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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
What do leukotriene receptor antagonists do?
block leukotriene receptors in smooth muscles - decr sm muscle contraction - decr mucus secretion - decr inflammation
26
What kind of administration is leukotriene receptor antagonists?
Oral
27
When is leukotriene receptor antagonists given for therapy?
Add on therapy for pts not well controlled on inhaled corticosteroids
28
What kind of drug is zileuton?
Leukotriene synthesis inhibitor
29
How does leukotriene synthesis inhibitors work?
Inhibits 5-lipoxygenase which stops synthesis of leukotrienes form arachidonic acid
30
How is leukotriene synthesis inhibitor administered?
Orally
31
How is leukotriene synthesis inhibitor used?
Asthma prophylaxis; effective in preventing exercise and aspirin induced asthma
32
What is a bad side effect to leukotriene synthesis inhibitor?
Hepatotoxic
33
What kind of drug is omalizumab?
Anti-IgE monoclonal antibody
34
How and why is anti-IgE monoclonal antibody used?
- 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
How is anti-IgE monoclonal antibody administered?
Subcutaneous
36
What are side effects of anti-IgE monoclonal antibody?
Generally mild (susceptibility to infection, pain, redness and swelling at injection site)
37
Sympathetic nerves (NorE) activate B2 receptors and cause what?
Bronchodilation
38
Parasympathetic systemic (ACh) activate muscarinic receptors and cause what?
Bronchoconstriction
39
B2 agonist bind to B2 adrenergic receptors and activates what?
Adenylyl cyclase that increase cAMP production that cause smooth muscle relaxation
40
B2 agonists can stimulate receptors on mast cells that decrease release of what ?
Leukotrienes and prostaglandins
41
How fast does B2 agonists work?
Fast
42
What kind of drugs are albuterol, metaproterenol, and terbutaline?
Short acting B2 agonists (SABA)
43
With SABA, when does bronchodilation occur and how long does it last?
Within 5 minutes | Lasts for 2-4 hrs
44
What are the side effects of SABA?
Increase sympathetic stimulation (tachycardia, palpitation, muscle tremors, restlessness, insomnia)
45
What kind of drugs are salmeterol and promoterol?
Long acting B2 agonists (LABA)
46
SABA onset and duration?
Slower onset and lasts over 12 hrs
47
How often do you give LABA?
Twice a day (maintenance therapy)
48
What are the side effects to LABA?
- increase sympathetic stimulation | - exaggerated bc duration of action
49
What kind of drugs are ipratropium bromide and tiotropium bromide?
Muscarinic antagonists
50
Muscarinic antagonists bind to M3 muscarinic recpeotrs and blocks what?
ACh and cause less smooth muscle contraction
51
Muscarinic antagonists: short acting and duration of 4-6 hrs
Ipratropium bromide
52
Muscarinic antagonists: long acting and duration of 24 hrs
Tiotropium bromide
53
When compared to B2 agonists, muscarinic antagonists are:
- less effective for asthma | - more effective for COPD
54
Muscarinic antagonists can be give with what for what?
LABA; additive effect for stronger and longer lasting bronchodilation
55
Side effects of muscarinic antagonists:
- tachy - dry mouth - restlessness - pupil dilation
56
What is the contraindication for muscarinic antagonists:
Narrow angle glaucoma; this relax ciliary muscles and worsens obstruction of aqueous humor drainage
57
What kind of drugs are theophylline and peroral?
Metyhlxanthines
58
How does methylxanthines work?
Enter smooth muscles in respiratory tract to inhibit phosphodiesterase (PDE) that increase cAMP with in cell to cause smooth muscle relaxation
59
What is methylxanthines used for?
Bronchodilator in COPD
60
Methylxanthines blocks what receptors throughout the body?
Adenosine
61
What is important for taking methylxanthines?
Narrow therapeutic index so its easy to overdose (5-15)
62
What is methylxanthines metabolized by?
Cytochrome p450; medications that inhibit these enzymes should be avoided like fluoxetine or ciproflocaxin
63
What is preferred for intermittent asthma?
SABA
64
What is preferred for mild persistent asthma?
Low dose ICS
65
What is preferred for moderate persistent asthma?
Low dose ICS + LABA or medium dose ICS
66
What is preferred for severe persistent asthma?
Medium dose ICS + LABA
67
What is preferred if there is consistent severe persistent asthma?
High dose ICS + LABA and omalizumba for pts who have allergies
68
What is used for pt who has out of control severe persistent asthma?
High dose ICS + LABA + oral corticosteroid and omalizumab for pts who have allergies
69
What is an alternative for pt who has mild persistent asthma?
Cromolyn, LTRA, or theophylline
70
What inhaled bronchodilators are short acting beta agonist?
SABA (albuterol)
71
What inhaled bronchodilators are short acting antimuscarinics?
SAMA (ipratropium)
72
What inhaled bronchodilators are long acting beta agonist?
LABA (formoterol)
73
What inhaled bronchodilators are long acting antimuscarinics?
LAMA (tiotropium or umeclidinium)
74
What is FEV1 for long acting COPD?
<60%
75
If symptom frequency increases despite treatment then what?
Use inhaled corticosteroids (budesonide)

Su. Pharm 2 (6 decks)

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