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Pharmacology > Exam 3: Respiratory Agents > Flashcards

Exam 3: Respiratory Agents Flashcards

1
Q

Class: antitussives

A

MOA: Acts on the cough control center of the medulla (CNS) to suppress the cough reflex -> decreases frequency and intensity of cough

Indications: Dry/annoying cough

Contraindications: Productive coughs

ADRs: different for nonopioid v. opioid

Interactions:

Implications:

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2
Q

Dextromethorphan

A

nonopioid antitussive

included in many different OTC meds, low dose, minimal ADRs
similar effect as opioids w/o ADRs
can have synergistic effect w/ morphine (enhance effectiveness for pain)
well absorbed, 15-30 min

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3
Q

Codeine

A

opioid antitussive

most effective antitussive
low dose (1/10 of the pain dose)
CNS depression -> sedation warning
Schedule V for cough and II for pain

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4
Q

Class: expectorants

A

MOA: Stimulates flow of secretions (turns non-prod into productive cough); Reduces viscosity and surface tension

Indications: Nonproductive coughs, colds, sinusitis, bronchitis

ADRs: Dizziness, HA, rash, urticaria

Implications: hydration still the best option -> push fluids

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5
Q

Guaifenesin

A

expectorant (Robitussin, Mucinex)

Used in many OTC meds

Action: ↓ mucus viscosity & ↓decrease surface tension

nonproductive cough&raquo_space;> productive

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6
Q

Class: mucolytic

A

MOA: Changes the molecular composition of mucus, decreases viscosity

Indications: THICK mucus: Chronic bronchitis, Cystic fibrosis

Contraindications: Severe respiratory insufficiency, asthma, or hx of bronchospasms

ADRs: Bronchospasm, N/V, rash, hypersensitivity (IV use more common)

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7
Q

Acetylcysteine

A

mucolytic (Mucomyst)

THICK mucus

ADR: Foul Odor, bronchospasm; n/v, runny nose, throat or lung irritation, sore mouth, stomatitis, hemoptysis

*can be used IV to reverse acetaminophen hepatotoxicity

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8
Q

Class: antihistamines

A

MOA: Histamine 1 receptor antagonists

Indications: prophylactic

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9
Q

Diphenhydramine

A

1st gen oral antihistamine (Benadryl)
“-ramine”

Contraindications: caution in patients with glaucoma, hyperthyroidism (^HR), HTN or BPH/urinary ret., BEERs

ADRs: sedation and **anticholinergic side effects

Interactions: CNS effects with ETOH, hypnotics, anti-psychotics, anxiolytics, narcotics- anticholinergic effects: antipsychotics, TCAs-

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10
Q

Loratidine

A

2nd gen oral antihistamine (Claritin)
“-dine” or “-zine”

non-sedating and fewer side effects

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11
Q

Azelastine, Olopatadine

A

2nd gen intranasal antihistamines

metered-spray device

ADR: epistaxis, HA , bad taste, possible somnolence reported by some patients

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12
Q

Class: Decongestants

A

sympathomimetics

MOA: Activates alpha1 adrenergic receptors on nasal blood vessels VASOCONSTRICTION

Indications: Nasal congestion

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13
Q

Oxymetazoline

A

Decongestant Intranasal

rapid nasal decongestion

ADRs: Rebound congestion from overuse

Implications: Limiting use to 3-5 consecutive days or break cycle: discontinuing use or dc one nares @time

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14
Q

Pseudoephedrine

A

Decongestant (Sudafed)

PO response is delayed, moderate, and prolonged

ADRs: systemic vasoconstriction, CNS -> restlessness, irritability, insomnia (similar to amphetamines)

Contraindications: Caution with CV disorders: HTN, CAD, arrhythmias, cerebrovascular disease

Implications: HIGH ABUSE POTENTIAL r/t to CNS stimulation

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15
Q

Class: Glucocorticoids

A

-SONE

MOA: Anti-inflammatory (decreases synthesis & release of mediators, infiltration and activity of inflammatory cells, and edema of airway mucosa)
* also increases the number of bronchial beta2 receptors and responsiveness to beta2 agonists

Indications: Prophylactic use for asthma or allergic rhinitis NOT FOR ATTACKS

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16
Q

Beclomethasone

A

INH glucocorticoid (IGC)

effective, daily, safer than PO

improved efficacy when used with a B2 agonist

low risk of toxicity - spacers, % absorbed

ADRs: Oral candidiasis, dysphonia

Implications: mouth rinses

17
Q

Prednisone

A

PO glucocorticoid

2nd line, when IGC isn’t controlling symptoms

ADRs: systemic -> Prolonged use (>10 days) -> Adrenal suppression; Osteoporosis, hyperglycemia, hypernatremia, hypokalemia, immunosuppression, fluid retention, growth suppression in children
**Acute adrenal insufficiency if abruptly withdraw

Implications: Recommend alternate day dosing if ADRs severe and would need to increase dosing if pt experiences extreme stress to compensate for their lack of endogenous response

18
Q

Fluticasone

A

Intranasal glucocorticoid

Best if used daily prophylactically, OTC and prescription

ADRs: primarily localized -> dry nasal mucosa, burning and/or itching, epistaxis (nosebleed), sore throat, & headache

19
Q

Class: leukotriene modifiers

A

anti- inflammatory

3 PO meds:
Zi LEU ton
Zafir LU kast
Monte LU kast

MOA: blocks leukotriene receptors, suppress effects of leukotrienes ↓ Bronchoconstriction ↓ Inflammatory response

Indications: Prophylactic asthma or COPD management (inadequate alone for asthma, 2nd line therapy)

ADRs: Neuropsychiatric effects

20
Q

Montelukast

A

PO (Singulair)

Indication: relieves nasal congestion

MOA: Blocks leukotriene receptors

21
Q

Class: monoclonal antibodies

A

anti- inflammatory
-MAB

SQ injection only

Indication: pts > 12years, allergy related, uncontrolled by IGC

MOA: Binds to IgE – these will limit the release of allergic mediators (histamine, leukotrienes)

ADRs: hypersensitivity/anaphylaxis

22
Q

Omalizumab

A

Monocolonal antibodies (Xolair)

Approved only for Allergy symptoms – esp. in Asthma

MOA: combines with free immunoglobulin E (IgE)…decreasing the available IgE to bind to receptors on the surface of mast cells. By decreasing mast cell activation, airway bronchospasm and airway inflammation are also decreased

ADRS: anaphylaxis

23
Q

Class: Mast cell stabilizer

A

anti- inflammatory

prophylactic, inhaled, safest - rare ADRs

MOA: Stabilizes the membrane of the Mast Cell; decreases release of inflammatory mediators = Suppresses inflammation

24
Q

Cromolyn

A

mast cell stabilizer

25
Q

Class: Beta 2 Adrenergic agonist

A

bronchodilator
- TEROL

MOA: sympathomimetic -> relaxes smooth muscle of bronchiole; promotes bronchodilation

Indications: Asthma/COPD and EIB

Implications: too high of a dose loses selectivity and pt can experience B1 ADRs

26
Q

Albuterol

A

SABA bronchodilator

selective B2 agonist -> don’t experience systemic effects unless dose too high

Indication: quick onset (5-30 min) -> used to ABORT ATTACK

ADRs: OD -> tachycardia, tremors, angina, seizures

27
Q

Salmeterol

A

LABA bronchodilator

prophylactic -> persistent or frequent attacks (not rescue), inhaled

selective B2 agonist -> don’t experience systemic effects unless dose too high

Not monotherapy: taken with glucocorticoids to increase effectiveness

28
Q

Class: Methylxanthines

A

bronchodilator

PO Theo PHYLLINE
IV Amino PHYLLINE

MOA: Relaxes smooth muscle of bronchi, bronchioles and pulmonary blood vessels

***Narrow therapeutic range: 5-15 mcg/mL

ADRs: can indicate toxicity vomiting, restless, dizzy, diarrhea, insomnia, Severe dysrhythmias , Ventricular dysrhythmias, convulsions

Interactions: caffeine & smoking

29
Q

Class: Anticholinergics

A

-PIUM

MOA: block muscarinic receptors -> block vasoconstriction in pulmonary blood vessels

Indications: approved for COPD and used off label for asthma

ADRs: ** anticholinergic side effects Dry mouth, irritation of pharynx, glaucoma, CV events

Tiotropium = LAMA (maintenance med for COPD)

30
Q

Drugs for Acute, Severe Asthma Exacerbation

A

Oxygen to relieve hypoxemia

Inhaled high-dose SAβA to relieve airflow obstruction

Systemic glucocorticoid to reduce airway inflammation

Nebulized ipratropium to further reduce airflow obstruction

(consider IV fluids)

31
Q

Phosphodiesterase-4 inhibitors

A

anti-inflammatory for COPD only to reduce exacerbation frequency
Roflumilast (Daliresp)

MOA: Selective inhibition of PDE-4 enzyme -> allows for accumulation of intracellular CyclicAMP
cAMP : Role as anti-inflammatory
^ cAMP -> decrease cytokines & inflammatory cells

ADR: mood changes, depression, suicidal behavior, weight loss, Loss of appetite, GI upset, diarrhea, insomnia, HA, dizziness

32
Q

“PIERr”

A

primary TB meds

Pyrazinamide
Isoniazid
Ethambutol
Rifampinr
rifapentine

MOA: bactericidal

ADRs: all hepatotoxic
Prophylactic treatment contraindicated for pt w/liver disease

Implications: Teachings around antibiotic use, monitor liver enzymes, teachings around signs of liver impairment (Stomach pain, Nausea, Anorexia, fatigue, Dark colored urine, clay colored stools, Jaundice)

33
Q

Isoniazid (INH)

A

Bactericidal -> highly selective for M. tuberculosis, primary for active & latent infections

ADRs: hepatotoxicity, peripheral neuropathies, drug induced B6 deficiency (CNS impact)

Interactions: CYP450 inhibitor (so monitor drug levels of other meds taken w/ it)

Implications: no alcohol, supplemental B, report new meds to provider, tingling in extremities

34
Q

Rifampin

A

Bactericidal: “broad spectrum”

ADRs: hepatotoxicity, discoloration of body fluids, GI disturbances

Interactions: anticoagulants and seizure meds *?

Teaching: glasses instead of contacts (staining), urine/tear discoloration

35
Q

Pyrazinamide

A

Bactericidal

ADRs: hepatotoxicity, non-gout polyarthralgia, n/v, rash, photosensitivity

36
Q

Ethambutol

A

Bacteriostatic: used when bacteria are sensitive rifampin & isoniazid -> effective against actively dividing mycobacteria

ADR: hepatotoxicity, Optic neuritis (Constricted visual fields, decreased ability to see red and green), GI distress, Anorexia, Nausea Other: confusion, disorientation, HA, peripheral neuritis

Admin with food

37
Q

Considerations for hepatotoxic drugs

A

monitor liver enzymes, avoid acetaminophen, alcohol

38
Q

Rifapentine

A

Long acting analog of Rifampin
only Respiratory TB (must be used w/another med due to resistance)
Same ADRS as Rifampin

39
Q

Considerations for CYP450 inhibitors

A

Decreasing levels of other medications because don’t have the same level of enzymes to metabolize the meds

especially important for meds with low therapeutic range

Pharmacology (12 decks)

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