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Last Pharm for Exam 1 Flashcards

1
Q

What are the 2 delivery options of respiratory meds?

A

Systemic Delivery (Oral or Injection)
Inhaled

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2
Q

Which delivery option is more selective for the respiratory tract? And why?

A

Inhaled because they are much better at delivering drug directly to the lungs

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3
Q

What is one main reason you would choose to use systemic delivery of respiratory meds?

A

They can reach lungs via pulmonary circulation if airway is obstructed (acute asthma, severe COPD)

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4
Q

What are the primary delivery options of inhaled respiratory meds?

A
  • Metered Dose Inhaler (MDI)
  • Nebulizer
  • Dry power inhaler
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5
Q

What are the 4 categories of respiratory meds?

A
  1. Control of respiratory tract irritation & secretion
  2. Bronchodilators
  3. Control of airway inflammation
  4. Other meds
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6
Q

What are some examples of medications that control respiratory tract irritation & secretion?

A
  • Antitussives
  • Antihistamines
  • Decongestants
  • Mucolytics, expectorants `
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7
Q

What is the mechanism of Antitussives: opioids?

A

Suppress cough reflex at brainstem

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8
Q

Antitussives:opioids are often combined with (BLANK) in OTC products

A

Decongestants

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9
Q

What are some examples of Antitussives: opioids ?

A

Codeine
Dextromethorphane
Hydrocodone

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10
Q

What is the mechanism of Benzonatate (antitussive)?
And what does this cause?

A
  • Has an anesthetic effect on vagal nerve endings in the airway
  • Causes a reduction to effects of irritation that starts the cough reflex
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11
Q

What are the primary problems of Antitussives?

A
  • Sedation
  • Dizziness
  • GI upset
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12
Q

What are the rehab concerns when a patient is using Antitussives?

A
  • Overuse, dependence
  • May limit productive cough
  • Not proven to be effective in children
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13
Q

Are cough meds recommended for children?

A

No
- Found to offer no symptomatic relief for acute cough in children
- Use of cough & cod meds place young children at risk for potential side effects & adverse reactions

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14
Q

What is the mechanism of Antihistamines?

A
  • Block H1 receptors which decreased the effects of histamine on upper respiratory tract
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15
Q

What are antihistamines used to treat?

A
  • Histamine mediated coughing, sneezing, & irritation
  • Widespread use: seasonal allergies, colds
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16
Q

What is the main difference between the old agent of antihistamine and the new agent?

A

New agents are non- sedating because the do not cross the blood brain barrier

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17
Q

What are the primary problems of antihistamines if they cross the blood brain barrier?

A
  • Sedation, fatigue
  • Incoordination, blurred vision
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18
Q

What are the rehab concerns in patients using antihistamines?

A
  • Sedative effects
  • Dry out respiratory tract (limit productive cough)
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19
Q

What is the primary drugs used to treat excessive coughing?

A

Opioid derivaties (antitussives)

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20
Q

What are some bronchodilators?

A
  • Beta adrenergic agonist
  • Xanthine derivates
  • Anticholingerics
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21
Q

What is the mechanism of Beta - adrenergic agonists?

A
  • Stimulate beta 2 receptors on airway smooth muscle
  • Increase intracellular production of cyclic AMP (2nd messenger)
  • cAMP initiates smooth muscle relaxation = bronchodilator
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22
Q

What are some Nonselective beta agonists?

A
  • Epinephrine
  • Isoproterenol
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23
Q

What are some selective beta agonists?

A
  • Albuterol
  • Formoterol
  • Metaproterenol
  • Salmeterol
  • Terbutaline
  • Suffix -erol indicates beta 2 agonist*
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24
Q

What is the primary problems of excessive use of beta- adrenergic agonists?

A
  • Bronchial irritation/constriction
  • Cardiac stimulation
  • CNS stimulation
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25
What are the rehab concerns in patients using beta-adrenergic agonist?
- Use before postural drainage - Look for signs of overuse
26
To produce bronchodilation a drug should selectively stimulate (BLANK) receptors in airway smooth muscle
beta-2
27
Xanthine derivatives are chemically similar to (BLANK)
caffeine, other methyl xanthines
28
What are the primary examples of Xanthine derivatives?
- Theophylline - Aminophylline
29
What is the mechanism of Theophylline (powerful bronchodilator)?
- Exact mechanism unclear - Probably a combination of: - inhibition of cAMP breakdown - Blocking adenosine stimulation - Inhibit intracellular Ca++ release - Anti inflammatory effects
30
What is the primary problem with Theophylline?
Theophylline toxicity - Toxicity begins if plasma levels >15 micrograms/ml and serious if >20 micrograms/ml
31
What are the signs of Theophylline toxicity?
- Nausea, confusion, irritability, restlessness - Cardia arrhythmias, seizures
32
When does the risk of theophylline toxicity increase?
If metabolism is impaired - Liver disease - Congestive heart failure - Patient age > 55 - Infections such as pneumonia - Concomitant use of other drugs
33
What is the mechanism of anticholinergic drugs?
- They block acetylcholine receptors (acetylcholine stimulates bronchial smooth muscle contraction)
34
What are some examples of Anticholinergic drugs?
Ipratropium Tiotropium
35
Anticholinergic are tolerated well at (BLANK) doses and side effects increase at (BLANK) doses
- tolerated at Lower doses - Side effects increase at higher doses
36
Describe the mechanism of decongestants
- Stimulates Alpha 1 receptors agonist (epinephrine, pseudoephedrine, many others) which vasoconstriction nasal mucosa
37
How should decongestants be administered and why?
- Should be administered locally (nasal spray) when possible because oral (systemic) administration may cause serious side effects
38
What are the primary problems of decongestants?
- Headache, nausea, nervousness - Cardiovascular stimulation
39
What are some of the rehab concerns for patients on decongestants?
- Dependence, overuse, abuse - Cardiac palpitations, increased BP
40
Decongestants used commonly in OTC products are designed to cause (BLANK) in the nasal mucosa, but systemic use can also cause a serious (BLANK) in certain patients.
Vasoconstriction increase in blood pressure
41
What do mucolytics do?
Break up, decrease the viscosity of mucous; make it easier to raise & expel secretions
42
What do Expectorants do?
Increase production of a thinner, more liquid phlegm; enhance effects of mucolytics
43
What is the mechanism of the primary mucolytics, Acetylcysteine?
Breaks up disulfide bounds in mucous which decreases viscosity
44
What is Acetylcysteine an antidote for?
acetaminophen poisoning
45
What is the mechanism of the more serious mucolytic, Dornase alfa?
- Breaks up DNA that has been released from inflammatory cells in airway - DNA makes mucous very viscous, so this drug reduces the DNA "glue" that holds mucous together
46
What patient population is Dornase alfa very helpful with?
People with cystic fibrosis
47
How does the primary expectorants, Guaifenesin work?
- Increases fluid content of phlegm which makes phlegm less viscous and easier to expel
48
Primary expectorants are found in many (BLANK) products
OTC
49
What are the primary problems of Mucolytics & Expectorants?
- Usually well tolerated - May have nausea, vomiting, irritation of mouth with excessive use
50
What are the rehab concerns in patient using Mucolytics & Expectorants?
- No major concern - Beneficial during postural drainage, vibration, percussion
51
What are 3 drugs that can control airway inflammation?
Anti- inflammatory steriods - Cromones - Leukotriene modifers
52
Anti- inflammatory steroids have powerful effects and inhibit what?
Virtually all components of the inflammatory response
53
What can be the issue with systemic administration of anti-inflammatory steroids? What development did this lead to?
- Issue: Many harmful catabolic & metabolic side effects - Development: of inhaled agents
54
The development of anti-inflammatory steroids inhaled agents caused what?
- Enabled the use of lower doses b/c drug is applied directly to respiratory tissues - Allowed earlier, more extensive use in airway disease
55
What are the rehab concerns when your patients are on anti-inflammatory steroids?
Severe side effects minimized if inhaled at limited daily dosage
56
What are anti-inflammatory steroids usually combined with? And what population is this combo useful in?
- Bronchodilator (usually long acting beta 2 agonist) - Useful in COPD & asthma
57
What is the mechanism of Cromones?
Prevents release of histamine, inflammatory mediators from pulmonary mast cells - Can prevent attack if taken before exposure to initiating agent/activity
58
What are Leukotrienes?
- Lipid compounds that mediate inflammatory response - Play important role in airway inflammation - Produced from arachdonic acid by lipoxygenase enzyme
59
How does the Leukotriene modifier, zileuton work?
Lipoxygenase inhibitor
60
How does the Leukotriene modifier, montelukast & zafirlukast work?
Leukotriene receptor blockers
61
How does supplemental oxygen work?
Can reduce hypoxemia whenever alveolar PO2 is unable to provide adequate O2 delivery to pulmonary circulation
62
What are some methods of delivering supplemental oxygen?
- Nasal cannula - Mask - Tent/hood - Direct delivery to endotracheal tube
63
Supplemental O2 is dosed in?
Liters per minute Hours per day
64
What is the typical desired SaO2 in patients with COPD & other patients?
COPD: 88-92% Other patients: 94-98%
65
What are the benefits of supplemental O2?
- Increase exercise tolerance - Decrease morbidity due to better oxygenation of tissues - Improved quality of life
66
What are the risks of supplemental O2?
- Fire - Nasal cannula, face mask can cause dry nose = nose bleeds - Tracheal administration: dry out airway, cause irritation & mucous occlusion - Oxygen toxicity
67
What is the mechanism of oxygen toxicity?
- O2 increase likelihood of generating free radicals - These free radicals damage membranes, proteins & DNA in various cells which lead to cell impairment & tissue/organ damage
68
What are some CNS signs/symptoms of oxygen toxicity?
- Muscle twitching - Dizziness - Confusion - Nausea - Incoordination - Loss of consciousness - Convulsions
69
How is surfactant replacement typically administered?
To neonates via endotracheal tube
70
What are the risks of surfactant replacement?
- Pulmonary or intracranial hemorrhage - Obstruct airway - Decrease O2 saturation during administration
71
What does Nitric oxide do to vascular smooth muscle?
Relaxes
72
How is nitric oxide administered?
-Inhalation to neonates to facilitate perfusion (improve V/Q ration)
73
Nitric Oxide may (BLANK) chance of survival and (BLANK) risk of developing chronic lung disease in some neonates
- Increase - Decrease
74
What are some drugs to help quit smoking?
- Nicotine replacement - Bupropion - Varenicline
75
How does Bupropion help people quit smoking?
Prolongs effects of dopamine, norepinephrine in brain which may decrease nicotine craving
76
How does Varenicline help people quit smoking?
- Partial agonist at nicotine receptors
77
What are some examples of other meds that help in pulmonary disease?
- antianxiety agents & sedatives - Opioid analgesics - NMJ blockers - Treatment & prevention of infections

Clinical Med (Year 2) (17 decks)

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