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Pharm 2 > Exam One (PNS, OXYGENATION & TB) > Flashcards

Exam One (PNS, OXYGENATION & TB) Flashcards

1
Q

what percent of drug reaches the lungs with MDI?

A

10%

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2
Q

what percent of drug reaches the lungs with dry powder inhaler?

A

20%

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3
Q

How much time between puffs of albuterol?

A

1 minute between puffs

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4
Q

How much time between albuterol and glucocorticoid?

A

5 minutes between puffs

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5
Q

Two classes of respiratory medications?

A

Bronchodilators and anti-inflammatory

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6
Q

Three classes of bronchodilators

A
  1. Beta-2 Agonists
  2. Anticholinergics
  3. Methylxanthines
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7
Q

Five classes of anti-inflammatory medications

A
  1. Glucocorticoids
  2. Leukotriene modifiers
  3. Mast cell stabilizers
  4. Monoclonal Antibodies
  5. Phosphodiesterase Inhibitors
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8
Q

MOA Beta-2 agonists

A

act by relaxing bronchial smooth muscle –> bronchodilation

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9
Q

What is the drug of choice for bronchoconstriction

A

Beta-2 agonists

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10
Q

Drug of choice for acute bronchoconstriction

A

SABA

- Albuterol (Proventil HFA)

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11
Q

Albuterol =

A

Proventil HFA

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12
Q

What is given during an asthma attack?

A

Albuterol

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13
Q

what is LABA used for

A

prevention and maintenance

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14
Q

Prototype for LABA

A

Salmeterol (servent diskus)

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15
Q

Salmeterol =

A

Servent diskus

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16
Q

Is LABA used alone?

A

NO; increased risk of death so use with glucocorticoid

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17
Q

SE for beta-2 agonists (high doses)

A

tachycardia, tremors, palpitations, angina

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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

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19
Q

MOA for anticholinergics

A

blocks the parasympathetic nervous system –> bronchodilation

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20
Q

Prototype for anticholinergics

A

Ipratropium (atrovent)

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21
Q

Ipratropium =

A

atrovent

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22
Q

Onset for SABA
Peak
Q ?

A

Onset = immediate
Peak = 30-60 min
Q 6H in hospital

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23
Q

Onset for anticholinergics
Peak
Lasts?

A 
Onset = 30 seconds
Peak = 3 minutes
Lasts = 6 hours
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24
Q

SE of anticholinergics

A

dry mouth, irritation of pharynx

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25
Q

Contraindications for anticholinergics

A

peanut allergy and glaucoma (increase IOP)

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26
Q

Methylxanthines oral prototype

A

Theophylline (theodur)

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27
Q

Theophylline =

A

theodur

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28
Q

Why are methylxanthines no longer standard therapy

A

narrow margin of safety
- NO SMOKING!
Half life varies 2-15 hours
Drug-drug interactions

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29
Q

Methylxanthines IV prototype

A

Aminophylline (somophyllin)

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30
Q

Aminophylline =

A

somophyllin

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31
Q

Aminophylline admin?

A

SLOW iv admin

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32
Q

MOA of glucocorticoids

A

suppress inflammation

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33
Q

Prototype of glucocorticoids

A

Beclomethasone

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34
Q

Combination glucocorticoid therapy

A 
Adavir discus (fluticasone + salmetrol)
Symbicort (budesonide + formoterol)
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35
Q

Inhaled glucocorticoid therapy used for ___

A

prevention

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36
Q

how long for full effects of inhaled glucocorticoids

A

1-4 weeks for full effects

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37
Q

SE of glucocorticoids

A

adrenal suppression, candidiasis, dyphonia

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38
Q

how to prevent candidiasis with glucocorticoids

A

last med taken, rinse and spit

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39
Q

oral glucocorticoids given for ____

A

acute bronchoconstriction

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40
Q

oral glucocorticoid prototype

A

prednisone

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41
Q

iv glucocorticoid prototype

A

methylprednisone (solumedrol)

42
Q

how do you transition from oral to inhaled glucocorticoids?

A

use both for a while, then off oral (if you just stop you’ll face adrenal suppression)

43
Q

what glucocorticoid is given for acute asthma that has been hospitalized

A

high dose solumedrol for several days

44
Q

MOA of leukotriene modifiers

A

modifying the action of leukotrienes

45
Q

why are leukotrienes important

A

important in the inflammatory response resulting in edema, inflammation and bronchoconstriction

46
Q

prototype for leukotriene modifiers

A

montelukast (singular)

47
Q

montelukast =

A

singular

48
Q

how long for effects of montelukast

A

24 hours to see maximum effects

49
Q

SE of montelukast

A

neuropsych effects (depression and suicidal ideation)

50
Q

MOA of mast cell stabilizers

A

inhibits mast cells from releasing histamine and other chemical mediators of inflammation

51
Q

prototype of mast cell stabilizers

A

Cromolyn (intal)

52
Q

how do you admin mast cell stabilizers

A

nebulizer

53
Q

SE of mast cell stabilizers

A

cough and bronchospasm

- rebound bronchospasm if stopped abruptly

54
Q

Prototype of monoclonal antibodies

A

Omalizumab (Xolair)

55
Q

Omalizumab =

A

xolair

56
Q

MOA of monoclonal antibodies

A

binds to IgE in the body

57
Q

when do you use monoclonal antibodies

A

severe, persistent allergic asthma not controlled by high dose steroids

58
Q

administration of monoclonal antibodies

A

injected SQ Q2-4 weeks

59
Q

why are monoclonal antibodies difficult

A

$10,000/year

60
Q

SE of monoclonal antibodies

A

viral infections, URI, sinusitis, headache, injection site response

61
Q

serious SE of monoclonal antibodies

A

anaphylaxis

62
Q

aggravators of allergic asthma

A

pet dander and dust mite feces

63
Q

prototype for phosphodiesterase type 4 (PDE4) inhibitor

A

roflumilast

64
Q

MOA PDE4 inhibitor

A

blocks action of enzyme PDE4 that breaks down cAMP resulting in a decrease in release of inflammatory response

65
Q

indication for PDE4 inhibitor

A

severe COPD with chronic bronchitis

66
Q

common SE for PDE4 inhibitors

A

loss of appetite and weight loss

67
Q

serious SE for PDE4 inhibitors

A

psychiatric effect (anxiety, depression, suicidal ideation)

68
Q

two categories for allergic rhinitis

A

preventers and relievers

69
Q

3 preventers for allergic rhinitis

A
  1. Antihistamines
  2. Intranasal glucocorticoids
  3. mast cell stablizers
70
Q

relievers for allergic rhinitis

A

oral and nasal decongestants (sympathomimetics)

71
Q

antihistamine MOA

A

work to block the actions of histamine at the H1 receptor classified as 1st generation and 2nd generation

72
Q

methods for admin antihistamines

A

oral and intranasal

73
Q

Antihistamines more effective when taken ____

A

prophylactically

74
Q

prototype 1st generation antihistamine

A

diphenhydramine (Benadryl)

75
Q

SE of diphenhydramine

A

sedation, anticholinergic effects (dry mouth, trouble urinating, etc)

76
Q

prototype 2nd generation antihistamine

A

loratadine (Claritin)

77
Q

benefit of 2nd generation antihistamine

A

less sedation

78
Q

what is most effective for seasonal allergies

A

intranasal glucocorticoids

79
Q

SE for intranasal glucocorticoids

A

drying/burning sensation, epistaxis

80
Q

prototype for intranasal glucocorticoids

A

fluticasone (Flonase)

81
Q

fluticasone =

A

flonase

82
Q

Sympathomimetics/ Decongestants MOA

A

stimulate SNS to relieve congestion

alpha-1 agonist (vasoconstriction of nasal blood vessels)

83
Q

administration of decongestants

A

oral or intranasal routes

84
Q

SE of decongestants

A

HTN, CNS stimulation (insomnia)

85
Q

what type of patients should not receive decongestants

A

cardiac patients

86
Q

prototype of oral decongestants

A

pseudoephedrine (Sudafed)

87
Q

pseudoephedrine =

A

sudafed

88
Q

prototype of intranasal decongestants

A

oxymetazoline (afrin)

89
Q

oxymetazoline =

A

afrin

90
Q

what do you watch out for with intranasal decongestants

A

rebound congestion

91
Q

rebound congestion

A

prolonged use causes escalating congestion requiring more drug to get the same result

92
Q

how long should patients use intranasal decongestants

A

3-5 days

93
Q

how to stop intransal decongestants

A

nasal glucocorticoid for 2-6 weeks; starting 1 week before stopping intranasal decongestant

94
Q

Antitussives (two options?)

A

opioid and non-opioid

95
Q

opioid antitussive prototype

A

codeine

96
Q

non opioid antitussive prototype

A

dextomethorpan (robotussin)

97
Q

dextomethorpan =

A

robotussin

98
Q

what does an expectorant do

A

stimulate the flow of secretions

99
Q

prototype experctorant

A

guaifenesin

100
Q

what does a mucolytic do

A

makes mucus more water; and cough more productive

101
Q

prototype mucolytic

A

acetylcysteine (mucomyst)

Pharm 2 (2 decks)

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