Exam One (PNS, OXYGENATION & TB) Flashcards
1
Q
what percent of drug reaches the lungs with MDI?
A
10%
2
Q
what percent of drug reaches the lungs with dry powder inhaler?
A
20%
3
Q
How much time between puffs of albuterol?
A
1 minute between puffs
4
Q
How much time between albuterol and glucocorticoid?
A
5 minutes between puffs
5
Q
Two classes of respiratory medications?
A
Bronchodilators and anti-inflammatory
6
Q
Three classes of bronchodilators
A
- Beta-2 Agonists
- Anticholinergics
- Methylxanthines
7
Q
Five classes of anti-inflammatory medications
A
- Glucocorticoids
- Leukotriene modifiers
- Mast cell stabilizers
- Monoclonal Antibodies
- Phosphodiesterase Inhibitors
8
Q
MOA Beta-2 agonists
A
act by relaxing bronchial smooth muscle –> bronchodilation
9
Q
What is the drug of choice for bronchoconstriction
A
Beta-2 agonists
10
Q
Drug of choice for acute bronchoconstriction
A
SABA
- Albuterol (Proventil HFA)
11
Q
Albuterol =
A
Proventil HFA
12
Q
What is given during an asthma attack?
A
Albuterol
13
Q
what is LABA used for
A
prevention and maintenance
14
Q
Prototype for LABA
A
Salmeterol (servent diskus)
15
Q
Salmeterol =
A
Servent diskus
16
Q
Is LABA used alone?
A
NO; increased risk of death so use with glucocorticoid
17
Q
SE for beta-2 agonists (high doses)
A
tachycardia, tremors, palpitations, angina
18
Q
How to administer beta-2 agonists
A
start to inhale, activate inhaler, hold the breath for 10 seconds, then wait 1 minute before second inhalation
19
Q
MOA for anticholinergics
A
blocks the parasympathetic nervous system –> bronchodilation
20
Q
Prototype for anticholinergics
A
Ipratropium (atrovent)
21
Q
Ipratropium =
A
atrovent
22
Q
Onset for SABA
Peak
Q ?
A
Onset = immediate
Peak = 30-60 min
Q 6H in hospital
23
Q
Onset for anticholinergics
Peak
Lasts?
A
Onset = 30 seconds Peak = 3 minutes Lasts = 6 hours
24
Q
SE of anticholinergics
A
dry mouth, irritation of pharynx
25
Contraindications for anticholinergics
peanut allergy and glaucoma (increase IOP)
26
Methylxanthines oral prototype
Theophylline (theodur)
27
Theophylline =
theodur
28
Why are methylxanthines no longer standard therapy
narrow margin of safety
- NO SMOKING!
Half life varies 2-15 hours
Drug-drug interactions
29
Methylxanthines IV prototype
Aminophylline (somophyllin)
30
Aminophylline =
somophyllin
31
Aminophylline admin?
SLOW iv admin
32
MOA of glucocorticoids
suppress inflammation
33
Prototype of glucocorticoids
Beclomethasone
34
Combination glucocorticoid therapy
```
Adavir discus (fluticasone + salmetrol)
Symbicort (budesonide + formoterol)
```
35
Inhaled glucocorticoid therapy used for ___
prevention
36
how long for full effects of inhaled glucocorticoids
1-4 weeks for full effects
37
SE of glucocorticoids
adrenal suppression, candidiasis, dyphonia
38
how to prevent candidiasis with glucocorticoids
last med taken, rinse and spit
39
oral glucocorticoids given for ____
acute bronchoconstriction
40
oral glucocorticoid prototype
prednisone
41
iv glucocorticoid prototype
methylprednisone (solumedrol)
42
how do you transition from oral to inhaled glucocorticoids?
use both for a while, then off oral (if you just stop you'll face adrenal suppression)
43
what glucocorticoid is given for acute asthma that has been hospitalized
high dose solumedrol for several days
44
MOA of leukotriene modifiers
modifying the action of leukotrienes
45
why are leukotrienes important
important in the inflammatory response resulting in edema, inflammation and bronchoconstriction
46
prototype for leukotriene modifiers
montelukast (singular)
47
montelukast =
singular
48
how long for effects of montelukast
24 hours to see maximum effects
49
SE of montelukast
neuropsych effects (depression and suicidal ideation)
50
MOA of mast cell stabilizers
inhibits mast cells from releasing histamine and other chemical mediators of inflammation
51
prototype of mast cell stabilizers
Cromolyn (intal)
52
how do you admin mast cell stabilizers
nebulizer
53
SE of mast cell stabilizers
cough and bronchospasm
| - rebound bronchospasm if stopped abruptly
54
Prototype of monoclonal antibodies
Omalizumab (Xolair)
55
Omalizumab =
xolair
56
MOA of monoclonal antibodies
binds to IgE in the body
57
when do you use monoclonal antibodies
severe, persistent allergic asthma not controlled by high dose steroids
58
administration of monoclonal antibodies
injected SQ Q2-4 weeks
59
why are monoclonal antibodies difficult
$10,000/year
60
SE of monoclonal antibodies
viral infections, URI, sinusitis, headache, injection site response
61
serious SE of monoclonal antibodies
anaphylaxis
62
aggravators of allergic asthma
pet dander and dust mite feces
63
prototype for phosphodiesterase type 4 (PDE4) inhibitor
roflumilast
64
MOA PDE4 inhibitor
blocks action of enzyme PDE4 that breaks down cAMP resulting in a decrease in release of inflammatory response
65
indication for PDE4 inhibitor
severe COPD with chronic bronchitis
66
common SE for PDE4 inhibitors
loss of appetite and weight loss
67
serious SE for PDE4 inhibitors
psychiatric effect (anxiety, depression, suicidal ideation)
68
two categories for allergic rhinitis
preventers and relievers
69
3 preventers for allergic rhinitis
1. Antihistamines
2. Intranasal glucocorticoids
3. mast cell stablizers
70
relievers for allergic rhinitis
oral and nasal decongestants (sympathomimetics)
71
antihistamine MOA
work to block the actions of histamine at the H1 receptor classified as 1st generation and 2nd generation
72
methods for admin antihistamines
oral and intranasal
73
Antihistamines more effective when taken ____
prophylactically
74
prototype 1st generation antihistamine
diphenhydramine (Benadryl)
75
SE of diphenhydramine
sedation, anticholinergic effects (dry mouth, trouble urinating, etc)
76
prototype 2nd generation antihistamine
loratadine (Claritin)
77
benefit of 2nd generation antihistamine
less sedation
78
what is most effective for seasonal allergies
intranasal glucocorticoids
79
SE for intranasal glucocorticoids
drying/burning sensation, epistaxis
80
prototype for intranasal glucocorticoids
fluticasone (Flonase)
81
fluticasone =
flonase
82
Sympathomimetics/ Decongestants MOA
stimulate SNS to relieve congestion
| alpha-1 agonist (vasoconstriction of nasal blood vessels)
83
administration of decongestants
oral or intranasal routes
84
SE of decongestants
HTN, CNS stimulation (insomnia)
85
what type of patients should not receive decongestants
cardiac patients
86
prototype of oral decongestants
pseudoephedrine (Sudafed)
87
pseudoephedrine =
sudafed
88
prototype of intranasal decongestants
oxymetazoline (afrin)
89
oxymetazoline =
afrin
90
what do you watch out for with intranasal decongestants
rebound congestion
91
rebound congestion
prolonged use causes escalating congestion requiring more drug to get the same result
92
how long should patients use intranasal decongestants
3-5 days
93
how to stop intransal decongestants
nasal glucocorticoid for 2-6 weeks; starting 1 week before stopping intranasal decongestant
94
Antitussives (two options?)
opioid and non-opioid
95
opioid antitussive prototype
codeine
96
non opioid antitussive prototype
dextomethorpan (robotussin)
97
dextomethorpan =
robotussin
98
what does an expectorant do
stimulate the flow of secretions
99
prototype experctorant
guaifenesin
100
what does a mucolytic do
makes mucus more water; and cough more productive
101
prototype mucolytic
acetylcysteine (mucomyst)
