Pulmonary Meds

Question 1

what are the 3 characteristic findings with acute bronchospasm?

Answer 1

Smooth muscle constriction
Mucous prod
Vascular engorgement

Question 2

muscarinic receptor stimulation

Answer 2

-Inc cGMP
-Enhanced bronchoconstriction
-Parasympathetic input

Question 3

adrenergic (B2) receptor stimulation

Answer 3

-Inc cAMP
-Enhanced bronchodilation
-Sympathetic input

Question 4

𝛽-Adrenergic agonists may be given to inc ____ and thereby promote ____

Answer 4

cAMP, bronchodilation

Question 5

ɑ-Adrenergic antagonists may be given to inhibit ____ and support ____

Answer 5

cGMP, bronchodilation

Question 6

Cholinergic/muscarinic (PNS) antagonism = dec ____, inc ____

Answer 6

cGMP, bronchodilation

Question 7

Primary factors that mediate bronchoconstriction in emphysema and bronchitis appears to be inc in ____ tone and ____ release

Answer 7

vagal tone, ACh release

Question 8

What are the top 2 drug choices for asthma?

Answer 8

1. Steroid
2. 𝛽-2 agonist

Question 9

MOA of xanthine derivatives

Answer 9

Inhibition of phosphodiesterases, resulting in increased cAMP (bronchodilation) along with an anti-inflammatory response

Question 10

What should you keep in mind regarding xanthine derivatives?

Answer 10

low toxicity (monitor pt closely!)

Question 11

What are the 3 types of antitussives?

Answer 11

-Topical anesthetic: block receptors
-Nonnarcotic: inc threshold of cough center in medulla
-Narcotic: inc threshold of cough center in medulla

Question 12

How do Codeine (and other opioid derivatives) act as antitussives?

Answer 12

-Dec brain threshold for coughing
-Act to suppress cough reflex centrally

Question 13

How do antihistamines (i.e. Benadryl) act as antitussives?

Answer 13

-Dec tickling, allergic feeling
-Inhibit irritating effects of histamines on resp mucosa or acts as local anesthetic on resp epithelium

Question 14

most decongestants are in what drug class?

Answer 14

alpha 1 adrenergic agonists

Question 15

how do alpha 1 adrenergic agonists work?

Answer 15

-Cause vasoconstriction
-Reduce blood flow and hence outflow from capillaries (dec pressure in sinuses, lungs, throat)

Question 16

what are some things to keep in mind with alpha 1 adrenergic agonists?

Answer 16

-Can mimic effects of inc SNS activity (can raise BP and HR)
-Can cause serious CV and CNS excitation
-AEs: HA, dizziness, nervousness, nausea, palpitations, inc BP
-Rebound effects occur if too much → nasal congestion get progressively worse

Question 17

what other pathology can antihistamines be used for?

Answer 17

-PD
-Dec brain activity to help with motor control

Question 18

Histamines are prod by ____ and ____

Answer 18

basophils, mast cells

Question 19

what are the 3 main actions of histamines?

Answer 19

1. Sneezing d/t histamine-assoc sensory neural stimulation
2. Hypersecretion from glandular tissue – inc mucus (swelling and permeability)
3. Nasal congestion d/t vascular engorgement assoc with vasodilation and inc capillary permeability

Question 20

Where are the H1 receptors located?

Answer 20

-Vascular smooth muscle (vasodilation)
-Vascular endothelial cells (inc vascular permeability)
-CNS tissue throughout body

Question 21

What are the primary AEs of antihistamines?

Answer 21

Sedation (due to crossing BBB), fatigue, dizziness, blurred vision, incoordination

Question 22

What is good about 2nd generation antihistamines?

Answer 22

-Don’t easily cross BBB
-May be used in pts with asthma bc they won’t dry up the airways

Question 23

quick relief asthma drugs (rescue inhaler)

Answer 23

-SABA
-Anticholinergics
-Systemic corticosteroids

Question 24

LT asthma meds

Answer 24

-LABA
-Leukotriene modifiers
-Mast cell stabilizers
-Theophylline

Question 25

when is a LABA indicated?

Answer 25

when pt needs SABA > 2x/week

Question 26

important things to know about LABAs

Answer 26

-Take 20 mins to begin working
-Duration of action: 12 hrs (2x/day puffs)
-Formulation of agonist protects them against degradation
-Reduce dosage of glucocorticoids used

Question 27

LABA AEs

Answer 27

-Palpitations, shakiness and cramping of hands/legs/feet
-Often caused by improper administration