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Pharmacology Test 2 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

what controls respiration?

A

1) . medullary rhythmic center
2) . Vagal input from lungs
3) . ABGs

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2
Q

effect of PNS on respiration?

A

produces mainly bronchoconstriction and mucus secretion

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3
Q

effect of SNS on respiration?

A

beta-2 receptors relax smooth muscles, increase mucocilliary clearance

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4
Q

what is a healthy V/Q ratio?

A

0.8

Ventilation to perfusion ratio

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5
Q

difference between volumes and capacities in the lungs?

A

capacities are when you add volumes up/together

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6
Q

drugs that can be used to treat respiratory tract irritation & control of secretions

A

1) . Decongestants
2) . Antitussives
3) . Antihistamines
4) . Mucolytics
5) . Expectorants

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7
Q

what do decongestants do?

A

counter mucous discharge from upper respiratory tract (nasal stiffness)

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8
Q

decongestants MOA

A

usually alpha-1 adrenergic agonist –> causes vasoconstriction –> reduces blood flow = “dry up” mucosal tracts

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9
Q

what do antitussives do?

A

used to suppress cough (dry unproductive cough)

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10
Q

Antitussives MOA

A

decrease afferent nerve activity or decrease cough center sensitivity

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11
Q

Antitussive drugs can include what?

A

Codeine and antihistamines

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12
Q

What are antihistamines used for?

A

to manage respiratory allergic responses to seasonal allergies

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13
Q

general MOA for antihistamines

A

act on nasal mucosa H1 receptor

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14
Q

what do H1 receptors blockers do?

A

reduce nasal congestion, mucosal irritation, and cough by reducing secretions

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15
Q

difference between 1st and 2nd generation antihistamines

A

1st generation cross the BBB which results in more drowsiness

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16
Q

general AEs for antihistamines

A

dry mouth, sore throat, cough, nausea, HA, diarrhea, and nervousness

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17
Q

Mucolytics MOA

A

split disulfide bonds –> decreases viscosity of respiratory secretions making it easier to clear mucus from the airway

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18
Q

what do expectorants do?

A

facilitate the production and ejection of mucus.

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19
Q

issues with cold remedies and hypertension

A

decongestants can mimic effects of increased sympathetic activity, thus hypertensive individuals should avoid them

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20
Q

COPD is an umbrella term for what conditions?

A

1) . emphysema
2) . chronic bronchitis
3) . asthma

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21
Q

what is emphysema?

A

pathologic accumulation of air in the tissues, particularly in the lungs

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22
Q

pathophysiology of emphysema?

A

alveoli are damaged and create large air spaces which reduce the SA for gas exchange.

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23
Q

clinical manifestations of emphysema

A

1) . barrel chests
2) . clubbed fingers
3) . tachypnea
4) . marked exertional dyspnea
5) . hypertrophied neck muscles
6) . anxiety related to dyspnea or fear of dyspnea

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24
Q

what is chronic bronchitis?

A

inflammation of airway and irritation that results in excess mucus production

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25
Q

hallmark of chronic bronchitis?

A

very productive cough that lasts for at least 3 months for 2 consecutive years

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26
Q

clinical manifestations of chronic bronchitis

A

1) . SOB
2) . persistent cough
3) . prolonged expiration
4) . recurrent infection due to increased mucus in airways
5) . late effects include pulmonary hypertension

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27
Q

goals of trx for COPD

A

reduce airway edema secondary to inflammation and bronchospasm

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28
Q

how to achieve trx goals for COPD

A

1) . facilitate the elimination of bronchial secretions
2) . prevent and treat respiratory infections
3) . increase exercise tolerance

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29
Q

Drug classes used to treat COPD

A

1) . Bronchodilators
2) . Anti-inflammatory
3) . Antibiotics

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30
Q

Types of Bronchodilators

A

1) . inhaled beta agonists

2) . inhaled antimuscarinics

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31
Q

MOA of inhaled beta-agonists

A

agonize beta-2 receptors –> increase bronchodilation

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32
Q

suffix for inhaled beta-agonists

A

-terol

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33
Q

what are SABAs?

A

short acting beta-agonists

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34
Q

what are SABAs used for?

A

acute exacerbations, works within 5 minutes and lasts 4-6 hours

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35
Q

what are LABAs?

A

long acting beta-agonists

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36
Q

what are LABAs used for?

A

chronic managements, 12-24 hour duration, must be dosed once or twice daily

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37
Q

AE for inhaled beta-agonists

A

generally well tolerated. AE can include: tachycardia, tremor, hypokalemia

38
Q

MOA for Inhaled antimuscarinics

A

primarily bind M3 in airway smooth muscle which antagonizes ACh actions at those sites resulting in bronchodilation

39
Q

what are SAMA/LAMAs?

A

short/long acting antimuscarinics

40
Q

AE for inhaled antimuscarinics?

A

generally well tolerated other than dry mouth

41
Q

Anti-inflammatory drugs used to treat COPD

A

1) . inhaled corticosteriods (-asone or -sonide)

2) . PDE-3 inhibitor

42
Q

typical use for ICS?

A

acute exacerbation of COPD or more severe disease

43
Q

ICS AEs?

A

oral candidiasis (prevent by rinsing mouth)

44
Q

MOA for PDE-3 inhibitor

A

decrease breakdown of intracellular cyclic AMP –> decreases inflammation

45
Q

when would PDE-3 inhibitors be used?

A

when a pt has a more severe COPD case, this drug is used in to the hopes to decrease the amount of exacerbations

46
Q

what is asthma?

A

reversible obstructive lung disease characterized by inflammation and increased smooth muscle reaction of the airways to various stimuli

47
Q

types of asthma?

A

1) . extrinsic
2) . intrinsic
3) . exercise-induced
4) . asthma associated with COPD

48
Q

Asthma Pathogenesis?

A

1) . abnormal airway response
2) . mediators cause thickening of airway walls and increased contractile response of bronchial smooth muscle
3) . mucous plug can become significant and block up the airways that are in spasm and swollen (traps air distally)

49
Q

Clinical manifestations of Asthma

A

1) . sensation of chest constriction
2) . inspiratory and expiratory wheezing
3) . nonproductive cough
4) . prolonged expiration
5) . tachycardia and tachypnea

50
Q

Goals for Asthma trx?

A

1) . decrease impairments
2) . decrease risk (prevent exacerbations, need for emergency care, prevent loss of lung function, decrease AE for therapy)

51
Q

1st line (maintenance trx) for Asthma

A

1) . ICS solo

2) . LABAs only in combo with ICS

52
Q

1st line trx for acute exacerbations of Asthma

A

PO ICS

53
Q

Alternative trx for Asthma

A

1) . Leukotriene Modifiers
2) . Immunomodulators
3) . Cromolyn Sodium
4) . Methylxanthines

54
Q

what are Leukotrienes?

A

released from mast cells eosinphils, they play a role in airway edema, smooth muscle contraction and inflammatory process

55
Q

types of Leukotriene modifiers

A

1) . Leukotriene receptor antagonist (LTRA)

2) . 5-lipoxygenase inhibitor

56
Q

MOA for LTRA

A

competitively antagonize leukotriene receptors

57
Q

Types of Immunomodulators

A

1) . Anti-IgE

2) . Interleukin Antagonist

58
Q

MOA of Anti-IgE?

A

binds IgE antibody –> prevents IgE binding to receptors on mast cells and basophils –> limits activation and release of allergic response mediators

59
Q

AE of Anti-IgE

A

HA, injection site reactions; very rare anaphylactic allergic reactions

60
Q

Interleukin antagonist MOA

A

monoclonal antibodies that binds interleukins results in decrease inflammatory response

61
Q

Common interleukin antagonist AE

A

injection site reactions, HA, increase creatine kinase

62
Q

What drugs are used for acute symptom relief and exacerbations of Asthma?

A

1) . SABAs
2) . SAMAs
3) . PO steroids

63
Q

what is used for acute symptom relief and EIB?

A

SABAs. typically used up to 3 trx at 20 min intervals

64
Q

when would SAMAs be used?

A

in combo with SABA in emergency care setting or as monotherapy if SABA not tolerated

65
Q

when would PO steroids be used to treat Asthma?

A

moderate to severe exacerbations

66
Q

what is a BPTs?

A

bronchial provocation test. Used to diagnose asthma in atheltes

67
Q

What is cystic fibrosis?

A

gene defect that doesn’t allow Cl- to pass in and out of the plasma membrane of epithelial cells. More commonly known for its copious amounts of mucus but is a multi-system disease

68
Q

CF complications

A

1) . CFRD
2) . bone disease
3) . liver disease
4) . lung transplants

69
Q

CF trxs

A

1) . Bronchodilators
2) . CFTR modulators
3) . Mucolytics
4) . Anti-inflammatory
5) . Inhaled Antibiotics
6) . PO Antibiotics
7) . Nutritional support

70
Q

Bronchodilators used in CF trx

A

may use LABAs for maintenance; SABAs used prior to chest physiotherapy

71
Q

what is a CF trans-membrane regulator?

A

membrane protein and Cl- channel –> regulates sodium and water which helps keep mucous thin

72
Q

how does CF effect CFTRs?

A

genetic mutations cause closing and/or narrowing of CFTR or prevents CFTR from getting to the cell surface

73
Q

purpose of CFTR modulators

A

decrease risk of exacerbation, increase lung function and QOL

74
Q

common AE for CFTR modulators

A

HA, GI issues, respiratory issue

75
Q

less common AE of CFTR modulators

A

dizziness and hypertension

76
Q

why are mucolytics used in trx of CF?

A

decrease risk of exacerbations, improve lung function and QOL

77
Q

type of mucolytic used ideally?

A

hypertonic saline and dornase alfa

78
Q

MOA of hypertonic saline?

A

increase salt in airways which draws more water into airways -> increases hydration of airway mucus secretions, increases mucucillary functions

79
Q

MOA of dornase alfa (Pulmozyme)

A

cleaves DNA –> decrease mucus viscosity –> improved airflow

80
Q

what is a red flag for a pt on dornase alfa?

A

chest pain -> merits an automatic referral to a physician

81
Q

what is a red flag for a pt on dornase alfa?

A

chest pain -> merits an automatic referral to a physician

82
Q

Anti-inflammatory used to trx CF

A

Chronic high dose ibuprofen if <18 years old - has been proven to slow the loss of lung function

83
Q

Inhaled Antibiotics used to trx CF

A

1) . Tobramycin (Tobi)

2) . Aztreonam

84
Q

when would an inhaled antibiotic be used chronically for CF trx?

A

if P. aeruginosa persistently present in cultures

85
Q

prescription instructions for Tobramycin

A

nebulized 2-3x daily for 28 days on and then 28 days off

86
Q

AE of Tobramycin (9)

A

voice disorder, HA, fever, respiratory issue, ototoxicity, pharyngolarngeal pain, cough, nasal congestion, wheezing

87
Q

additional AE for aztreonam

A

fever

88
Q

supplemental vitamins used for nutritional support in pts with CF?

A

Vitamins A, D, E, and K

89
Q

what is PERT?

A

pancreatic enzyme replacement therapy

90
Q

Therapeutic concerns with Anti-cholinergic drugs used to trx respiratory conditions?

A

dry mouth, HTN and tachycardia

91
Q

Therapeutic concerns with steroids used to trx respiratory conditions?

A

1) . inhaled: oral candidiasis and thrush

2) . increased infection risk, HTN, Osteoporosis (muscle weakness, skin atrophy)

92
Q

Therapeutic concerns with Beta-2 agonists used to trx respiratory conditions

A

tremor, trachycardia, hypokalemia, hyperglycemia, reduced exercise capacity

Pharmacology Test 2 (9 decks)

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