Pharmacology 2 - Exam 2

Question 1

Albuterol (Ventolin) MOA / Uses / Admin

Answer 1

–> Short acting beta2 agonist
–> Oral (long acting) or Inhaler (short acting) / nebulizer
–> MOA: acts on beta2 adrenergic receptors in bronchial smooth muscle for bronchodilation
–> Uses: PRN in emergencies / rescue inhaler; treatment or prevention of asthma symptoms

Question 2

Albuterol ADEs / Monitoring / Interactions

Answer 2

ADEs: Tachycardia (expected 20bpm increase), tremors, chest pain
Interactions: Beta Blockers

Question 3

Ipratropium (Atrovent) & Tiotropium (Spiriva) MOA / Uses

Answer 3

–> Anticholinergic
–> Scheduled dose inhaler
–> Blocks muscarinic receptors in bronchi for bronchodilation, reduces mucus secretions
–> Not a rescue inhaler; less effective than beta2 agonists

Question 4

Ipratropium (Atrovent) Onset / Dosing

Answer 4

Onset: 30 min
Peak: 3 minutes
Duration: 3 hours
Dosing: QID

Question 5

Tiotropium (Spiriva) Onset / Dosing

Answer 5

Onset: 30 min
Peak: 3 hours
Duration: 24 hours
Dosing: Once / day

Question 6

Formoterol & Salmeterol

Answer 6

–> Scheduled dose long acting beta2 agonist (LABAs)
–> Selectively actives beta2 receptors to activate dilation of bronchioles
–> Admin: every 12 hours (BID)
–> Pt should also be on anti-inflammatories

Question 7

Types of asthma

Answer 7

1) Mild intermittent (1x/week or less)
2) Mild persistent (2-6x week)
3) Moderate persistent (Daily)
4) Severe persistent (continuous or very frequent)

Question 8

Ipratropium / Tiotropium ADEs and Pt Teaching

Answer 8

–> ADEs: anticholinergic effects (esp. dry mouth)
–> Teaching: rinse mouth after admin for help with dry mouth and metallic taste
–> Teaching: wait 5 min between puffs
–> 10% of pts have cross allergy with peanut allergy
–> Drink plenty of fluids and can suck on sugar-free candy to help with dry mouth

Question 9

Glucocorticoids MOA and Admin = Beclomethasone (QVAR) / Prednisone (Prelone) / Methylprednisone (Solu-medrol)

Answer 9

–> MOA: Prevent inflammation, suppress mucus production, make beta2 receptors more responsive
–> Scheduled dosing every 12 hours (BID), fixed

Question 10

Glucocorticoids ADEs & Teaching

Answer 10

–> ADEs for inhaled = difficulty speaking or hoarseness; Candida
–> Rinse mouth with saltwater to help with hoarseness; good oral hygiene
–> ADEs for oral med: immunosuppression / risk of infection, osteoporosis, poor control of blood sugars

Question 11

Montelukast (Singular)

Answer 11

–> Leukotriene receptor antagonist
–> Suppression of inflammation, airway edema, bronchoconstriction, mucus production
–> Oral admin 1x/day at bedtime (no food for better absorption)
–> 2nd line drug after steroids; can be used with children 12 and up
–> Black box warning for anxiety/depression/suicide and hallucinations

Question 12

Combination Inhalers

Answer 12

• Combivent (Albuterol / ipratropium)
• Duoneb (albuterol / ipratropium in nebulizer form)
• Dulera (formoterol / mometasone)
• Symbicort (formoterol / budesonide)
• Advair (salmeterol / fluticasone)
• Breo Ellipta (vilanterol / fluticasone)

Question 13

Treatment for mild intermittent asthma

Answer 13

Albuterol PRN, no daily meds needed

Question 14

Treatment for mild persistent asthma

Answer 14

Albuterol PRN + low dose glucocorticoid inhaler scheduled daily

Question 15

Treatment for moderate persistent asthma

Answer 15

Albuterol PRN + low dose glucocorticoid inhaler + long acting beta agonist inhaler scheduled daily
–> Combo inhalers commonly used

Question 16

Treatment for severe persistent asthma

Answer 16

Albuterol PRN + high dose glucocorticoid inhaler + long acting beta2 agonist inhaler daily
–> Also can use singulair

Question 17

Fluticasone (Flonase) & Mometasone (Nasonex) MOA and Uses

Answer 17

–> Nasal glucocorticoids (metered dose nasal spray)
–> MOA: decrease in inflammation
–> Used for allergic rhinitis
–> May take up to 7 days for relief, more effective than antihistamines

Question 18

Fluticasone & Mometasone ADEs and Teaching

Answer 18

–> ADEs: nasal dryness, epistaxis, sore throat / irritation
–> Well tolerated with local admin
–> Used as daily scheduled medication, not PRN
–> Blow nose before use or may use decongestant

Question 19

Antihistamines MOA & Uses

Answer 19

1st gen = diphenhydramine ; 2nd gen = loratadine, cetirizine
–> MOA: histamine 1 antagonists for prevention of itchiness, sneezing, nasal secretions
–> Used only for allergic rhinitis; prevention of symptoms (2nd gen used for allergy symptoms)

Question 20

Antihistamines ADEs & Teaching

Answer 20

–> ADEs: sedation (1st gen), anticholinergic effects, GI discomfort, Acute toxicity