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OPT 540 > Quiz 3 Study > Flashcards

Quiz 3 Study Flashcards

1
Q

With which three respiratory diseases is a troublesome cough often associated?

A

Asthma, COPD, allergic rhinitis

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2
Q

What percentage of the US population is affected with asthma?

A

7% (about 20 million)

It also results annually in 2 million emergency room visits, 500,000 hospitalizations, and 5000 deaths.

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3
Q

What two diseases are included in COPD?

A

Emphysema and chronic bronchitis.

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4
Q

How many Americans are affected with COPD?

A

24 million

It is also the 4th most common cause of preventable deaths in the US.

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5
Q

What percentage of the US population is affected with allergic rhinitis?

A

20%

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6
Q

What are some of the symptoms of allergic rhinitis?

A

Itchy, watery eyes, runny nose, and a nonproductive cough.

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7
Q

Into what two categories may the goals of chronic asthma therapy be divided?

A

Reduction of impairment, and reduction of risk.

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8
Q

What role can beta2 receptor phenotype play in a patient’s response to drug therapy?

A

16-20% of asthma patients have been demonstrated to have a link between beta2 receptor phenotype and response to long-acting beta2 agonists.

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9
Q

What type of drug is the drug of choice for mild asthma? Why would this type of drug not be a good choice for treating persistent asthma?

A

Beta2 agonists; however, they should not be used as the sole therepeutic agents for patients with persistent asthma due to a lack of anti-inflammatory effects.

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10
Q

What adverse effects are avoided by administering beta2 blockers via inhalation as opposed to via a systemic route?

A

Tachycardia, hyperglycemia, hypokalemia.

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11
Q

What class of drugs is the first choice in a patient with any degree of persistent asthma?

A

Inhaled corticosteroids (ICS)

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12
Q

What may be required (in addition to the persistent asthma medication) in a patient with severe persistent asthma?

A

A short course of oral glucocorticoid treatment (to decrease immune response).

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13
Q

What is the “step up” therapy?

A

Selected ICS therapy for a newly-diagnosed asthma patient should be done at dosing equivalent to the patient’s asthma classification.

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14
Q

What is the “step down” therapy?

A

Asthma patients who have achieved 3-6 consecutive months of improved asthma control may be considered for a reduction in ICS dosing.

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15
Q

True or false: ICS act on the smooth muscle of the airways

A

False. It targets the inflammatory cascade, decreasing eosinophils, magrophages, and T lymphocytes, and inhibiting the release of leukotrienes.

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16
Q

What is the method of inhalation for a MDI?

A

Breathe slowly and deeply just before and during activation of the inhaler; improper administration can result in only 10-20% of the drug depositing in the airway.

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17
Q

What is the method of inhalation for a DPI?

A

Breathe quickly and deeply to avoid local immune suppression through drug deposition on the oral and laryngeal mucosa. Patients should swish and spit after administration.

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18
Q

What problem do spacers reduce, and for what types of patients are they recommended?

A

They reduce the problem of adrenal suppression; they are recommended for all patients, but especially children less than 5 years old and elderly patients.

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19
Q

What is status asthmaticus?

A

Severe exacerbation of asthma.

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20
Q

What may be done for a patient in response to status asthmaticus?

A

Intravenous administration of methylprednisolone or oral prednisone.

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21
Q

When should alternative asthma drugs be considered?

A

In the treatment of moderate to severe allergic asthma in patients who are poorly controlled by conventional therapy; but they should be used in conjunction with ICS therapy, not as sole therapies.

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22
Q

What is the action of leukotriene B4?

A

It acts as a potent chemoattractant for neutrophils and eosinophils.

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23
Q

What is the action of the cysteinyl leukotrienes (LTC4, D4, and E4)?

A

They act to constrict bronchiolar smooth muscle, increase endothelial permeability, and promote mucus secretion.

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24
Q

What drug inhibits 5-lipoxygenase?

A

Zileuton; it prevents the formation of LTB4 and the cysteinyl leukotrienes.

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25
Q

What drugs inhibit the cysteinyl leukotriene-1 receptor?

A

Zafirlukast and montelukast; they prevent formation of the cysteinyl leukotrienes.

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26
Q

What are two advantages of montelukast compared to other alternative asthma drugs?

A

There are dosing recommendations for children 6 months and older; it is available as chewable tablets.

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27
Q

True or false: zileuton, zafirlukast, and montelukast are all appropriate for both prophylaxis of asthma and in providing immediate bronchodilation.

A

False. They are approved only for prophylaxis of asthma.

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28
Q

How does cromolyn provide its action?

A

It inhibits mast cell degranulation and release of histamine. (Hence, it is useful only as a prophylactic anti-inflammatory mediation.)

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29
Q

How long of a trial period is required to determine the efficacy of cromolyn?

A

4 to 6 weeks; it is quite safe, even for children and pregnant women

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30
Q

How do anticholinergic agents treat asthma?

A

They block vagally mediated bronchoconstriction and mucus secretion.

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31
Q

Which anticholinergic agent is useful for patients who are unable to tolerate adrenergic agonists?

A

Ipratropium, especially if the asthma patient also has COPD.

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32
Q

Theophylline is a bronchodilator that has largely been replaced by beta2 agonists and corticosteroids. Why has it been replaced?

A

Its narrow therepeutic window; overdose may cause seizures or potentially fatal arrhythmias.

33
Q

How does omalizumab take its effect?

A

It is a recombinant DNA-derived monoclonal antibody that binds to IgE, which in turn decreases the amount of IgE that can bind to the surface of mast cells and basophils. This decreases the release of mediators in the allergic response.

34
Q

What is the greatest risk factor for COPD?

A

Smoking.

35
Q

COPD is directly linked to the progressive decline of lung function. How was this demonstrated?

A

Through forced expiratory volume (FEV).

36
Q

What drugs form the foundation of COPD therapy?

A

Inhaled bronchodilators such as anticholinergic agents (ipratropium, tiotropium) and beta2 agonists (albuterol, salmetrol).

37
Q

What combination of anticholinergic agent and beta2 agonist provides relief, but requires more frequent dosing?

A

Albuterol and ipratropium (Al’s a short [acting] prat)

38
Q

What combination of anticholinergic agent and beta2 agonist provides relief with less frequent dosing?

A

Salmeterol and tiotropium (Sal’s been my tio for a long [acting] time)

39
Q

What drugs are common in the treatment of allergic rhinitis?

A

H1-receptor blockers: diphenhydramine, chlorpheniramine, loratadine, and fexofenadine.

(-ramines and -tadines)

40
Q

What are some side effects of first-generation antihistamines?

A

Dry eyes, dry mouth, difficulty urinating, difficulty defecating.

41
Q

When are antihistamines used in treating allergic rhinitis?

A

To treat sneezing and rhinorrhea.

42
Q

What are some examples of alpha agonists used to treat allergic rhinitis? Which symptoms do they alleviate?

A

Phenylephrine and oxymetazoline (longer-lasting); they decongest the nasal mucosa by constricting the arterioles; however, they should not be used longer than 3 days due to potential for rebound nasal decongestion.

43
Q

Which corticosteroids are used as nasal sprays in treating nasal symptoms of allergic rhinitis?

A

Beclomethasone, budesonide, fluticasone, funisolide, ciclesonide, mometasone, and triamcinolone

(-sones, -lones, -nides, and -lides)

44
Q

What are some of the side effects of corticosteroids when used as nasal sprays?

A

Nasal irritation, nosebleed, sore throat, and, rarely, candidiasis

45
Q

When might intranasal cromolyn be useful for allergic rhinitis?

A

If administered qid starting at least one to two weeks prior to exposure to allergen.

46
Q

Which leukotriene antagonist can be used to treat allergic rhinitis as well as asthma?

A

Montelukast.

47
Q

What is the gold standard for cough suppression?

A

Codeine (at low dose)

48
Q

What drug is a synthetic derivative of codeine and is equally effective in cough suppression?

A

Dextromethorphan; it also has a better side effect profile.

49
Q

What are some preservatives used in ophthalmic drugs?

A

Benzalkonium chloride, thimerosal (mercurial), polyquaternium, purite (less toxic)

50
Q

What are some viscosity-increasing agents used in ophthalmic drugs?

A

Gelatin, glycerin, methylcellulose

51
Q

What are some antioxidants used in ophthalmic drugs?

A

EDTA, sodium bisulfite

52
Q

What are some wetting agents used in ophthalmic drugs?

A

Polysorbate 20 and 80, poloxamer 282

53
Q

What are some buffers used in ophthalmic drugs?

A

Acetic acid, boric acid, sodium bicarbonate

54
Q

Why do some ophthalmic drops sting?

A

Because their pH is a little lower for acidic stability

55
Q

What are some tonicity agents used in ophthalmic drugs?

A

NaCl, KCl

56
Q

What osmolarity of drug is considered isotonic with the tear film?

A

0.9%

57
Q

What range of osmolarity of drug is usually comfortable for ophthalmic use?

A

0.6-1.8%

58
Q

Why would you use 5% NaCl?

A

To draw water out of a corneal swelling.

59
Q

What color are the caps for beta blocker drugs?

A

Blue or yellow, or both

60
Q

What color are the caps for mydriatic and cycloplegic drugs?

A

Red

61
Q

What color are the caps for miotic drugs?

A

Green

62
Q

What color are the caps for NSAID drugs?

A

Grey

63
Q

What color are the caps for anti-infective drugs?

A

Brown, tan

64
Q

What color are the caps for carbonic anhydrase inhibitor drugs?

A

Orange

65
Q

What color are the caps for protaglandin analog drugs?

A

Teal

66
Q

What are some common uses for lid scrubs?

A

Eyelid cleansing, antibiotic solutions, treatment for blepharitis.

67
Q

What are some common uses for cotton pledgets?

A

Administration of mydriatic solutions such as phenylephrine; to break posterior synechiae or dilate sluggish pupils.

68
Q

What can filter paper strips be used for?

A

To disclose corneal injuries, infections such as herpes simplex, and dry eye.

69
Q

What advantages do filter paper strips have over drops?

A

Less chance of contamination, helps assess dry eye status

70
Q

What is in an artificial tear insert, and how does it take its action?

A

Hydroxypropyl cellulose (Lacrisert); it absorbs fluid, swells, and releases nonmedicated polymer for up to 24 hours to help with dry eye

71
Q

What is Vitrasert?

A

A ganciclovir vitreous implant that supplies antiviral agents to the vitreous and retina for 4 to 6 months.

72
Q

What is Retrisert?

A

Intravitreal fluocinolone implant that supplies steroid to the posterior segment for 2 to 3 years.

73
Q

What is the max lacrimal volume (with and without blinks)?

A

With blinks: 10 mcL

Without blinks: 30 mcL

74
Q

How many mcL’s are in a drop?

A

About 50 mcL (glaucoma meds range from 24-56 mcL

75
Q

What is the typical tear turnover rate?

A

16%/min
(So 5 min after instillation of drug, only 40% of drug originally retained is still present; only 8% of the drug originally administered.)

76
Q

How can an anesthetic drop increase drug absorption?

A

It minimizes the issue of reflex tearing after instillation of the drug.

77
Q

Why do cocaine, homatropine, and pilocarpine have less effect on the pupils of blacks and Asians (as compared to whites)?

A

Uveal pigment binds drugs; these individuals have more uveal pigment than whites do.

78
Q

What information is found in a prescription?

A 
Name, address, office phone number of doctor
Patient's name, age, current address
Name/dosage of drug
How drug is to be taken
Refill and safety cap information
Doctor's signature
DEA number for controlled substances
79
Q

What are some contraindications for dilation?

A

Patient refusal, iris-supported IOL, angle closure glaucoma, hypersensitivity to dilation drops

OPT 540 (12 decks)

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