Exam 2 Prep - Respiratory

Question 1

There are two black box warnings for LABAs:

Answer 1

1. NEVER EVER give them in an acute exacerbation, because they can actually make matters worse
2. NEVER EVER give them without an ICS

Question 2

There are two classifications of bronchodilators:

Answer 2

Anticholinergics (SAMA, LAMA)

Beta AGONISTS (SABA, LABA)

Question 3

What is the most commonly used SAMA?

Answer 3

Ipratropium

Question 4

What is the most commonly used SABA?

Answer 4

Albuterol

Question 5

What do phosphodiesterase inhibitors do?

Answer 5

They inhibit the enzyme that breaks down cAMP

In smooth muscles, cAMP activation actually INHIBITS contraction

So if we increase the amount of cAMP in smooth muscle cells, we’re decreasing its contractility

Question 6

Which respiratory drug class is comprised of phosphodiesterase inhibitors?

Answer 6

Methylxanthines are all phosphodiesterase inhibitors

Question 7

Which type of bronchodilator is more effective in COPD: A beta agonist or an anticholinergic?

Answer 7

An anticholinergic (SAMA)

Question 8

What percentage of MDIs is delivered to the lungs?

DPIs?

Answer 8

MDIs 10% without a spacer

DPIs 20%

Question 9

Name two SABAs

Answer 9

Albuterol

Levalbuterol

Question 10

Name two LABAs

Answer 10

Salmeterol

Formoterol

Question 11

Name three ICSs

Answer 11

Beclomethasone (QVAR)

Budesonide (Pulmicort)

Fluticasone (Flovent)

Question 12

Which oral glucocorticoids are used for relief of COPD and asthma?

Answer 12

Prednisone

Prednisolone

Question 13

Name two drugs that are ICS/LABA combinations

Answer 13

Fluticasone/Salmeterol (Advair)

Budesonide/Formoterol (Symbicort)

Question 14

Mast Cell Stabilizer

MOA, Therapeutic Use, Drug List

Answer 14

Blocks degranulation

Cromolyn

Used for asthma prevention, especially cold weather and exercise induced asthma

Question 15

METHYLXANTHINES

Drugs, MOA, Uses

Answer 15

Theophylline

Phosphodiesterase Inhibitor

Long term control of COPD and nocturnal asthma attacks

Question 16

What is a therapeutic theophylline level?

Answer 16

10-20

Levels >30 cause severe dysrhythmias

Question 17

What are the symptoms of Theophylline overdose?

Answer 17

N/V/D

Tachydysrhythmias

(Makes sense, because increasing cAMP would cause increased inotropy in the heart)

Question 18

Theophylline should never be taken by patients who consume large amounts of:

Answer 18

Caffeine

Question 19

Name two anticholinergic bronchodilators:

Answer 19

SAMA: Ipratropium Bromide (DuoNeb, Atrovent)

LAMA: Tiotropium (Spiriva)

Question 20

Name a Leukotriene Receptor Antagonist that is used is respiratory disease

Answer 20

Montelukast (Singular)

Question 21

What is a major concern for patients taking Singular?

Answer 21

Studies have shown increased rates of suicide and depression

Question 22

List the centrally acting and peripherally acting antihistamines

Answer 22

Centrally Acting

• Benadryl
• Chlorpheniramine

Peripherally Acting

• Fexofenadine (Allegra)
• Loratadine (Claritin)
• Cetirizine (Zyrtec)
• Levocetirizine (Xyzal)

Question 23

Antihistamines are used for ______ rhinitis

Answer 23

Seasonal allergic

Question 24

What is the first line treatment for perennial allergic rhinitis?

Answer 24

Intranasal glucocorticoids

Question 25

List four intranasal glucocorticoids

Answer 25

1. Beclomethasone
2. Fluticasone
3. Budesonide
4. Triamcinolone

Question 26

What should patients know before beginning an intranasal glucocorticoid?

Answer 26

It will take 3-4 weeks to work

can slow (but not stunt) the growth of children

Question 27

Histamine is used by the body in three ways:

Answer 27

1. Released by mast cells and basophils for local inflammation and vasodilation
2. Used as a neurotransmitter in the brain
3. Stimulates acid secretion by enterochromaffin cells in the stomach

Question 28

What is the role of H1 receptors in the brain?

Answer 28

Wakefulness

Appetite Suppresion