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Advanced Pharmacology > Lesson 2: Mucolytics, Corticosteroids, & Nonsteroidal Antiasthma Drugs > Flashcards

Lesson 2: Mucolytics, Corticosteroids, & Nonsteroidal Antiasthma Drugs Flashcards

1
Q

What diseases use mucolytics?

A

CF, chonic bronchitis, PNA, asthma, and bronchectasis

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2
Q

3 FDA approved mucoactive agents

A

N-acetylcyseine: Mucomyst
Dornase Alfa: Pulmozyme
Hypersmoler saline: Hypertonic saline

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3
Q

What are the two doses for mucomyst

A

10% or 20%
SVN: 3-5 mL

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4
Q

What is the dose for Dornase Alfa

A

2.5 mg QD

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5
Q

What are the side affects associated with Dornase Alfa

A

Voice alteration, pharyngitis, rash, chest pain

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6
Q

What is the dose for hypertonic saline

A

7% for sputum induction

Note: 0.9% is normal saline

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7
Q

What are the contraindications of mucolytics

A

Profound airway compromise: FEV1 <25% predicted
Severely compromised: Vital capacity, expiratory flow
Inability to protect airway

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8
Q

What steroids are naturally secreted by the adrenal glands, and what do they do?

A

Cortisol: Circadian rhythm, stress hormone

Aldosterone: regulates body water by increasing sodium reabsorption in renal tubules

Androgens and estrogens: sex hormones

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9
Q

What does administering steroidal drugs supress?

A

naturally occurring steroids (adrenal supression)

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10
Q

Indications for corticosteroids

A

Maintenance therapy of asthma and severe COPD

Control of allergic and nonallergic rhinitis

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11
Q

What step is corticosteroids indicated in the asthma guidelines?

A

Step 2

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12
Q

What is the HPAA control?

A

Hypothalamic - pituitary - adrenal axis: body’s feedback mechanism for controlling the production of corticosteroids

Plays large role in times of stress

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13
Q

What is the main purpose of cortisol

A

Helps mobilize glucose for energy

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14
Q

What must you do before discontinuing steroid tx

A

Must taper dosage of steroids to allow for body to being producing steroids naturally

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15
Q

Why does steroid diabetes happen?

A

Corticosteroids make the liver less sensitive to insulin, so it continues to make glucose with high levels of insulin.

It also reduces the ability of muscle and fats to absorb glucose for use.

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16
Q

Why does corticosteroids cause muscle wasting

A

Causes a breakdown of protein stores

Low doses and low systemic distribution, inhaled corticosteroids do not usually see muscle wasting and diabetes as side effects

17
Q

Why does corticosteroids cause overall increase in white cell count

A

Demargination: causes a depletion of neutrophil stores reduces their accumulation at inflammatory sites and in exudates.

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18
Q

What are the 3 groups of non steroidal anti asthma meds

A

Cromolyn like drugs (mast cell stabilizers)
Antileukotrienes
Monoclonal antibodies

19
Q

What step is NSAAD used in regards to asthma managment

A

Step 2

20
Q

What are the mediators of inflammation that allergic stimuli trigger IgE-mediated cells to release

A

Leukotrienes
Histamines
Cytokines

21
Q

What does cromolyn sodium inhibit?

A

Degranulation of mast cells in response to allergic and non allergic stimuli

Prevents release of histamine, etc

22
Q

Leukotrienes cause problems with what?

A

Bronchoconstriction, mucus secretion, vascular permeability, and plasma exudation into airway

23
Q

What are the three types of antileukotrienes

A

5-LO inhibitor: Zileuton (Zyflo)

Leukotriene receptor antagonist:
Zafirlukast (Accolate)
Montelukast (Singulair)

24
Q

What antileukotrienes were approved for pediatric dosing

A

Montelukast

25
Q

What are disadvantages of antileukotrienes

A

Unknown long term toxicity
Effective in 50-70% of patients
No predictor of who will respond

26
Q

What are the 4 types of monoclonal antibodies

A

Omalizumab (Xolair)
Benralizumab (Faserna)
Mepolizumab (Nucala)
Relizumab (Cinqair)

27
Q

How does Omalizumab (Xolair) work

A

Inhibits attachment of IgE to mast cells and basophils, reducing release of chemical mediators of allergic response

28
Q

How does Benralizumab (Faserna), Mepolizumab (Nucala), Relizumab (Cinqair) work?

A

Blocks interleukin-5 (IL-5) changing the signaling of IL-5 reducing eosinophils

29
Q

What is the route of admin for monoclonal antibodies

A

Parenteral

30
Q

What is the side effects of monoclonal antibodies

A

Most severe is anaphylaxis

Advanced Pharmacology (5 decks)

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