Module 7 - REspiratory

Question 1

Decongestant - Action:
Decongestants are ___________ agents that stimulate _________ and _______-adrenergic receptors, causing ______________________ in the respiratory tract mucosa and thereby improving ___________.

Answer 1

sympathomimetic; alpha and beta; vasoconstriction; ventilation

Question 2

Topical decongestants in the form of _________ _________ slow _____________ motility and mucocilicary __________.

Answer 2

nasal sprays; ciliary; clearance

Question 3

Topical decongestants should not be used more than _____ days, because it can cause ___________ ___________.

Answer 3

3; rebound congestion

Question 4

Oral decongestants have the same mode of action as topical but can cause more ____________responses.

Answer 4

systemic

Question 5

Asthma and allergic rhinitis are Type ___ hypersensitivity. In this type Imunoglobulin ______ attached to ___________ cells binds with an antigen causing a release of _____________, ___________, and _________.

Answer 5

Type I. IgE; mast cells; histamine, leukotrienes, and prostaglandins (causing inflammation)

Question 6

Histamine is synthesized and stored in _____________ and _____________.

Answer 6

mast cells and basophils

Question 7

True or False

Histamine release may be triggered by allergic and non-allergic mechanisms.

Answer 7

True

Question 8

Vasodilation, increased capillary permeability, pain, itching, bronchoconstriction, and CNS effects are the result of ___________ stimulation.

Answer 8

H1 stimulation

Question 9

Release of gastric acid from the parietal cells of the stomach is the result of ___________ stimulation.

Answer 9

H2 stimulation

Question 10

Two major classes of histamine receptor antagonists:

H1 receptor antagonists are used to treat ______________. H2 receptor antagonists are used to treat ______________.

Answer 10

H1: mild allergic reactions; H2: gastric and duodenal ulcers

Question 11

H1 Antagonists Method of Action:
Relieve __________ symptoms by blocking ___________ receptors on __________ ___________ ____________, ____________ and ___________ ____________. They do NOT block release of _______________ from _________ cells and _______________.

Answer 11

allergy, histamine, small blood vessels, capillaries, and sensory nerves.

histamine; mast cells and basophils

Question 12

First generation H1 antagonists (dipenhydramine, hydroxyzine, chlorpheniramine, etc.) frequently cause _______________ and ________________ effects.

Answer 12

sedation and anticholinergic effects

Question 13

True or False

Second generation H1 receptor antagonists (loratidine & fexofinidine) often cause sedation and dry mouth.

Answer 13

False

Question 14

1st generation antihistamines are contraindicated in:

Answer 14

lactating mothers, narrow angle glaucoma, men with BPH, elderly.

Question 15

Decongestant contraindications

Answer 15

Narrow angle glaucoma, hypertension, severe CAD; caution in pt with hyperthyroidism, diabetes and prostatic hypertrophy

Question 16

Decongestant side effects

Answer 16

Hypertension, increased HR, palpitations, headache, dizziness, GI distress and tremor

Question 17

Expectorant Mechanism of Action

Answer 17

Increase the output of respiratory tract fluid by decreasing the adhesiveness and surface tension of the respiratory tract and by facilitating removal of viscous mucous.

Question 18

Expectorants and other cough products should not be used for more than _______ because they can ___________ ________ of other a more _______ __________ ____________.

Answer 18

one week; mask symptoms; serious underlying disorder.

Question 19

Cough suppressant MOA

Answer 19

Diminish the cough reflex by direct inhibition of the cough center in the medulla

Question 20

Expectorant contraindications

Answer 20

Breast feeding mothers, pregnancy cat c

Question 21

Cough suppressant contraindications

Answer 21

pt with productive cough, hx of substance abuse, COPD; children - especially under 2

Question 22

Cough suppressant side effects

Answer 22

dizziness, nausea, drowsiness, sedation

Question 23

How is bacterial sinusitis differentiated from viral sinusitis in children?

Answer 23

symptoms persist without improvement for more than 10 days or when they are unusually sever facial tenderness, transient perorbital swelling, daytime cough, or fever of 102.2 (39) or higher in combination with purulent rhinorrhea

Question 24

First line tx for bacterial sinusitis in children?

Answer 24

Amoxicillin 45mg/kg normal dose or 90mg/kg high dose if mild-moderate. Augmentin 90mg/kg if severe or at risk for s. pneumoniae (day care or recent abx)

Question 25

Asthma is a chronic _______________ disease characterized by ______________of the airways, bronchial ________________, and __________________.

Answer 25

inflammatory; inflammation; hyperreactivity; bronchospasm.

Question 26

______________is often the underlying cause of asthma.

Answer 26

allergy

Question 27

What two types of drugs are used to treat asthma?

Answer 27

anti-inflammatory and bronchodilators

Question 28

Advantages of inhaled asthma drugs (3)

Answer 28

1. increase therapeutic effects (delivered to site of action)
2. reduce systemic effects
3. facilitate rapid relief

Question 29

Inhaled steroids: MOA

Answer 29

Supress inflammation and promote synthesis of bronchial beta2 receptors; increase their responsiveness to beta2 agonists.

Question 30

What are the most effective anti-asthma drugs for reducing risk of asthma flare up (prevents attacks)?

Answer 30

Glucocorticoids

Question 31

True / False

Glucocorticoids are for long term prophylaxis, not aborting an ongoing attack.

Answer 31

True

Question 32

When should glucocorticoids be administered orally for asthma?

Answer 32

Only when it is severe.

Question 33

How long does it take for glucocorticoid therapy to achieve maximum effectiveness?

Answer 33

Approximately 2 weeks

Question 34

Glucocorticoid contraindications

Answer 34

acute attacks; use cautiously with children due to growth restriction

Question 35

Glucocorticoid side effects

Answer 35

candidiasis, dysphonia, hoarseness, cough, headache; can promote bone loss - low dose as possible and weight bearing exercise with adequate vit d and calcium

Question 36

Prolonged glucocorticoid therapy can cause (5):,

Answer 36

adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer, and growth suppression

Question 37

What may be used as a first line therapy in children because it doesn’t affect linear growth?

Answer 37

Cromolyn/Mast cell stabilizers (reduce inflammation primarily by preventing release of mediators from mast cells)

Question 38

What is commonly used for EIB? And how?

Answer 38

Cromolyn; 15 min before anticipated exertion

Question 39

Disadvantages of cromolyn?

Answer 39

Taken 3-4 times/day

Question 40

SABA MOA

Answer 40

provide smooth muscle relaxation by activating beta2 receptors in bronchial smooth muscle

Question 41

SABA/LABA contraindications

Answer 41

Use caution with ischemic heart disease, hypertension, cardiac arrhythmia, seizure disorder, and hyperthyroidism

Question 42

SABA/LABA side effects

Answer 42

tachycardia, muscle tremor, hypokalemia, hyperglycemia, increased lactic acid, headache.

Question 43

What does nebulized ipratropium do for an acute severe exacerbation of asthma? What else is also done?

Answer 43

Relieves airflow obstruction; O2, systemic glucocorticoid, nebulized saba

Question 44

Allergens:

Answer 44

house dust mite, warm blooded pets, cockroaches, mold

Question 45

Triggers:

Answer 45

tobacco smoke, wood smoke, household sprays

Question 46

Key points for COPD:

Answer 46

Reduce triggers

Question 47

Pharmocologic therapy for COPD is focused on

Answer 47

reducing symptoms, frequency and severity. It does not change to decline of lung function

Question 48

COPD tx for those at high risk for exacerbations:

Answer 48

inhaled ICS and LABA