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Pharmacology last exam > Pharmacology asthma/copd/RA/Gout/OA/opioids > Flashcards

Pharmacology asthma/copd/RA/Gout/OA/opioids Flashcards

1
Q

SABA/LABA Method of action?

A

relaxes airway smooth muscle by DIRECT stimulation of B2 receptors in airway

(bronchodilation)

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2
Q

SABA/LABA adverse effects?

A

tachycardia, tremor, hypoK, palpitations, sleep disturbances

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3
Q

what are the most effective agents for reversing acute airway obstruction caused by bronchoconstriction?

A

SABAs (short acting beta 2 agonists)

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4
Q

1st line treatment for acute asthma

A

SABA

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5
Q

What are LABAs commonly used in combination with?

A

commonly used in combination with ICS

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6
Q

what is a typical SABA dose? (how many puffs in how many hours?)

A

1-2 puffs every 4-6 hours (RESCUE THERAPY)

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7
Q

The duration of LABAs starts at 12-24 hours, but decreases to ____ hours with chronic use

A

5

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8
Q

true or false: it’s ok to use LABAs for monotherapy in chronic asthma if they don’t tolerate SABAs

A

FALSE! never use LABAs for monotherapy in chronic asthma

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9
Q

What is the risk of using LABAs in chronic asthma therapy?

A

increased risk of severe asthma exacerbations and death (USE WITH ICS!!!)

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10
Q

True or false: it is ok to use LABAs as monotherapy in COPD

A

True (but add SABA for rescue medication)

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11
Q

Inhaled Anticholinergics MOA?

A

inhibit effects of acetylcholine on muscarinic receptors in airways

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12
Q

Which Adverse effect is NOT associated with inhaled anticholinergics?
blurred vision, dry mouth, urinary frequency, constipation, tachycardia

A

urinary frequency; inhaled anticholinergics can cause urinary RETENTION

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13
Q

Which class of copd/asthma medications is metabolized by CYP1A2, CYP2E1, and CYP3A4

A

Methylxanthines (theophylline)

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14
Q

Theophylline MOA/

A

inhibits phosphodiesterase and antagonizes adenosine

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15
Q

Theophylline acts as a bronchodilator at _____ concentrations

A

HIGH

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16
Q

Theophylline acts as anti-inflammatory agent at _____ concentrations

A

LOW

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17
Q

Because theophylline is metabolized by all those “CYP” drugs, what does that mean when adding it to patient’s med regimen?

A

there are many drug interactions including: alcohol, ciprofloxacin, diltiazem, erythromycin, contraceptives verapamil…

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18
Q

target serum concentration for theophylline?

A

5-15 mg/L

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19
Q

does tobacco increase or decrease the clearance of theophylline?

A

INCREASES clearance, so increase dose for smokers.

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20
Q

when is the only good time to prescribe theophylline?

A

only when those cannot use inhaled medicines OR if they have symptoms despite appropriate use of inhaled meds

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21
Q

What are the anti-inflammatory drugs used in treating asthma/copd?

A

corticosteroids, immunomodulators, PDE-4 inhibitors

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22
Q

If your patient is on a phosphodiesterase-4 inhibitor for COPD, which other COPD medication does it interact with?

A

theophylline (they both inhibit PDE-4)

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23
Q

onset and duration of SABA?

A

onset: 5 min
Duration: 4-6 hours

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24
Q

what is the caution with buproprion in patients with coronary heart disease?

A

it widens the QRS complex at high doses

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25
Incase of overdose of acetaminophen, what drug can we administer?
Acetylcysteine (give in both mild-moderate and severe cases)
26
If you absolutely HAVE TO use ketorolac for pain, what is the MAXIMUM days recommended for use?
5 days
27
What is the syndrome that occurs due to excessive doses of aspirin and/or salicylic acid?
Salycylism
28
What are the signs that someone may have Salycylism from aspirin overdose?
Severe headache, tinnitus, nausea, confusion, seizures, coma, DEATH
29
True or false: All OTC NSAIDs are safe, it's only the prescription level that are dangerous
FALSE - even OTC NSAIDs can be dangerous
30
Nonselective NSAIDs inhibit which enzyme(s)?
COX1 and COX2 | allows for analgesic and antipyretic properties
31
best treatment order for asthma regarding the order in which you Rx
SABA + ICS + LABA
32
Best order to prescribe medicine for COPD
LABA + ICS +/- Long acting anticholinergic | they'll already have SABAs for rescue
33
how long does it take for ICS to take maximum effect?
2 weeks with correct use
34
local AE of ICS
candidiasis, dysphonia, cough
35
what can the asthma/copd interactions with CYP3A4 inhibitors cause?
Cushings Syndrome and adrenal insufficiency
36
if you put patient on systemic oral corticosteroids, how long do they continue it for?
3-10 days (onset is 4-12 hours)
37
which leukotriene receptor antagonist is less likely to interact with CYP2C9 drugs
montelukast | zileuton and zafirlukast interfere the most
38
immunomodulator MOA
inhibits binding of IgE to receptors on mast cells and basophils
39
which drug class do you Rx epinephrine incase of injection site reactions?
immunomodulator
40
PDE-4 inhibitor MOA?
inhibits breakdown of cAMP
41
The only reason for prescribing PDE-4 inhitibitors
Preventing COPD exacerbation
42
2 drugs inhibits PDE-4, and interact with each other. What are they?
Roflumilast and theophylline
43
This drug is less effective AND less cost effective than ICS, therefore used only when patient CANT tolerate ICS
Cromolyn
44
Bupropion interactions
MAOIs, drugs that lower seizure threshold
45
Bupropion black box warning:
may increase suicidality in patients w/ depression (increased risk in kids)
46
Contraindications of Bupropion
hx seizures, eating disorder, use of MAOI in past 14 days
47
Increased risk of ______ in those taking Varenicline
CV events
48
Samters Triad?
Asthma + nasal polyps + Aspirin/NSAIDs
49
When starting Methotrexate for RA, what else do you start and why?
Folic acid - reduces risk of folate-depleting reactions
50
AE of methotrexate
nausea, diarrhea, hepatotoxicity, alopecia
51
hepatotoxicity is a major concern with what common RA medication?
methotrexate. If folic acid is prevented from converting to its active form, toxicity occurs
52
Signs of hepatic toxicity with methotrexate and how to treat it?
signs: stomatitis, diarrhea, nausea, myelosuppression, elevated LFTs GIVE LEUCOVORIN!
53
which conventional DMARD is LESS associated with renal, bone marrow, or hepatic changes, BUT may cause vision changes?
Hydroxychloroquine
54
which conventional DMARD takes 6 months (slow) for determining if it's effective?
Hydroxychloroquine and sulfasalazine
55
contraindication for sulfasalazine?
sulfa allergy
56
MOA of leflunomide?
inhibits T-lymphocyte response
57
risk of _______ increases with using leflunomide in combo with methotrexate
hepatotoxicity
58
cholestyramine used for what?
excrete levoflunamide from body quickly in hepatotoxicity and pregnancy
59
Which biological DMARD to avoid in Heart failure?
TNF antagonists
60
Screen for ____ before administering TNF antagonists
TB - the TNF is what keeps the TB trapped and inactive
61
MOA costimulation modulators
blocks T-cell signalling
62
what is the LAST RESORT choice of biological DMARD?
Anti-CD20 Monoclonal antibody. Can cause FATAL infusion reactions
63
Anti-IL-6 Receptor antibody DMARDs block IL-6, but what adverse effects are seen?
elevated LFTs, total Cholesterol, triglycerides, HDL. Also nasopharyngitis and infection
64
Targeted synthetic DMARD?
Tofacitinib
65
MOA of Tofacitinib
inhibits specific kinases
66
you CANNOT USE ________ (DMARD) in pregnancy, but you may use __________
methotrexate; sulfasalazine | may be able to use corticosteroids, hydroxychloroquine and azathioprine too
67
Is APAP beneficial for anti-inflammatory purposes?
No - it is mostly analgesic and antipyretic
68
Alcohol consumption of 2-3 drinks per day yields a decrease maximum daily dose of APAP of ______ mg/day
2500 mg/day
69
acute APAP overdose will show elevated ALT and AST how many days after ingestion?
2-3 days
70
signs of acute APAP overdose:
n/v, elevated ALT/AST, liver and renal failure
71
What do we administer to patients with APAP overdose?
Acetylcysteine | along with emergent care: frozen plasma, intubation, vasopressors, etc
72
Sever toxicity is classified as symptoms still present > ___ hours after ingestion
36 hours greater risk of liver injury --> give acetylcysteine
73
NSAID onset for pain _____ while the onset for anti-inflammatory effect _______
1 hour; 2-3 weeks
74
This nonselective NSAID has a significant risk of fatal GI adverse effects, CV events, renal insufficiency
Ketorolac
75
Syndrome characterized by mixed respiratory alkalosis and metabolic acidosis
Salycylism | ASA/salicylic acid overdose
76
Treatment for someone with salycyiism
urine alkalinization
77
AE of ALL NSAIDs
Gi issues, renal insufficiency, hepatic dysfunction, increased CNS events
78
strongest NSAID associated with CV events
celecoxib (selective COX2)
79
nonselective NSAIDs with highest risk of CV events
diclofenac (topical) and ibuprofen
80
SAFEST NSAID to use on patients with high CV risk
Naproxen
81
Contraindications/cautions for NSAIDs
peptic ulcers, bleeding risk, renal insufficiency, uncontrolled HTN, heart failure
82
which drug may promote premature closing of the ductus arteriosus in fetus >30 weeks gestation?
NSAIDs
83
in treating Gout, toxicity is likely with colchicine and ____ insufficiency
renal

Pharmacology last exam (2 decks)

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