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Advanced Pharmacology Exam 1 > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

guaifenesin MOA

A

expectorant - increases volume of resp tract secretions to loosen phlegm/bronchial secretions

increases the efficacy of cough reflex

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2
Q

guaifenesin max dosage

A

maximum dose 2400 mg/day

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3
Q

guaifenesin AEs/drug interactions

A

generally well tolerated

N/V, dizziness, HA, rash

risk of kidney stone formation in high quantities –> hydration!

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4
Q

dextromethorphan (robitussin) MOA

A

antitussive - relieves throat irritation by cough suppression in medulla

most commonly used non-opioid agent for cough

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5
Q

dextromethorphan maximum dosage

A

adults and children >12 - 120 mg/day

children 6-12- 60 mg/day

children 4-5- 30 mg/day

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6
Q

dextromethorphan AEs/interactions

A

N, drowsiness, euphoric effect (robotripping)

avoid in asthma/COPD, hyperglc, bradypnea, pregnancy

interactions w/ MAOI - serotonin syndrome, quinidine

can cause + urine tox - PCP, opioids, heroin

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7
Q

benzonatate (Tessalon) MOA

A

peripherally anesthetizes stretch receptors in airways to reduce cough reflex

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8
Q

benzonatate AEs

A

sedation, HA, confusion, visual hallucinations, pruritis, N

*must be taken whole

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9
Q

benzonatate dosing

A

100-200mg TID

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10
Q

codeine dosing for cough

A

10-20 mg q4-6h

max dose 120 mg/day

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11
Q

codeine/hydrocodone AEs

A

constipation, sedation, N/V, dizziness

many drug interactions w CYP2D6

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12
Q

hydrocodone dosage for cough

A

5 mg q4-6h

max dose 30 mg/day

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13
Q

antihistamines MOA for cough

A

anticholinergic activity helps reduce post-nasal drip

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14
Q

AEs of antihistamines

A

dry mouth, dry eyes, blurred vision, constipation, bladder outlet obstruction, CNS impairment

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15
Q

what children should use OTC cough and cold products?

A

> 2 years

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16
Q

gabapentin MOA for cough

A

inhibits neutrotransmitter release to help reduce chronic refractory cough

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17
Q

gabapentin dosing

A

300 mg QD, increase as needed

max 600 mg TID

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18
Q

gabapentin AEs/precautions

A

CNS depression

adjust dose to renal function

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19
Q

intransal corticosteroids MOA for allergic rhinitis

A

most effective prevention and treatment of allergic rhinitis!

anti-inflammatory

reduces ocular symptoms (itching, tearing, redness)

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20
Q

intransasal corticosteroids AEs

A

dryness, irritation, burning, bleeding of nasal mucosa, sore throat, loss of smell

> 12 month use can stunt growth in children

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21
Q

most common OTC intransal corticosteroid

A

fluiticasone propionate

OTC and prescription

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22
Q

what generation is fluticasone propionate?

A

second generation intranasal corticosteroid

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23
Q

fluticasone propionate dosage

A

50 mcg/spray

4-6 years - one spray per nostril QD
>12 years - 2 sprays per nostril QD for 7d, than 1-2 sprays QD

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24
Q

first generation oral antihistamines examples

A

diphenhydramine (benadryl)

chlorpheniramine (chlor-trimeton)

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25
Q

antihistamines AEs

A

sedation, CNS impairment

anticholinergic

hangovereffect

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26
Q

second generation oral antihistamines examples

A

fexofenadine (allegra)
cetirizine (zyrtec)
levocetirizine (xyzal)
loratidine (claritin)

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27
Q

first vs second generation oral antihistamines

A

second generation - less sedating d/t limited bbb penetration
preferred first line for allergic rhinitis
less effective for nasal congestion
cetirizine may cause sedation

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28
Q

most used second generation antihistamine

A

loratidine

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29
Q

loratidine dosing

A

10 mg QD - adults

5 mg QD - peds

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30
Q
  • intransasal antihistamines example
A

azelastine

0.15% available OTC for ages 6 and older

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31
Q

pseudophedrine dosing

A

30-60 mg Q6h

max dose 240 mg in 24 h

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32
Q

pseudoephedrine MOA

A

oral decongestant

vasoconstriction in nasal mucosa

stimulation of alpha 1 in venus sinusoids

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33
Q

pseudoephedrine use

A

relief of nasal congesion and itching, NOT sneezing

tolerance

sales restrictions

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34
Q

pseudoephedrine AEs/precautions

A

tachycardia, insomnia, excitability/palpitations

use w caution in patients with HTN, cardiovascular disease, DM, hyperthyroid, glaucoma, bladder neck obstruction

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35
Q

oxymetazoline (Afrin) MOA

A

intransasal decongestant - stimulates A receptors in arterioles of the nasal mucosa to produce vasoconstriction

OTC

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36
Q
  • oxymetazoline AEs
A

stinging, burning, dryness of mouth

less likely than PO to have systemic effects

do not use as monotherapy >3 d - risk of rebound nasal decongestant

37
Q

cromolyn sodium (nasalcrom) MOA

A

mast cell stabilizer

intranasal cromolyn inhibits mast cell degranulation and mediator release

less effective than intranasal corticosteroids and second generation antihistamines

38
Q

mast cell stabilizer AEs

A

nasal stinging and sneezing

may take 1-2 weeks to achieve maximum effect

39
Q

alpha1-proteinase inhibitors MOA/use

A

congenital antitrypsin (AAT) deficiency leads to increase elastic damage in lungs causing emphysema

these drugs render proteolytic enzymes seen in inflammation inactive

40
Q

alpha1-proteinase inhibitors dosage

A

60 mg/kg IV infusion weekly

41
Q

lung surfactants MOA

A

reduce surface tension in alveoli during ventilation in premature infants

reduces mortality and pneumothoraces associated with respiratory distress syndrome

42
Q

lung surfactant AEs

A

hypotension, bradycardia, decreased O2 saturation

43
Q

corticosteroid AEs

A

adrenal insufficiency (cushings), osteoporosis, immunosuppression, fluid/electrolyte imbalance (d/t fluid retention), hyperglycemia, GI effects, CNS effects (psychosis), dermatologic effects

44
Q

betamethasone (celestone soluspan) use

A

glucocorticoid used in preterm mothers to reduce the incidence of RDS

used w surfactantI

45
Q

SABA precautions

A

regularly scheduled use is not recommended - may lower effectiveness and increase airway hyperresponsiveness

more than one canister per month suggests inadequate asthma control

46
Q

albuterol MOA

A

SABA

stimulates b-adrenergic receptors

do not decrease airway inflammation

47
Q

SABA/LABA AEs

A

tachycardia, skeletal muscle tremors, HA, palpitations, QT prolongation, insomnia, hypokalemia, hyperglc

may develop tolerance

48
Q

ipratropium MOA

A

SAMA

49
Q

SAMA/LAMA AEs

A

dry mouth, urinary retention, blurred vision, tachycardia, increased intraocular pressure

use w caution w glaucoma, BPH

50
Q

when is a SAMA used?

A

pts unable to tolerate SABA and in combo w SABA for acute bronchoconstriction

longer duration than albuterol

51
Q

what is the most effective long-term control therapy for persistent asthma?

A

inhaled corticosteroids

52
Q

ICS AEs

A

oral candidiasis, dysphonia

*rinse mouth and use spacer!

may increase risk for pneumonia with COPD

53
Q

what is a LABA used?

A

ASTHMA - mainly ICS/LABA combinations

not monotherapy, not for acute

COPD - can be monotherapy to reduce frequency of severe exacerbations

54
Q

LABA examplaes

A

salmeterol - asthma/COPD
formoterol - asthma/COPD
aformoterol - COPD
olodaterol - COPD

55
Q

formoterol dosing

A

nebulizer

20 mcg BID

56
Q

tiotropium MOA

A

LAMA

57
Q

when is a LAMA used?

A

added to ICS/LABA in poorly controled severe asthma

COPD - helps s/s but does not improve lung function

58
Q

tiotropium ISI dosing for asthma and COPD

A

asthma - 2 inhalations (2.5 mcg) QD

COPD - 2 inhalations (5mcg) QD

ihlalation spray

59
Q

what is trelegy?

A

fluticosone furoate/umeclidinium/vilanterol

ICS/LAMA/LABA

60
Q

when are leukotriene modifiers used?

A

alternative to low-dose ICS

not for acute

61
Q

leukotriene modifiers AEs

A

hepatotoxicity w/ zafirlukast and zilueton requires monitoring

black box warning w montelukast

62
Q

commonly used leukotriene modifier & dosage

A

montelukast (singulair) 10 mg QD in evening

63
Q

theophylline use & precautions

A

limited use
bronchodilator w lots of AEs

add on therapy for asthma and COPD

hepatic monitoring required, drug monitoring, significant AEs, interactions w many drugs

64
Q

concerning AEs w theophylline

A

convulsions and cardiac arrhythmias at high concentrations

65
Q

what is the most effective agent for asthma exacerbation not responding to bronchodilators?

A

oral corticosteroids

66
Q

prednisone dosing for asthma exacerbation

A

40 mg/day PO x 5-7 days

may have 6-8 hour delay so should be considered early in treatment

67
Q

omalizumab (xolair) use and MOA

A

patients >6 years not well controlled on ICS w/ documented sensitization to airborne allergens

monoclonal antibody that prevents IgE from binding to mast cells and basophils

68
Q
  • omalizumab (xolair) AEs
A

injection site pain, bruising, black box anaphylaxis warning –>monitor!

69
Q

Benralizumab (fasenra) MOA and use

A

IL-5 antagonist

add on therapy for patients >12 w eosinophilic phenotype asthma not controlled w corticosteroids

70
Q

IL - 5 antagonists

A

benralizumab (fasenra)
reslizumab (cinqair) - IV
Mepolizumab (nucala)

71
Q

benralizumab (fasenra) AEs

A

HA, pyrexia, pharyngitis, hypersensitivity reaction

72
Q

dupilumab (dupixent) MOA and use

A

IL-4 agonists

add on therapy for patients >12 w moderate to severe eosinophilic phenotype

73
Q

emergency astma mgmt

A
  • SaO2 > 90%
  • albuterol/levalbuterol nebs continuous
  • inhaled ipratropium in ED if needed
  • systemic corticosteroids - PO prednisone
74
Q

albuterol dosing for acute asthma exacerbation

A

nebulizer - 2.5-5mg q20 minutes, then 2.5-10 mg q 1-4h PRN

MDI - 90 mcg/puff. 4-8 puffs q 20 mins, then ever 1-4h PRN

75
Q

injections for asthma exacerbations

A

epinephrine 0.3-0.5 mg q 20 minutes SQ

terbutatline .25 mg q 20 minutes SQ x 3 doses

76
Q

ipratropium dosing for asthma exacerbation

A

0.5 mg q 20 minutes x3, then PRN

MDI - 17 mcg/puff. 8 puffs q 20 m PRN

77
Q

emphysema patho

A

permanent and destructive enlargement of airspaces distal to the terminal bronchioles without obvious fibrosis and with loss of normal architecture

always involves clinically significant airflow

“pink puffer”

78
Q

chronic bronchitis patho

A

presence of a cough productive of sputum not attributable to other causes on most days for at least 3 months over 2 consecutive years

may be present in the absence of airflow limitation

“blue bloater”

79
Q

duoneb dosing

A

2.5 mg albuterol/0.5 mg ipratropium QID PRN

80
Q
  • roflumilast (daliresp) use and MOA
A

oral phosphodisterase-4 inhibitor

used for severe COPD associated w chronic bronchitis and hx of exacerbations

tx can reduce hospitalizations

81
Q

roflumilast (daliresp) AEs

A

changes in mood and behavior, weight loss

82
Q

azithromycin MOA and use

A

macrolide antibiotic

can decrease rate of COPD exacerbations 250 mg QD

83
Q

azithromycin AEs

A

hearing loss, antimicrobial resistance, drug interactions

84
Q

what COPD LAMA is available as a nebulizer?

A

revefenacin

85
Q

what preparations is albuterol available?

A

MDI, nebulizer, DPI

86
Q

LAMA examples

A

tiotropium
umeclidinium
revefenacin

87
Q

which ICS is available as a neb?

A

budesonide

88
Q

what formulation is trelegy?

A

DPI

Advanced Pharmacology Exam 1 (4 decks)

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