Pulmonary Pharm Flashcards
1
Q
What are the two main drug types for pulmonary?
A
Bronchodilators and Anti-inflammatories
2
Q
What classes are in bronchodilators?
A
Beta2 Agonists, Anticholinergics, Xanthine derivatives
3
Q
What classes are in Anti-inflammatories?
A
Leukotriene receptor antagonists (LTRAs), Inhaled glucocorticoids, Mast cell stabilizers
4
Q
What drug classes are used to treat COPD?
A
Beta2 Adrenergic and Glucocorticoids
5
Q
What do bronchodilators do?
A
Dilate the bronchioles. Give before giving an inhaled glucocorticoid to open airways and improve efficacy of steroid.
6
Q
What do Glucocorticoids do?
A
Decrease inflammation of the bronchioles
7
Q
How do bronchodilators works?
A
Relaxes the smooth muscle in the bronchial –> dilates bronchi and bronchioles
8
Q
What meds are short acting Beta-adrenergic agonists?
A
Albuterol (PO or inhaled) and Levalbuterol (Inhaled)
9
Q
What meds are long acting Beta-adrenergic agonists?
A
Salmeterol and Formoterol
10
Q
What should be used in an asthma attack?
A
Short acting Beta-Adrenergic agonists. Albuterol or Levalbuterol.
11
Q
Suffix for Beta-Adrenergic Agonists
A
-erol
12
Q
What is a rescue drug?
A
Short acting beta-adrenergic agonists (SABA)
13
Q
What is the duration for SABA?
A
Q4-6 hrs
14
Q
What is the duration for LABA?
A
Q12-14 hrs. THIS IS GIVEN FOR PREVENTION
15
Q
Beta-Adrenergic Agonists MOA
A
Mimics the action of the SNS to stimulate the fight or flight response. Relaxes and dilates the airway by stimulating the Beta2-adrenergic receptors in the LUNGS.
16
Q
Non-selective adrenergic drugs
A
stimulate both beta 1 and beta 2 and alpha receptors. EPINEPHERINE
17
Q
Non-selective beta-adrenergic drugs
A
stimulates both beta 1 and beta 3 receptors METAPROTERENOL.
18
Q
Selective beta-2 receptors
A
stimulates only beta 2 in the lungs. ALBUTEROL.
19
Q
Epinephrine MOA
A
Stimulates the alpha receptors, beta 1 in the heart and beta 2 in the lungs. Decreases edema and swelling in mucous membranes by vasoconstriction, has cardiovascular effects (Increases HR and BP) and stimulates CNS.
20
Q
Where is the beta 1 receptor?
A
Heart
21
Q
Where is the beta 2 receptor?
A
Lungs
22
Q
Indication for Beta-adrenergic agonists
A
prevention or relief of bronchospasm related to asthma, bronchitis, or other pulmonary conditions
23
Q
Contraindications for Beta-adrenergic agonists
A
uncontrolled HTN, cardiac dysrhythmias, high risk for TIA
24
Q
What do you need to avoid while on Beta-adrenergics?
A
MAOIs and sympathomimetics (ephedrine/Sudafed) bc it increases risk for HTN
25
Effect of Beta-adrenergic agonists on DM pt?
May increase blood sugar. Need higher doses of the med and insulin to compensate.
26
Adverse effects of Beta-adrenergic agonists
Insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache, HTN or hypotension
27
What do you do if too many beta-adrenergic agonists are given? (Overdose)
Beta blocker
28
MDI
metered dose inhaler. Non-breath activated. Pt. must be coordinated. (Evohaler)
29
DPI
dry powder inhaler. Breath-activated and propellant not required. (Accuhaler and Terbuhaler)
30
Types of inhalers
MDI, DPI and nebulizer. Can give higher doses and doesn't required pt coordination.
31
Albuterol delivery method
MDI or nebulizer
32
Albuterol indications
Asthma, bronchitis, and emphysema. ACUTE episodes of wheezing, chest tightness and SOA
33
Onset of Albuterol
minutes
34
What is the first line of defense for an asthma attack?
Albuterol
35
What indicates inadequate control of asthma?
If pt. is using more than one cannister of Albuterol per month. Need to be transitioned to anti-inflammatory therapy with possible PO med.
36
How many actuations are in a canister?
200
37
Indications for Salmeterol
Worsening of COPD, moderate to severe asthma - typically given twice daily
38
Do you give salmeterol alone?
NO. It's given with an inhaled corticosteroid.
39
What is the warning for Salmeterol?
It has been associated with an increase in asthma-related deaths (more common in black/african americans)
40
Anticholinergic MOA
Blocks action of acetylcholine --> creates bronchodilation by preventing bronchoconstriction
41
KEY POINT for anticholinergic meds
By blocking the effect of acetylcholine, we inhibit the normal physiological response of bronchoconstriction and mucus production.
42
Indications for anticholinergics
prophylaxis and maintenance therapy
43
Type of anticholinergic
Ipratropium
44
What do we normally give with anticholinergics?
Albuterol
45
Anticholinergic adverse effects
dry as a bone (dry throat, dry mouth, constipation, dry eyes, urinary retention), hot as a hare (feeling hot and decreased sweating), blind as a bat (blurred vision), red as a beet (redness), mad as a hatter (sedation, dizziness, confusion, hallucinations), tachycardia
46
Xanthine Derivatives (Methylxanthines) MOA
Increases levels of the cAMP enzyme by inhibiting phosphodiesterase --> stimulates CNS and CVD systems
47
What are the meds for Xanthine derivatives
Theophylline and aminophylline
48
Suffix for Xanthine derivatives
-phylline
49
What are xanthine derivatives used for?
second-line treatment
50
Why are xanthine derivatives used as a second treatment?
High risk of toxicity and drug-drug interactions
51
Indications for xanthine derivatives
preventative treatment for asthma attacks and COPD exacerbations
52
What do high levels of cAMP do?
induce smooth muscle relaxation and inhibit IgE induced release of chemical mediators of an allergic reaction
53
SE of xanthine derivatives
Toxicity --> N/V/D, Headache, tachycardia, dysrhythmias, seizure disorders, hyperthyroid, and peptic ulcers
54
Interactions with xanthine derivatives
Caffeine may increase SE because the body processes it similarly to caffeine. Smoking can decrease absorption.
55
Therapeutic index for xanthine derivatives
NARROW. Monitor the serum levels to watch for toxicity
56
drug interactions of xanthine derivatives
macrolide antibiotics, allopurinol, cimetidine, quinolones, flu vaccine, and oral contraceptives
57
What is the antidote for xanthine derivatives?
activated charcoal
58
Leukotriene receptor agonists (LTRA) MOA
prevent leukotrienes from attaching to receptors located on immune cells and within the lungs --> prevent inflammation
59
Normal function of leukotrienes
They are released by mast cells during the inflammatory response --> induce inflammation, bronchoconstriction and mucus production
60
Route for leukotriene receptor antagonists
PO
61
Meds for LTRAs
montelukast and zafirlukast
62
suffix for LTRAs
-kast
63
What LTRA can't be given to children under 5?
Zafirlukast
64
What LTRA is used for child over 12 months?
Montelukast
65
Indication for LTRAs
Prophylaxis and chronic treatment of asthma in adults and children. Also used for allergies.
66
AE of LTRAs
Headache, nausea, dizziness, insomnia, diarrhea
67
When are corticosteroids given PO rather than inhaled?
Temporarily during a COPD exacerbation until switch to inhaled
68
Inhaled corticosteroids MOA
Reduces inflammation and enhances activity of beta agonists, also helps with bronchodilation
69
What are the meds for inhaled coritcosteroids?
beclomethasone diproprionate, budesonide, and fluticasone
70
Downside of inhaled corticosteroids
Can take several weeks of continuous therapy before seeing full effect of steroids. May be started on PO med to bridge over.
71
Inhale corticosteroid route
MDI or nebulizer
72
What do you teach to asthma pts about inhaled corticosteroids?
This is not a PRN medication, you need to take it on a regular schedule. When you take it, take the bronchodilator first to increase absorption of the corticosteroid. Commonly given with beta-adrenergic med.
73
AE of inhaled corticosteroid
Pharyngeal irritation, coughing, dry mouth, and oral fungal infections
74
What do you do to prevent oral fungal infections with inhaled corticosteroids?
Rinse mouth after use
75
What would you give to a pt with an oral fungal infection?
Nystatin rinse
76
Combination inhaled glucocorticoid and bronchodilator meds
budesonide with formoterol and fluticasone with salmeterol
77
KEY POINT for combination inhalers
Not for acute attacks
78
Indications for combination inhalers
Moderate to severe asthma
79
Mast cell stabilizer MOA
Stabilizes membranes of mast cells to prevent release of broncho-constrictive inflammatory substances
80
Mast cell stabilizer med
Cromolyn
81
Indication for Mast cell stabilizer
Prevention of acute asthma attacks. Given 15-20 minutes prior to known triggers.
82
Monoclonal antibody anti-asthmatic MOA
monoclonal antibody which selectively binds to immunoglobulin IgE --> limits the release of mediators of allergic response (decreases hyperresponsiveness)
83
Monoclonal antibody Anti-asthmatic med
omalizumab
84
Route for monoclonal antibody therapy
injection -- must be monitored for hypersensitivity reactions
85
When is monoclonal antibody therapy used?
As an add-on therapy for asthma
86
Selective PDE-4 Inhibitor MOA
Selectively inhibits PDE4 enzyme in the lung cells --> anti-inflammatory effects
87
Indication for Selective PDE4 inhibitors
Prevention of COPD exacerbations. Works best for chronic bronchitis with hx of alot of exacerbations.
88
Route for Selective PDE4 inhibitors
PO
89
SE of Selective PDE4 inhibitors
N/V/D, headache, muscle spasm, decreased appetite, uncontrollable tremors
90
What med is a selective PDE4 inhibitor?
roflumilast
91
What is the PDE4 enzyme?
inflammation trigger
92
What are the long-term control medications?
anticholinergics, xanthine derivatives, inhaled corticosteroids, leukotriene modifiers, mast cell stabilizers and LABA
93
What are the short-term or quick relief medications?
SABA and albuterol
94
Antitubercular drug categories
First-line, used to treat first; and second-line, used for more complicated cases that are resistant to primary meds
95
Typical treatment for TB
Started on a 4 drug regimen and then tested to see what the pt is susceptible to and adjust from there. Treatment for rest of life.
96
Most common medication for TB
Isoniazid or INH
97
Isoniazid (INH) MOA
Disrupts the cell wall synthesis essential to the function of mycobacteria
98
Route for INH
Oral
99
SE of INH
Peripheral neuropathy, hepatoxicity, optic neuritis, visual disturbances, hyperglycemia
100
What do you need to avoid while on INH?
Antacids. They can reduce the absorption.
101
Black box warning for INH
Increased risk of hepatitis
102
What do we monitor with INH?
Liver enzymes --> metabolized in the liver
103
Rifampin MOA
Inhibits protein synthesis via attacking the hydrocarbon ring structure of mycobacteria
104
What is Rifampin used for in addition to TB?
meningitis, HIV, and leprosy mycobacterium
105
Why does rifampin decrease the effect of certain drugs?
It's a CYP450 inhibitor
106
SE of rifampin
hepatitis, hematologic disorders, red-brown discoloration of urine and other body fluids
107
Route of rifampin
PO and IV
108
Teaching point for rifampin
May change the color of body fluids, need to tell a pharmacist or HCP if taking because of the drug interactions
109
Ethambutol MOA
Diffusing into the mycobacteria and suppresses RNA synthesis, which inhibits protein synthesis
110
SE of ethambutol
retrobulbar neuritis (nerve neuritis in eye), blindness
111
Route of ethambutol
PO
112
Pyrazinamide (PZA) MOA
unknown - thought to inhibit lipid and nucleic acid synthesis necessary for DNA replication
113
SE of PZA
hepatotoxicity and hyperuricemia
114
Contraindication for PZA
people with severe hepatic disease or acute gout because gout is already high uric acid levels
115
What TB drug is not safe for pregnant women in US but used in other countries?
PZA
116
Streptomycin MOA
aminoglycoside --> interferes with the normal synthesis, causing production of faulty proteins within the bacteria
117
SE of streptomycin
ototoxicity, nephrotoxicity, blood dyscrasias
118
Streptomycin Route
IM injection only - given daily
119
Antitubercular meds
Streptomycin, Pyrazinamide (PZA), Ethambutol, Rifampin, and Isoniazid (INH)
