obstructive pulmonary PHARM

Question 1

what are the three classes of bronchodilators

Answer 1

beta-adrenergic agonists
anti-cholinergics
xanthine derivatives

Question 2

what are the short acting beta-adrenergic agonists

Answer 2

albuterol

levalbuterol

Question 3

what are the long acting beta-adrenergic agonists

Answer 3

salmetrol

formoterol

Question 4

inhalation times for short and long acting beta-adrenergic agonists

Answer 4

short: inhaled q4-6 hrs
long: inhaled q12 hrs

Question 5

beta-adrenergic agonist MOA

Answer 5

mimic action of SNS (fight or flight)

relax and dilate the airways by stimulating the beta2-adrenergic receptors throughout the lungs

Question 6

what is the goal of beta-adrenergic agonist

Answer 6

bronchial dilation and increased airflow into and out of the lungs

Question 7

indications for beta adrenergic agonist

Answer 7

prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions

Question 8

contraindications of beta adrenergic agonist

Answer 8

uncontrolled hypertension, cardiac dysrhythmias, high risk for stroke

Question 9

Nursing considerations for beta adrenergic agonist

Answer 9

beta blockers may reduce effect when given together
avoid use with MAOIs and sympathomimetics b/c risk of hypertension
diabetics may need higher doses of meds b/c raises blood sugar

Question 10

SE of beta adrenergic agonist

Answer 10

insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache

Question 11

why are long acting beta 2 agonists used

Answer 11

salmeterol and formoterol

given for maintenance twice daily

Question 12

what drug is an anticholinergic

Answer 12

ipratroprium (Atrovent)

Question 13

MOA of ipratroprium

Answer 13

blocks action of acetylcholine –> causes bronchodilation

Question 14

indications for ipratroprium

Answer 14

used for prophylaxis and maintenance therapy

Question 15

SE of ipratroprium

Answer 15

urinary retention
dry throat, mouth, constipation
feeling hot, decreased sweating
tachycardia
blurred vision, dry eyes 
sedation, dizziness, confusion, hallucinations

Question 16

pneumonic for SE of anticholinergic

Answer 16

dry as a bone
hot as a hare
blind as a bat
red as a beet
mad as a hatter

Question 17

drugs in xanthine derivatives class

Answer 17

theophylline

aminophylline

Question 18

MOA of theophylline and aminophylline

Answer 18

increasing levels of the cAMP enzyme by inhibiting phosphodiesterase

xanthine derivatives class

Question 19

what are xanthine derivatives used for

Answer 19

theophylline and aminophylline

preventative treatment of asthma attacks and COPD

-second line treatment

Question 20

side effects of theophylline and aminophylline

Answer 20

xanthine derivatives class

toxicity, N/V/D, insomnia, head ache, tachycardia, dysrhythmias, seizures

Question 21

Drug classes of anti-inflammatories

Answer 21

LTRAs, inhaled corticosteroids, mast cell stabilizers

Question 22

drugs in leukotriene receptor antagonist class (LTRA)

Answer 22

montelukast

zafirlukast

Question 23

what is the MOA of montelukast

Answer 23

LTRAs prevent leukotrienes from attaching to receptors located on immune cells and within lungs –> prevents inflammation

Question 24

what is zafirlukast used for

Answer 24

LTRAs

used for oral prophylaxis and chronic treatment of asthma in adults and children
NOT FOR ACUTE ASTHMA ATTACKS

Question 25

side effects of LTRAs

Answer 25

headache, nausea, dizziness, insomnia, diarrhea

Question 26

what drugs are in inhaled corticosteroid class

Answer 26

beclomethasone diproprionate
budesonide
fluticasone

Question 27

MOA of inhaled corticosteroids

Answer 27

beclomethasone diproprionate
budesonide
fluticasone

reduce inflammation and enhance activity of beta agonists

Question 28

adverse effects of beclomethasone diporprionate

Answer 28

inhaled corticosteroid class

pharyngeal irritation, coughing, dry mouth, and oral fungal infections

Question 29

Are inhaled corticosteroids a rescue drug

Answer 29

NO, given to prevent persistent asthma attacks and long-term maintenance of severe COPD

Question 30

what drugs are in the combined inhaled glucocorticoid and bronchodilator class

Answer 30

budesonide & formoterol

fluticasone & salmeterol

Question 31

what is budesonide & formoterol used for

Answer 31

moderate to severe asthma, NOT FOR ACUTE ATTACKS

Question 32

what drug is in the mast cell stabilizer class

Answer 32

cromolyn

Question 33

MOA of cromolyn

Answer 33

mast cell stabilizer

stabilize membranes of mast cells and prevent release of broncho-constrictive inflammatory substances

Question 34

what is a mast cell stabilizer used for

Answer 34

cromolyn

to prevent acute asthma attack
-15-20 min prior to known triggers

Question 35

what drug is in monoclonal antibody anti-asthmatic class

Answer 35

omalizumab

Question 36

MOA of omalizumab

Answer 36

monoclonal antibody which selectively binds to immunoglobulin IgE –> limits the release of mediators of allergic response

Question 37

omalizumab NC

Answer 37

must be monitored closely for hypersensitivity reactions

Question 38

what is omalizumab used for

Answer 38

add-on therapy for asthma

Question 39

what drug is a selective PDE-4 inhibitor

Answer 39

roflumilast

Question 40

moa of roflumilast

Answer 40

selectively inhibits PDE4 enzyme in the lung cells

potent anti-inflammatory effects within the lungs

Question 41

what is roflumilast indicated for

Answer 41

prevention of COPD exacerbations

NOT FOR ACUTE/IMMEDIATE ACTION

Question 42

SE of roflumilast

Answer 42

n/v/d
headache
muscle spasms
decreased appetite
uncontrollable tremors

Question 43

what are the classes of long term control medications/preventers

Answer 43

anticholinergics 
xanthine derivative 
inhaled corticosteroids 
leukotriene modifiers 
mast cell stabilizers 
long acting beta 2 agonist agent

Question 44

what are the classes of quick relief meds/rescue meds

Answer 44

short acting beta 2 agonist

albuterol