Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Exam 3 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Family HX (age of onsent) Asthma and COPD

A

Asthma: < 30
-Family Hx: usually

COPD: > 40
-Family Hx: uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prominent cough (age of onsent) Asthma and COPD

A

Asthma: < 30
- Prominent cough: Nocturnal, post excercise

COPD: > 40
- Prominent cough: early in the morning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hx of Atopy (age of onsent) Asthma and COPD

A

Asthma: < 30
- Hx of Atopy: often

COPD: > 40
- Hx of Atopy: uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bronchodilator Reversibility (age of onsent) Asthma and COPD

A

Asthma: < 30
- Bronchodilator reversibility: highly to completely

COPD: > 40
- Bronchodilator reversibility: partial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Steroid responsiveness (age of onsent) Asthma and COPD

A

Asthma: < 30
- steroid responsiveness: strong

COPD: > 40
- steroid responsiveness: weak usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Progressive deterioration (age of onsent) Asthma and COPD

A

Asthma: < 30
- Progressive deterioration: uncommon

COPD: > 40
- Progressive deterioration: typical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anticholinergic responsivity (age of onsent) Asthma and COPD

A

Asthma < 30
- Anticholinergic Deterioration: B agonist better

COPD > 40
- Anticholinergic Deterioration: Best first line treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Beta agonist responisivity (age of onsent) Asthma and COPD

A

Asthma < 30
Beta Agonist Responisvity:
Excellent

COPD > 40
Beta agonist responisivity: Anticholinergic better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Purulent sputum (age of onsent) Asthma and COPD

A

Athma < 30
Purulent sputum: uncommon

COPD > 40
Purulent Sputum: Typical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Smoking hx (age of onsent) Asthma and COPD

A

Asthma > 30
Smoking hx:
Variable

COPD > 40
Smoking hx:
Usually present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pulmonary - Parental route:

A
  • Will result in high plasma concentrations
  • High ratio of side effects to desired effects
  • Only used for severely ill patients who cannot be administered drugs via any other means
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pulmonary - Oral Route:

A
  • Theophylline( ineffective if given via inhaled route)
  • Corticosteroids when needed for interstitial disease
  • β 2 Agonist and Corticosteroids only if the patient is too young or physically unable to administer the drugs via inhaler
  • Dose will have to be about 20:1 greater if given via oral route
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

80% of the drug delivered via inhalation will be swallowed, absorbed and enter the systemic circulation after first pass metabolism and some drug will also enter the systemic circulation after it reaches the lungs.
T/F

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the optimum particle size for inhaled medications?

A

2-5 um mass medium aerodynamic diameter (MMAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Delivery to smaller airways in cases of COPD and severe asthma will need 1um using hydrofluoroalkane propellant.
T/F

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The lack of a spacer will reduce the amount swallowed and absorbed and therefore will decrease systemic effects.
T/F

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pressurized Metered-Dose Inhalers (pMDI)

A
  • Patients frequently fail to use these appropriately
  • Must be coordinated with inspiration
  • Usually will contain up to 400 doses of medication (100-400 range)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What to know about Spacer Chambers

A
  • Device that is placed between the pMDI and the patient
  • Decreases the velocity of the drug and the amount of the drug deposited on the oropharynx = more drug to pulmonary tissue
  • Useful in small children
    Requires less coordinated effort
  • Decreases side effects of drugs (less systemic absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dry Powder Inhalers

A

More difficult for children less than 7 years of age as they cannot generate enough respiratory flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nebulizers

A
  • Jet: Stream of air or oxygen
  • Ultrasonic: vibrating piezo-electrical crystal
  • Delivers much higher dose of drug
  • Used for acute exacerbations of asthma or COPD
  • Infants and children who cannot use inhaler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Commonly used bronchodilators

A
  • β 2 Adrenergic Agonist
  • Theophylline
  • Anticholinergic Agents (muscarinic receptor antagonists) – primarily parasympathetic muscarinic receptors in lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What role do B2 agonists play in the role of bronchodilation?

A

Decrease:

  • plasma exudation
  • cholinergic neuro-transmission
  • neutrophil function
  • bacterial adherence

Increases –> mucociliary clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which class and medications are indicated to treat:

  • Acute asthma attack
  • Not for prophylaxis
  • Duration of Action 2-4 hrs
A

B2 Agonist - Short acting bronchodilator

  • Albuterol
  • Metaproterenol
  • Terbutaline
    Oral and Parenteral also
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which class and medications are indicated to treat:

  • Asthma Prophylaxis not for acute attacks
  • Duration of Action 12-24 hrs
  • Bronchoconstriction prevention > 12 hours
  • Always used with inhaled corticosteroid as they do not reduce chronic inflammation
A

B2 Agonist Long action (LABA)

  • Salmeterol,
  • Formoterol,
  • Indacaterol
  • Vilanterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the recommended dose of epinephrine given SQ)

A
  • Adults in doses of 0.3 to 0.5 mg subcutaneously. -Epinephrine injection is associated with some pain at the injection site; potential side effects include: -headache
    -tremor
  • palpitations
    -GI upset
    Injections may be repeated every 20 to 30 minutes for a total of 1 mg.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the recommended dose of terbulatine given SQ?

A

1 dose of 0.5 mg or in 2 doses of 0.25 mg 30 minutes apart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are side effects of B2 agonists?

A
  • Muscle tremor
  • Tachycardia
  • Hypokalemia
  • Restlessness
  • Hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

LABAs should typically be used as an independent therapy.

T/F

A

FALSE

  • ALWAYS USE IN COMBINATION OR ALONG WITH ICS.
    COMBINED USE OBVIATES THE ISSUE WITH LABAS AND INCREASED MORTALITY.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Increased morbidity and mortality are associated with which two classes of medications used to treat pulmonary ailments?

A

Found with both short-acting β2 Agonist and LABA

Possibly related to Up regulation of PLC (phospholipase C) which can lead to an increased broncho-constrictor response to cholinergic activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If the use of short acting inhaled β2 agonist for short term symptom control are needed more than 3 X a week, which adjunct therapy is recommended?

A

ICS is also required for control of asthma at this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe the effects of Mehtylxanthines

A

THEOPHYLLINE:

  • Phosphodiesterase Inhibition and Adenosine Receptor Antagonist
  • Decreases Eosinophil Count
  • Acts on T-Lymphocytes to decrease cytokines
  • Acts on Mast cells to decrease mediators of inflammation
  • Acts on Macrophages to decrease circulating cytokines
  • RESULTLING IN BRONCHODILATION
  • INCREASED STRENGTH IN MUSCLES OF RESPIRATION
  • DECREASE LEAK IN ENDOTHELIAL CELLS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the administration requirements for theophylline?

A 
Nocturnal Asthma:
- Slow Release Pill
- Duration: 12 hours
IV for Acute Asthma:
- 6mg/kg over 20-30 minutes
- Maintenance Dose = 0.5mg/kg/hour
- Beta agonist are preferred over this choice and theophylline is used in addition to the beta agonist in a patient with severe asthma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the side effects of theophylline?

A 
PDE4 Inhibition:
- Nausea and Vomiting
A1 Receptor antagonism:
- Diuresis and Epileptic seizures
PDE3 Inhibition and A1 Receptor antagonism:
- Cardiac arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a muscarinic antagonist?

A
  • An agent that have high binding affinity for the muscarinic receptor but have no intrinsic activity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What do muscarinic antagonists compete with occupy muscarinic receptors?

A
  • Acteylcholine
  • They are competitive (reversible) antagonists of acetylcholine
  • Their pharmacological actions are opposite to that of the muscarinic agonists.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Anticholinergic medications effectively inhibit the bronchoconstriction mediated via vagal nerve activation AS WELL AS bronchoconstriction caused by inflammatory such as histamine or leukotrienes. T/F

A

FALSE

They do NOT inhibit bronchoconstriction caused by inflammatory such as histamine or leukotrienes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Muscarinic cholinergic antagonists in asthma are more effective against asthma exacerbated by cold air and emotional triggers?
T/F

A

TRUE

38
Q

Muscarinic cholinegic antagonists in asthma are less effective in older asthmatic patients if there is fixed airway obstruction.
T/F

A

FALSE

39
Q

Muscarinic Cholinergic Antagonists in Asthma May have an additive effect in acute asthma attacks when combined with a β2 Agonist.
T/F

A

TRUE

40
Q

Muscarinic Cholinergic Antagonist in COPD May be as effective or even better than β2 Agonist. T/F

A

TRUE

  • Inhibits the vagal tone which may be one of the few reversible elements in this population
  • Reduces air trapping
  • Improve exercise tolerance in this population
41
Q

Tiotropium Bromide: Spiriva

A
  • Long acting for once daily dosing
  • More effective in COPD patients than Ipratropium multi-dosing
  • Improved lung function and reduces exacerbations and mortality in COPD population
42
Q

Ipratropium Bromide: Atrovent

A
  • Slow onset with maximum effect 30-60 minutes after administration
  • LOA = 6-8 hours so given 3-4 X a day
  • May be used as a combination with B2 agonist albuterol Combivent for patient with COPD to decrease side effects of increase B2 dose
43
Q

Adverse effects of Spriva and atrovent (which are muscarnic cholinergic antagonists) are…

A
  • Rebound effect after stopping
  • Little systemic absorption so few systemic side effects.
  • May cause glaucoma in elderly due to drug coming in contact with the eye: use a mouth piece.
  • Urinary retention and dry mouth are possible.
44
Q

Are corticosteroids the most effective controller therapy available for asthma?

A

YES

45
Q

What disease processes are corticosteroids primary used for?

A
  • Asthma
  • Sarcoidosis
  • Interstitial lung disease
  • Pulmonary eosinophilic syndromes.
46
Q

Glucocorticoids in asthma are involved in Transcription of anti-inflammatory genes and suppression of other genes responsible for inflammation.
T/F

A

TRUE

47
Q

Glucocorticoids in asthma may increase the inflammatory cells in the epithelium and sub-mucosal layers in pulmonary tissue.
T/F

A

FALSE

48
Q

Glucocorticoids in asthma may completely resolve issues in patients with mild asthma pathology.
T/F

A

TRUE

49
Q

Glucocorticoids in asthma inhibit the formation of cytokines and secretions of T-lymphocytes, macrophages and mast cells and the formation of mucus. T/F

A

TRUE

50
Q

Glucocorticoids in Asthma ARE effective in early response but very effective in later response (within a few hours) but most effective in decreasing the hyper-responsive nature of the asthmatic pulmonary airway.
T/F

A

FALSE

are NOT effective in the early response

51
Q

It is true that when Glucocorticoids in Asthma are withdrawn the airway eventually returns to the original state
T/F

A

TRUE

52
Q

ICS do not potentiate the effect of the B2 agonist. T/F

A

FALSE

Increase the transcription of the β2 receptor in pulmonary mucosa and stabilize the messenger RNA

53
Q

β2 agonist potentiate the effect of ICS.

T/F

A

TRUE

Increase nuclear translocation of GR receptors and enhance the binding of the Glucocorticoid receptor to the DNA in the nucleus of the cell

54
Q

The use of a reduces the systemic absorption of ICS reducing side effects.
T/F

A

TRUE

55
Q

Beclomethasone and Ciclesonide are pro-drugs which are only active after the ester group has not NOT been removed by esterases in the lung.
T/F

A

FALSE

56
Q

Budesonide and fluticasone propionate undergo more extensive first pass metabolism and therefore result in less systemic side effects.
T/F

A

TRUE

57
Q

ICSs are recommended for patients who are using a β2 Agonist inhaler more than twice a week to control their asthma.
T/F

A

TRUE

58
Q

Initial recommendations may be to use an oral steroid or ICS up to 4 times a day until the initial asthma exacerbation is controlled.
T/F

A

TRUE

59
Q

ICS is recommended for use three times daily (to improve compliance) after asthma has been brought under control.
T/F

A

FALSE

Only two times daily

60
Q

In regards to ICS, the dose should be minimal required to control the asthma.
T/F

A

TRUE

  • < 400 υg per day up to 2000ug per day in resistant individuals
  • > 800 ug per day? USE A SPACER to decrease systemic effects
  • Children < 400 ug/day showed no growth suppression.
  • Young children can utilize a nebulizer for delivery
61
Q

ICS have a place in the treatment of COPD unless there is also a component of asthma.
T/F

A

FALSE

62
Q

ICS have no effect on slowing the progression of COPD.

T/F

A

TRUE

63
Q

Predisolone and prednisone oral steroids: clinical improvement takes several weeks.
T/F

A

FALSE

several days, not several weeks.

  • 30-40 mg daily to achieve maximal effect
  • Then 10 =15 mg day
  • Dose may be increased to 30-40 mg a day for two weeks and then tapered.
  • Usually given in the morning
64
Q

If lung function is < 30% or show no response to β2 agonist then IV steroids are not indicated.
T/F

A

FALSE

They are indicated.

-Hydrocortisone: 4mg/kg for initial dose then 3mg/kg every 6 hours; effective in 5-6 hours

65
Q

Adverse effects of systemic steroids?

A
  • Dysphonia
  • Oropharyngeal candidiasis
  • Cough
  • Adrenal suppression and insufficiency
  • Growth suppression
  • Bruising
  • Osteoporosis
  • Cataracts
  • Glaucoma
  • Psychiatric disturbances
  • Pneumonia
  • Abnormalities in glucose, insulin and triglyceride levels
66
Q

As mediator antagonists, newer Antihistamines (such as cetirizine and azelastine) may have some beneficial effects.
T/F

A

TRUE

67
Q

Anti-leukotrienes used in the prophylaxis of asthma. MOA block the leukotriene pathways.
T/F

A

TRUE

68
Q

Anti-Leukotrienes have been found in clinical trials to inhibit bronchoconstriction related to allergens, exercise, cold air in asthmatics. Because they are orally administered this increases compliance.
T/F

A

TRUE

69
Q

Anti-Leukotrienes have been found to not help in the following symptoms:
- Reduce need for rescue inhalers
- Improve lung function in patients with mild to moderate asthma
- Less improvement in patients with severe asthma
- Effective in blocking exercise induced asthma.
T/F

A

FALSE

They do help!

70
Q

Anti-Leukotrienes: meds

A
  • Zileuton: (Zyflo): Reduces synthesis of leukotrienes
  • Montelukast (Singulair): Antagonist at leukotriene receptor
  • Zafirlukast: (Allocate): Antagonist at leukotriene receptor
71
Q

Adverse effects of Anti- Leukotrienes

A

RARE:

  • Hepatic dysfunction
  • Churg Strauss syndrome
72
Q

Immunotherapy/Antibodies/Others

A

Mepolizumab: interleukin-5 antagonist for patients 12 or over with severe asthma:

  • Injection 100 mg every 4 weeks
  • Eosinophilic phenotypes (only for those with eosinophilic phenotype; NOT for all asthma types)

Omalizumab: IGE antibody is bond on mast cells:

  • Prophylaxis of asthma
  • Given by injection
    • Fevipiprant is an orally available antagonist of the prostaglandin D2 receptor.
      Appears to prevent eosinophils from collecting in the lungs. Just cleared Phase III trials.
73
Q

Pharmacologic Control of Asthma/Bronchospasm After Induction of Anesthesia

A

1) Deepen level of anesthesia with your volatile anesthetic agent. Consider ketamine, propofol, lidocaine.
2) Administer 100% oxygen
3) Administer a β2 Agonist
4) Consider epinephrine IV or sq
5) IV corticosteroids
Hydrocortisone IV: 4mg/kg bolus; infusion 0.5mg/kg/hr
Methylprednisolone IV: 0.8 mg/kg bolus; infusion: 0.1mg/kg/hr

74
Q

Albuterol

*Metaproterenol and Terbutaline are similar

A

Subclass:
Short-acting agonists

MOA:
Beta2-selective agonist
• bronchodilation

Use:
Asthma acute attack relief drug of choice (not for prophylaxis)

P-Kinetics:
Inhalation (aerosol) Duration: 2–4 h

S.E.
Tremor, tachycardia

75
Q

Salmeterol and Formoterol

A

Sublass:
Long-acting agonist

MOA:
Beta2-selective agonists; bronchodilation; potentiation of corticosteroid action

Use:
Asthma prophylaxis (not for acute relief) • indacaterol and vilanterol for COPD

P-Kinetics:
Inhalation (aerosol) Duration: 12–24 h

S.E.:
Tremor, tachycardia, cardiovascular events

76
Q

Epinephrine & Isoproterenol

A

Subclass:
Nonselective Sympathomimetics

MOA:
Nonselective β activation • epinephrine also an α agonist

Use:
Asthma (obsolete)

P-Kinetics:
Inhalation (aerosol, nebulizer) Duration: 1–2 h

S.E.:
Excess sympathomimetic effect (Chapter

77
Q

Theophylline

A

Subclass:
Methylxanthines

MOA:
Phosphodiesterase inhibition, adenosine receptor antagonist • other effects poorly understood

Use:
Asthma, especially prophylaxis against nocturnal attacks

P-Kinetics:
Oral slow-release Duration: 12 h

S.E.:
Insomnia, tremor, anorexia, seizures, arrhythmias

78
Q

Ipratropium

A

Subclass:
Antimuscarinic

MOA:
Competitive pharmacologic muscarinic antagonists

Use:
Asthma and chronic obstructive pulmonary disease

P-Kinetics:
Inhalation (aerosol) Duration: several hours

S.E.:
Dry mouth, cough

79
Q

Montelukast

A

Subclass:
Leukotriene antagonists

MOA:
Pharmacologic antagonists at LTD4 receptors

Use:
Prophylaxis of asthma

P-Kinetics:
Oral Duration: 12–24 h

S.E.:
Minimal

80
Q

Zileuton

A

Subclass:
Leukotriene antagonists

MOA:
Inhibitor of lipoxygenase • reduces synthesis of leukotrienes

Use:
Prophylaxis of asthma

P-Kinetics:
Oral Duration: 12 h

S.E.:
Elevation of liver enzymes

81
Q

Beclamethasone

A

Subclass: Corticosteroids - Inhaled

MOA:
Inhibition of phospholipase A2 • reduces expression of cyclooxygenase

Use:
Prophylaxis of asthma: drugs of choice

P-Kinetics:
Inhalation Duration: 10–12 h

S.E.:
Pharyngeal candidiasis • minimal systemic steroid toxicity (eg, adrenal suppression)

82
Q

Prednisone

A

Subcalss:
Corticosteroids - Systemic

MOA:
Like inhaled corticosteroids

Use:
Treatment of severe refractory chronic asthma

P-Kinetics:
Oral Duration: 12–24 h

S.E.:
See Chapter 39

83
Q

Omalizumab & Mepolizumab

A

Subclass: Antibodies

MOA:
Binds IgE antibodies on mast cells; reduces reaction to inhaled antigen

Use:
Prophylaxis of severe, refractory asthma not responsive to all other drugs

P-Kinetics:
Parenteral • administered as several courses of injections

S.E.:
Extremely expensive • long-term toxicity not yet well documented

84
Q

Bronchodilators

A

Relax constricted airway smooth muscle in vitro and cause immediate reversal of airway obstruction in asthma in vivo. Alos prevent bronchoconstriction.
Meds:
- Β2 Adrenergic Agonist
- Theophyllline
- Anticholinergic agents (muscarinic receptor antagonists)

85
Q

Β2 Adrenergic Agonist

A

Bronchodilator tx of choice for asthma, most effective, with minimal side effects.
Systemic, short acting, long acting, nonselective and inhaled.

86
Q

Methylxanthines

A

Similar to caffeine. Used since 1930s. Heavily used in developing countries d/t low cost. Frequency of side effects and relatively low efficacy has diminished its use.
Drug: Theophylline

87
Q

Inhaled Corticosteroids

A

First line therapy for patients with asthma.
Should be started in any patient who needs a B2 agonist inhaler more than twice a week.
Use two daily.
Utilized in mild, moderate and severe asthma.

88
Q

Anti-cholinergic agents (muscarinic receptor antagonists)

A

Anagonists of ACh at muscarinic receptors for lung relief.
Competitive binding at muscarinic receptors of ACh, resulting in inhibition of bronchoconstriction.
Play a role in the parasympathetic nervous systems ability to regulate bronchomotor tone.

89
Q

Mediator Antagonists

A

Antihistamine (H1) and anti-leukotrienes.
Many mediators have been noted in both asthma and COPD; in theory, suppression of these receptors have shown to be minimally effective in controlling inflammation in airways. Overall, intermittent efficacy.

90
Q

Immunomodulators

A

Methotrexate, cyclosporin A, gold intravenous immunoglobulin

Immunosupressive therapy, utilized in asthma when oral steroids have been proven to be ineffective. Many side effects and more difficult to regulate therapeutic levels.

91
Q

Antitussives

A

Viral infx of the upper respiratory tract are common causes.
cough is a defensive mechanism; inhibiting it w/ bacterial infx is ill advised.
meds used to suppress:
- narcotics
- dextromethorphan
- benzonatate (tessalon pearls)
-

Pharmacology Exam 3 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions