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Su. Pharm 2 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Airway narrowing is due to muscle spasms

-reversible

A

Asthma

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2
Q

Chronic inflammatory damage to the airways

-irreversible

A

COPD

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3
Q

What 2 things does COPD have?

A

Chronic bronchitis and emphysema

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4
Q

Inflammatory process (macrophages, neutrophils, T lymphocytes)

  • increase mucus production
  • obstructs the airways
A

Chronic bronchitis

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5
Q

Breakdown of elastin

-destruction of alveolar wall with dilation of the airspace

A

Emphysema

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6
Q

These bind to bronchial smooth muscles to cause contract and bind to mucous glands to increase mucus secretion

A

Leukotriene

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7
Q

These bind on smooth muscles and mucous glands and increased mucus secretion

A

Prostaglandins

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8
Q

What 3 things does contact smooth muscle cause in asthma?

A
  1. Increase mucus secretion
  2. Increase vascular permeability
  3. Increase immune cells
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9
Q

What are the 7 Obstructive lung disease drug classes?

A 
ABCLLMMM

Anti-IgE monoclonal antibody 
Beta 2 Agonists 
Corticosteroids 
Leukotriene agonist
Leukotrine synthesis inhibitors
Mast cell stabilizers 
Methylxanthines 
Muscarinic antagonists
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10
Q

Work inside immune cells to inhibit synthesis of inflammatory cytokines

A

Corticosteroids (synthetic glucocorticoids)

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11
Q

What does corticosteroids do in mast cells?

A

Inhibit phospholipase A2
-decr leukotrines
-decr prostaglandins

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12
Q

How does corticosteroids increase activity of mast cell and eosinophils?

A

Inhibit proliferation of Th2 cells
- decr IL4
- decr IL5

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13
Q 
Beclomethasone
Budesonide
Ciclesonide
Mometasone 
Fluticasone
Triamcinolone
A

Inhaled corticosteriods

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14
Q

When is oral corticosteriods used?

A

Sever chronic asthma

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15
Q

When is IV corticosteriods used?

A

Acute asthma attack

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16
Q

Which has high risk of advert affects, inhaled or systemic corticosteriods ?

A

Systemic

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17
Q

Hydrocortisone
Prednisone
Prednisolone
Methylprednisolone

A

Systemic corticosteriods

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18
Q

Side effects of corticosteroids

A 
Susceptibility to infections 
Growth retardation in children 
Easy bruising 
Hyperglycemia 
Weight gain
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19
Q

Which therapy weakens the immune response in mouth and throat and cause oropharyngreal candida infections

A

Inhaled therapy

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20
Q

Which therapy causes pituitary adrenal suppression which lessens cortisol produced?

A

Systemic therapy

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21
Q

Mast Cell Stabilizers

A

Nedocromil
Cromolyn

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22
Q

What 2 things do mast cell stabilizers do?

A

inhibits release of prostaglandins and leukotrines

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23
Q

3 facts about mast cell stabilizers?

A
  1. Mild to moderate asthma
  2. Administered aerosol
  3. Very short duration of action (rarely used now)
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24
Q

What kind of drugs are montekukast and zafirlukast?

A

Leukotriene receptor antagonists

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25
Q

What do leukotriene receptor antagonists do?

A

block leukotriene receptors in smooth muscles
- decr sm muscle contraction
- decr mucus secretion
- decr inflammation

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26
Q

What kind of administration is leukotriene receptor antagonists?

A

Oral

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27
Q

When is leukotriene receptor antagonists given for therapy?

A

Add on therapy for pts not well controlled on inhaled corticosteroids

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28
Q

What kind of drug is zileuton?

A

Leukotriene synthesis inhibitor

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29
Q

How does leukotriene synthesis inhibitors work?

A

Inhibits 5-lipoxygenase which stops synthesis of leukotrienes form arachidonic acid

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30
Q

How is leukotriene synthesis inhibitor administered?

A

Orally

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31
Q

How is leukotriene synthesis inhibitor used?

A

Asthma prophylaxis; effective in preventing exercise and aspirin induced asthma

32
Q

What is a bad side effect to leukotriene synthesis inhibitor?

A

Hepatotoxic

33
Q

What kind of drug is omalizumab?

A

Anti-IgE monoclonal antibody

34
Q

How and why is anti-IgE monoclonal antibody used?

A
  • bind to IgE antibodies in bloodstream and this can’t stimulate FceR1 receptors, decrease activation of mast cells, and reduces synthesis and release of inflammatory mediators
  • effective for allergic asthma
35
Q

How is anti-IgE monoclonal antibody administered?

A

Subcutaneous

36
Q

What are side effects of anti-IgE monoclonal antibody?

A

Generally mild (susceptibility to infection, pain, redness and swelling at injection site)

37
Q

Sympathetic nerves (NorE) activate B2 receptors and cause what?

A

Bronchodilation

38
Q

Parasympathetic systemic (ACh) activate muscarinic receptors and cause what?

A

Bronchoconstriction

39
Q

B2 agonist bind to B2 adrenergic receptors and activates what?

A

Adenylyl cyclase that increase cAMP production that cause smooth muscle relaxation

40
Q

B2 agonists can stimulate receptors on mast cells that decrease release of what ?

A

Leukotrienes and prostaglandins

41
Q

How fast does B2 agonists work?

A

Fast

42
Q

What kind of drugs are albuterol, metaproterenol, and terbutaline?

A

Short acting B2 agonists (SABA)

43
Q

With SABA, when does bronchodilation occur and how long does it last?

A

Within 5 minutes

Lasts for 2-4 hrs

44
Q

What are the side effects of SABA?

A

Increase sympathetic stimulation (tachycardia, palpitation, muscle tremors, restlessness, insomnia)

45
Q

What kind of drugs are salmeterol and promoterol?

A

Long acting B2 agonists (LABA)

46
Q

SABA onset and duration?

A

Slower onset and lasts over 12 hrs

47
Q

How often do you give LABA?

A

Twice a day (maintenance therapy)

48
Q

What are the side effects to LABA?

A
  • increase sympathetic stimulation

- exaggerated bc duration of action

49
Q

What kind of drugs are ipratropium bromide and tiotropium bromide?

A

Muscarinic antagonists

50
Q

Muscarinic antagonists bind to M3 muscarinic recpeotrs and blocks what?

A

ACh and cause less smooth muscle contraction

51
Q

Muscarinic antagonists: short acting and duration of 4-6 hrs

A

Ipratropium bromide

52
Q

Muscarinic antagonists: long acting and duration of 24 hrs

A

Tiotropium bromide

53
Q

When compared to B2 agonists, muscarinic antagonists are:

A
  • less effective for asthma

- more effective for COPD

54
Q

Muscarinic antagonists can be give with what for what?

A

LABA; additive effect for stronger and longer lasting bronchodilation

55
Q

Side effects of muscarinic antagonists:

A
  • tachy
  • dry mouth
  • restlessness
  • pupil dilation
56
Q

What is the contraindication for muscarinic antagonists:

A

Narrow angle glaucoma; this relax ciliary muscles and worsens obstruction of aqueous humor drainage

57
Q

What kind of drugs are theophylline and peroral?

A

Metyhlxanthines

58
Q

How does methylxanthines work?

A

Enter smooth muscles in respiratory tract to inhibit phosphodiesterase (PDE) that increase cAMP with in cell to cause smooth muscle relaxation

59
Q

What is methylxanthines used for?

A

Bronchodilator in COPD

60
Q

Methylxanthines blocks what receptors throughout the body?

A

Adenosine

61
Q

What is important for taking methylxanthines?

A

Narrow therapeutic index so its easy to overdose (5-15)

62
Q

What is methylxanthines metabolized by?

A

Cytochrome p450; medications that inhibit these enzymes should be avoided like fluoxetine or ciproflocaxin

63
Q

What is preferred for intermittent asthma?

A

SABA

64
Q

What is preferred for mild persistent asthma?

A

Low dose ICS

65
Q

What is preferred for moderate persistent asthma?

A

Low dose ICS + LABA or medium dose ICS

66
Q

What is preferred for severe persistent asthma?

A

Medium dose ICS + LABA

67
Q

What is preferred if there is consistent severe persistent asthma?

A

High dose ICS + LABA and omalizumba for pts who have allergies

68
Q

What is used for pt who has out of control severe persistent asthma?

A

High dose ICS + LABA + oral corticosteroid and omalizumab for pts who have allergies

69
Q

What is an alternative for pt who has mild persistent asthma?

A

Cromolyn, LTRA, or theophylline

70
Q

What inhaled bronchodilators are short acting beta agonist?

A

SABA (albuterol)

71
Q

What inhaled bronchodilators are short acting antimuscarinics?

A

SAMA (ipratropium)

72
Q

What inhaled bronchodilators are long acting beta agonist?

A

LABA (formoterol)

73
Q

What inhaled bronchodilators are long acting antimuscarinics?

A

LAMA (tiotropium or umeclidinium)

74
Q

What is FEV1 for long acting COPD?

A

<60%

75
Q

If symptom frequency increases despite treatment then what?

A

Use inhaled corticosteroids (budesonide)

Su. Pharm 2 (6 decks)

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