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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
Theophylline has a _______
narrow therapeutic window
26
Theophylline can increase risk of _____ if over that therapeutic window
seizures and arrhythmias other GI upset many drug-drug interactions
27
Theophylline monitoring with
PFTs LFTs serum theophylline concentrations
28
Inhaled corticosteroids indications
acute and/or persistent asthma (mild-severe), COPD
29
MOA inhaled corticosteroids
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
30
SE of inhaled corticosteriods
cough thrush, hoarseness, cataracts growth suppression reduction in bone density
31
Inhaled corticosteroids include
budesonide beclomethasone fluticasone mometasone
32
intranasal forms are not a treatment for
asthma
33
oral corticosteroids include
methylprednisolone prednisone prednisolone
34
Long-acting beta agonists (LABA) are used in
maintenance of asthma and prevention of asthma attacks, exercise-induced bronchoconstriction prevention and COPD maintenance
35
LABA's are not used in
acute asthma attacks or acute COPD attacks
36
LABA can not be used as monotherapy in
asthma treatment
37
LABA can be used in monotherapy in
COPD management
38
difference of LABA and SABA
LABA lasts approximately 12 hours SABA lasts 4-6 hours
39
LABA names
salmeterol formoterol (in combination)
40
Formoterol is ______ than Salmeterol
more potent and faster acting
41
Combination inhalers LABA/ICS include
salmeterol/ fluticasone (ADVAIR) formoterol/budesonide (SYMBICORT) formoterol/mometasone (DULERA)
42
Combination inhalers SABA/anticholinergic include
Combivent (albuterol/ipratropium)
43
Mast cell stabilizers/ Modulators are medications that
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
44
Mast cell stabilizers/ Modulators include
Cromolyn
45
Cromolyn is
a mast cell stabilizer
46
Omalizumab is used
to control severe allergic forms of asthma that are steroid resistant
47
SE of Omalizumab is
anaphylaxis, inscrease stroke and MI risks by 60%
48
MOA of Omalizumab
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
COPD is a _____ disease
progressive, irreversible
50
Ipratropium indication
management of COPD, specifically to block cholinergic mediated bronchospasm and mucus production
51
COPD is associated with a decrease in ____
FEV1
52
MOA ipratropium
antimuscarinic activity on the bronchial smooth muscle that results in decreased contractility of smooth muscle
53
Toxic effects of ipratropium
local and systemic anticholinergic effects xerostomia urinary retention (overall well tolerated)
54
A 'long acting' antimuscarinic medication is
Tiotropium
55
Tiotropium is a ______ alternative to ______ with the same indications
costly ipratropium
56
Gold 1 - mild COPD = FEV1 of
greater than or equal to 80%
57
Gold 2 - moderate COPD = FEV1 of
50% - 79%
58
Gold 3 - severe COPD = FEV1 of
30% - 49%
59
Gold 4 - very severe COPD = FEV1
less than 30%
60
During COPD exacerbation we usually give (name of SAMA)
Ipratropium (inhaled, neb)
61
Daily LAMA for COPD management
Tiotropium
62
SAMA and LAMA can be used in
COPD and severe persistent asthma
63
Antitussives (suppress cough)
Centrally acting - dextromethorphan and opiates (codeine, hydrocodone) Locally acting - benzonatate
64
MOA dextromethorphan (DM)
crosses the BBB and activates the sigma opioid receptors on the cough center in the medulla -- suppressing the cough reflex
65
Dextromethorphan indications
short term relief of cough
66
Dextromethorphan does not affect
ciliary activity (Bronchial tree)
67
Dextromethorphan adverse reactions
mild and infrequent dizziness and drowsiness high doses can cause hallucinogenic states
68
Dextromethorphan contraindications
avoid in chronic cough, hepatic disease, operating machinery
69
Codeine MOA
suppress the cough reflex centrally, dries bronchial secretions often co-administered with guaifenesin
70
Codeine indications
short term relief of cough
71
Codeine interactions
converts to morphine in the liver via CYP450 other use of opiates with this can lead to sedation and resp depression
72
Codeine contraindications
resp depression, head injury, seizures, hepatic failure
73
Codeine adverse reactions
tolerance resp depression sedation N/V potential for abuse pruritus
74
Benzonatate MOA
anesthetizes the stretch receptors of vagal afferent fibers in the lungs, reducing the urge to cough after deep inhalation
75
Benzonatate interactions
can be additive to other local anestetics
76
Benzonatate indications
mostly for relief of chronic cough sometimes used for acute cough
77
Benzonatate adverse reactions
well tolerated - GI upset, local anesthesia from chewing overdose - cardiac arrhythmia, seizure, bronchospasm
78
Benzonatate contraindications
avoid in allergy to ester anesthetics
79
Guaifenesin (expectorant) MOA
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
Guaifenesin indications
Treatment of acute cough
81
Guaifenesin contraindications
should not be used for chronic cough avoid in pediatrics - can lead to seizures
82
Guaifenesin adverse reactions
excessive can result in nephrolithiasis
83
Histamine MOA
Produced by mast cells and basophils Released by an immunologic trigger or following a mechanical or chemical stimulus
84
Histamine 4 different receptors
H1 - smooth muscle cells, endothelium and brain H2 - gastric mucosa mast cells, immune cells and brain
85
Histamine general effects
local vasodilation transudation of fluid through endothelial cells stimulates nerve endings, producing pain and itching
86
Histamine organ specific effects
lung - bronchoconstriction GI tract - contraction of smooth muscle, potent secretagogue for gastric acid secretion, pepsin, and intrinsic factor brain - neurotransmitter
87
Antihistamines first generation includes
Diphenhydramine and hydroxyzine
88
Avoid first generation antihistamines in
elderly; may cause delirium, dizziness, urinary retention
89
first generation antihistamines act ______ and are ______
quick sedating
90
Hydroxyzine can be used as an
anxiolytic agent
91
Second generation antihistamines include
Cetirizine, loratadine, fexofenadine
92
Second generation are _____ hour _____ formulation
24hr non-drowsy
93
Second generation antihistamine - certrizine
crosses the BBB a little little drowsiness but better for itching, hives
94
Decongestants include
pseudoephedrine phenylephrine
95
Pseudoephedrine MOA
decongestant - a and b2 adrenergic receptor agonist - reduces tissue hyperemia and edema reduces nasal congestion and opens blocked eustachian tubes
96
pseudoephedrine indications
acute nasal congestion, sinusitis, otitis media
97
pseudoephedrine adverse reactions
increases HR and contractility
98
pseudoephedrine contraindications
pts with heart disease, severe HTN, uncontrolled DM
99
Phenylephrine MOA
binds primarily to a1 receptors causing vasoconstriction - used as a nasal decongestant
100
Phenylephrine is ______ effective than ___________ for treatment of rhinitis sx
less pseudoephedrine
101
Phenylephrine adverse reactions
increases systolic and diastolic pressure - reflex bradycardia
102
ACE inhibitors can increase clearance of _______ making less effective
Phenylephrine
103
Topical decongestants include
Oxymetazoline Fluticasone
104
Oxymetazoline indications
treating acute rhinitis (from the common cold)
105
Long duration of Oxymetazoline can lead to
rebound congestion
106
Fluticasone MOA
glucocorticoid receptor agonist - causes vasoconstriction and inhibitory effects of cells and mediators of inflammation (mometasone and budesonide also)
107
Fluticasone indications
treatment and prevention of allergic rhinitis, treatment of chronic nasal polyps
108
Fluticasone is not indicated for
treatment of acute upper respiratory infections
109
Inhaled antihistamines include
azelastine and olopatadine
110
Inhaled antihistamines indications
allergic rhinitis in adults and children
111
Inhaled antihistamines side effects
nosebleeds, HA, somnolence, poor taste

Pharmacology (7 decks)

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