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Pulmonary > Pharm 16 > Flashcards

Pharm 16 Flashcards

1
Q

Identify airway insults that can contribute to the development of the asthmatic airway

A

Allergens
Microbes
Viruses
Environmental factors

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2
Q

Identify the physiological changes in the airway smooth muscle and extracellular network

A

Fibrotic
Increased cell size (hypertrophy)
Increased cell numbers (hyperplasia)

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3
Q

Describe the contribution of leukotrienes to respiratory symptoms of asthma and anaphylaxis

A

Beta-2 receptor stimulation

  • Smooth muscle = relaxation
  • Mast cell membrane = stabilization
  • Skeletal muscle = stimulation
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4
Q

Effects of physiologic cholinergic input to bronchial smooth muscle.

A
  • M1 and M3 = bronchoconstriction

- M2 = bronchodilation

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5
Q

Effects of physiologic adrenergic input to bronchial smooth muscle.

A
  • Activates the G proteins within the cell membranes of the smooth muscle causing relaxation
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6
Q

Locations of beta-adrenergic receptors in the body and the anticipated pharmacologic effects of agonizing the beta-2 receptor.

A

Bronchial smooth muscle - Bronchodilation

Uterine muscle - Uterine relaxation (toxolysis)

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7
Q

Clinical applications of the short-acting beta-agonists

A
  • “rescue” medications
  • Mild, intermittent asthma or in patients with just exercise-induced bronchoconstriction
  • Needing a rescue medications more than twice a week indicated asthma is not well controlled
  • Ex. Albuterol
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8
Q

Clinical applications of the long-acting beta-agonists

A
  • Not rescue medications
  • Not be used as the only controller therapy
  • Increases risk of asthma-related death and asthma-related hospitalizations
  • Can be acceptable as the only “controller drug” in COPD
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9
Q

Describe the mechanism of action of muscarinic antagonist drugs used as bronchodilators

A

Block acetylcholine (bronchoconstriction) resulting in bronchodilation especially in COPD

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10
Q

Describe the potential benefits of muscarinic antagonist drugs used as bronchodilators

A

Many different ways to take medications - inhalation in powder or mist

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11
Q

Proper inhalation technique of metered-dose HFA inhalers (MDIs

A
  • Shaking (dissolving of the crystals)
  • Priming (if first use, dropped, or not used for > 7 days)
  • Time interval between inhalations
  • Inhaling slowly and deeply
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12
Q

Proper inhalation technique of Dry powder inhalers/diskus (DPIs), Handihaler, Ellipta

A

Flip open to put powder into a chamber and then inhale the powder

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13
Q

Proper inhalation technique of Respimat

A

spin to put mist into the chamber and press button to cause the release of mist and then inhale the mist

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14
Q

Recognize when the use of alternative or additional inhalation devices may be helpful/necessary

A
  • The most effective “controller” asthma medications available are the glucocorticoids
  • Inhibit many immune cells
  • Regular use of an ICS as a controller
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15
Q

List the adverse effects of glucocorticoid (AKA, corticosteroids) use; particularly with long-term systemic glucocorticoids

A
  • Infection risk
  • Risk for developing diabetes, osteoporosis, weight gain, abnormal fat distribution
  • Adrenal suppression (crisis)
  • Hypertension
  • Glaucoma, cataracts
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16
Q

Inhaled corticosteroids and inhibition of growth in children.

A
  • Reassure
  • Studies have shown that it does not cause growth impairment
  • Reach their target adult height despite initial growth retardation
  • Slowed growth velocity in the first year only
  • Same growth velocity for 2-4 years
  • 0.5 cm less than the average for the control group
17
Q

Alternative controller medicines if not well controlled or do not tolerate ICS

A

Cromolyn, LTRA or theophylline

18
Q

Explain the MOA and clinical role/benefit of Theophylline

A
  • Controller medication
  • Metabolized by CYP1A2
  • Well absorbed widely distrubuted, crosses BBB
  • apnea and bradycardia in premature babies
19
Q

Explain the potential toxicity of theophylline

A
  • Smoking induces CYP1a2 so toxicity more likely to occur
  • Nausea/vomiting/abdominal pain, coarse muscle tremor
  • Seizures, hypotension, and dysrhythmias
  • Death occurs, d/t intractable ventricular dysthymias
20
Q

Leukotriene receptor antagonists (LTRA)

A
  • Prophylaxis and chronic treatment of asthma in patients >12 months
  • Acute prevention of exercise-induced bronchoconstriction in patients >6 years
  • Relief of symptoms of allergic rhinitis
21
Q

Leukotriene receptor antagonists (LTRA) ASEs

A

Headache, dyspnea, sinusitis, nausea, diarrhea, myalgia, leukopenia

22
Q

Leukotriene receptor antagonists (LTRA) caution use in

A
  • Neuropsychiatric events
  • Eosinophilic conditions
  • Phenylketonuria
23
Q

Omalizumab (monoclonal antibodies)

A
  • Only for refractory “allergic asthma”, eosinophilia
24
Q

Omalizumab (monoclonal antibodies) caution use in

A
  • Should only be administered in a healthcare setting by providers who are prepared to identify and treat anaphylaxis
25
Q

Omalizumab (monoclonal antibodies) black box warning

A
  • First 3 injections, monitored in office for 2+ hours, delayed hypersensitivity can also occur
26
Q

Cromolyn (mast cell stabilizer)

A
  • used for asthma tx

- caution: not a bronchodilator, reduces hyper-reactivity of the bronchi

27
Q

Roflumilast (PDE- 4 Inhibitor) use

A
  • COPD exacerbation
  • Once daily
  • But $$$
  • SE: neuropsychiatric effects, decreased weight, nausea, diarrhea

Pulmonary (12 decks)

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