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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
Q

Duration of 1st vs 2nd generation antihistamines

A

1st: shorter 6-12 hours 2nd: longer 12;24 hours

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26
Q

Antiemetic 1st vs 2nd generation antihistamines

A

1st: med/ high 2nd: no effect

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27
Q

anticholinergic GI effects

A

1st: med/high 2nd: very low

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28
Q

Chlorpheniramine

A

1st gen antihistamine

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29
Q

Dimenhydrinate

A

1st gen antihistamine

30
Q

Diphenhydramine

A

Bendryl

1st gen antihistamine

31
Q

Cetirizine

A

Zyrtec

2nd get antihistamine

32
Q

Fexofenadine

A

allegra

2nd gen antihistamine

33
Q

Azelastine

A

inhaled 2nd gen antihistamine

Optivar

34
Q

1st gen vs 2nd gen antihistamine uses

A

1st: allergy, motion sickness, sleep aid
2nd: allergy

35
Q

Topical Decongestant mechanism

A

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
Q

S/E of topical decongestant

A

Rebound congestion (rhinitis medicamentosa) due to ischemia local irritation

37
Q

Phenylephrine

A

Neosynephrine - most effect, but shorter duration

topical decongestant with 4 hr duration and high irritation

38
Q

Oxymetazloine

A

afarin - topical decongestant with 6-12 hr duration. BID. Limited rebound congestion

39
Q

Advantages of oral Decongestant (compared to topical)

A

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
Q

Side effects of oral decongestants

A

headache, dizzy, nausea, increased BP-palpitations at chronic high dose.

41
Q

Pseduoephedrine

A

Sudafed
oral decongestant
good vasocontrictor, but less effective vasopressor.
Less CNS stimulation, so safest and most effective decongestant

42
Q

Phenylephrine

A

Sudafed PE
Oral decongestant
Hepatic MAO with variable interpatient blood levels

43
Q

pathophysiology of histamine

A

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
Q

Anaphylactic Rxn

A

Type 1 where H1 receptors are stimulated to cuase urticaria, abdominal cramps, laryngospasm, bronchospasm, decreased BP and shock

45
Q

Channels responsible for Allergic Rx treatment

A

H1 Receptor Block

46
Q

Cough Supression channel block antihistamine

A

Na Channel Block

47
Q

Motion sickness Tx - antihistamine channel blcoks

A

H1 and M

48
Q

N/V in pregnancy Tx - antihistamine channel blcok

A

H1 and M

49
Q

Sleep Aid tx - antihistamine block

A

H1 and M

50
Q

Antihistamines are good for…. and not so good for

A

3+> for sneezing, pruritis, rhinorrhea
+ = congestion
- inflammation

51
Q

Corticosteroids vs Antihistamine uses

A

Corticosteroids are good for Sneezing, Pruritis, Rhinorrha, congestion and inflammation
Antihistamines only for sneeze, pruritis, rhinorrhea
Steroids have delayed onset

52
Q

target receptors for decongestants

A

Alpha, H1 and Bradykinin

53
Q

Role of histamine in viral colds

A

Minor role!

54
Q

uses of decongestants

A

equally effective for Allergic rhinitis as viral rhinitis

55
Q

Allergic Rhinits vs. Viral rhinitis tx

A

Allergic - antihistmaine and decongestant

Vrial: only decongestant and analgesic

56
Q

Antitussive mechanism

A

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
Q

Antitussive uses

A

reduce frequency of cough - especially dry-nonproductive ones
Reduce excessive cough discomfort

58
Q

Codeine, Hydrocodone, hydromorphone

A

opioid antitussives that are effective at low doses.

Adverse effects: nausea, drowsiness, constipation, allergic reactions (puruitus)

59
Q

Dextromethorphan

A 
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
Q

Side Effects of Dextromethorphan

A

Drowsy, GI Upset, at high dose can cuase PCP like effects called Robo-tripping and coma.

61
Q

Destromethorphan four dose plateaux

A

Mild stimulation –> euphoria –> distorted visual/Loss of motor control –> dissociative sedation

62
Q

Diphenhydramine

A

Benylin - antitussive

Safe and mostly effective, but greater propensity for sedation, anti-muscarinic effects than dextromehorphan

63
Q

Acute Cough due to common cold

A

1st gen antihistmaine/decongestant

Naproxgen

64
Q

Acute cough due to upper airway cough syndrome

A

PND

1st gen antihistamine/decongestant

65
Q

Expectorants

A

no cough suppression

Increase respiratory secretions to think mucus and increase clearance.

66
Q

Expectorants effectivity

A

not proven to be effective - increasing fluid intake, cool mist/vapor is as effective.

67
Q

Guanifesein

A

expectorant that is safe and moderately effecitve

68
Q

N-Acetyl Cysteine

A

Mucolytic that splits disulfide linkage between mucoproteins to decrease viscosity. Used to treat COPD and acetaminophen overdose.

69
Q

Bosentan

A

antagonist of Endothelin R1 to decrease pulmonary vaso resistance

70
Q

Sildenafil

A

inhibits cGMP PDE-5 to be vasodilatory to prolong the effect of NO. Tx: PH and erectile dysfunction

71
Q

Epoprostenol

A

PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.

72
Q

Iloprost

A

PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.

CVPR (12 decks)

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