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Pharmacology > Pharm 3 SE #2 > Flashcards

Pharm 3 SE #2 Flashcards

1
Q

What are some adverse effects/drug interactions of antimuscarinics?

A

Poor absorbtion, Dryness of mouth, urinary symptoms, Bitter metallic taste (ipratropium), nebulization with mask over eyes may precipitate acute glaucoma, Anticholinergic side effects in mod to severe renal function, additive interaction with other anticholinergics.

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2
Q

Prototype SAMA

A

Ipratropium

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3
Q

Prototype LAMA

A

Tiotropium

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4
Q

Prototype SABA

A

Albuterol

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5
Q

Prototype DPI LABA

A

Salmeterol

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6
Q

Prototype Nebulized solution LABA

A

Formoterol

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7
Q

Phosphodiesterase inhibitor, therapy must be individualized to achieve optimal responses and minimal side effects.

A

Theophylline - used for the treatment of asthma and COPD for decades. Currently, the role of theophylline is limited for these indications due to the introduction of inhaled bronchodilators and the potential for serious adverse reactions with xanthine derivatives. Theophylline is now considered as last-line or adjunct therapy for these indications. Theophylline has a narrow therapeutic range, and changes in dosing should only occur after a serum concentration is obtained.

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8
Q

At low doses, this drug can cause nausea, irritability, insomnia, headache, vomiting. At high doses, it can cause ventricular arrhythmias, seizures

A

Theophylline

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9
Q

This drug should not be given in patients with cirrhosis or patients who smoke cigarettes.

A

Theophylline

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10
Q

What are the key points of bronchodilators?

A

Inhaled treatment is preferred, Long-acting bronchodilators are preferred, consider combo mechanisms, LAMA has a greater effect on exacerbation rates vs LABA, Theophylline not recommended unless other long-term tx are not an option.

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11
Q

Does regular treatment of ICS improve disease progression or mortality?

A

No

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12
Q

Are ICS as a monotherapy recommended?

A

No

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13
Q

ICS should have the best effect if blood eosinophil count is what?

A

Blood eosinophil count > 300 cells/ul

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14
Q

What is the holy trinity of COPD treatment that improves lung function, symptoms and health status and reduces exacerbation.

A

ICS + LABA + LAMA

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15
Q

Do ICS put you at an increased risk of pneumonia?

A

Yes

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16
Q

What should ICS be used in combination with for COPD?

A

Long-acting bronchodilators

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17
Q

Name a LABA + ICS combo that is a DPI.

A

Fluticasone/Salmeterol (advair)

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18
Q

Name a LABA +ICS combo that is a MDI

A

Budesonide/Formoterol (symbicort)

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19
Q

Name a ICS + LAMA + LABA combo. DPI

A

Fluticasone, umeclidinium, vilanterol (Trelegy)

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20
Q

This is a phosphodiesterase-4 inhibitor. Adverse effects ae nausea, reduced appetitie, abd pain, diarrhea, sleep disturbances, headache. You must monitor weight loss and depression.

A

Roflumilast (Daliresp)

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21
Q

PDE-4 inhibitors must always be used in combination with what?

A

One long-acting bronchodilator

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22
Q

These drugs can be used as anti-inflammatory drugs for COPD.

A

Azithromycin and Erythromycin

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23
Q

What is the adverse effect of azithromycin?

A

Increased bacterial resistance, impaired hearing tests.

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24
Q

What is the adverse effect of Erythromycin?

A

GI discomfort

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25
Q

FEV1: 50-79% predicted

A

Moderate GOLD 2

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26
Q

FEV1: 30-49% predicted

A

Severe GOLD 3

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27
Q

What two vallidated questionnaires do we use to assess COPD?

A

COPD Assessment Test (CAT)

Modified British Medical Research Council (mMRC)

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28
Q

Which test only looks at dyspnea?

A

mMRC

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29
Q

Name the two groups that are mMRC 0-1 or CAT<10.

A

A and C

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30
Q

Name the two groups that are mMRC ≥2 CAT ≥ 10

A

B and D

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31
Q

Treatment for Group A COPD

A

Bronchodilator

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32
Q

Treatment for Group C COPD

A

LAMA

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33
Q

Treatment for Group B COPD

A

LABA or LAMA

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34
Q

Treatment for Group D COPD

A

LAMA, or LAMA+LABA, or ICS+LABA

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35
Q

What two COPD treatment groups are considered if there are 0 or 1 moderate exacerbations not leading to hospitalization?

A

Group A or B

36
Q

What two COPD treatment groups are considered if there are ≥ 2 moderate exacerbations or ≥ 1 leading to hospitalization.

A

Group C or D

37
Q

When treating Dyspnea, what is the next step if a LABA or a LAMA is ineffective?

A

Use both a LABA + LAMA together

38
Q

When treating Dyspnea, what is next step if a LABA + ICS is ineffective?

A

Use the trio of LABA+LAMA+ICS

39
Q

When treating Dyspnea, what should you do if the LABA+LAMA combo or the Trio is ineffective?

A

Consider switching inhaler device or molecules.

Investigate and treat other causes of dyspnea.

40
Q

When treating Dyspnea, what should you do if you’re using an ICS and the patient has pneumonia?

A

Consider de-escalation to just a LABA+LAMA combo

41
Q

When treating Dyspnea exacerbations, when would you jump from a LABA or LAMA straight to a LABA +ICS instead of the LABA/LAMA combo?

A

If their blood eosinophil count is ≥ 300 and 2 moderate exacerbations or 1 hospitalization.

42
Q

What is the most effective anti-inflammatory med class available for asthma?

A

ICS

43
Q

Response to this drug therapy includes: symptoms improve in 1-2 weeks 4-8 max, FEV1 requires 2 mo for max improvement.

A

ICS

44
Q

What may be a systemic adverse effect of ICS

A

Alterations in glucose metabolism.

45
Q

What strategies reduce potential for adverse of events when using ICS?

A 
Using a holding chamber
Rinse mouth 
Using lowest dose possible
Using in combination with LABAs
Avoiding drugs that are CYP3A4 inhibitors like Ritonavir, ketoconazole
46
Q

These drugs stimulate adenyl cyclase resulting in increased intracellular cyclic AMP which triggers bronchial smooth muscle relaxation.
They selectively work on beta 2 receptors.

A

LABA

47
Q

For Asthma, are LABA’s appropriate as a monotherapy?

A

No

48
Q

Salmeterol has a box warning of what?

A

Increased risk of asthma-related death.

49
Q

What ICS LABA combos are there for asthma?

A

Fluticaslone/Salmeterol (Advair)
Fluticasone/Vilanterol (Breo)
Budesonide/Formoterol (Symbicort)

50
Q

What are the main adverse effects of Leukotriene RREceptor Antagonist (LTRA)?

A

Nightmares and neuropsychiatric events.

51
Q

What is the most effective medication for relief of acute bronchospasms?

A

SABA

52
Q

What SABA uses frequency indicates inadequate asthma control?

A

using > 2 days/week.

53
Q

These are used in treatment of asthma exacerbations and in treatment of impending episodes of severe asthma unresponsive to bronchodilator therapy.

A

Oral steroids

54
Q

What are the monitoring intervals for asthma?

A

2-6 weeks, follow up 1-6 months, step-down therapy in 3 mo intervals.

55
Q

What are 1st line agents for HTN

A

ACE/ARBS, Ca channel blockers, Thiazide diuretics

56
Q

What are the criteria for diagnosing HTN?

A

2 or more properly measured BP readings taken 1-2 minutes apart and BP is elevated when measuring two or more visits spaced 1-4 weeks apart.

57
Q

What is the 10-year risk of stroke or MI in an elevated 120-129/<80 BP and what is the recommendation?

A

N/A 10-year risk

Non-pharm, reassess in 3-6 mo.

58
Q

What is the 10-year risk of a Stage 1 130-139/80-89? What is the recommendation?

A

<10% 10-year risk
Non-pharm, reassess in 3-6 mo
If ≥10% or clinical ASCVD then non-pharm +med and reassess in 1 month.

59
Q

What is the 10-year risk and recommendation of a stage 2 ≥140/90?

A

N/A 10-year risk

Non-pharm + meds (2)

60
Q

JNC8 BP goals for:

General population <60 years, Chronic kidney disease, ≥18 years, and Diabetes, ≥18 years.

A

<140/90mmHg

61
Q

JNC8 BP goal for General population ≥60 years.

A

<150/90 mmHg

62
Q

If the patients BP is ≥130/80 mmHg what other guidelines indicates use of meds.

A

If they also have a clinical CVD, a 10-year ASCVD risk ≥10% or if their BP is ≥140/90 mmHg

63
Q

What are 2nd line HTN meds?

A

Loop diuretics,
Potassium-sparing diuretics,
Aldosterone antagonist diuretics, Beta blockers, alpha 1 blockers, Alpha agonist, Vasodilators.

64
Q

For patients with BP >20/10 mmHg over their goal.

A

You can give two first-line agents of different classes except you can’t combine ACE and ARBs.

65
Q

What broad class of drugs should you consider to reduce blood volume (reduces CVP and CO)?

A

Diuretics

66
Q

What broad class of drugs should you consider if you want to reduce cardiac output (Decrease HR, contractility, and stroke volume)

A

Beta blockers and Non-dihydropyridine calcium channel blockers.

67
Q

Inhibit sodium chloride cotransporter in distal convoluted tubule in the kidney –> increased sodium and chloride excretion.

A

Thiazide diuretics

68
Q

SE: hypokalemia*; metabolic alkalosis; hypotension; sun sensitivity; hyperglycemia; hypo-natremia, magnesemia, -phosphatemia; hypercalcemia
SSE are: cardiac arrhythmias, SJS

A

Thiazide diuretics

69
Q

Not appropriate for: patients with active gout; caution with history of gout; anuricpatients; less effective in patients with CrCl <30ml/min

A

Thiazide Diuretics

70
Q

SE are: cough; hypotension; dizziness; headache; hyperkalemia.

A

ACE inhibitor

71
Q

Not appropriate for pregnant patients and those with a hx of angioedema.

A

ACE inhibitors and ARBS

72
Q

SE: Hypotension; dizziness; headache; hyperkalemia.
SSE: Angioedema

A

ARBs

73
Q

Ca channel blockers that are more selective for vascular cells; minimal direct cardiac effects.

A

Dihydropyridines - Amlodipine, nifedipine, felodipine

74
Q

Ca channel blockers that are more selective for cardiac myocytes; less effects on systemic vasodilation.

A

Non-dihydropyridines - Diltiazem, verapamil

75
Q

SE are: Hypotension, dizziness, peripheral edema*

A

Dihydropyridines like amlodipine

76
Q

Effective as antihypertensive as well as anti-arrhthmics.

A

Non-dihydropyridines

77
Q

Not appropriate for patients with heart failure, bradycardia, hypotension

A

Non-dihydropyridines

78
Q

Side effects: Bronchospasm, bradycardia, hypotension, dizziness, fatigue, depression.

A

Beta blockers

79
Q

Boxed warning: Abrupt cessation of therapy may lead to angina, myocardial infarction, death.

A

Beta blockers

80
Q

BB’s of choice for heart failure with a reduced ejection fraction.

A

Metoprolol succinate, carvedilol, and bisoprolol.

81
Q

Inhibit sodium-potassium-chloride cotransporter in the thick ascending limb

A

Loop diuretics

82
Q

Side effects: hypomagnesemia; hypokalemia; hyperuricemia; hypotension; metabolic alkalosis
SSE: Ototoxicity, anemia, thrombocytopenia, SJS.

A

Loop diuretics

83
Q

inhibit sodium channels in late distal convoluted tubule and collecting ducts. Used to prevent hypokalemia.

A

Potassium-sparing diuretics - Amiloride and triamterene.

84
Q

SE: gynecomastia and erectile dysfunction.

A

Aldosterone antagonist diuretics - Spironolactone

85
Q

Block the action of aldosterone at distal segment of the distal tubule; compete for the aldosterone-dependent sodium-potassium exchange site in distal tubule cells –> increased secretion of water and sodium.

A

Aldosterone antagonist diuretics - Spironolactone

86
Q

Last line treatment for HTN, these act as vasodilators acting in the CNS to reduce sympathetic outflow from the CNS – > decreased peripheral resistance, renal vascular resistance, heart rate and blood pressure.

A

Alapha-2 Agonists (clonidine, Methyldopa, Guanfacine)

87
Q

This drug may be considered an add-on for resistant hypertension. Highly specific action on arterial vessels reduces vascular resistance and arterial pressure. Opening of K+ channels to cause smooth muscle hyperpolarization; inhibition of calcium release in smooth muscle; stimulates formation of nitric oxide to produce vasodilation. Has a SSE of lupus-like syndrome.

A

Hydralazine

Pharmacology (6 decks)

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