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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
Q

Incase of overdose of acetaminophen, what drug can we administer?

A

Acetylcysteine (give in both mild-moderate and severe cases)

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26
Q

If you absolutely HAVE TO use ketorolac for pain, what is the MAXIMUM days recommended for use?

A

5 days

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27
Q

What is the syndrome that occurs due to excessive doses of aspirin and/or salicylic acid?

A

Salycylism

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28
Q

What are the signs that someone may have Salycylism from aspirin overdose?

A

Severe headache, tinnitus, nausea, confusion, seizures, coma, DEATH

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29
Q

True or false: All OTC NSAIDs are safe, it’s only the prescription level that are dangerous

A

FALSE - even OTC NSAIDs can be dangerous

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30
Q

Nonselective NSAIDs inhibit which enzyme(s)?

A

COX1 and COX2

allows for analgesic and antipyretic properties

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31
Q

best treatment order for asthma regarding the order in which you Rx

A

SABA + ICS + LABA

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32
Q

Best order to prescribe medicine for COPD

A

LABA + ICS +/- Long acting anticholinergic

they’ll already have SABAs for rescue

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33
Q

how long does it take for ICS to take maximum effect?

A

2 weeks with correct use

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34
Q

local AE of ICS

A

candidiasis, dysphonia, cough

35
Q

what can the asthma/copd interactions with CYP3A4 inhibitors cause?

A

Cushings Syndrome and adrenal insufficiency

36
Q

if you put patient on systemic oral corticosteroids, how long do they continue it for?

A

3-10 days (onset is 4-12 hours)

37
Q

which leukotriene receptor antagonist is less likely to interact with CYP2C9 drugs

A

montelukast

zileuton and zafirlukast interfere the most

38
Q

immunomodulator MOA

A

inhibits binding of IgE to receptors on mast cells and basophils

39
Q

which drug class do you Rx epinephrine incase of injection site reactions?

A

immunomodulator

40
Q

PDE-4 inhibitor MOA?

A

inhibits breakdown of cAMP

41
Q

The only reason for prescribing PDE-4 inhitibitors

A

Preventing COPD exacerbation

42
Q

2 drugs inhibits PDE-4, and interact with each other. What are they?

A

Roflumilast and theophylline

43
Q

This drug is less effective AND less cost effective than ICS, therefore used only when patient CANT tolerate ICS

A

Cromolyn

44
Q

Bupropion interactions

A

MAOIs, drugs that lower seizure threshold

45
Q

Bupropion black box warning:

A

may increase suicidality in patients w/ depression (increased risk in kids)

46
Q

Contraindications of Bupropion

A

hx seizures, eating disorder, use of MAOI in past 14 days

47
Q

Increased risk of ______ in those taking Varenicline

A

CV events

48
Q

Samters Triad?

A

Asthma + nasal polyps + Aspirin/NSAIDs

49
Q

When starting Methotrexate for RA, what else do you start and why?

A

Folic acid - reduces risk of folate-depleting reactions

50
Q

AE of methotrexate

A

nausea, diarrhea, hepatotoxicity, alopecia

51
Q

hepatotoxicity is a major concern with what common RA medication?

A

methotrexate. If folic acid is prevented from converting to its active form, toxicity occurs

52
Q

Signs of hepatic toxicity with methotrexate and how to treat it?

A

signs: stomatitis, diarrhea, nausea, myelosuppression, elevated LFTs

GIVE LEUCOVORIN!

53
Q

which conventional DMARD is LESS associated with renal, bone marrow, or hepatic changes, BUT may cause vision changes?

A

Hydroxychloroquine

54
Q

which conventional DMARD takes 6 months (slow) for determining if it’s effective?

A

Hydroxychloroquine and sulfasalazine

55
Q

contraindication for sulfasalazine?

A

sulfa allergy

56
Q

MOA of leflunomide?

A

inhibits T-lymphocyte response

57
Q

risk of _______ increases with using leflunomide in combo with methotrexate

A

hepatotoxicity

58
Q

cholestyramine used for what?

A

excrete levoflunamide from body quickly in hepatotoxicity and pregnancy

59
Q

Which biological DMARD to avoid in Heart failure?

A

TNF antagonists

60
Q

Screen for ____ before administering TNF antagonists

A

TB - the TNF is what keeps the TB trapped and inactive

61
Q

MOA costimulation modulators

A

blocks T-cell signalling

62
Q

what is the LAST RESORT choice of biological DMARD?

A

Anti-CD20 Monoclonal antibody. Can cause FATAL infusion reactions

63
Q

Anti-IL-6 Receptor antibody DMARDs block IL-6, but what adverse effects are seen?

A

elevated LFTs, total Cholesterol, triglycerides, HDL. Also nasopharyngitis and infection

64
Q

Targeted synthetic DMARD?

A

Tofacitinib

65
Q

MOA of Tofacitinib

A

inhibits specific kinases

66
Q

you CANNOT USE ________ (DMARD) in pregnancy, but you may use __________

A

methotrexate; sulfasalazine

may be able to use corticosteroids, hydroxychloroquine and azathioprine too

67
Q

Is APAP beneficial for anti-inflammatory purposes?

A

No - it is mostly analgesic and antipyretic

68
Q

Alcohol consumption of 2-3 drinks per day yields a decrease maximum daily dose of APAP of ______ mg/day

A

2500 mg/day

69
Q

acute APAP overdose will show elevated ALT and AST how many days after ingestion?

A

2-3 days

70
Q

signs of acute APAP overdose:

A

n/v, elevated ALT/AST, liver and renal failure

71
Q

What do we administer to patients with APAP overdose?

A

Acetylcysteine

along with emergent care: frozen plasma, intubation, vasopressors, etc

72
Q

Sever toxicity is classified as symptoms still present > ___ hours after ingestion

A

36 hours

greater risk of liver injury –> give acetylcysteine

73
Q

NSAID onset for pain _____ while the onset for anti-inflammatory effect _______

A

1 hour; 2-3 weeks

74
Q

This nonselective NSAID has a significant risk of fatal GI adverse effects, CV events, renal insufficiency

A

Ketorolac

75
Q

Syndrome characterized by mixed respiratory alkalosis and metabolic acidosis

A

Salycylism

ASA/salicylic acid overdose

76
Q

Treatment for someone with salycyiism

A

urine alkalinization

77
Q

AE of ALL NSAIDs

A

Gi issues, renal insufficiency, hepatic dysfunction, increased CNS events

78
Q

strongest NSAID associated with CV events

A

celecoxib (selective COX2)

79
Q

nonselective NSAIDs with highest risk of CV events

A

diclofenac (topical) and ibuprofen

80
Q

SAFEST NSAID to use on patients with high CV risk

A

Naproxen

81
Q

Contraindications/cautions for NSAIDs

A

peptic ulcers, bleeding risk, renal insufficiency, uncontrolled HTN, heart failure

82
Q

which drug may promote premature closing of the ductus arteriosus in fetus >30 weeks gestation?

A

NSAIDs

83
Q

in treating Gout, toxicity is likely with colchicine and ____ insufficiency

A

renal

Pharmacology last exam (2 decks)

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