Pharm Side Door test

Question 1

-Methylxanthines (Side Door)

Answer 1

-Referred to simply as xanthines, xanthine derivatives, or as methylxanthines

-These are phosphodiesterase inhibitors which indirectly increase the amount of cyclic AMP within smooth muscle causing bronchodilation

Question 2

-Xanthines used therapeutically include:

Answer 2

-Caffeine found in the seeds of a coffee plant

-Theophylline found in tea leaves (mostly oral medications Theo-Dur

Question 3

-Clinical uses of theophylline include the management of:

-Asthma

Answer 3

-Sustained release theophylline is indicated as an alternative for maintenance therapy of mild, persistent asthma and higher in patients older than 5 years of age

	-Listed as an alternative for patients older than 5 years of age in combination with ICS

	-Side effects and narrow therapeutic index may make it a poor choice vs. others agents

Question 4

-Clinical uses of theophylline include the management of:

-Chronic obstructive pulmonary disease(COPD)

Answer 4

-The global initiative for chronic obstructive lung disease (gold) states that inhaled bronchodilators are preferred when available

	-Theophylline: recommended by GOLD as alternative to B2 agonist and anticholinergics

	-Not used in acute exacerbation

Question 5

-Clinical uses of theophylline include the management of:

-Apnea of prematurity in neonates

Answer 5

-Methylxanthines are considered the first line agents of choice as treatment

-Theophylline was most extensively used in the past, but caffeine citrate may be a better choice (as it is safer, higher therapeutic index)

Question 6

All xanthine’s have the following effects

Answer 6

-CNS stimulation

	-Skeletal muscle stimulation

	-Bronchodilaton

	-Pulmonary vasodilation

	-Smooth muscle relaxation

		-Theophylline is generally classified as a bronchodilator

Question 7

-The basic effects on the lung are:

Answer 7

-Decreased airway resistance (result of Bronchodilation

-Decreased pulmonary vascular resistance (result of pulmonary vasodilation)

-Stimulated ventilation (CNS)

Question 8

metabolic rates of Theophylline

Answer 8

-There is variability in individual metabolic rates among patients, which makes it difficult to control therapeutic dosages

-To optimum serum theophylline level for maximal bronchodilation in adults is between 10n and 20 mcg/ml. And 5-10 mcg/mL in neonates and children

Question 9

-Side effects or lack of therapeutic effects are associated with the following serum levels:

Answer 9

-10-20 micrograms/ ml therapeutic range

	- > 20 micrograms/ ml Nausea

	- 40-45 micrograms/ ml seizures

-Asthma management

	- 5 to 15 ug/ ML ug means micrograms

-COPD management

	-5 to 10 ug/ ml

Question 10

toxic effects of Theophylline

Answer 10

-It is possible for an individual to bypass the nausea phase of toxicity and begin having seizures immediately

Question 11

aminophylline

Answer 11

-It should be noted that aminophylline is a double salt of theophylline compound to give aqueous solubility

-This enables one to give the drug IV

Question 12

-Adverse Reaction with Theophylline

-Central nervous system

Answer 12

-Headaches

	-Anxiety

	-Restlessness

	-Insomnia

	-Tremor Convulsions

Question 13

-Adverse Reaction with Theophylline

-Respiratory

Answer 13

-Tachypnea

Question 14

-Adverse Reaction with Theophylline

-Renal

Answer 14

-Diuresis

Question 15

xanthines contraindications

Answer 15

-Because of side effects in the gastrointestinal system, xanthines are contraindicated in subjects with active peptic ulcers or acute gastritis

Question 16

-Mucolytic

Answer 16

-Mucolytic refers to an agent that breaks down or liquifies thick mucus to a watery state

Question 17

-Mucoactive

Answer 17

-Mucoactive refers to any agent that has an effect on mucus secretion (mucolytic, expectorant, mucokinetic, etc.)

Question 18

indication for mucoactive therap

Answer 18

-The general indication for mucoactive therapy is to reduce the accumulation of airway secretions, with improvement in pulmonary function ans gas exchange and the prevention of repeated infection and airway damage

Question 19

-Disease in which mucoactive therapy is indicated are those with hypertension or poor clearance of airway secretions such as

Answer 19

-Cystic Fibrosis

-Acute and chronic bronchitis

Question 20

-Three drugs are available that have been used for administration as an aerosol, to treat abnormal pulmonary secretions

Answer 20

-N-acetylcysteine (NAC) aka mucomyst

	-Dornase alfa aka Pulmozyme

	-Hypertonic saline

Question 21

-The therapeutic options for controlling mucus hypersecretion are outlined as follows

Answer 21

-Remove causative factors where possible

		-Treat infections

		-Stop smoking

		-Avoid pollution and allergens

Question 22

-Acetylcysteine

Answer 22

-Generic name: N-Acetylcysteine, Acetylcysteine, or NAC

-TRade name: Mucomyst, mucosil

-Mechanism of action: Lyses disulfide bonds holding mucoproteins together, thus increasing fluidity of mucoid sputum

-Concentration: 20% W/V solution or 10% W/V solution

Question 23

-Acetylcysteine

-Indication for use

Answer 23

-Treatment of conditions associated with viscous secretions

-Also used for Acetaminophen overdose

Question 24

-Acetylcysteine

-Side effects

Answer 24

-Bronchospasm

-Nausea

-Rhinorrhea

Question 25

-Highly recommended that the drug be administered -Acetylcysteine

Answer 25

be administered in conjunction with a bronchodilator

Question 26

-Dornase Alfa

Answer 26

-Generic name: Dornase Alfa

-Trade name: Pulmozyme

-Inication: For the management of cystic fibrosis, to reduce the frequency of respiratory infections requiring parenteral antibiotics and to improve or preserve pulmonary function

-Mode of action: Reduce the viscosity and adhesivity if infected respiratory secretion when given by aerosol, accomplished with a decrease in the size of the DNA in the sputum

Question 27

-Dornase Alfa Optimal delivery

Answer 27

-Optimal delivery of the enzyme requires a neb system capable of producing appropriate sized particles and quantity of aerosol. Important when goven expensive drugs or medication with a narrow TI

		-Hudson RCI UP-DRAFT OPTI_NEB
		-ACRON 2 NEB

		-PARI LC PLUS neb

		-Mesh neb

Question 28

-Dornase Alfa

-Adverse effects:

Answer 28

voice alteration, and pharyngitis

Question 29

-Expectorants

Answer 29

-Expectorants are medications meant to increase the volume or hydration of airway secretion for clearance

	-Cough suppressants should never be given to a patient with thick retained secretions

Question 30

-Sodium bicarbonate

Answer 30

-Inflammation caused by bicarbonate is thought to draw water into secretions

Question 31

Guaifenesin (Mucinex)

Answer 31

-Usually considered an expectorant

-CAn be ciliotoxic when applied directly to respiratory epithelium

-Thought that expectorant action is mediated by stimulation of the GI tract

Question 32

Antihistamines

Answer 32

drugs that reduce the effects mediated by histamine, a chemical released by the body during allergic reactions.

-Antihistamines are often administered to reduce secretions (e.g., runny nose and sneezing), but they can cause drowsiness and impaired responses

Question 33

-Antitussives

Answer 33

drugs that suppress the cough reflex

-Note productive coughs should not be suppressed

Question 34

-Four classes of agents can be distinguished in cold remedies, used individually or in combination

Answer 34

-Sympathomimetics: For decongestion

		-Pseudoephedrine (sudafed)

	-Antihistamines: To reduce (dry) secretions

		-Diphenhydramine HCI (benadryl) cetirizine (zyrtec), Loratadine (claritin)

	-Expectorants: To increase mucus clearance

		-Guaifenesin (Mucinex)

		-Robitussin DM

	-Antitussives: To suppress the cough reflex

		-Codeine, dextromethorphan, (Delsym, Trocal, Robitussin Maximum Strength Cough)