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CPR > Pharm: Lung and Renal > Flashcards

Pharm: Lung and Renal Flashcards

1
Q

What are the two distinct targets for drug therapy to asthma?

A
  1. symptoms (treated by bronchodilators)

2. underlying cause (anti-inflammatory actions)

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2
Q

What three classes of bronchodilators are used to treat asthma?

A
  1. beta2 adrenergic agonists (sympathomimetics)
  2. muscarinic antagonists (anticholinergics)
  3. methylxanthines
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3
Q

How do beta2 adrenergic agonists function to relieve the symptoms of an asthma attack?

A

They relax smooth muscle and inhibit the release of some bronchoconstricting substances from mast cells.

They also stimulate adenylate cyclase and increase the intracellular concentration of cAMP.

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4
Q

What are some nonselective beta adrenergic agonists that can be used in the treatment of asthma? Side effects?

A
  • epinephrine
  • isoproterenol

Side effects: tachycardia, arrhythmias, aggravated angina

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5
Q

What are some short acting beta2 adrenergic agonists (SABA)?

A
  • albuterol, terbutaline, metaproterenol, bitoterol

- only terbutaline is available in emergency therapy

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6
Q

What are some long-acting beta2 adrenergic agonists (LABA)? Why should they not be administered in acute bronchospasm?

A

-salmeterol and formoterol

They should not be used in acute attacks because of their slow onset.

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7
Q

How do anticholinergics work to stop an asthma attack?

A

Much like beta2 adrenergics, they reduce bronchospasm. However, they work at the muscarinic receptor.

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8
Q

What anticholinergic drugs are used to reduce asthma symptoms?

A
  • atropine
  • ipratropium
  • tiotropium
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9
Q

How do methylxanthines function to reduce the symptoms of an asthma attack?

A

They are antagonists to the adenosine receptor, and they inhibit the function of phosphodiesterase.

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10
Q

What methylxanthines are used to treat asthma?

A

theophylline, caffeine, theobromine

aminophylline is the name of the therapeutic prep of theophylline

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11
Q

What are the problems with theophylline therapy?

A
  • The therapeutic index is very narrow, so blood levels must be monitored.
  • major drug interactions
  • wide plasma clearance based on age children fastest, then adults, neonates slowest. This can lead to toxicity in children younger than 1yo
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12
Q

What three classes of anti-inflammatory drugs are used to treat asthma?

A
  1. corticosteroids
  2. leukotriene pathway modifiers
  3. anti-IgE antibody
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13
Q

How do corticosteroids work to reduce inflammation?

A
  • block late phase response to allergens
  • inhibit cytokine production
  • inhibit release of arachidonic acid from cell membranes
  • inhibit inflammatory cell migration and activation
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14
Q

What are primary oral and inhaled corticosteroids used in asthma therapy?

A

Oral: prednisone
Inhaled: beclomethasone, fluticasone, budesonide, flunisolide, mometasone, new generation ciclesonide

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15
Q

What are the advantages of inhaled vs. oral corticosteroids in asthma therapy?

A

Inhaled has decreased side effects due to inactivation when absorbed orally.

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16
Q

What are the functions of leukotrienes (LTB4, LTC4, LTD4) in inflammation in the airway?

A
  • They are synthesized by inflammatory cells in the airway.
  • LTB4 is a neutrophil chemoattractant
  • LTC4 and LTD4 function in bronchoconstriction, increased bronchial reactivity, mucosal edema, and mucus hypersecretion
17
Q

What is the leukotriene synthesis inhibitor and what are the leukotriene receptor antagonists used in the treatment of asthma?

A

inhibitor: zileuton (inhibits 5-lipooxygenase)
receptor antagonists: zafirlukast, montelukast (antagonize LTD4
receptor)

18
Q

What is the name of the anti-IgE antibody used in anti-inflammatory asthma treatment, and how does it function?

A
  • omalizumab

- binds to IgE and prevents it from activating mast cells

19
Q

What drug used to reduce smoking is a dopaminergic-noradrenergic reuptake inhibitor? What drug is a nicotine receptor agonist (replacement therapy)?

A

uptake inhibitor: bupropion

agonist: varenicline

20
Q

What bronchodilators are used for COPD treatment (one SABA, one LABA, one short acting anticholinergic, one long acting anticholinergic)? What antibiotic is ok for use in COPD patients?

A 
SABA: albuterol
LABA: salmeterol
short-acting antichol: ipratropium bromide
long-acting antichol: tiotropium bromide
antibiotic: azithromycin
21
Q

What drugs should be avoided for COPD patients?

A

strong CYP3A4 inhibitors:

  • clarithromycin
  • itraconazole
  • ritonavir

CPR (3 decks)

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