Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing-Sem 1 > Pharm Section 2 > Flashcards

Pharm Section 2 Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

components/function of central nervous system

A

brain + spinal cord; interprets incoming sensory info, dictates motor response (integration, command center)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components/function of peripheral nervous system

A

spinal nerves (impulses to/from spinal cord); cranial nerves (impulses to/from brain); sensory/afferent (impulses from sensory receptors to CNS); motor/efferent (impulses from CNS to effector organs); somatic afferent (impulses from skin, skeletal muscle, joints); visceral afferent (impulses from visceral organs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

voluntary/somatic nervous system

A

impulses from CNS to skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

involuntary/autonomic nervous system

A

impulses that regular activity of smooth muscles, cardiac muscles, and glads (“automatic”). consists of sympathetic (fight/flight) and parasympathetic (rest/digest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ganglion and parasympathetic post-ganglionic fibers release…

A

acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sympathetic post-ganglionic fibers release…

A

catecholamines (norepinephrine and epinephrine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

the release of catecholamines produces a _________ response

A

fight or flight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what enzyme inhibits the action of acetylcholine?

A

acetylcholinesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what enzymes inhibit the action of catecholamines?

A

monoamine oxidase (MAO) and catechol-o-methyl transferase (COMT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What types of receptors are present in the sympathetic/adrenergic system?

A

alpha 1, dopaminergic, beta 1, beta 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

alpha 1 receptors (location/stimulation)

A

located in vascular smooth muscle; stimulation causes vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

dopaminergic receptors (location/stimulation)

A

located in renal and coronary vessels; stimulation causes vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

beta 1 receptors (location/stimulation)

A

located in heart; stimulation causes tremors, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

beta 2 receptors (location/stimulation)

A

located in lungs; stimulation causes tremors, bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

“you have one heart and two lungs” explain.

A

beta 1 receptors located at heart; beta 2 receptors located at lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of receptors are present in the parasympathetic/cholinergic system?

A

muscarinic and nicotinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

muscarinic receptors

A

end-receptor stimulated by the release of acetylcholine from post-ganglionic fibers in the parasympathetic nervous system. subclasses M1 (CNS), M2 (heart), M3 (smooth muscle), M4 (CNS), and M5 (CNS).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

nicotinic receptors

A

end-receptor stimulated by the release of acetylcholine from post-ganglionic fibers in the parasympathetic nervous system. subclasses N1 (neuromuscular junction) and N2 (autonomic ganglia, CNS, adrenal medulla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

adrenergic refers to…

A

sympathetic nervous system (adrenaline–adrenergic. Think catecholamines.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cholinergic refers to…

A

parasympathetic nervous system (think acetylCHOLINE–cholinergic.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

steps in enzymatic synthesis of catecholamines

A

tyrosine > dopa > dopamine > norepinephrine > epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

types of sympathomimetic (adrenergic) drugs

A

alpha stimulants/agonists (aka alphamimetics), beta stimulants/agonists (aka betamimetics), and mixed alpha and beta stimulants/agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

alpha 1 agonists

A

phenylephrine (Neo-Synephine) and norepinephrine (Levophed). potent vasoconstrictors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are alpha 1 agonists used for?

A

vasoconstrictors (hypotensive shock), treat priapism, nasal decongestant (constrict vessels @ nasal mucosa, decrease swelling, increase nasal patency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which route of administration would you NEVER use to administer alpha 1 agonists?

A

Intramuscular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what do you use to reverse the effects of alpha 1 agonists?

A

alpha blocker phentolamine (Regitine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

beta agonists + mechanism of action

A

some are “preferential” or “selective” or beta 1 or 2, but none are 100% selective, so will always get some stimulation @ both. mechanism of action: activate adenyl cyclase and increase intracellular concentrations of cAMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are beta agonists used for?

A

bronchodilation for asthma/COPD, cardiac stimulant, tocolytic effect (uterine relaxation),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

dobutamine and dopamine are what type of beta agonists?

A

beta 1 agonists (heart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

terbutaline, albuterol, levabuterol, salmeterol, formoterol, arformoterol, clenbuterol are what type of agonists?

A

beta 2 agonists (lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

mixed alpha and beta agonists

A

includes epinephrine (Adrenalin, Epi-pen, AuviQ), ephedrine, pseudoephedrine (Sudafed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are mixed alpha and beta agonists used for?

A

allergic reactions/anaphylaxis, nasal and sinus decongestants, bronchodilation, and cadriogenic shock and bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

side effects of adrenergic/sympathomimetic drugs?

A

increased BP, vasoconstriction, increased HR, stroke, mydriasis (dilated pupils), cardiac arrhythmias, increased BGC (hyperglycemia), intracellular movement of K+ (hypokalemia), urinary retention (males with enlarged prostate), and uterine relaxation (tocolytic effect–B2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

sympatholytic/antiadrenergic drugs

A

include alpha and beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

alpha blockers

A

include phentolamine (Regitine, OraVerse) and phenoxybenzamine (Dibenzyline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are alpha blockers used for?

A

diagnosis and pre-op mgmt of pheochromocytoma (adrenal gland tumor) and to reverse the vasoconstrictive effects of alpha agonists.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how can you reverse severe vasoconstriction?

A

give alpha blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

beta blockers

A

some of the most widely-used drugs. usually end in -olol/-alol/-ilol, esp -olol. Selective and non-selective, but selective only so for beta 1. don’t want to block beta 2 because it would stop breathing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

contraindications or precautions for using beta blockers

A

diabetes, asthma, COPD, peripheral vascular disease,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

why would you want to use a selective beta blocker?

A

if you have asthma, COPD pts where you want to limit the action of the blocker @ lungs. Will still get some stimulation, but less than if use a non-selective beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

benefit of using beta blockers with ISA (intrinsic sympathomimetic activity) or PAA (partial agonist activity)?

A

fewer side effects, esp decrease in heart rate at rest. preferred for clients who develop bradycardia with other beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

when should you NOT use beta blockers with ISA?

A

for patients with angina pectoris, as cardiac protection during surgery, or after MI (b/c low O2 levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are beta blockers used for?

A

cardiac arrythmias, angina pectoris, hypertension, migraine headache prophylaxis, actue anxiety reactions, prevent recurrent MIs, glaucoma (topical), chronic CHF, pre/post-op (non cardiac surgeries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

side effects of beta blockers

A

hypoglycemia/masks signs of hypoglycemia, bradycardia, fatigue, prevents bronchiole dilation, don’t stop abruptly or “super reactive” to sympathetic stimulation, caution with peripheral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

parasympathomimetic (cholinergic) agonists

A

direct-acting drugs that stimulate cholinergic receptors like acetylcholine. includes pilocarpine, mathacholine, cevimeline, and bethanechol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

pilocarpine

A

cholinergic agonist. direct acting. eye drops for glaucoma and for dry mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

methacholine (Provocholine)

A

cholinergic agonist. direct acting. inhaled for tx of bronchial airway hyperactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

cevimeline (Evoxac)

A

cholinergic agonist. direct acting. dry mouth tx for pts with Sjogren’s syndrome (dry mouth, eyes, mucosa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

bethanechol (Urecholine, Duvoid)

A

cholinergic agonist. direct acting. tx for urinary retention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

acetylcholinesterase inhibitors

A

indirect acting cholinergic drugs. inhibits enzyme acetylcholinesterase, which increases body’s natural ACh activity. Includes drugs to treat alzheimer’s, myasthenia graves, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) are used to treat what?

A

Alzheimer’s disease. indirect acting cholinergic drugs (aka acetylcholinesterase inhibitors).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Neostigmine (Prostigmin) and Pyridostigmine (Mestinon) are used to treat what?

A

myasthenia gravis (muscle weakness, face droop that moves down body). indirect actin cholinergic drugs (aka acetylcholinesterase inhibitors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

organophosphates are used as what?

A

insecticides. poisonous to humans because they are acetylcholinesterase inhibitors. atropine is antidotal. (Scene from “The rock” where nick cage is exposed and uses atropine injection to heart to save himself)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are cholinergic agents used for?

A

neurological diseases (Alzheimer’s, myasthenia gravis), glaucoma, dry mouth, stimulate GIT and GUT (tx urinary prevention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

side effects of cholinergic agents?

A

abdominal cramping, diarrhea, increased secretions, DUMBBELSS mnemonic (diarrhea, urination, mitosis–pupil constriction, bradycardia, bronchoconstriction, emesis, lacrimation, salivation, sweating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

parasympatholytics (anticholinergic/antimuscarinic)

A

derived from natural sources like the belladonna plant or manufactured synthetically. tertiary amines absorbed @ CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

belladonna alkaloids

A

atropine (classic anticholinergic drug), scopolamine, and hyoscyamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what are anticholinergic drugs used for?

A

decrease glandular secretions, pupil dilation (either mydriasis–dilation or cycloplegia–paralysis of focusing mechanism @ eye), treatment of Parkinsonism, stimulate heart for bradyarrythmias (atropine), stimulate bronchodilation (asthma, COPD), illicit central effect @ CNS to produce anti-nausea effect and somnolence (sleepiness) and “twilight sleep”, to decrease GIT/GUT actions (tx for diarrhea, enuresis–involuntary urination, IBS, and OAB), to treat hyperhidrosis (excessive sweating), and to block skeletal muscles for intubation prior to surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

side effects of anticholinergic drugs

A

classic adverse reactions: dry mouth, blurred vision (cycloplegia), urinary retention, constipation, increased temp (flushing), tachycardia (heart palpitations), central effects including confusion, amnesia, hallucinations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

anticholinergic drugs and elderly

A

strong evidence that they are associated with brain atrophy in elderly patients…increase risk for dementia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

two main types of incontinence

A

stress and urge incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

symptoms of stress incontinence

A

involuntary loss of urine, associated with sneezing/coughing/laughing/lifting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

symptoms of urge incontinence

A

involuntary urine loss preceded by strong desire to empty bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

causes of stress vs. urge incontinence

A

stress: inefficient urethral closure
urge: uncontrolled bladder contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

receptors associated with stress vs urge incontinence?

A

stress: serotonin and norepinephrine receptors
urge: cholinergic muscarinic receptors

66
Q

traditional treatment of urinary incontinence

A

alpha adrenergic stimulants
anticholinergic drugs
trycyclic antidepressants

67
Q

current tx for urinary incontinence

A

more specific anticholinergic/ antimuscarinic agents that relax smooth muscle tissue @ bladder and decrease bladder contractions

68
Q

suspected cause of overactive bladder

A

overactive/unstable detrusor muscles in bladder

69
Q

tolterodine (Detrol LA), oxybutynin (Ditropan XL, Oxytrol transdermal), Trospium (Sanctura), Solifenacin (VESIcare), Darifenacin (Enablex), Fesoterodine (Toviaz) are used to treat what?

A

overactive bladder. all are anticholinergic/antimuscarinic agents that work to relax smooth muscle @ bladder

70
Q

non-muscarinic agents used to treat OAB

A

Botox (paralyzes muscles in bladder), Mirabegron (Myrbetriq) = beta 3 (in bladder) agonist help relax bladder muscles and increase its capacity–doesn’t have anticholinergic side effects (dry mouth, blurred vision, etc)

71
Q

asthma

A

chronic inflammatory disorder of the airways in which many inflammatory mediators (histamines, leukotrienes, prostaglandins) recruit inflammatory cells in response to triggers (esp mast cells, eosinophils, and T lymphocytes). constriction of bronchioles due to inflammation.

72
Q

inflammation associated with asthma causes recurrent episodes of…

A

wheezing, breathlessness, increased mucous secretion, chest tightness, cough

73
Q

asthma episodes generally occur at what time of day?

A

1-2 am (late night, early morning) and during exercise

74
Q

step and severity classifications for asthma

A

step 1: mild intermittent(

75
Q

what type of treatment approaches are recommended for asthma patients? (general)

A

stepwise approach to treating where doses or types of medications are stepped up as needed and stepped down when possible

76
Q

asthma drugs are classified as…

A

1) quick relief or rescue bronchodilators for treatments (inhaled B2 agonists–SABAs)
2) long term control or anti-inflammatories for prevention (ICS, mast cell stabilizers, leukotriene inhibitors, theophylline)

77
Q

oral steroids and asthma

A

can be used for exacerbations, but not fast enough for rescue. can be used chronically, persistent severe asthma, but has systemic side effects when used chronically.

78
Q

recommended regimen for intermittent asthma

A

SABA as needed

79
Q

recommended regimen for mild persistent asthma

A

low dose ICS

alternatives: leukotriene modifier like montelukast aka Singular or theophylline

80
Q

recommended regimen for moderate persistent asthma

A

low-med dose ICS + LABA

alternatives: low dose ICS plus leukotriene modifier or theophylline

81
Q

recommended regimen for severe persistent asthma

A

medium-high dose ICS + LABA

alternatives: same as moderate persistent

82
Q

corticosteroids

A

anti-inflammatory agents. major role of “controllers” for asthma prevention/tx

83
Q

first line therapy in the long-term management of asthma

A

ICS

84
Q

off label use for ICS

A

in children with croup

85
Q

actions of corticosteroids

A

reduce immune response and increases B2 receptors (airway smooth muscles)

86
Q

why should clients taking ICS rinse and gargle with water after?

A

to reduce the risk of thrush (oral candidiasis)

87
Q

side effects of ICS

A

reduce body’s ability to fight off infection (effect on inflammation, immune system); stunted growth (maybe); increased risk of glaucoma and cataracts; bone loss in young women.

88
Q

ICS and growth in children

A

concerns that they stunt growth, but if they do it’s not by much and better to be a little shorter than dead (risk-benefit analysis).

89
Q

ICS agents

A

generally seem to end in -one or -ide. oral prednisone, prednisolone, triamcinolone, (for severe exacerbations) + flunisolide, beclomethasone (Vanceril, Qvar), fluticasone propionate(Flovent/Flonase)/furoate (Veramyst), budesonide (Pulmicort, Symbicort), mometasone (Nasonex, asmanex), ciclesonide (Omanis, Alvesco, Zetonna)

90
Q

current evidence on ICS

A

all ICSs show sufficient therapeutic indexes. similar efficacy and safe in low-med doses.

91
Q

combination ICS therapies

A

ICS + LABAs. Advair Diskus (Fluticasone + LABA); Symbicort Turbuhaler (Budesonide + LABA); BreoEllipta (Fluticasone furoate + LABA) once daily

92
Q

SABAs

A

short acting beta2 agonist. most effective drugs available for treatment of acute asthma symptoms and exercise induced asthma. prn use not recommended. not selective and selective.

93
Q

epinehprine, isoproterenol (Isuprel)

A

non-selective SABAs

94
Q

bitolterol (Tornalate), pirbuterol (Maxair), terbutaline (Bricanyl), albuterol (Ventolin, Proventil, ProAir RespiClick), levabuterol (Xopenex)

A

selective SABAs

95
Q

LABAs

A

long acting beta2 agonists. long-term asthma care, prevention. also approved for COPD, chronic bronchitis, emphysema. safety concerns when used alone, but they are not used alone. Standard of care is to use in conjunction with ICS.

96
Q

LABA boxed warning controversy

A

study of LABAs only showed risk for death due to exacerbation of asthma (which it’s used to treat…), but they aren’t used alone. Std care is ICS + LABA. when used like that no significant increase in risk for negative outcomes.

97
Q

LABA agents

A

salmeterol (Serevent, in Advair); formoterol (Foradil, in Symbicort, in Dulera, Perforomist); aformoterol (Brovana–R isomer of formoterol for nebulizers)

98
Q

LABAS and bronchospasms

A

LABAs are NOT recommended for acute tx of bronchospasms because they take ~1 hour to work. Clients can also take SABA b/c LABA don’t fully occupy B2 receptors.

99
Q

COPD

A

chronic obstructive pulmonary disease. have trouble breathing out once they breath in (continually over inflated lungs). 85% caused by smoking.

100
Q

COPD and asthma

A

COPD symptoms similar to asthma, so often misdiagnosed with asthma.

101
Q

ACOS

A

asthma-COPD overlap syndrome. worse outcomes. combined risk factors of smoking and atopy, generally younger than COPD pts, experience more severe exacerbation more frequently than with COPD alone.

102
Q

1st line treatment for COPD pts with FEV1

A

long acting bronchodilators–either long acting anticholinergics or LABAs or a combination of the two.

103
Q

COPD drugs

A

long-acting anticholinergics or LABAs or combo. tiotropium, formoterol, aformoterol, fluticasone/salmeterol, roflumilast, vilanterol , olodaterol, glycopyrrolate, aclidinium, indacaterol,

104
Q

anticholinergic bronchdilators (muscarinic antagonists)

A

short-acting muscarinic antagonists (SAMAs) and long acting muscarinic antagonists (LAMAs)

105
Q

SAMAs

A

short acting muscarinic antagonists. blocks cholinergic response, causing bronchodilation. 10-30 minute onset, so cannot be used as rescue. used 3-4 x a day.

106
Q

MDI is….

A

metered dose inhaler

107
Q

LAMAs

A

long acting muscarinic antagonists. Tiotrpium (Spiriva, Spiriva Respimat) or Glycopyrrolate (Seebri)

108
Q

DPI is…

A

dry powder inhaler

109
Q

Triotropium (Spiriva, Spiriva Respimat)

A

LAMA. inhaled 1x a day. DPI or spray. causes more dry mouth than Atrovent. 1st line treatment for bronchospasm associated with COPD.

110
Q

Glycopyrrolate (Seebri)

A

LAMA. long acting anticholinergic form of glycopyrrolate approved for COPD tx. Also used in combination tx with LAMA glycopyrrolate and LABA formoterol fumarate. For COPD, but not asthma or acute bronchospasm relief.

111
Q

mast cell stabilizers

A

reduce the release of histamine, serotonin, leukotrienes, etc. (precipitate asthma attack). Similar mechanism to ICS, but with fewer side effects. Less effective than ICS. cromolyn (Intal)

112
Q

LTRAs

A

Leukotriene receptor antagonists. prevents breakdown of prostaglandins, leukotrienes. reverse bronchoconstriction, mucus hypersecretion, and airway inflammation. less effective than ICS. e.g. monolukast (Singular)

113
Q

methylxanthine agents

A

theophylline and amniophylline. inhibits phosphodiesterase to cause bronchodilation. theophylline notorious for fluctuations in blood levels due to drug interactions. narrow therapeutic index. side effects similar to large doses of caffeine. chocolate.

114
Q

IgE antagonist

A

Omalizumab (Xoliar) = 1st biotech product for asthma caused by allergies and chronic hives. for people who ICSs don’t work for. disables IgE. side effects = injection site reactions, viral/URT infections, headache. Black box warning for possible delayed reaction. wait @ office 2+ hours.

115
Q

Interleukin-5 (IL5) antagonist

A

mepolizumab (Nucala) and Reslizumab (Cinqair). work to lower levels of blood/circulating eosinophils. expensive.

116
Q

how many people does in the FDA predict have eosinophilic phenotype for asthma

A

1 in 20.

117
Q

exercise induced asthma or bronchospasm (EIA/EIB)

A

bronchial spasm, edema, and mucus secretion brought on by exercise (esp in cool, dry climates). Recovery usually within 90 min. 10-15% reduction in FEV1 confirms diagnosis

118
Q

tx for EIA/EIB

A

inhaled SABA 15 minutes before workout.If that doesn’t work, daily LABA + ICS, but some of these banned by athletic regulatory agencies. Tailor regimen for athletes. Don’t use ICS just before exercise (takes 2-4 weeks to work) and don’t take LABAs alone.

119
Q

preferred SABA for use in pregnancy

A

albuterol

120
Q

preferred ICS for use in pregnancy

A

budesonide

121
Q

LABAs and pregnancy

A

appear to be safe

122
Q

montelukast and pregnancy

A

appears to be safe

123
Q

PAH

A

pulmonary arterial hypertension. tx with vasodilators.

124
Q

standardized tx for PAH

A

warfarin (Coumadin) and furosemide (Lasix)

125
Q

CFC vs. HFA inhalers

A

CFC inhalers banned in 2009. Most manufacturers switched from MDI to DPI systems, but some now make hydrofluoroalkane (HFA) inhalers to propel meds out of container and into lung. equally as effective. Need to clean HFAs more often, but don’t have to prime as often.

126
Q

DPI

A

dry powder inhaler. requires deep, rapid force inhalation because doesn’t have propellents. don’t shake. clean with brush/dry cloth.

127
Q

nebulizers

A

aerosolize a liquid

128
Q

chronobiology of asthma

A

asthma attacks late at night/early AM (1-2am) because cortisol drops, airway reactivity/inflammation peaks, sympathetic tone trough, vagal tone peak, airway/cilia function trough.

129
Q

Mucolytic/Expectorant agents

A

Guaifenesin (combo expectorant and anti-tussive); N-acetylcysteine (Mucomyst)

130
Q

cough suppressants

A

aka anti-tussives. Codeine (central suppression), dextromethorphan (DX,DM central suppression), Guaifenesin, diphenhydramine (Benadryl-histamine blocking +CNS), Benzonatate (Tesslon, Perles, Zonatuss–peripheral action…anesthetizes stretch receptors @ resp passages), hydrocodone (central suppression)

131
Q

anti-tussives in children

A

no longer recommended. honey before bed instead.

132
Q

anti-tussives in adults

A

antihistamine-decongestant combos recommended for 1st line tx for acute coughs due to colds, postnasal drip. Don’t use DX or guaifenesin for cold-realted coughs. Atrovent if cough persists 3-8 weeks after URI.

133
Q

sympathomimetic amines (nasal + sinus decongestants)

A

vasoconstrictors in nasal mucosa, sinus, ear via alpha 1 adrenergic receptors. decrease blood supply, improve nasal patency. Short-term therapy, if longer = rebound congestion.

134
Q

topical sympathomimetic amines

A

phenylephrine (Neo-Synephine) and oxymethazoline (Afrin)

135
Q

oral sympathomimetic amines

A

pseudoephedrine, phenylephrine (Sudafed PE)

136
Q

are sympathomimetic amines effective as decongestants?

A

oral pheylephrine = same as placebo
oral pseudopephedrine = nasal congestion only
intranasal like oxymethazoline = effective, less likely for systemic adverse effects
ICS = most effective drugs for prevention and relief of nasal congestion and other seasonal allergic rhinitis symptoms

137
Q

cromolyn sodium as decongestant

A

anti inflammatory. prevents the degranulation of mast cells. used for nasal allergies and allergic rhinitis. NasalCrom = OTC.

138
Q

anticholinergics as decongestants

A

used for drying effects in the nasal mucosa

139
Q

antihistamines/histamine blockers

A 
H1 = increases bronchial smooth muscle contraction and nasal/eye secretions
H2 = increases G1 secretion. Diphenhydramine (Benadryl) = still gold standard histamine blocker.
140
Q

traditional/1st gen vs second gen antihistamines

A

1st gen: penetrate blood brain barrier, nonspecific, many side effects (drowsiness, anticholinergic effects), every 4-6 hours; 2nd gen: decreased movement across BBB–fewer side effects but not better, usually 1x a day, use more now

141
Q

side effects of antihistamines

A

competitive inhibition of histamine activity, CNS depression/drowsiness, anti-vertigo, anticholinergic

142
Q

indications for use of antihistamines

A

immunotherapy (allergic rhinitis), allergic disorders, acute anaphylaxis, sedation

143
Q

1st gen antihistamines (list)

A

generally end in -ine/ -amine. oral, intranasal.

144
Q

2nd gen antihistamine agents (list)

A

loratidine (Claratin), desloratidine (Clarinex), Certizine (Zyrtec), Fexofenadine (Allegra), levocertirzine (Xyzal)

145
Q

comparing antihistamines

A

efficacy (1st/2nd gen same), sedation (1st gen more sedating), onset (cortisone/levocertizine = 1 hour, others = 1-3 hours), allergy type (all effective for outdoor and indoor allergies), price (OTC cheapest. pts respond diff so try others if needed)

146
Q

allergy meds and driving

A

may impair driving more than alcohol. 25mg Benadryl can cause more impairment than legal alcohol limit

147
Q

Benadryl in elderly, infants

A

linked to dementia. may stimulate infants

148
Q

NSAIDSs

A

pain relief. no systemic review for NSAID relief of common colds.

149
Q

children’s cold medicine

A 
2008 = cold meds should not be used for kids under 2
2011 = cold meds taken off market, the rest not labeled for kids under 4-6
150
Q

allergic rhinitis

A

“Asthma of the face” chronic IgE mediated respiratory illness that causes inflammation of the membranes lining the nose…nasal congestion, rhinorrhea, sneezing, itching of the nose, and post-nasal drip.

151
Q

Treatment for allergic rhinitis

A

first line = nasally inhaled corticosteroids, as well as oral antihistamines and intranasal antihistamines
others = oral decongestants, oral corticosteroids, intranasal cromolyn, intranasal anticholinergics, oral anti-leukotriene agents

152
Q

Tx of allergic rhinitis during pregnancy

A

nasal cromolyn or beclomethasone
avoid oral decongestants in 1st trimester (infant gastroschisis). don’t initiate immunotherapy during pregnancy, but can continue if already on it.

153
Q

Tx allergic rhinitis in athletes

A

oral decongestants banned by USOC
oral and parenteral steroids banned
oral antihistamines allowed by USOC but not international federation.
e.g. advil cold and sinus and UT track athlete. Must disclose (exactly) all meds on before testing.

154
Q

Alternative therapies for common cold

A

echinacea, goldenseal, green tea, zinc, airborne

155
Q

echinacea possible benefits

A

shorter, less severe cold (not proven)

156
Q

goldenseal benefits

A

contains berberine salts, which may have antibacterials and ant-iinflammatory properties. present in small amounts in goldenseal.

157
Q

green tea benefits

A

polyphenols in green tea have antiviral effects. may help prevent cold and flu symptoms (1-5 cups a day in kids, need more research)

158
Q

zinc benefits

A

thought to assist t cells, which kill virus infected cells. mechanism unknown. adverse effects: GI upset, altered taste/smell. conflicting results. metaanalysis…12/ say it works, 1/2 say it doesnt.

159
Q

airborne

A

no proof that it can prevent or treat colds

160
Q

what sort of immunotherapy is available for people who are afraid of needles?

A

new sublingual immunotherapies (Oralair, Grastek) have been approved to treat multiple grass pollens and ragweed allergies (Ragwite). More expensive than allergy shots, but sublingual is safer, more convenient, and almost as effective as shots.

Nursing-Sem 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions