Q

Advantages of _________ for asthma:

  • -Therapeutic effects enhanced by delivering drugs directly to their site of action
  • -Systemic effects are minimized
  • -Relief of acute attacks are rapid
A

inhalers

111
Q

When 2 inhalations are needed, an interval of at least ________ should separate the first inhalation from the second.

A

1 minute

112
Q

The single most important thing to remember about asthma therapy is the difference and appropriate use of __________ vs _____________–so that we can teach our patients about this difference too!

A

rescue drugs vs. maintenance drugs

113
Q

The primary rescue drug for asthma is _______________, a short-acting beta-adrenergic agonist (SABA)

A

albuterol (AcuNeb ProAir HFA)

114
Q

albuterol (AcuNeb ProAir HFA) and Levalbuterol (Xopenex) are given through ____________ or ____________

A

metered dose inhaler (MDI) or through a nebulizer

115
Q

drug that is thought to provide as effective bronchodilation as albuterol and facilitates mucous drainage, but with reduced side effects (such as tachycardia and tremor).
***more expensive

A

Levalbuterol (Xopenex)

116
Q

contraindications of___________:
children under age 4 (sometimes Rx’d off-label)
nursing mothers

A

Levalbuterol (Xopenex)

117
Q

Asthma __________:
Short-acting beta-2 agonists (SABAs)
Short-acting muscarinic agents (SAMAs)
Oral corticosteroids

A

Relievers

118
Q

Asthma _________:
Inhaled corticosteroids
Leukotriene Modifiers/Leukotriene Receptor Antagonist (LTM/LTRA)
Inhaled corticosteroid/Long-acting beta-2-agonists

A

Controllers

119
Q

effect that can be seen with corticosteroid use, typically at high doses for extended amounts of time which may lead to adrenal crisis and death

A

Adrenal Suppression (hypothalamic-pituitary-adrenal (HPA) axis)

120
Q

Increased occurrence of _____________ in:
younger children
patients receiving high doses for prolonged periods.

A

Adrenal Suppression (hypothalamic-pituitary-adrenal (HPA) axis)

121
Q

Particular care to prevent adrenal suppression is required when patients are transferred from _________ to __________ due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms.

A

systemic corticosteroids; inhaled products

122
Q

Adult patients receiving doses as low as ____ mg per day of prednisone (or equivalent) may be susceptible to adrenal suppression, especially if > ____ days.

A

20 mg

14 days

123
Q

_______ steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.

A

aerosol

124
Q

the increase of incidence of secondary infection, masking of acute infection (including fungal infections), prolonged or exacerbated viral infections, or limited response to killed or inactivated vaccines caused by corticosteroid use

A

immunosuppression

125
Q

chickenpox or measles should be avoided while using ___________

A

corticosteroids

126
Q

________ should not be used while treating viral hepatitis or cerebral malaria, or TB

A

corticosteroids

127
Q

Latent or active amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to _________ initiation

A

corticosteroid

128
Q

Use __________ with extreme caution in patients with Strongyloidiasis infections (hyperinfection, dissemination and fatalities have occurred)

A

corticosteroids

129
Q

Prolonged treatment with ____________ has been associated with the development of Kaposi sarcoma; if noted, discontinuation of therapy should be considered.

A

corticosteroids

130
Q

Acute myopathy has been reported with high dose ____________, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.

A

corticosteroids

131
Q

____________ use may cause psychiatric disturbances, including euphoria, insomnia, mood swings, personality changes, severe depression or frank psychotic manifestations. Preexisting psychiatric conditions may be exacerbated by use.

A

Corticosteroid

132
Q

Use ____________ with caution in patients with heart failure and/or hypertension; long-term use has been associated with electrolyte disturbances, fluid retention, and hypertension. Use with caution in patients with a recent history of myocardial infarction; left ventricular free wall rupture has been reported after the use.

A

Corticosteroid

133
Q

Use caution with ____________ in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia

A

corticosteroids

134
Q

Use with caution with ___________ in patients with GI diseases (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, ulcerative colitis [nonspecific]) due to perforation risk.

A

corticosteroids

135
Q

______ are used only in combination with an ICS, not as monotherapy

A

LABAs

136
Q

mainstay of maintenance therapy for asthma

A

inhaled glucocorticoids

137
Q

Because they do not provide immediate relief of bronchoconstriction, ____________ should not be used alone for someone experiencing acute asthma symptoms.

A

inhaled glucocorticoids

138
Q

can be given via inhaler, nebulizer, or systemically (PO, IV)

A

inhaled glucocorticoids

139
Q

_____________ inhalers:

beclomethasone, budesonide, flunisolide, fluticasone & triamcinolone

A

glucocorticoids

140
Q

______ is used quite commonly in asthma because it combines a long-acting B2-agonist (salmeterol) with the steroid fluticasone and is an inhaled powder. Many people find the diskus system of inhaled medication simpler to use correctly than the aerosol MDIs. However, the individual must be able to inhale deeply in order to achieve the desired benefit.

A

Advair

141
Q

There have been mixed reports on the long-term effect of ________________ on the height of children with asthma.
Research demonstrates that there is a reduction in growth velocity in the first year of using ICS.
Although the growth velocity returns to normal, this delay in the first year of usage does not impact height as an adult.

A

inhaled steroids

142
Q 
Concerns of \_\_\_\_\_\_\_\_\_\_\_\_:
growth restriction
bone loss
cataracts/glaucoma
tapered discontinuation
A

inhaled steroids

143
Q

Cautions of __________:
oral candidiasis
immunosuppression
adrenal suppression

A

inhaled steroids

144
Q 
SE of \_\_\_\_\_\_\_\_\_\_:
Headache
Dizziness
Trouble sleeping
Inappropriate happiness.
Severe mood swings.
Hyperglycemia
Bone loss
A

PO glucocorticoids

145
Q

Nedocromil (Tilade) and cromolyn sodium (Intal)

A

Mast cell stabilizers

146
Q

These drugs take several weeks for a full effect and are administered three to four times a day, which reduces adherence.
Therefore, these are not an initial, primary treatment source.
S/E’s:
Headaches
Nasal irritation
Cough

A

Mast cell stabilizers

147
Q

___________ may be used in children 5 years of age and older while montelukast (Singulair), may be used in children as young as 12 months

A

Zafirlukast (Accolate)

148
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_:
Headache
Stomach pain, heartburn, upset stomach, nausea, diarrhea
Tooth pain
Tiredness
Dizziness
Fever, stuffy nose, sore throat, cough, hoarseness
Mood changes* (see above)
A

montelukast (Singulair)

149
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Headache
Dry mouth
Hoarseness
Cough
Stuffy Nose
Sinus Pain
Nausea
A

Antimuscarinic bronchodilators (Ipratropium bromide (Atrovent)

150
Q 
Drug Interactions of \_\_\_\_\_\_\_\_\_:
Macrolides
Quinolones
Cimetidine
Anticonvulsants
A

Methylxanthines:

Aminophylline (Theophylline)

151
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_:
Stomach upset and heartburn. 
Trouble sleeping (insomnia).
Headache
Nervousness or irritability
Rapid heart rate (tachycardia)
Rapid breathing (tachypnea)
A

Methylxanthines:

Aminophylline (Theophylline)

152
Q

Salmeterol (Serevent) is added to an inhaled corticosteroid _____________ for long-acting control of bronchoconstriction

A

fluticasone (Advair)

153
Q

____________may be used alone in treating COPD symptoms but not for patients with asthma

A

LABAs

154
Q

increase the risk of asthma-related death. All are contraindicated in patients with asthma without use of a short-term asthma control medication. They decrease frequency of asthma episodes, but may increase severity of asthma episodes when they occur!

A

LABAs

155
Q

_____________ increase the risk of asthma-related hospitalization in pediatric and adolescent patients. For those with asthma who require the addition of this drug to an inhaled corticosteroid, a fixed-dose combination product should be used whenever possible.

A

LABAs

156
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_:
Throat irritation and hoarseness (caused by inhaled corticosteroids in combination of medicines).
Rapid heartbeat or palpitations
Headache and dizziness
Nausea, vomiting, and diarrhea
Anxiety
Nervousness or tremor
A

LABAs

157
Q

____________ is a monoclonal IgG antibody; IgG molecules are known to cross the placenta therefore exposure to the fetus during pregnancy may occur. Uncontrolled asthma is associated with adverse events on pregnancy (increased risk of preeclampsia, preterm birth, low birth weight infants).

A

Dupilumab

158
Q

Use of ____________ is encouraged.
It increases the delivery of the aerosolized drug to the lungs.
Minimizes oral thrush from steroids (don’t forget to have patients brush and clean out mouth after inhaled steroid use)

A

a spacer or chamber (Areochamber)

159
Q

PRN inhaler should now be a _________ with ICS or __________ with an ICS to reduce their risk of serious exacerbations, even in patients with infrequent symptoms.

A

SABA (albuterol)

LABA (formoterol)

160
Q

always ask about asthma before prescribing ___________

A

NSAIDs w/ aspirin

161
Q

_____________ is marked by sputum production

A

chronic bronchitis

162
Q

for mild, intermittent asthma, no _________therapy is indicated

A

controller

163
Q

_________ is the preferred inhaled corticosteroid for use during pregnancy.

A

Budesonide

164
Q

the first-choice for asthma in pregnancy

A

Inhaled albuterol

165
Q

In general, pregnant patients should use up to ___ treatments of inhaled albuterol (two to six puffs) or nebulized albuterol at ___-minute intervals for most mild to moderate symptoms; higher doses can be used for severe symptom exacerbation.

A

two, 20 min

166
Q

For those with ___________ asthma, no controller therapy is indicated

A

mild, intermittent

167
Q

__________ and _________ are considered safe in breastfeeding due to low bioavailability and maternal serum levels.

A

Albuterol and Budesonide

168
Q

__________ may cause hyperstimulation and disrupted sleep in infants who are breastfed by mother on this drug. Even so, breastfeeding is still indicated due to its overwhelming benefits

A

Theophylline

169
Q

Research is non-existent for some asthma medications in breastfeeding, such as _________. In this case, an alternate medication is recommended

A

Zileuton

170
Q

5 A’s of Smoking Cessation

A

Ask: Make sure smoking status is documented. Ask if they are ready to quit at every visit.
Advise: Mention the benefits of quitting smoking at every visit and show support.
Assess: Review your patient’s willingness to quit and their potential barriers to quitting.
Assist: Offer support, resources, and pharmacotherapy if your patient is ready to quit.
Arrange: Have follow-up plans set, if applicable, and offer on-going support.

171
Q

The goal of these drugs is to relieve cravings for nicotine and reduce nicotine withdrawal symptoms.
Binds to nicotine receptors. At high doses, has predominately a reward effect and at low doses, it primarily has a sedative effect.

A

nicotine replacement therapies (NRTs)

172
Q 
Precautions of \_\_\_\_\_\_\_\_\_\_\_\_:
CV disease- tachycardia, HTN
angina
HTN
recent MI
A

nicotine replacement therapies (NRTs)

173
Q

Discontinue ____________ if heart palpitations or arrythmia occur.

A

nicotine replacement therapies (NRTs)

174
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_ NRT:
Hypersalivation
Hiccups
Dyspepsia
Mouth/jaw soreness
A

nicotine gum

175
Q

Advantages of _________ NRT:
Might serve as an oral substitute for tobacco
Might delay weight gain
Can be titrated to manage withdrawal symptoms
Can be used in combination with other agents

A

nicotine gum

176
Q

Disadvantages of __________ NRT:
Need for frequent dosing can compromise adherence
Might be problematic for patients with significant dental work
Proper chewing technique is necessary for effectiveness and to
minimize adverse effects
Gum chewing might not be acceptable or desirable for some patients

A

nicotine gum

177
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_ NRT:
Nausea
Hiccups
Cough
Insomnia
A

nicotine lozenge

178
Q

Advantages of _________ NRT:
Might serve as an oral substitute for tobacco
Might delay weight gain
Can be titrated to manage withdrawal symptoms
Can be used in combination with other agents

A

nicotine lozenge

179
Q

Disadvantages of __________ NRT:
Need for frequent dosing can compromise adherence
GI side effects might be problematic for patients

A

nicotine lozenge

180
Q

SE of ___________ NRT:
Local skin reactions (erythema, pruritus, burning)
Headache

Sleep disturbances (insomnia, abnormal/vivid dreams); associated with nocturnal nicotine absorption

A

transdermal patch

181
Q

Advantages of _________ NRT:
Once-daily dosing associated with fewer adherence problems
Of all NRT products, its use is least obvious to others
Can be used in combination with other agents; delivers consistent nicotine levels over 24 hours

A

transdermal patch

182
Q

Disadvantages of __________ NRT:
When used as monotherapy, cannot be titrated to acutely manage withdrawal symptoms
Not recommended for use by patients with dermatologic conditions (e.g., psoriasis, eczema, atopic dermatitis)

A

transdermal patch

183
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_ NRT:
Nasal and/or throat irritation (hot, peppery, or burning sensation)
Rhinitis
Tearing
Sneezing
Cough
Headache
A

nasal spray - Rx required!!

184
Q

Advantages of _________ NRT:
Can be titrated to rapidly manage withdrawal symptoms
Can be used in combination with other agents

A

nasal spray - Rx required!!

185
Q

Disadvantages of __________ NRT:
Need for frequent dosing can compromise adherence
Nasal administration might not be acceptable or desirable for some patients
Nasal irritation
Not recommended for use by patients with chronic nasal disorders or severe reactive airway disease

A

nasal spray - Rx required!!

186
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_ NRT:
Mouth and/or throat irritation
Cough

Headache

Rhinitis
Dyspepsia
Hiccups
A

oral inhaler- Rx required!!!

187
Q

Advantages of _________ NRT:
Might serve as an oral substitute for tobacco
Might delay weight gain
Can be titrated to manage withdrawal symptoms
Can be used in combination with other agents

A

oral inhaler- Rx required!!!

188
Q

Disadvantages of __________ NRT:
Need for frequent dosing
Cartridges might be less effective in cold environments (≤60°F)
Once cartridge is open, only effective for 24 hours

A

oral inhaler- Rx required!!!

189
Q

Partial neuronal nicotinic receptor agonist; prevents nicotine stimulation of the dopaminergic system associated with nicotine addiction. Also binds to 5-HT3receptor (significance not determined) with moderate affinity.
Stimulates dopamine activity but to a much smaller degree than nicotine does, resulting in decreased craving and withdrawal symptoms.

A

Partial Nicotinic Agonists- Chantix (Varenicline)

190
Q

Interactions of __________:
Alcohol: may enhance the adverse/toxic effect of Alcohol. Specifically, alcohol tolerance may be decreased and the risk for neuropsychiatric adverse effects may be increased.
Histamine H2 Receptor Antagonists: May increase the serum concentration
Nicotine: may enhance the adverse/toxic effect of Nicotine.

A

Partial Nicotinic Agonists- Chantix (Varenicline)

191
Q

SE of ____________:
CNS Depression- impair physical and mental abilities**
Rare: Angioedema & Stevens-Johnson Syndrome
Nausea
Suicidal thoughts/Depression
Cardiovascular events (risk seems to be associated with prior CVD hx)
Dosing adjustment needed for severe renal impairment

A

Partial Nicotinic Agonists- Chantix (Varenicline)

192
Q

Tips about ___________:
Start 1 week before quit date. Typically used for 12 weeks, but can extend another 12 weeks if necessary.
Offers a different MOA for those that have failed prior treatments.
May be superior to bupropion in its effectiveness.

A

Partial Nicotinic Agonists- Chantix (Varenicline)

193
Q

Contraindications of ____________:

Use of MAO inhibitors (concurrently or within 14 days of discontinuing either bupropion or the MAO inhibitor).

A

Partial Nicotinic Agonists- Chantix (Varenicline)

194
Q

this drug’s exact mechanism unknown… Has antidepressant effect and primary mechanism of action is thought to be dopaminergic and/or noradrenergic

A 
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
195
Q

Contraindications of ____________:
Seizure disorder
History of anorexia/bulimia
Patients undergoing abrupt discontinuation of ethanol or sedatives, including benzodiazepines, barbiturates, or antiepileptic drugs
Use of MAO inhibitors (concurrently or within 14 days of discontinuing either bupropion or the MAO inhibitor).

A 
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
196
Q

SE of ____________:
Suicidal thoughts, mood changes, hallucinations, panic, depression
CNS Stimulation: restlessness, insomnia, anxiety, anorexia
Cognitive impairment
HTN
Weight loss (when not desired/intended)
Seizures (may lower threshold)

A 
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
197
Q

Tips about ___________:
Therapy should begin at least 1 week before target quit date. If the patient successfully quits smoking after 7 to 12 weeks, may consider ongoing maintenance therapy. Efficacy of maintenance therapy (300 mg daily) has been demonstrated for up to 6 months. Conversely, if significant progress has not been made by the seventh week of therapy, success is unlikely and treatment discontinuation should be considered
May double chances of success when used for smoking cessation vs no therapy at all.
Avoid dosing near bedtime.
A taper is not required.

A 
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
198
Q 
Precautions for ALL \_\_\_\_\_\_\_\_\_\_\_:
Recent (≤ 2 weeks) myocardial infarction
Serious underlying arrhythmias
Serious or worsening angina pectoris
Pregnancy and breastfeeding
Adolescents (<18 years)
A

nicotine replacement therapies (NRTs)

199
Q

Precautions for __________:
Concomitant therapy with medications/conditions known to lower the seizure threshold
Hepatic impairment
Pregnancy and breastfeeding
Adolescents (<18 years)
Treatment-emergent neuropsychiatric symptoms- BOXED WARNING REMOVED 12/2016

A 
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
200
Q

Precautions for __________:
Severe renal impairment (dosage adjustment is necessary)
Pregnancy and breastfeeding
Adolescents (<18 years)
Treatment-emergent neuropsychiatric symptomss-BOXED WARNING REMOVED 12/2016
DOSING

A

Partial Nicotinic Agonists- Chantix (Varenicline)

201
Q 
Avoid \_\_\_\_\_\_\_\_\_\_ in:
HTN
coronary artery disease- angina, MI
glaucoma
MAOI use
stimulants- caffeine, Ritalin
A

Decongestants

202
Q

_____________ such as oxymetazoline and phenylephrine, used for short-term use (BID, PRN, or three days) are considered safe. However, after 3 days, there is a risk of rhinitis medicamentosa

A

Topical nasal decongestants

203
Q

_________ such as diphenhydramine should be avoided in the elderly

A

Antihistamines

204
Q

Nasal (topical) decongestants are safe while _________

A

breastfeeding

205
Q

Potential adverse effects in pediatric population from misuse of ___________ include respiratory depression, neurological impairments, cardiovascular instability, and death

A

common cold medicines

206
Q

primarily used for emergent situations in asthmatics and for routine therapy with COPD

A

Ipratropium Bromide (Atrovent)- Short Acting Muscarinic Agonist

207
Q

________ is OK with an ICS for PRN inhaler because it has a quick onset of action like a SABA (Albuterol)

A

Formentol

208
Q

Cautions for ________:
Heart Disease
Diabetes
Glaucoma

A

Albuterol

209
Q

Beta2 agonists may increase risk of ________ so use caution in patients w/ CVD

A

arrythmias

210
Q

MOA of ___________:

Block late-phase activation to allergen and inhibit inflammatory cell migration and activation (ICS)

A

ICS Inhaled Corticosteroids

211
Q

MOA of __________:

Halts degradation of mast cells and release of histamine and other inflammatory agents

A

Mast cell stabilizers- Cromolyn

212
Q

MOA of ___________:

Suppresses the cytokine release and inhibits lung infiltration by neutrophils and other leukocytes

A

PDE4 Inhibitors

213
Q

Which medications are controllers for asthma?

A 
Leukotriene Modifier (Singulair)
Mast cell Stabilizer (Cromolyn)
Inhaled Corticosteroids (Flovent)
214
Q

Cromolyn helps reduce ________ in asthma

A

inflammation

215
Q

Do not give oral ____________ in:
Uncontrolled HTN
Tachyarrhythmia
Severe insomnia

A

decongestants

216
Q

Critical teaching point for oral decongestants

A

Use only 3 days d/t rebound congestion, rhinitis medicamentosa - rebound nasal congestion that occurs after 3 days of using

Advanced Pharmacology (8 decks)

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