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Block 2 > Pharm: Pulm II > Flashcards

Pharm: Pulm II Flashcards

1
Q

Types of drugs for bronchodilation of airways

A
  • bronchodilators (sympathomimetic drugs)
  • Methylxanthine drugs
  • Muscarinic antagonist (Anticholinergics)
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2
Q

Two types of sympathomimetic drugs

A

non-selective & selective

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3
Q

Types of drugs for inflammation/thickening of airways

A
  • Corticosteroids
  • Cromolyn & Nedocromil
  • Leukotriene Pathway Inhibitors
  • Monoclonal antibodies
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4
Q

Beta-adrenergic agonists

A

-SABAs & LABAs

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5
Q

Anticholinergics (antimuscarinic) agents

A

SAMAs & LAMAs

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6
Q

What do alpha & beta agonist drugs mimic?

A

epinephrine or norepinephrine

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7
Q

What tissue do B2 drugs attack?

A

resp, uterine, & vascular smooth muscle

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8
Q

What is the actions of B2 drugs?

A

promotes smooth muscle relaxation

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9
Q

Name the short-acting selective beta-2 agonist

A
  • albuterol & terbutaline
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10
Q

Name the long-acting selective beta-2 agonist

A

salmeterol

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11
Q

SE of selective B2 agonist

A
  • tachycardia
  • hypokalemia
  • hypoxemia
  • dysrhythmias
  • tremor
  • restlessness
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12
Q

When it says nonindicated in asthma this means…

A

contraindicated in monotherapy can be used in combo therapy

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13
Q

What is the name of the OTC direct agonist used for asthma?

A

Primatene MIST (straight epi)

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14
Q

NOTES

A

anticholinergics + SABA is more beneficial in tx of severe asthmatic attacks

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15
Q

MOA for selective B2 agonist?

A

selective stimulates B2-adrenergic receptors, relaxing airway smooth muscle

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16
Q

Uses for Albuterol (Proventil)

A
  • asthma
  • exercise-induced asthma
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17
Q

Interaction characteristics for Albuterol (Proventil) & Levalbuterol (Xopenex)

A
  • HTN
  • hypokalemia
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18
Q

Age to use Neb form for Albuterol (Proventil)

A

< 2yo

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19
Q

Age to uses MDI form of Albuterol (Proventil)

A

4 yo or older

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20
Q

Serious reactions of Albuterol (Proventil) & Levalbuterol (Xopenex)

A
  • heart stuff
  • hyper/hypotension
  • K+ & Glucose problems
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21
Q

Uses for Levalbuterol (Xopenex)

A
  • asthma
  • exercise-induced asthma
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22
Q

Uses for Salmeterol (Serevent) & Formoterol (Foradil)

A
  • asthma maintenance
  • exercise-induced asthma
  • COPD maintenance
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23
Q

MOA for Salmeterol (Serevent) & Formoterol (Foradil)

A

selectively stimulated beta 2 adrenergic receptors, relaxing airways smooth muscle

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24
Q

BB warning for Salmeterol (Serevent) & Formoterol (Foradil)

A
  • asthma: if monotherapy–> incr risk of asthma-related death
  • peds/kids: if monotherapy–> may incr risk of hospitalization
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25
Q

What is the anti-cholinergic (muscarinic) antagonist that is short acting?

A

Ipratropium (Atrovent)

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26
Q

What is the anti-cholinergic (muscarinic) antagonist that is long acting?

A

Tiotropium (Spiriva)

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27
Q

MOA for anti-cholinergic (muscarinic) antagonist

A

reverse vagally (blocks Ach) mediated bronchospasm. May decr mucous gland hypersecretion

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28
Q

Are anti-cholinergic (muscarinic) antagonist typically not used in___?

A

allergen or exercise-induced bronchospasm

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29
Q

Uses for Ipratropium (Atrovent)

A
  • COPD maintenance
  • Asthma exacerbation mod-severe
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30
Q

Uses for Tiotropium (Spiriva)

A

COPD maintenance

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31
Q

SEs for Anti-cholinergic (muscarinic) antagonist

A

Caution w/
- glaucoma angle-closure
- prostatic hypertrophy
- bladder neck obstruction

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32
Q

Important methylxanthines

A
  • Theophylline (tea)
  • Theobromine (cocoa)
  • Caffeine (coffee)
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33
Q

Sustained-release theophylline can improve what SE of this medication?

A

nocturnal symptoms

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34
Q

SEs for Theophylline

A
  • N/V
  • HA
  • GI discomfort
  • Diuresis
  • Cardiac arrhythmias
  • Seizures
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35
Q

Uses for Theophylline (Elixophyllin)

A
  • asthma/COPD maintenance
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36
Q

Is Theophylline (Elixophyllin) used in asthma exacerbations

A

NO

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37
Q

MOA for Theophylline (Elixophyllin)

A

phosphodiesterase inhibitor & bronchodilator; increased cAMP

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38
Q

What are the 1st line agents for all patients w/ persistent asthma?

A

Inhaled corticosteroids

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39
Q

Local SEs of inhaled cortitcosteroids

A
  • dysphonia
  • Oropharyngeal candidiasis
  • Cough
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40
Q

System SEs of inhaled corticosteroids

A
  • adrenal suppression
  • growth suppression
  • bruising
  • osteoporosis
  • cataracts/glaucoma
  • psychiatric disturbances
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41
Q

Why do we see systemic effects when using inhaled corticosteroids?

A

with inhaled corticosteroids, most of it is swallowed. Only 10-20 percent are inhaled

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42
Q

Patient Education for inhaled corticosteroids

A

rinse mouth w/ water or brush teeth after taking meds

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43
Q

Inhaled corticosteroids (2)

A
  • Fluticasone [Flovent]
  • Budesonide inhalation [Pulmicort]
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44
Q

Uses for Fluticasone inhalation [Flovent]

A
  • prevent asthma attacks
  • COPD?
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45
Q

Age range for Fluticasone inhalation [Flovent]

A

> /= 4yo

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46
Q

Can fluticasone be used as a rescue med for asthma attacks?

A

NO

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47
Q

Can condition can long term steroid use cause?

A

osteoporosis

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48
Q

Warning for Fluticasone inhalation [
Flovent]

A

Do not use in powder form if allergic to milk

49
Q

MOA for Fluticasone [Flovent]

A

uses fluorocarbothioate ester linkage to cause potent vasoconstrictive and anti-inflammatory activity. (direct local effect)

50
Q

Uses for Budesonide inhalation [Pulmicort]

A
  • asthma maintenance & prophylaxis
  • COPD exacerbation
51
Q

What are the age limitation of Budesonide inhalation [Pulmicort] asthma maintenance?

A
  • > /= 6yo for dry powder
  • 12mo - 8yo for nebulizer
52
Q

Is Budesonide [Pulmicort] a rescue med for asthma attacks?

53
Q

MOA for Budesonide inhalation [Pulmicort]

A

thought to inhibit multiple inflammatory cytokines

54
Q

Warning of Budesonide inhalation [Pulmicort]

A

severe hypersensitivity to milk proteins should avoid

55
Q

Which medication is preferred (1st line) for pregnant women w/ persistent asthma?

A

Budesonide inhalation [Pulmicort]

56
Q

Can you use Budesonide inhalation during lactation?

57
Q

Name a systemic corticosteroid used in pulm issues?

A

Prednisone

58
Q

Uses for Prednisone

A
  • Anaphylaxis
  • Angioedema
  • Urticaria
  • Asthma acute ex.
  • COPD acute ex.
59
Q

MOA for Prednisone

A
  • decr inflammation by suppressing the immune system via lymphatic system
  • it also suppresses adrenal function at high doses
60
Q

Concerns related adverse effects of prednisone

A
  • adrenal suppression
  • immunosuppression
  • Kaposi sarcoma
  • Myopathy
  • Psychiatric issues
61
Q

Prednisone Pearls for the elderly.

A

use the smallest possible effective dose for the shortest time

62
Q

Prednisone pearls for peds

A
  • may mess w/ speed of growth & development
63
Q

How must one stop prednisone?

A

gradual tapering of dose

64
Q

Prednisone pearls for stress

A

higher dosing when subject to stress (trauma, surgery, severe infx)

65
Q

Uses for Cromolyn sodium (intal) [cromolyn inhaled]

A
  • asthma chronic (decr gradually to bid after stabilized)
  • asthma, exercise-induced
66
Q

MOA for Cromolyn sodium (Intal) [Cromolyn inhaled]

A

inhibits mast cell degranulation (mast cell stabilizer)

67
Q

Off label uses for Cromolyn sodium (Intal) [Cromolyn inhaled]

A
  • food allergies
  • IBD
68
Q

Cromolyn sodium (Intal) Serious Rxns

A
  • bronchospasm
  • anaphylaxis
69
Q

Cromolyn sodium (Intal) common rxns

A
  • throat issues
  • bitter taste
  • wheezing/cough
70
Q

Main Leukotriene receptor antagonists (LRA) (2)

A
  • Montelukast & Zafirlukast
71
Q

Uses for Montelukast (Singulair)

A
  • asthma, maintenance
  • exercise-induced asthma
  • allergic rhinitis
72
Q

BB warning for Montelukast [Singulair]

A

serous neuropsychiatric events

73
Q

MOA for Montelukast [Singulair]

A

cysteinyl leukotriene receptor antagonist–> block leukotriene inflammatory mediators

74
Q

Uses for Zileuton (Zyflo)

A

asthma maintenance

75
Q

MOA for Zileuton (Zyflo)

A

inhibits 5-lipoxygenase interfering w/ leukotriene formation

76
Q

Zileuton (Zyflo): BB Warnings

A

avoid in alcoholics & patient w/ mood disorders

77
Q

Zileuton (Zyflo) Pearls

A
  • monitor for liver toxicity & behavior disturbances
78
Q

NOTE

A
  • LRAs + ICSs = mod persistent asthma
79
Q

List the Monoclonal Antibodies in asthma

A
  • Omalizumab (IgE)
  • Mepolizumab, Bernalizumab, Resilzumab (IL-5)
  • Dupilumab (IL-4) [self-administered]
80
Q

Asthma: Approach to Management

A
  • Assessing asthma control & severity
  • Severe vs uncontrolled asthma
  • Pharmacotherapy for asthma (meds)
  • Treat modifiable risk factors & control environmental factors
  • Guided asthma self-management edu & skills training
81
Q

Non pharmacologic Tx for Asthma

A
  • Encourage exercise
  • Stop smoking
  • Pt. edu
  • control triggers
82
Q

Acute bronchospasms must be treated promptly & effectively with… (and list them)

A

bronchodilators

  • B2 agonist
  • muscarinic antagonist
  • theophylline
  • Nasal O2
83
Q

Long-term preventive tx requires control of inflammatory process which include what names?

A
  • corticosteroids
  • LABA w/steroid (never monotherapy)
  • Anti-IgE antibodies
  • Leukotriene antagonist
84
Q

Inhaled SABAs are not recommended for long-term daily tx.

A
  • albuterol CFC/HFA
  • Pirbuterol CFC
  • Levalbuterol
85
Q

Inhaled SABAs via Nebulizer that can be mixed w/ budesonide

A
  • Albuterol
  • Levalbuterol (R-albuterol)
86
Q

List the anticholinergic meds for asthma.

A
  • Ipratropium HFA (MDI/Neb)
  • Ipratropium w/ albuterol (MDI/Neb)
87
Q

Duo-neb includes what medications

A

albuterol & ipratropium

88
Q

List systemic corticosteroids

A
  • Methylprednisolone
  • Prednisolone
  • Prednisone
  • Methylprednisolone acetate
89
Q

Which systemic corticosteroids can be used for short course “bursts” therapy?

A
  • Methylprednisolone
  • Prednisolone
  • Prednisone
90
Q

When do you use methylprednisolone acetate?

A

use in place of oral corticosteroids in pts who are vomiting or if adherence is a problem

91
Q

Describe the drug: Ipratropium bromide/albuterol inhaled [Combivent]

A

inhaled & combo SAMA & SABA

92
Q

Uses for Ipratropium bromide/albuterol inhaled [Combivent]

A
  • COPD
  • asthma exacerbation, mod-sever
93
Q

MOA for ipratropium bromide/albuterol inhaled [Combivent]

A

combo SABA & SAMA

94
Q

Safety warnings for ipratropium bromide/ albuterol inhaled [Combivent].

A

caution during labor & delivery
risk of interference w/ uterine contractility

95
Q

Uses of budesonide/formoterol inhaled [Symbicort]

A

-asthma maintenance
- COPD maintenance

96
Q

MOA for budesonide/formoterol inhaled [Symbicort]

A

combo ICS & LABA

97
Q

Is budesonide/formoterol inhaled a rescue medication?

98
Q

Uses of Fluticasone/Salmeterol [Advair]

A
  • asthma maintenance
  • COPD maintenance
99
Q

MOA of Fluticasone/Salmeterol [Advair]

A

combo inhaled ICS & LABA

100
Q

In people w/ COPD fluticasone/salmeterol [Advair], is what type of tx?

A

long-term tx

101
Q

In people w/ asthma fluticasone/salmeterol [Advair], is what type of tx?

A

short-term tx until symptoms are well controlled w/ ds other meds

102
Q

Uses for Mometasone/Formoterol [Dulera]

A

asthma, maintenance tx

103
Q

MOA for Mometasone/Formoterol [Dulera]

A

combo ICS + LABA

104
Q

Pearls: Mometasone/Formoterol [Dulera]

A
  • long tern uses –> adrenal suppression
  • paradoxical bronchospasm
105
Q

Uses for Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]

A
  • asthma, maintenance tx
  • COPD, maintenance tx
106
Q

MOA for Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]

A

inhaled combo ICS/LAMA/LABA

107
Q

Pearls: Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]

A
  • angioedema
  • cardiac arrhythmia
  • adrenal suppression
  • paradoxical bronchospasm
  • eosinophilia
  • Churg-Strauss syndrome
108
Q

In all combo medications, you should monitor for

A
  • osteoporosis
  • chronic use of bone mass-reducing drugs
  • height in children
  • vision disturbances (IOP, glaucoma)
109
Q

Study Slide 87 for 10 mins

110
Q

Study Slide 89 for 10 mins

111
Q

In immediate tx w/ a SABA, if w/n 20 mins, a pts has an incomplete response, then what is next?

A

3 more SABA treatments w/m 1 hours

112
Q

In immediate tx w/ a SABA, if there is a poor response, then what is next?

A

addition of oral or intravenous corticosteroids

113
Q

In immediate tx w/ a SABA, if pt continues to have inadequate or poor response, then what is next?

A

in-patient management w/ continuous oximetry & close monitoring

114
Q

Study slide 91 for 10 minutes

115
Q

Differentiate b/t COPD & asthma

A

COPD (cigarette smoke) - asthma (allergens)

COPD (damage/injury) - asthma (inflammation)

COPD (older) - asthma (younger)

COPD (irreversible) - asthma (reversible)

116
Q

Study Slide 116 for 10 minutes

116
Q

Uses for Aform

Block 2 (13 decks)

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