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CVPR > Pharmacology - Pulmonary > Flashcards

Pharmacology - Pulmonary Flashcards

1
Q

Albuterol

A

SABA - used in Asthma and COPD to relieve acute symptoms and prevent exercise induced asthma.
Inhalation with rapid onset of action - minutes.
Duration for 4-6 hours.
bronchial smooth muscle dilation (beta agonist) and decreased respiratory secretion

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2
Q

LABA - Drug names

A

Salmeterol and Formoterol

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3
Q

LABA

A

Salmeterol and Formoterol for sustained release.
Used for treatment of Asthma, but not alone due to not being anti-inflammatory.
More standard of treatment for chronic COPD.

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4
Q

Prednisone

A

Systemic Glucocorticoide.
Inhibitis phospholipase I and cytokine syntheseis.
Used inc aute asthma (severe)
36-48 hour duration
Antiinflammaotry, vasoconstriction to decrease edema

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5
Q

Inhaled glucocorticoides - names

A

Flutacasone and Budensonide

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6
Q

ICS

A

inhaled corticosteroids
Preferred for long term treatment of asthma and severe forms of COPD.
inactivates NFKbeta the precursor for inflammatory TNFalpha and other agents.

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7
Q

Omalizumab

A

anti IgE immune modulator that inhibits IgE binding to Mast Cells to decrease allergic asthma response.
Used for Tx of allergic asthma that are not responding to ICS and LABA

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8
Q

Mepolizumab

A

Anti IL-5 (produced the Th2 and Mast cells to prevent the growth, differenetiation, recruitment, and activation of eosinophils.

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9
Q

Leukotriene Modifiers

A

Oral D4 antagonist and 5-Lipoxygenase inhibitor
blocks or modifies the luekotriene pathway to cause bronchodilation and anti-inflammation.
attenuates exercise induced asthma.

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10
Q

Anticholinergic Medications

A

Atropine, Ipratropium and Tiotropium

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11
Q

Atropine

A

anticholinergic receptor that causes bronchodilation due to Smooth muscle relaxation and inhibits respiraotry secretion.
used for COPD but not Asthma

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12
Q

Ipratropium

A

muscarinic agonsst/short term anti-cholinergic to cause bronchodilation

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13
Q

Tiotropium

A

Long term anti-cholinergic used for Asthma or COPD tx

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14
Q

Theophylline

A

Oral or IV that has 12-24 hr duration. Inhibits phosphodiesterase to increase cAMP for bronchodilation and some anti-inflammatory use.
not used anymore for asthma tx due to side effects - narrow theraputic window, seizure, neuro damage and DDI

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15
Q

Cormolyn Na

A

inhalation drug to inhibit mast cell release to prevent exercise induced asthma and prevent allergen induced asthma.

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16
Q

Nedocromil

A

inhalation drug to inhibit mast cell release to prevent exercise induced asthma and prevent allergen induced asthma.

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17
Q

Tx of Asthma vs COPD

A

both for mild: SABA PRN
Asthma: needs ICS before LABA (not alone)
COPD: LABA/LAMA before ICS

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18
Q

Muscarinic Receptor block

A

Used for Sedation, prevent N/V (motion sickness via block of M and H1) and blocks secretions in nonallergic rhinorrhea. (but may be drying effect like urinary retention, blurred vision, dry mouth, constipation)

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19
Q

Na Channel Block

A

diphenydramine - benedryl

acts like a local anesthetic and can ca be used topicallys

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20
Q

Affects of an alpha adrenergic Receptor block

A

although sparse in lung, cause vasocontriction in the lung. to cause orthostatic hypotension.

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21
Q

Pharmacokinetics of 1st gen antihistamines

A

Oral absorbtion with penetration into CNS. Metabolism in liver. Bind to non-H1 receptors.

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22
Q

Pharmacokinetics of 2nd gen antihistamines

A

Oral Absorption, not CNS penetration, renally elminiated.

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23
Q

Antihistamine uses

A

Allergic rxs (rhinitis, urticaria), cough suppression (na block), Motion sickness, N/V in pregnancy, sleep aid

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24
Q

Side effects of antihistamines

A

Sedation 1>2; of second gen Cetirizie is most sedative. Additive effect with EtOH or CNS depresseants.
Antimuscarinic Dry mouth
Postural hypotension

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25
Duration of 1st vs 2nd generation antihistamines
1st: shorter 6-12 hours 2nd: longer 12;24 hours
26
Antiemetic 1st vs 2nd generation antihistamines
1st: med/ high 2nd: no effect
27
anticholinergic GI effects
1st: med/high 2nd: very low
28
Chlorpheniramine
1st gen antihistamine
29
Dimenhydrinate
1st gen antihistamine
30
Diphenhydramine
Bendryl | 1st gen antihistamine
31
Cetirizine
Zyrtec | 2nd get antihistamine
32
Fexofenadine
allegra | 2nd gen antihistamine
33
Azelastine
inhaled 2nd gen antihistamine | Optivar
34
1st gen vs 2nd gen antihistamine uses
1st: allergy, motion sickness, sleep aid 2nd: allergy
35
Topical Decongestant mechanism
stimulate alpha adrenergic (alpha agonist) to cause vasoconstriction that in dilated vessled by histamine or bradykinin. Increase drainage and aids in breathing. Very rapid effect
36
S/E of topical decongestant
Rebound congestion (rhinitis medicamentosa) due to ischemia local irritation
37
Phenylephrine
Neosynephrine - most effect, but shorter duration | topical decongestant with 4 hr duration and high irritation
38
Oxymetazloine
afarin - topical decongestant with 6-12 hr duration. BID. Limited rebound congestion
39
Advantages of oral Decongestant (compared to topical)
Same mechanism with Alphe1 receptor vasoconstriction.. no rebound congestion, increased duration of action, unaffected by mucus characters, less intense vasoconstriction, but longer duration of action compared to topical
40
Side effects of oral decongestants
headache, dizzy, nausea, increased BP-palpitations at chronic high dose.
41
Pseduoephedrine
Sudafed oral decongestant good vasocontrictor, but less effective vasopressor. Less CNS stimulation, so safest and most effective decongestant
42
Phenylephrine
Sudafed PE Oral decongestant Hepatic MAO with variable interpatient blood levels
43
pathophysiology of histamine
Increases NO synthesis - Vasodilation of arterioles to cause hypotension, nasal congestion, increased HR Increased capillary permeability - edema, shock, rhinorrhea, hives-urticaria. Acts in the Gut to cause Smooth muscle contraction - cramping and Gastric acid secretion. In lung: bronchoconstriction Nerves: pain and itching
44
Anaphylactic Rxn
Type 1 where H1 receptors are stimulated to cuase urticaria, abdominal cramps, laryngospasm, bronchospasm, decreased BP and shock
45
Channels responsible for Allergic Rx treatment
H1 Receptor Block
46
Cough Supression channel block antihistamine
Na Channel Block
47
Motion sickness Tx - antihistamine channel blcoks
H1 and M
48
N/V in pregnancy Tx - antihistamine channel blcok
H1 and M
49
Sleep Aid tx - antihistamine block
H1 and M
50
Antihistamines are good for.... and not so good for
3+> for sneezing, pruritis, rhinorrhea + = congestion - inflammation
51
Corticosteroids vs Antihistamine uses
Corticosteroids are good for Sneezing, Pruritis, Rhinorrha, congestion and inflammation Antihistamines only for sneeze, pruritis, rhinorrhea Steroids have delayed onset
52
target receptors for decongestants
Alpha, H1 and Bradykinin
53
Role of histamine in viral colds
Minor role!
54
uses of decongestants
equally effective for Allergic rhinitis as viral rhinitis
55
Allergic Rhinits vs. Viral rhinitis tx
Allergic - antihistmaine and decongestant | Vrial: only decongestant and analgesic
56
Antitussive mechanism
Decrease vagal afferent and efferent pathways to/from the central cough center in the brainstem to depress this signal. Most effective: agonist at endogenous u-opioid receptors in brainstem less effective - antihistaminic and/or local anesthetic actions
57
Antitussive uses
reduce frequency of cough - especially dry-nonproductive ones Reduce excessive cough discomfort
58
Codeine, Hydrocodone, hydromorphone
opioid antitussives that are effective at low doses. | Adverse effects: nausea, drowsiness, constipation, allergic reactions (puruitus)
59
Dextromethorphan
``` Robitussin DM Antitussive (most common OTC) with variable effectiveness. Opiod agonists (blocks NMDA glutamate receptors) that does not depress respiration or predispose to addiction. ```
60
Side Effects of Dextromethorphan
Drowsy, GI Upset, at high dose can cuase PCP like effects called Robo-tripping and coma.
61
Destromethorphan four dose plateaux
Mild stimulation --> euphoria --> distorted visual/Loss of motor control --> dissociative sedation
62
Diphenhydramine
Benylin - antitussive | Safe and mostly effective, but greater propensity for sedation, anti-muscarinic effects than dextromehorphan
63
Acute Cough due to common cold
1st gen antihistmaine/decongestant | Naproxgen
64
Acute cough due to upper airway cough syndrome
PND | 1st gen antihistamine/decongestant
65
Expectorants
no cough suppression | Increase respiratory secretions to think mucus and increase clearance.
66
Expectorants effectivity
not proven to be effective - increasing fluid intake, cool mist/vapor is as effective.
67
Guanifesein
expectorant that is safe and moderately effecitve
68
N-Acetyl Cysteine
Mucolytic that splits disulfide linkage between mucoproteins to decrease viscosity. Used to treat COPD and acetaminophen overdose.
69
Bosentan
antagonist of Endothelin R1 to decrease pulmonary vaso resistance
70
Sildenafil
inhibits cGMP PDE-5 to be vasodilatory to prolong the effect of NO. Tx: PH and erectile dysfunction
71
Epoprostenol
PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.
72
Iloprost
PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.

CVPR (12 decks)

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