Endocrine/ENT Flashcards
1
Q
__________________ have a relatively quick onset of action ~15 minutes to 30 minutes
A
1st generation antihistamines
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)
3
Q
Cautions for ____________:
Narrow-angle Glaucoma (increases intraocular pressure)
BPH (decrease UOP)
Elderly (anticholinergic effects)
A
1st generation antihistamines
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
5
Q
\_\_\_\_\_\_\_\_\_\_ effects: dry mouth blurred vision urinary hesitancy constipation mental confusion
A
anticholinergic
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
7
Q
___________ have CNS SE including:
sedation, drowsiness, somnolence, fatigue, cognitive decline, psychomotor effects, and loss of coordination.
A
1st generation antihistamines
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
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)
10
Q
2nd generation antihistamine onset time/steady state
A
1-2.5 hrs…1-3 days for steady state
11
Q
_____ can impair absorption of 2nd generation antihistamines
A
food
12
Q
SE of \_\_\_\_\_\_\_\_\_\_: Headache dry mouth dyspepsia nausea fatigue
A
2nd generation antihistamines
13
Q
Interactions of __________:
Antifungals- causes concentration of this drug to increase
CAN PROLONG QT INTERVAL!!!
A
Fexofenadine (Allegra)
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
15
Q
_________ are available over-the-counter, but often combined with other agents (antihistamines, pain relievers, caffeine
A
Nasal decongestants
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
17
Q
Nasal decongestants are not recommended for more than _____ days
A
3
18
Q
SE of _______:
Elevate blood pressure & heart rate
Insomnia
Palpitations
A
Oral Decongestants
19
Q
drugs such as codeine, dextromethorphan, and diphenhydramine are agents that prevent or relieve a nonproductive cough
A
Antitussives
20
Q
__________ should be used only when the client has a nonproductive cough or for rest at night (and only if needed)
A
Antitussives
21
Q
________ antitussives should be avoided in patients with COPD and a history of substance abuse
A
opioid
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)
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
24
Q
________ is a 3 pronged approach:
Trigger avoidance
Pharmacology
Immunotherapy
A
Allergic Rhinitis Treatment
25
mainstays of medication for ________ symptoms are antihistamines, nasal corticosteroids, and decongestants
allergy/allergic rhinitis
26
For severe allergic reactions, PO, IM or IV __________ (depending on the severity) are utilized.
corticosteroids
27
______________ reduce rhinitis, sneezing, and itching, but minimal effect on nasal congestion.
PO antihistamines
28
_____________ are used to treat allergic disorders and to relieve histamine-induced symptoms but do not treat the underlying cause
H1 antagonists / Antihistamines
29
drugs that provide relief of urticaria and angioedema in about 70% of patients and are more effective for prevention than reversal of histamine effects
H1 antagonists / Antihistamines
30
```
Avoid __________ in the elderly due to potential SE:
arrhythmias
dizziness
sedation
hypotension
difficulty with urination
```
1st generation antihistamines
31
____________:
| loratadine, cetirizine and levocetirizine
2nd generation antihistamines
32
drugs that are more selective for peripheral H1 receptors and cause less sedation
2nd generation antihistamines
33
____________, 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
cimetidine (Tagamet)
34
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,
Fexofenadine (Allegra)
35
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
Intranasal Antihistamines
36
Consider a combination of intranasal ________ and intranasal _________ for moderate to severe nasal symptoms of seasonal allergic rhinitis
corticosteroids + antihistamines
37
SE of ________:
Sedation
bitter taste
CNS depression- impair physical or mental abilities
Intranasal Antihistamines
38
```
SE of _____________:
agitation
aggression
anxiousness
dream abnormalities
hallucinations
depression
insomnia
irritability
restlessness,
suicidal thinking and behavior (including suicide)
tremor
```
Montelukast (Singulair)
39
Approved U.S. _________:
Montelukast (Singulair)
Zafirlukast (Accolate)
Leukotriene Modifiers
40
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
Leukotriene Modifiers
41
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
Leukotriene Modifiers
42
Leukotriene Modifiers onset of action
several days to see benefit
43
Great add-on after second-generation antihistamines and intranasal steroid sprays; also, can be used in asthma
Leukotriene Modifiers
44
two U.S. approved medicines for treatment of allergies
Montelukast (Singulair) and zafirlukast (Accolate)
45
Consider prescribing these alone or in combination with antihistamines; b/c they are less effective than intranasal steroids
Leukotriene Modifiers
46
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).
Montelukast (Singulair)
47
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
Intranasal Corticosteroids
48
```
EX of __________:
beclomethasone [Beconase]
fluticasone [Flonase],
budesonide [Rhinocort],
beclomethasone [Beconase],
mometasone [Nasonex],
triamcinolone [Nasacort
```
Intranasal Corticosteroids
49
most effective treatment for allergic rhinitis.
Intranasal Corticosteroids
50
ery effective in preventing allergy symptoms
| They do not treat symptoms but prevent symptoms.
Intranasal Corticosteroids
51
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
oral antihistamine
52
the patient has seasonal or perennial allergic rhinitis, then _________ of a nasal steroid should prevent allergy symptoms.
daily use
53
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
prednisone burst
54
Unless absolutely essential, oral __________ should not be given if the patient is diabetic due to steroids elevating blood sugar
prednisone
55
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
Nasal Decongestants
56
EX of_________: Oxymetazoline, Sudafed
Nasal Decongestants
57
primary difference between OTC decongestants and prescription decongestants
dosing frequency
58
```
__________ stimulate alpha-adrenergic receptors, this may lead to CNS stimulation:
tremors
elevated heart rate
arrhythmias
elevated blood pressure
insomnia
```
Nasal Decongestants
59
PO ___________ are discouraged and the topical (intranasal) should be used for a brief period of time (for only up to 3 days)
decongestants
60
Contraindications of __________:
uncontrolled HTN
caution in well-controlled HTN
Nasal Decongestants
61
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.
Saline spray
62
_____________:
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
Intranasal Cromolyn
63
*Consider _________________ to improve allerigic rhinitis symptoms, especially for patients with a preference for not using medication
nasal saline irrigation
64
Eye symptoms can be treated _______ with eye drops (e.g., ant-histamines, mast cell stabilizers, corticosteroids, decongestants, NSAIDs
directly
65
Eye symptoms can be treated __________ with oral antihistamines, sublingual immunotherapy, or subcutaneous immunotherapy
Systemically
66
Ocular administration of mast cell stabilizers, antihistamines, or dual-action medications is the ________ therapy for allergic conjuctivitis
first-line
67
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.
allergic conjunctivitis
68
FDA is now requiring safety labeling changes for prescription opioid cough and cold medicines containing _________ or ___________
codeine or hydrocodone
69
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.
codeine or hydrocodone opioid cough/cold meds
70
recommendations for URI in __________:
| rest, hydration, a diet high in fruits and vegetables, and saline nasal spray or washe
pregnancy women
71
Also note that many sore throat sprays and lozenges contain soothing agents, antiseptics, and anesthetics—some of which are contraindicated in both ___________ and __________
pregnancy and breastfeeding
72
______________ are likely the most effective agent for allergic rhinitis and are often considered first-line during pregnancy
Nasal corticosteroids
73
_____________ is the only corticosteroid that is pregnancy category B
Budesonide [Rhinocort]
74
___________ 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
Nasal corticosteroids
75
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
pregnancy and lactation
76
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.
C
77
Oxymetazoline may reduce _________
milk supply
78
Oxymetazoline (Afrin and an active ingredient in common OTC nasal preparations), xylometazoline (Novorin, Sinutab nasal spray), and naphazoline are all Pregnancy Category ___
C
79
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.
teratogenic
80
If used in small, occasional doses, small amounts of diphenhydramine or chlorpheniramine are considered safe with ___________
breastfeeding
81
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
2nd generation, non-sedating antihistamines
82
___________, a 2nd generation antihistamine, has not been associated with teratogenicity in any trimester and small, occasional doses are likely harmless with breastfeeding
Cetirizine (Zyrtec)
83
Similar to loratadine, __________ may decrease milk supply, especially if combined with a sympathomimetic (such as pseudoephedrine/Sudafed)
Cetirizine (Zyrtec)
84
____________ is a newer 2nd generation antihistamine safe for 2nd trimester use
Loratadine (Claritin)
85
Doxylamine (similar structure to Benadryl) is a tried and true medication known for its safety in __________, however is possibly unsafe in _____________
pregnancy; breastfeeding
86
_________ likely passes into breast milk and may cause sedation and paradoxical CNS stimulation
Doxylamine
87
_________ likely passes into breast milk and may cause sedation and paradoxical CNS stimulation
*** Use with caution, especially for infants with respiratory disorders.
Doxylamine
88
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
codeine
89
Antitussives guaifenesin and dextromethorphan are pregnancy category ____
C
90
Guaifenesin in the first trimester may be associated with _________
birth defects
91
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
Codeine
92
_________ are given to infants as young as 2 months (Guaifenesin) and 1 month (Dextromethorphan) so a much smaller amount is passed through breastmilk
antitussives
93
_________ 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)
Decongestants less than 3 days
94
Start with ________ forms of decongestants first in pregnancy
nasal
95
Oxymetzaoline nasal spray (Afrin®), category ____ (good first-line but only less than ____ days)
C; 3 days
96
________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
Sudafed
97
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 _______
hypoxia
98
The safety of oxymetazoline (Afrin®) and pseudoephedrine use during lactation is _________
unknown
99
Consider use of _______ oxymetazoline before oral systemic decongestants (such as Sudafed).
nasal
100
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!
inhaled corticosteroid
101
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).
controller
102
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
Asthma
103
Treatment for _____________ asthma:
All adults and adolescents with ________ should receive either symptom-driven (in mild) or daily low dose ICS-containing controller treatment!!!
mild intermittent asthma
104
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 ________
```
ICS-containing controller
reliever inhaler (SABA)
```
105
Treatment for _____________ asthma:
| long-acting beta-agonist inhaler plus inhaled steroids to suppress the overactive immune response in the lungs.
mild persistent asthma
106
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
moderate persistent asthma
107
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.
severe persistent asthma
108
The presence of one severe feature is sufficient to diagnose _____________.
severe persistent asthma
109
Reducing ___________ is a critical element of treatment in asthma
airway inflammation
110
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
inhalers
111
When 2 inhalations are needed, an interval of at least ________ should separate the first inhalation from the second.
1 minute
112
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!
rescue drugs vs. maintenance drugs
113
The primary rescue drug for asthma is _______________, a short-acting beta-adrenergic agonist (SABA)
albuterol (AcuNeb ProAir HFA)
114
albuterol (AcuNeb ProAir HFA) and Levalbuterol (Xopenex) are given through ____________ or ____________
metered dose inhaler (MDI) or through a nebulizer
115
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
Levalbuterol (Xopenex)
116
contraindications of___________:
children under age 4 (sometimes Rx'd off-label)
nursing mothers
Levalbuterol (Xopenex)
117
Asthma __________:
Short-acting beta-2 agonists (SABAs)
Short-acting muscarinic agents (SAMAs)
Oral corticosteroids
Relievers
118
Asthma _________:
Inhaled corticosteroids
Leukotriene Modifiers/Leukotriene Receptor Antagonist (LTM/LTRA)
Inhaled corticosteroid/Long-acting beta-2-agonists
Controllers
119
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
Adrenal Suppression (hypothalamic-pituitary-adrenal (HPA) axis)
120
Increased occurrence of _____________ in:
younger children
patients receiving high doses for prolonged periods.
Adrenal Suppression (hypothalamic-pituitary-adrenal (HPA) axis)
121
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.
systemic corticosteroids; inhaled products
122
Adult patients receiving doses as low as ____ mg per day of prednisone (or equivalent) may be susceptible to adrenal suppression, especially if > ____ days.
20 mg
| 14 days
123
_______ steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.
aerosol
124
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
immunosuppression
125
chickenpox or measles should be avoided while using ___________
corticosteroids
126
________ should not be used while treating viral hepatitis or cerebral malaria, or TB
corticosteroids
127
Latent or active amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to _________ initiation
corticosteroid
128
Use __________ with extreme caution in patients with Strongyloidiasis infections (hyperinfection, dissemination and fatalities have occurred)
corticosteroids
129
Prolonged treatment with ____________ has been associated with the development of Kaposi sarcoma; if noted, discontinuation of therapy should be considered.
corticosteroids
130
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.
corticosteroids
131
____________ 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.
Corticosteroid
132
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.
Corticosteroid
133
Use caution with ____________ in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia
corticosteroids
134
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.
corticosteroids
135
______ are used only in combination with an ICS, not as monotherapy
LABAs
136
mainstay of maintenance therapy for asthma
inhaled glucocorticoids
137
Because they do not provide immediate relief of bronchoconstriction, ____________ should not be used alone for someone experiencing acute asthma symptoms.
inhaled glucocorticoids
138
can be given via inhaler, nebulizer, or systemically (PO, IV)
inhaled glucocorticoids
139
_____________ inhalers:
| beclomethasone, budesonide, flunisolide, fluticasone & triamcinolone
glucocorticoids
140
______ 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.
Advair
141
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.
inhaled steroids
142
```
Concerns of ____________:
growth restriction
bone loss
cataracts/glaucoma
tapered discontinuation
```
inhaled steroids
143
Cautions of __________:
oral candidiasis
immunosuppression
adrenal suppression
inhaled steroids
144
```
SE of __________:
Headache
Dizziness
Trouble sleeping
Inappropriate happiness.
Severe mood swings.
Hyperglycemia
Bone loss
```
PO glucocorticoids
145
Nedocromil (Tilade) and cromolyn sodium (Intal)
Mast cell stabilizers
146
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
Mast cell stabilizers
147
___________ may be used in children 5 years of age and older while montelukast (Singulair), may be used in children as young as 12 months
Zafirlukast (Accolate)
148
```
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)
```
montelukast (Singulair)
149
```
SE of ______________:
Headache
Dry mouth
Hoarseness
Cough
Stuffy Nose
Sinus Pain
Nausea
```
Antimuscarinic bronchodilators (Ipratropium bromide (Atrovent)
150
```
Drug Interactions of _________:
Macrolides
Quinolones
Cimetidine
Anticonvulsants
```
Methylxanthines:
| Aminophylline (Theophylline)
151
```
SE of ___________:
Stomach upset and heartburn.
Trouble sleeping (insomnia).
Headache
Nervousness or irritability
Rapid heart rate (tachycardia)
Rapid breathing (tachypnea)
```
Methylxanthines:
| Aminophylline (Theophylline)
152
Salmeterol (Serevent) is added to an inhaled corticosteroid _____________ for long-acting control of bronchoconstriction
fluticasone (Advair)
153
____________may be used alone in treating COPD symptoms but not for patients with asthma
LABAs
154
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!
LABAs
155
_____________ 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.
LABAs
156
```
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
```
LABAs
157
____________ 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).
Dupilumab
158
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 spacer or chamber (Areochamber)
159
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.
SABA (albuterol)
| LABA (formoterol)
160
always ask about asthma before prescribing ___________
NSAIDs w/ aspirin
161
_____________ is marked by sputum production
chronic bronchitis
162
for mild, intermittent asthma, no _________therapy is indicated
controller
163
_________ is the preferred inhaled corticosteroid for use during pregnancy.
Budesonide
164
the first-choice for asthma in pregnancy
Inhaled albuterol
165
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.
two, 20 min
166
For those with ___________ asthma, no controller therapy is indicated
mild, intermittent
167
__________ and _________ are considered safe in breastfeeding due to low bioavailability and maternal serum levels.
Albuterol and Budesonide
168
__________ 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
Theophylline
169
Research is non-existent for some asthma medications in breastfeeding, such as _________. In this case, an alternate medication is recommended
Zileuton
170
5 A's of Smoking Cessation
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
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.
nicotine replacement therapies (NRTs)
172
```
Precautions of ____________:
CV disease- tachycardia, HTN
angina
HTN
recent MI
```
nicotine replacement therapies (NRTs)
173
Discontinue ____________ if heart palpitations or arrythmia occur.
nicotine replacement therapies (NRTs)
174
```
SE of ___________ NRT:
Hypersalivation
Hiccups
Dyspepsia
Mouth/jaw soreness
```
nicotine gum
175
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
nicotine gum
176
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
nicotine gum
177
```
SE of ___________ NRT:
Nausea
Hiccups
Cough
Insomnia
```
nicotine lozenge
178
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
nicotine lozenge
179
Disadvantages of __________ NRT:
Need for frequent dosing can compromise adherence
GI side effects might be problematic for patients
nicotine lozenge
180
SE of ___________ NRT:
Local skin reactions (erythema, pruritus, burning)
Headache
Sleep disturbances (insomnia, abnormal/vivid dreams); associated with nocturnal nicotine absorption
transdermal patch
181
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
transdermal patch
182
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)
transdermal patch
183
```
SE of ___________ NRT:
Nasal and/or throat irritation (hot, peppery, or burning sensation)
Rhinitis
Tearing
Sneezing
Cough
Headache
```
nasal spray - Rx required!!
184
Advantages of _________ NRT:
Can be titrated to rapidly manage withdrawal symptoms
Can be used in combination with other agents
nasal spray - Rx required!!
185
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
nasal spray - Rx required!!
186
```
SE of ___________ NRT:
Mouth and/or throat irritation
Cough
Headache
Rhinitis
Dyspepsia
Hiccups
```
oral inhaler- Rx required!!!
187
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
oral inhaler- Rx required!!!
188
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
oral inhaler- Rx required!!!
189
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.
Partial Nicotinic Agonists- Chantix (Varenicline)
190
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.
Partial Nicotinic Agonists- Chantix (Varenicline)
191
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
Partial Nicotinic Agonists- Chantix (Varenicline)
192
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.
Partial Nicotinic Agonists- Chantix (Varenicline)
193
Contraindications of ____________:
| Use of MAO inhibitors (concurrently or within 14 days of discontinuing either bupropion or the MAO inhibitor).
Partial Nicotinic Agonists- Chantix (Varenicline)
194
this drug's exact mechanism unknown... Has antidepressant effect and primary mechanism of action is thought to be dopaminergic and/or noradrenergic
```
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
```
195
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).
```
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
```
196
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)
```
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
```
197
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.
```
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
```
198
```
Precautions for ALL ___________:
Recent (≤ 2 weeks) myocardial infarction
Serious underlying arrhythmias
Serious or worsening angina pectoris
Pregnancy and breastfeeding
Adolescents (<18 years)
```
nicotine replacement therapies (NRTs)
199
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
```
Antidepressant, Dopamine/Norepinephrine Re-uptake inhibitor
Bupropion SR (Zyban)
```
200
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
Partial Nicotinic Agonists- Chantix (Varenicline)
201
```
Avoid __________ in:
HTN
coronary artery disease- angina, MI
glaucoma
MAOI use
stimulants- caffeine, Ritalin
```
Decongestants
202
_____________ 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
Topical nasal decongestants
203
_________ such as diphenhydramine should be avoided in the elderly
Antihistamines
204
Nasal (topical) decongestants are safe while _________
breastfeeding
205
Potential adverse effects in pediatric population from misuse of ___________ include respiratory depression, neurological impairments, cardiovascular instability, and death
common cold medicines
206
primarily used for emergent situations in asthmatics and for routine therapy with COPD
Ipratropium Bromide (Atrovent)- Short Acting Muscarinic Agonist
207
________ is OK with an ICS for PRN inhaler because it has a quick onset of action like a SABA (Albuterol)
Formentol
208
Cautions for ________:
Heart Disease
Diabetes
Glaucoma
Albuterol
209
Beta2 agonists may increase risk of ________ so use caution in patients w/ CVD
arrythmias
210
MOA of ___________:
| Block late-phase activation to allergen and inhibit inflammatory cell migration and activation (ICS)
ICS Inhaled Corticosteroids
211
MOA of __________:
| Halts degradation of mast cells and release of histamine and other inflammatory agents
Mast cell stabilizers- Cromolyn
212
MOA of ___________:
| Suppresses the cytokine release and inhibits lung infiltration by neutrophils and other leukocytes
PDE4 Inhibitors
213
Which medications are controllers for asthma?
```
Leukotriene Modifier (Singulair)
Mast cell Stabilizer (Cromolyn)
Inhaled Corticosteroids (Flovent)
```
214
Cromolyn helps reduce ________ in asthma
inflammation
215
Do not give oral ____________ in:
Uncontrolled HTN
Tachyarrhythmia
Severe insomnia
decongestants
216
Critical teaching point for oral decongestants
Use only 3 days d/t rebound congestion, rhinitis medicamentosa - rebound nasal congestion that occurs after 3 days of using
