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Pharmacology > Pulmonary Drugs > Flashcards

Pulmonary Drugs Flashcards

1
Q

Albuterol is a

A

short acting beta 2 agonist

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2
Q

inhalation of this product leads to relaxation of bronchial and tracheal smooth muscles in management of acute bronchospasm in asthma and other Chronic obstructive airway diseases

A

albuterol

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3
Q

Albuterol indications

A

management of acute bronchospasm in asthma and other chronic obstructive airway diseases

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4
Q

what part of the anatomic structures of the respiratory system do these drugs target

A

the bronchial tree - the conducting zone

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5
Q

The conducting zone of the bronchial tree contain

A

sympathetic innervation
parasympathetic innervation
mucus secreting goblet and ciliated cells that remove inhaled products

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6
Q

MOA albuterol

A

activates adenylate cyclase – increasing cAMP –
less intracellular Ca2+ – leading to dilation

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7
Q

Relaxation of the bronchial and tracheal smooth muscle leads to

A

relieves bronchospasm
reduces airway resistance
facilitates mucous drainage
increases vital capacity

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8
Q

SE of albuterol

A

tachycardia (most common)
hyperglycemia (not a contraindication in DM)
hypokalemia (low potassium)
tremor (common)
paradoxical bronchospasm (rare)

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9
Q

Alternatives to albuterol

A

metaproterenol (inhaled and tablet)
levalbuterol (deemed inferior to albuterol)

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10
Q

Leukotriene modifiers are

A

montelukast
zafirlukast

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11
Q

Leukotriene modifiers job is to

A

reduces edema, decrease mucous production, bronchoconstriction, allergic rxns

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12
Q

Indications for Leukotriene modifiers

A

asthma
allergic rhinitis
exercise-induced bronchoconstriction

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13
Q

Contraindications for Leukotriene modifiers

A

phenylketonuria
hepatic disease

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14
Q

daily drug to prevent sx of acute asthma

A

Leukotriene modifiers (montelukast, zafirlukast)

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15
Q

chronic urticaria can also be used by this acute asthma daily preventative

A

montelukast

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16
Q

Leukotriene modifiers are thought to be _______ effective than inhaled glucocorticoids for management of persistent asthma

A

less

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17
Q

5-lipoxygenase inhibits

A

formation of leukotrienes

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18
Q

Example of a 5-lipoxygenase inhibitor

A

Zileuton

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19
Q

Common adverse affect of 5-lipoxygenase inhibitor

A

elevated of liver enzymes and interferes with CYP metabolism

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20
Q

Methylxanthines indications

A

oral and IV treatment of asthma, bronchospasm and COPD (rarely)
also infant apnea

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21
Q

MOA of Methylxanthines

A

structurally similar to caffeine
relaxes smooth muscle and anti-inflammatory and immunomodulatory effect

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22
Q

Methylxanthines name

A

Theophylline

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23
Q

Theophylline MOA

A

is a competitive nonselective phosphodiesterase inhibitor which raises intracellular cAMP – activates PKA – inhibits TNF-alpha – inhibits leukotriene synthesis – reducing intracellular Ca2+

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24
Q

Aminophylline is _____ and _____ acting than Theophylline

A

less potent
shorter acting

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25
Q

Theophylline has a _______

A

narrow therapeutic window

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26
Q

Theophylline can increase risk of _____ if over that therapeutic window

A

seizures and arrhythmias
other GI upset
many drug-drug interactions

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27
Q

Theophylline monitoring with

A

PFTs
LFTs
serum theophylline concentrations

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28
Q

Inhaled corticosteroids indications

A

acute and/or persistent asthma (mild-severe), COPD

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29
Q

MOA inhaled corticosteroids

A

suppress inflammation and immune responses and reduce edema and secretions by:
controls rate of protein synthesis
depresses the migration of polymorphonuclear leukocytes and fibroblasts
reverse capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation

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30
Q

SE of inhaled corticosteriods

A

cough
thrush, hoarseness, cataracts
growth suppression
reduction in bone density

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31
Q

Inhaled corticosteroids include

A

budesonide
beclomethasone
fluticasone
mometasone

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32
Q

intranasal forms are not a treatment for

A

asthma

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33
Q

oral corticosteroids include

A

methylprednisolone
prednisone
prednisolone

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34
Q

Long-acting beta agonists (LABA) are used in

A

maintenance of asthma and prevention of asthma attacks, exercise-induced bronchoconstriction prevention and COPD maintenance

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35
Q

LABA’s are not used in

A

acute asthma attacks or acute COPD attacks

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36
Q

LABA can not be used as monotherapy in

A

asthma treatment

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37
Q

LABA can be used in monotherapy in

A

COPD management

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38
Q

difference of LABA and SABA

A

LABA lasts approximately 12 hours
SABA lasts 4-6 hours

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39
Q

LABA names

A

salmeterol
formoterol (in combination)

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40
Q

Formoterol is ______ than Salmeterol

A

more potent and faster acting

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41
Q

Combination inhalers LABA/ICS include

A

salmeterol/ fluticasone (ADVAIR)
formoterol/budesonide (SYMBICORT)
formoterol/mometasone (DULERA)

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42
Q

Combination inhalers SABA/anticholinergic include

A

Combivent (albuterol/ipratropium)

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43
Q

Mast cell stabilizers/ Modulators are medications that

A

are used to prevent or control certain allergic disorders
block mast cell degranulation, stabilizing the cell and thereby preventing the release of histamines and related mediators

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44
Q

Mast cell stabilizers/ Modulators include

A

Cromolyn

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45
Q

Cromolyn is

A

a mast cell stabilizer

46
Q

Omalizumab is used

A

to control severe allergic forms of asthma that are steroid resistant

47
Q

SE of Omalizumab is

A

anaphylaxis, inscrease stroke and MI risks by 60%

48
Q

MOA of Omalizumab

A

monoclonal antibody that specifically binds to free IgE in the blood and interstitial fluid and membrane bound form of IgE on the surface of mlgE-expressing B lymphocytes

49
Q

COPD is a _____ disease

A

progressive, irreversible

50
Q

Ipratropium indication

A

management of COPD, specifically to block cholinergic mediated bronchospasm and mucus production

51
Q

COPD is associated with a decrease in ____

52
Q

MOA ipratropium

A

antimuscarinic activity on the bronchial smooth muscle that results in decreased contractility of smooth muscle

53
Q

Toxic effects of ipratropium

A

local and systemic anticholinergic effects
xerostomia
urinary retention
(overall well tolerated)

54
Q

A ‘long acting’ antimuscarinic medication is

A

Tiotropium

55
Q

Tiotropium is a ______ alternative to ______ with the same indications

A

costly
ipratropium

56
Q

Gold 1 - mild COPD = FEV1 of

A

greater than or equal to 80%

57
Q

Gold 2 - moderate COPD = FEV1 of

58
Q

Gold 3 - severe COPD = FEV1 of

59
Q

Gold 4 - very severe COPD = FEV1

A

less than 30%

60
Q

During COPD exacerbation we usually give (name of SAMA)

A

Ipratropium (inhaled, neb)

61
Q

Daily LAMA for COPD management

A

Tiotropium

62
Q

SAMA and LAMA can be used in

A

COPD and severe persistent asthma

63
Q

Antitussives (suppress cough)

A

Centrally acting - dextromethorphan and opiates (codeine, hydrocodone)
Locally acting - benzonatate

64
Q

MOA dextromethorphan (DM)

A

crosses the BBB and activates the sigma opioid receptors on the cough center in the medulla – suppressing the cough reflex

65
Q

Dextromethorphan indications

A

short term relief of cough

66
Q

Dextromethorphan does not affect

A

ciliary activity (Bronchial tree)

67
Q

Dextromethorphan adverse reactions

A

mild and infrequent dizziness and drowsiness
high doses can cause hallucinogenic states

68
Q

Dextromethorphan contraindications

A

avoid in chronic cough, hepatic disease, operating machinery

69
Q

Codeine MOA

A

suppress the cough reflex centrally, dries bronchial secretions
often co-administered with guaifenesin

70
Q

Codeine indications

A

short term relief of cough

71
Q

Codeine interactions

A

converts to morphine in the liver via CYP450
other use of opiates with this can lead to sedation and resp depression

72
Q

Codeine contraindications

A

resp depression, head injury, seizures, hepatic failure

73
Q

Codeine adverse reactions

A

tolerance
resp depression
sedation
N/V
potential for abuse
pruritus

74
Q

Benzonatate MOA

A

anesthetizes the stretch receptors of vagal afferent fibers in the lungs, reducing the urge to cough after deep inhalation

75
Q

Benzonatate interactions

A

can be additive to other local anestetics

76
Q

Benzonatate indications

A

mostly for relief of chronic cough
sometimes used for acute cough

77
Q

Benzonatate adverse reactions

A

well tolerated - GI upset, local anesthesia from chewing
overdose - cardiac arrhythmia, seizure, bronchospasm

78
Q

Benzonatate contraindications

A

avoid in allergy to ester anesthetics

79
Q

Guaifenesin (expectorant) MOA

A

Loosens secretions to allow for more productive cough
increases volume and reduces viscosity of phlegm in trachea/ bronchi - cilia can then more easily propel/ mobilize secretions upwards

80
Q

Guaifenesin indications

A

Treatment of acute cough

81
Q

Guaifenesin contraindications

A

should not be used for chronic cough
avoid in pediatrics - can lead to seizures

82
Q

Guaifenesin adverse reactions

A

excessive can result in nephrolithiasis

83
Q

Histamine MOA

A

Produced by mast cells and basophils
Released by an immunologic trigger or following a mechanical or chemical stimulus

84
Q

Histamine 4 different receptors

A

H1 - smooth muscle cells, endothelium and brain
H2 - gastric mucosa mast cells, immune cells and brain

85
Q

Histamine general effects

A

local vasodilation
transudation of fluid through endothelial cells
stimulates nerve endings, producing pain and itching

86
Q

Histamine organ specific effects

A

lung - bronchoconstriction
GI tract - contraction of smooth muscle, potent secretagogue for gastric acid secretion, pepsin, and intrinsic factor
brain - neurotransmitter

87
Q

Antihistamines first generation includes

A

Diphenhydramine and hydroxyzine

88
Q

Avoid first generation antihistamines in

A

elderly; may cause delirium, dizziness, urinary retention

89
Q

first generation antihistamines act ______ and are ______

A

quick
sedating

90
Q

Hydroxyzine can be used as an

A

anxiolytic agent

91
Q

Second generation antihistamines include

A

Cetirizine, loratadine, fexofenadine

92
Q

Second generation are _____ hour _____ formulation

A

24hr
non-drowsy

93
Q

Second generation antihistamine - certrizine

A

crosses the BBB a little
little drowsiness but better for itching, hives

94
Q

Decongestants include

A

pseudoephedrine
phenylephrine

95
Q

Pseudoephedrine MOA

A

decongestant - a and b2 adrenergic receptor agonist - reduces tissue hyperemia and edema
reduces nasal congestion and opens blocked eustachian tubes

96
Q

pseudoephedrine indications

A

acute nasal congestion, sinusitis, otitis media

97
Q

pseudoephedrine adverse reactions

A

increases HR and contractility

98
Q

pseudoephedrine contraindications

A

pts with heart disease, severe HTN, uncontrolled DM

99
Q

Phenylephrine MOA

A

binds primarily to a1 receptors causing vasoconstriction - used as a nasal decongestant

100
Q

Phenylephrine is ______ effective than ___________ for treatment of rhinitis sx

A

less
pseudoephedrine

101
Q

Phenylephrine adverse reactions

A

increases systolic and diastolic pressure - reflex bradycardia

102
Q

ACE inhibitors can increase clearance of _______ making less effective

A

Phenylephrine

103
Q

Topical decongestants include

A

Oxymetazoline
Fluticasone

104
Q

Oxymetazoline indications

A

treating acute rhinitis (from the common cold)

105
Q

Long duration of Oxymetazoline can lead to

A

rebound congestion

106
Q

Fluticasone MOA

A

glucocorticoid receptor agonist - causes vasoconstriction and inhibitory effects of cells and mediators of inflammation
(mometasone and budesonide also)

107
Q

Fluticasone indications

A

treatment and prevention of allergic rhinitis, treatment of chronic nasal polyps

108
Q

Fluticasone is not indicated for

A

treatment of acute upper respiratory infections

109
Q

Inhaled antihistamines include

A

azelastine and olopatadine

110
Q

Inhaled antihistamines indications

A

allergic rhinitis in adults and children

111
Q

Inhaled antihistamines side effects

A

nosebleeds, HA, somnolence, poor taste

Pharmacology (7 decks)

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