Pharm Respiratory Flashcards
Drugs (12), week 1
Indications for Albuterol?
Acute Asthma Sx
Prevent Exertion-Induced Asthma
COPD
Indications for Beclomethasone?
Asthma (not controlled)
Rhinitis
Indications for Budesonide?
Asthma (not controlled)
Rhinitis
Indications for Cromolyn?
Asthma: prophylaxis (not helpful once begun)
Indications for Epinephrine?
Anaphylaxis (IV/IM)
Acute asthma (inhalation)
Ocular HTN, Open-Angle Glaucoma (eye drops)
Indications for Fluticasone?
Rhinitis
Nasal polyps
Asthma (prophylactic)
Eosinophillic esophagitis
Indications for Ipratropium?
COPD
2nd line for asthma
Indications for Mometasone?
Asthma (uncontrolled)
Allergic rhinitis
Nasal polyps
Indications for Montelukast?
Asthma (chronic, prophylaxis)
Allergic rhinitis
Indications for Salmeterol?
Chronic asthma (mod-severe)
Indications for Tiotropium?
COPD
Indications for Triaminolone?
Rheumatic/Arthritic d/o MS Dermatitis Inflammation/Allergy Asthma (uncontrolled) Rhinitis
What are contraindications for Albuterol and why?
Eclampsia (pre-), intra-uterine infx or fetal death, antepartum hemorrhage, placenta prevue, cord compression, threatened miscarriage
ALL d/t DEC uterine contracility
Cardiac dz, tachycardia
What are contraindications for Beclomethasone and why?
Status asthmaticus
Systemic fungal infx
What are contraindications for Budesonide and why?
Status asthmaticus
Systemic fungal infx
What are contraindications for Epinephrine and why?
HTN, occlusive vascular dz, cardiac arrhythmias, tachycardia
Hyperthyroidism
Cerebrovascular insufficiency
Closed angle glaucoma
Not IM to digits, ears, nose, penis, scrotum
What are contraindications for Fluticasone and why?
Status asthmaticus
Systemic fungal infx
Allergy to milk proteins
What are contraindications for Ipratropium and why?
Narrow angle glaucoma
Prostatic hypertrophy
Milk/Lactose allergy
What are contraindications for Mometasone and why?
Status asthmaticus
Systemic fungal infx
What are contraindications for Montelukast and why?
Acute asthma exacerbation
What are contraindications for Salmeterol and why?
Status asthmaticus
Acute asthma exacerbation
What are contraindications for Tiotropium and why?
Narrow angle glaucoma
Prostatic hypertrophy
Milk/Lactose allergy
What are contraindications for Triamcinolone and why?
Status asthmaticus
Systemic fungal infx
Idiopathic thrombocytopenia purpura
Administration of live/attenuated vaccinations
SE of Albuterol?
MC: CNS tremor (hands)
Tachy, HTN, angina
Vertigo, unusual taste
Dry/irritation of oropharynx
Vomiting
SE of Beclomethasone?
Thrush
Prevents healing of damaged nasal mucosa
SE of Budesonide?
Thrush
Prevents healing of damaged nasal mucosa
SE of Cromolyn?
Sore throat
SE of EPI?
CNS Simulation: urinary retention, SOB, hyperglycemia, sweats, hypersalivation, weakness, tremor, cold extremities, hypokalemia, epigastric pain (GI issues), CV d/o, tachycardia
Gangrene, necrosis to tissue IM
Eyes - blurry vision, photophobia, obstruction of duty, edema, hyperemia, inflammation of eyes
SE of Fluticasone?
URI, HA, pharyngitis, cough, rhinitis, nasal congestion
Thrust, prevents healing of damaged nasal mucosa
Topical: pruritus, excess hair growth, dryness, numbness, burning, eruptions, hypo pigmentation, skin atrophy, Cushing’s syndrome
SE of Ipratropium?
URI, dry mouth, sinusitis, constipation, cough, tachycardia, urinary retention, UTI, pupil dilation, blurry vision, myalgia, dyspepsia, rash, pharyngitis, rhinitis, epistaxis
SE of Mometasone?
Thrush
Prevents healing of damaged nasal mucosa
Burning, itching, rosacea
SE of Montelukast?
MC: HA
dizziness, rash, cough, flu like sx, insomnia
INC resp Info in elderly
hepatic eosinophilic infiltration
SE of Salmeterol?
Tachycardia, HA, nervousness, nasopharyngitis, cough, INC asthma related death
SE of Tiotropium?
URI, dry mouth, sinusitis, constipation, cough, tachycardia, urinary retention, UTI, pupil dilation, blurry vision, myalgia, dyspepsia, rash, pharyngitis, rhinitis, epistaxis
SE of Triamicinolone?
Jt swelling, contusions, sinusitis, cough
Thrush
Prevents healing of damaged nasal mucosa
What drug interacts with MAO inhibitors, Tricyclic antidepressants, sympathomimetics.
Is inhibited by beta blockers
Can lead to hypokalemia with diuretics, corticosteroids, and xanthines.
INC absorption of sulfamethoxazole
DEC. serum levels of digoxin?
Albuterol
Salmeterol
What drug interacts with MAO inhibitors, Tricyclic antidepressants, sympathomimetics, halogenated inhalation anesthetics, B or A blockers, methyldopa, guanethidine, anti-HTN, adrenergic neuron blockers, K depleting drugs, cardiac glycosides, ephedra, yohimbe?
Epineprhine
What drug has DEC levels in the blood when combined with Phenytoin and Phenobarbitol?
Motelukast
What respiratory medication should not be combined with Mifepristone?
Triamcinolone
This asthma-related inhalant should be avoided in diabetes, CVD, angina, and hyperthyroidism
Albuterol/Salbutamol
The practitioner needs to monitor growth in children while on this inhaler
Fluticasone
Use of this nasal spray should not exceed 3 days due to risk of rebound congestion or rhinitis medicamentosa?
Oxymetazolin
Used in combination with dextromethorphan and other antitussives, this medication is an expectorant that may cause kidney stones, with prolonged use
Guaifenesin
This medication can be used to treat low blood pressure from shock without directly affecting chronotropy and inotropy
Phenylephrine
Selective Leukotriene receptor antagonist used long-term to reduce asthma attacks
Montelukast
Used for acute glaucoma, bronchospasms, ventricular fibrillation, and anaphylaxis. It is an alpha & beta 1,2 adrenergic agonist
Epinephrine
Raises blood pressure by causing vasoconstriction. It may also be used to provide hemorrhoid relief
Phenylephrine
A long-acting oral asthma medication taken at night that may cause Churg-Strauss Syndrome (vasculitis) with hyper-eosinophilia
Montelukast
After using this inhaled medication the patient should rinse his mouth out with water
Fluticasone
Antitussive that potentiates serotonin syndrome risk in people taking an SSRI or MAOI
Dextromethorphan
Inhaled corticosteroid used to prevent asthma attacks
Fluticasone
Nasal decongestant spray used to replace pseudoephedrine. This selective alpha-1 agonist does not have an effect on heart rate or its contractility
Phenylephrine
This topical decongestant is an over the counter nasal spray that can also be used for nosebleeds
Oxymetazolin
This nasal spray is contraindicated in pregnancy. It is used for nasal congestion and nosebleeds
Oxymetazolin
Children with a history of atopy should not take this cough suppressant because it may stimulate the release of histamine and lead to an anaphylactic episode
Dextromethorphan
A long-acting muscarinic receptor antagonist that acts as a bronchodilator.
It is contraindicated in glaucoma because the medication may have anticholinergic side effects that exacerbate glaucoma
Tiotropium bromide
Eye drops used for mydriasis but contraindicated in glaucoma
Phenylephrine
Anti-tussive that has shown to be no more effective than placebo but is contained in many cough syrups and lozenges. With very high doses, this medication has been used as a dissociative hallucinogenic agent
Dextromethorphan
Fluticasone
i.) Clinical Use
i. ) Clinical Use
a. ) Allergic Rhinitis
b. ) Prevent asthma attacks (not used in treatment of an attack though)
Fluticasone
ii.) Mechanism
a.) Inhaled corticosteroid (potent anti-inflammatory)
Fluticasone iii.) Side Effects
a. ) URI
b. ) Oral candida infection
Fluticasone
iv.) Contraindications
a. ) Do not use topically when pregnant
b. ) Not to be used as a primary treatment in status asthmaticus
Fluticasone
v.) Interactions
a. ) Salmeterol improves its response
b. ) Immunostimulant botanicals may antagonize it
Montelukast
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Especially good for aspirin-induced asthma
b. ) Seasonal Allergies
ii. ) Mechanism
a. ) Selective leukotriene receptor antagonist
Montelukast
iii. ) Side Effects iv. ) Contraindications
iii. ) Side Effects
a. ) Increased bleeding tendency
b. ) Churg-Strauss Syndrome (eosinophilic granulomatosis vasculitis)
c. ) Hypereosinophilia
iv. ) Contraindications
a. ) NOT used acutely
Oral; Taken in the evening
Salmeterol
i. ) Clinical Use
ii. ) Mechanism
iii. ) Side Effects
a. ) Arrhythmia & Tachycardia
b. ) Tremor
iv. ) Contraindications
a. ) Not used for Treating acute asthma attack
b. ) CVD & angina
v. ) Interactions
a. ) Often prescribed with a corticosteroid
i. ) Clinical Use
a. ) To prevent asthma attacks & bronchospasms in COPD
* only prescribed to patients with severe persistent asthma.
ii. ) Mechanism
a. ) Long-acting Beta-2-adrenergic agonist
Salmeterol
iii. ) Side Effects
iv. ) Contraindications
v. ) Interactions - prescribe w/?
iii. ) Side Effects
a. ) Arrhythmia & Tachycardia
b. ) Tremor
iv. ) Contraindications
a. ) Not used for Treating acute asthma attack
b. ) CVD & angina
v. ) Interactions
a. ) Often prescribed with a corticosteroid
Tiotropium Bromide
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Asthma & COPD
ii. ) Mechanism
a. ) Long-acting (24-hour) Muscarinic receptor antagonist
b. ) Inhalant Bronchodilator
Tiotropium Bromide
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Anticholinergic effects = Dry eyes, Dry mouth, Mydriasis, Urinary retention, glaucoma, palpitations
iv. ) Contraindications
a. ) Glaucoma
Phenylephrine
i. ) Clinical Use
ii. ) Mechanism
i.) Clinical Use
a.) Mydriatic Agent *eye drops
b.) Hemorrhoids (symptomatic relief by decreasing swelling)
c.) Increase blood pressure (without affecting heart rate) -> septic shock
d.) Decongestant *nasal spray
(substitute to pseudoephedrine in cases where pseudoephedrine’s positive chronotropy & inotropy is a concern)
(oxymetazolin is a more commonly used nasal spray)
Controversial about whether or not it is an effective decongestant. There has been a push to use it to reduce the abuse of pseudoephedrine
ii. ) Mechanism
a. ) Selective Alpha-1 adrenergic receptor agonist
Phenylephrine
iii. ) Side Effects
iv. ) Contraindications
v. ) Interactions
iii. ) Side Effects
a. ) HTN & Reflex Bardycardia
iv. ) Contraindications
a. ) Glaucoma (when using eye drops for mydriasis)
b. ) Prostatic Hyperplasia
v. ) Interactions
a. ) Extensively metabolized by MAO
Oxymetazoline
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Over the counter Topical Decongestant (Nasal Spray)
b. ) Nose bleeds (d/t vasoconstriction from alpha-1 agonistic activity)
ii. ) Mechanism
a. ) Selective alpha-1 agonist & partial alpha-2 agonist
b. ) Vasoconstrictive also
Oxymetazoline
iii.) Side Effects
iv.) Contraindications
= Interactions
iii. ) Side Effects
a. ) Rhinitis medicamentosa
iv. ) Contraindications
a. ) Use for more than 3 days (to prevent rebound congestion)
b. ) Pregnancy
INTERACTIONS
c.) Concomitant MAOI use
Dextromethorphan
i.) Clinical Use (abuse potential?)
i. ) Clinical Use
a. ) Antitussive in lozenges, cough syrups, and in pill form (some studies have shown it to be no more effective than placebo)
In large doses, dextromethophan is used recreationally for a dissociative halluginogenic effect and possible euphoria
Dextromethorphan
ii. ) Side Effects
iii. ) Contraindications
iv. ) Interactions
a. ) MAOIs & SSRIs (b/c it may potentiate the risk of serotonin syndrome)
b. ) Dextromethorphan is metabolized by P450 and may reach toxic levels with grapefruit juice
ii. ) Side Effects
a. ) Nausea, vomiting
b. ) Nervousness, increased energy, and increased confidence
c. ) Hallucinations
iii. ) Contraindications
a. ) Children with a history of atopy (b/c it can trigger histamine release and possible anaphylactic reaction)
Dextromethorphan
iv.) Interactions
a. ) MAOIs & SSRIs (b/c it may potentiate the risk of serotonin syndrome)
b. ) Dextromethorphan is metabolized by P450 and may reach toxic levels with grapefruit juice
Guaifenesin
i.) Clinical Use
ii.) Mechanism
i. ) Clinical Use
a. ) Common cold usually combined with pseudoephedrine, phenylephrine, acetaminophen, and/or dextromethorphan
ii. ) Mechanism
a. ) Expectorant (increases volume & decreases viscosity of secretions in the trachea and bronchi)
Guaifenesin
iii.) Side Effects
a. ) Nausea, vomiting
b. ) Formation of kidney stones (prolonged use)
Albuterol/Salbutamol
i.) Clinical Use
ii.) Mechanism
iii. ) Side Effects
a. ) Tremor
b. ) Altered Taste
c. ) Hypotension, Arrhythmias, Tachycardia
d. ) May contain sulfites (which some asthmatics are sensitive to)
e. ) High doses may result in hypokalemia
iv. ) Contraindications
a. ) CVD & angina
b. ) Hyperthyroidism
c. ) Diabetes
v. ) Interactions
a. ) Avoid concomitant use of CNS stimulants
i. ) Clinical Use
a. ) Asthma Attack (acute bronchospasm)
* 15 mins to take effect. Lasts 3-4 hours*
ii. ) Mechanism
a. ) Beta-2 agonist. Relaxes bronchial smooth muscle
Albuterol/Salbutamol
iii.) Side Effects
iv. ) Contraindications
v. ) Interactions
iii. ) Side Effects
a. ) Tremor
b. ) Altered Taste
c. ) Hypotension, Arrhythmias, Tachycardia
d. ) May contain sulfites (which some asthmatics are sensitive to)
e. ) High doses may result in hypokalemia
iv. ) Contraindications
a. ) CVD & angina
b. ) Hyperthyroidism
c. ) Diabetes
v. ) Interactions
a. ) Avoid concomitant use of CNS stimulants
Epinephrine
i.) Clinical Use
ii.) Mechanism
i. ) Clinical Use
a. ) Anaphylaxis
b. ) Acute bronchospasms
c. ) Glaucoma
d. ) ventricular tachycardia & fibrillation
ii. ) Mechanism
a. ) Alpha & Beta 1,2 adrenergic agonist
Epinephrine
SE and CI
iii. ) Side Effects
a. ) HTN, Tachycardia, Arrhythmia, Ventricular Fibrillation, Angina
iv. ) Contraindications
a. ) CVD
b. ) DM2
c. ) Hyperthyroidism
d. ) Epilepsy
e. ) Severe Anxiety
