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Emily: Pharm 2 > Quiz 6: Respiratory Drugs and Antihistamines > Flashcards

Quiz 6: Respiratory Drugs and Antihistamines Flashcards

1
Q

What are the respiratory medications?

A
  • anticholinergics
  • Adreneric Agonist
  • Membrane Stabilizers
  • Xanhines
  • Related Drugs: Tocolytics
  • Corticosteriods
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2
Q

List the drugs that are anticholinergics:

A
  • Atropine
  • Ipratropium
  • Tiotropium
  • Aclidium
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3
Q

There are 5 muscarinic receptor subtypes what is the location, clinical effects, and is/are there selective drugs for this receptor for M1:

A
  • CNS, Stomach
  • Hydrogen ion secretion
  • Yes
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4
Q

There are 5 muscarinic receptor subtypes what is the location, clinical effects, and is/are there selective drugs for this receptor for M2:

A
  • Heart , CNS
  • Bradycardia
  • NO
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5
Q

There are 5 muscarinic receptor subtypes what is the location, clinical effects, and is/are there selective drugs for this receptor for M3:

A

-CNS, Salivary glands
Airway smooth muscles

  • Salivation and Bronchodi
  • NO
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6
Q

There are 5 muscarinic receptor subtypes what is the location, clinical effects, and is/are there selective drugs for this receptor for M4:

A
  • CNS
  • ?
  • NO
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7
Q

There are 5 muscarinic receptor subtypes what is the location, clinical effects, and is/are there selective drugs for this receptor for M5:

A
  • CNS
  • ?
  • NO
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8
Q

What is the mechanism of action for Atropine?

A

-Antagonizes ACh effects on airway smooth muscle in large and mmedium sized airways

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9
Q

T/F: Atropine effects airwasys that respond to vagal stimulation.

A

TRUE

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10
Q

What would you see in lung capacity if using atropine:

A
  • Decreases in airway resistance

- Increase in dead space

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11
Q

T/F: Ipratropium is effective in treating bronchospasm due to the beta AGONIST.

A

FALSE (…due to the beta antagonist)

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12
Q

Ipratropium has an onset of (_______ minutes) and less effective than beta agonist in treating ______ ________.

A
  • 30 to 90

- bronchial asthma

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13
Q

Ipratropium is more effective than beta agonist in ____ ____ or ________.

A
  • chronic bronchitis

- emphysema

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14
Q

T/F: Ipratropium is highly soluble and results in systematic effect.

A

FASLE (Limited absorption results in prolonged local site effect

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15
Q

Atropine may have paradoxical bronchospasm due to what muscarinic receptor subtype?

A

M2

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16
Q

What is tiotropium?

A

Spiriva

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17
Q

Tiotropium mechanism of action is:

A
  • it blocks the muscarinic receptor subtypes M1 and M3
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18
Q

Tiotropium would cause what reaction in the lungs?

A
  • Facilitates bronchodilation

- Reduces mucous secretion

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19
Q

Tiotropium would be use in the treatment of:

A

-bronchospasm associated with COPD including chronic bronchitis and emphysema

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20
Q

Tiotropium is a long term or short term drug?

A

Long term

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21
Q

What is aclidinium?

A

Tudorza

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22
Q

What is aclidinium similar too?

A

tiotropium (Spiriva)

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23
Q

Two differences about aclidinium vs. Tiotropium.

A
  • Given twice daily

- Faster onset to peak (2 days vs. 7 days)

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24
Q

What adrenergic agents are beta agonist:

A
  • Ephedrine
  • Isoproterenol
  • Albuterol
  • Terbutaline
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25
Q

Ephedrine is an _______ acting synthetic noncatecholamine that stmulates ____ and ___ receptors.

A
  • indirect
  • alpha
  • beta
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26
Q

What receptor does ephedrine work on to cause broncho-dilatation:

A

Beta 2

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27
Q

Ephedrine can be used as a ____ oral medication to treat bronchial asthma.

A

chronic

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28
Q

Isoproterenol act at which adrenergic receptor(s):

A
  • Beta 1

- Beta 2

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29
Q

What is unique about a beta 2 agonist:

A
  • Relax bronchial smooth muscle
  • Lack stimulating effects on the heart
  • Structure makes them resistant to COMT (COMT break down catecholemines except synthetic are broken down only by MAO)
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30
Q

What are the uses of a beta 2 agonist:

A
  • Preferred treatment for acute episodes of asthma
  • Prevention of exercise induced asthma
  • Improve airflow and exercise toerance in patient with COPD
  • Tocolytic to stop uterine contractions
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31
Q

An intermediate class of a beta 2 agonist would last for:

A

-3 to 6 hours

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32
Q

An long acting class of a beta 2 agonist would last for:

A
  • greater 12 hours
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33
Q

What is a long acting beta 2 agonist:

A

-Salmeterol (>12 hours)

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34
Q

What is a intermediate acting beta 2 agonist:

A
  • Albuterol
  • metaproterenol
  • Terbutaline
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35
Q

How much inhalation medication is delivered to the lung with inhalation technique.

A

-12%

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36
Q

What are the side effects of a beta 2 agonist:

A
  • Tremor
  • Tachycardia
  • Metabolic Response
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37
Q

Where do the tremors come from on when using a beta 2 agonist?

A

-Stimulation of the beta 2 receptors on skeletal muscle

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38
Q

Where does the tachycardia come from on when using a beta 2 agonist

A
  • Direct stimulation of receptors on the heart

- REFLEX TACHYCARDIA due to Beta2 induced vasodilitation

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39
Q

What type of metabolic response would be seen with a beta 2 atagonist.

A
  • Hyperglycemia
  • Hypokalemia
  • Hypomagnesemia
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40
Q

What is the preferred beta 2 agonist for bronchospasm?

A

Albuterol

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41
Q

What would be the side effect albuterol?

A
  • tachycardia

- hypokalemia

42
Q

What is levoalbuerol?

A

-xopenex

43
Q

Levoalbuterol is a ____________ of racemic albuterol.

A

(R)-enantiomer of racemic albuterol

44
Q

T/F: Levoalbuterol has little or no clinically significant difference in adverse effects compared to albuterol.

A

TRUE

45
Q

Metaproterenol is a selective _________ _______.

A

beta 2 agonist

46
Q

Terbutaline has two uses what are they for:

A
  • Treatment of asthma

- Tocololytic

47
Q

Terbutaline is a Selective ______ ______.

A

beta 2 agonist

48
Q

What would salmeterol be given for:

A

Prophylaxis of asthma

49
Q

What is a membrane stabilizer?

A

-Inhibits antigen induced release of histamine and other mediators from pulmonary mast cells during antibody mediated allergic responses

50
Q

What drug would be a membrane stabilizer?

A

-Cromolyn Sodium (INTAL)

51
Q

Does cromolyn sodium (Intal) have a use in ACUTE asthma attack.

A

NO

52
Q

Cromolyn Sodium (_____) does ___ relax the bronchial or vascular smooth muscle.

A
  • intal

- NOT

53
Q

What does cromolyn sodium (INTAL) suppress and what does in NOT interact with?

A
  • Secretory response

- Ag-Ab

54
Q

What drugs are methylxanthines?

A
  • Theophylline/aminophylline
  • caffiene
  • theobromine
55
Q

What are the uses of methylxanthines?

A
  • stimulate the CNS
  • INCREASE B/P
  • Increase myocardial contractility and heart rate
  • Relax smooth muscle (airways)
56
Q

Methylxanthines are a competitive antagonist of ______ receptor.

A

adenosine

57
Q

Which of the methylxanthines is most active?

A

theophylline

58
Q

What replaced theophyllines when treating an acute exacerbation of asthma.

A

-Beta 2 agonist

59
Q

An infant has apnea how would you treat it:

A

Theophylline

60
Q

Theophylline toxicity of 15-25 mcg/ml would cause:

A
  • GI upset
  • N/V
  • tremor
61
Q

Theophylline toxicity of 26 - 35 would cause:

A
  • Tachycardia

- PVC

62
Q

Theophylline toxicity of >35 would cause:

A
  • VTach

- seizures

63
Q

What are the effects of caffeine?

A
  • CNS stimulant
  • Cerebral vasoconstrictor
  • Secretion of gastric acid
64
Q

What are the uses of caffeine?

A
  • apnea of prematurity
  • post dural puncture headache
  • Cold rememdies (offset sedation from antihistamines)
65
Q

Ritodine is a ____.

A

Tocolytic

66
Q

What is the mechanism of action for ritodine?

A

-beta 2 agonist stimulated and activates adenyl cyclase

67
Q

T/F: Ritodrine has some beta 1 effects.

A

TRUE

68
Q

T/F: Ritodrine is okay to use after the first trimester of a pregnancy.

A

FALSE (NO teratogenic effet when used after 20 weeks of EGA)

69
Q

What are some side effect of ritodrine?

A
  • Tachycardia
  • Elevated cardiac output
  • Increase in RENIN secretion
  • Exaggerated systemic BP decrease
  • Hyperglycemia in mother may cause reavtive hypoglycemia in fetus.
70
Q

What will the renin increase do to the parturient which is on ritodrine?

A
  • Decreased NA and water secretion
  • Increase K and H loss (hypokalemia)
  • Pulmonary edema may occur
71
Q

What would be the definition of a histamine?

A

-Low molecular weight , naturally occurring hydrophilic endogenous amine that produces a variety of physiologic and pathologic responses

72
Q

Where are histamine found?

A
  • skin
  • lungs
  • GI tract
  • circulating basophils
73
Q

Histamine act through ______ couple membrane receptors.

A

G protein

74
Q

Histamines are released to what kind of response:

A
  • Certain drugs

- AG-AB reaction

75
Q

T/F: Histamine do no easily cross the blood brain barrier.

A

TRUE

76
Q

H-1 receptors cause:

A
  • evoke smooth muscle contraction in the respiratory and G.I tracts
  • Cause pruritus and sneezing by sensory nerve stimulation
  • Cause nitric oxide mediated vasodilitation
  • Slow the heart rate by decreasing A-V nodal conduction
  • Mediate epicardial coronary vasoconstriction
77
Q

H-2 receptors cause:

A
  • activates adenyl cyclase and increases intracellular cAMP
  • Increase myocardial contractility and heart rate
  • With H1 receptors increase capillary permeability and vasodilitation
78
Q

An H-2 has what effect on the gastric parietal cells.

A

-causes them to secrete hydrogen ions

79
Q

H-2 have a vasodilating effects on coronary vasculature that ______the vasoconstricting effects of H-1 receptors.

A

-opposes

80
Q

What do both the H1 and H2 receptor histamines cause:

A
  • Increased capillary permeability
  • Hypotension
  • Tachycardia
  • Flushing
  • Headache
81
Q

Triple response (Wheal and Flare) is:

A
  • Edema due to increased permeability
  • Dilated arteries around the edema (FLARE)
  • Pruitus due to histamine in the superficial layers of the skin
82
Q

What will H1 receptor activation do within the lungs?

A

-Constricts bronchial smooth muscle

83
Q

What will H2 receptor activation do within the lungs?

A

-Relax bronchial smooth muscle

84
Q

H1 activation within the lung of a normal patient is usually ________.

A

negligible

85
Q

H1 activation within the lungs of a asthmatic or bronchitis patient is more likely to develop increases in _____ _____.

A

-airway resistance

86
Q

Other than H2 receptor what else can increase H secretions.

A

Vagal activity

87
Q

Histamine receptor antagonists do ___ inhibit the release of histamine, but rather ___ to receptors and prevent the responses mediated by histamine.

A
  • NOT

- attach

88
Q

H1 receptor antagonist have two generation, the first generation will cause ______ and may also activate ______, _______, or _________ receptors.

A
  • SEDATION
  • muscarinic
  • serotonin
  • alpha-adrenergic
89
Q

The H1 receptor antagonist that is a first generation will do what to the CNS:

A
  • Somnolence
  • Decreased alertness,
  • Slowed reaction time
  • Impaired cognitive function
90
Q

The H1 receptor antagonist that is a first generation will do what to anticholinergic:

A
  • dry mouth
  • blurred vision
  • urinary retention
  • impotence
91
Q

The H1 receptor antagonist that is a first generation will do what to cardiovascular:

A
  • tachycardia
  • QT prolongation
  • heart block
  • cardiac dysrhythmias
92
Q

The H1 receptor antagonist the is a second generation will have what effects:

A

-Unlikely to produce CNS side effects UNLESS recommended doses are exceeded

93
Q

T/F: The H1 receptor antagonist that is a second generation enhancement of sedative or alcohol is unlikely.

A

TRUE

94
Q

What are the H1 histamine receptor antagonist clinical uses:

A
  • prevent and relieve the symptoms of allergic rhinoconjunctivitis
  • Pretreatment may provide some protection against bronchospasm induced by various stimuli
  • Antipruitic
  • Sedative
  • Antiemetic
95
Q

Diphenhydramine (_____) is a H1 antihistamine which is a _ generation.

A
  • Benadryl

- 1st

96
Q

Dimenhydrinate (______) is a H1 antihistamine which is a __ generation.

A
  • Dramamine

- 1st

97
Q

What would Diphenhydramine be used for:

A
  • sedative
  • antipruritic
  • antiemetic
  • anaphylaxis
98
Q

What would dimenhydrinate be used for:

A

-motion sickness
-PONV
-

99
Q

How does dimenhydrinate work within the body:

A

-inhibits the integrative functioning of vestibular nuclei by decreasing vestibular and visual input.

100
Q

List some H1 antihistamines that are 2nd generations:

A
  • Zyrtex/xyzal = cetirizine/levovetirizine
  • Claritin = Loratidine
  • Allegra = fexofenadine

Emily: Pharm 2 (11 decks)

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