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
2
Q
List the drugs that are anticholinergics:
A
- Atropine
- Ipratropium
- Tiotropium
- Aclidium
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
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
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
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
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
8
Q
What is the mechanism of action for Atropine?
A
-Antagonizes ACh effects on airway smooth muscle in large and mmedium sized airways
9
Q
T/F: Atropine effects airwasys that respond to vagal stimulation.
A
TRUE
10
Q
What would you see in lung capacity if using atropine:
A
- Decreases in airway resistance
- Increase in dead space
11
Q
T/F: Ipratropium is effective in treating bronchospasm due to the beta AGONIST.
A
FALSE (…due to the beta antagonist)
12
Q
Ipratropium has an onset of (_______ minutes) and less effective than beta agonist in treating ______ ________.
A
- 30 to 90
- bronchial asthma
13
Q
Ipratropium is more effective than beta agonist in ____ ____ or ________.
A
- chronic bronchitis
- emphysema
14
Q
T/F: Ipratropium is highly soluble and results in systematic effect.
A
FASLE (Limited absorption results in prolonged local site effect
15
Q
Atropine may have paradoxical bronchospasm due to what muscarinic receptor subtype?
A
M2
16
Q
What is tiotropium?
A
Spiriva
17
Q
Tiotropium mechanism of action is:
A
- it blocks the muscarinic receptor subtypes M1 and M3
18
Q
Tiotropium would cause what reaction in the lungs?
A
- Facilitates bronchodilation
- Reduces mucous secretion
19
Q
Tiotropium would be use in the treatment of:
A
-bronchospasm associated with COPD including chronic bronchitis and emphysema
20
Q
Tiotropium is a long term or short term drug?
A
Long term
21
Q
What is aclidinium?
A
Tudorza
22
Q
What is aclidinium similar too?
A
tiotropium (Spiriva)
23
Q
Two differences about aclidinium vs. Tiotropium.
A
- Given twice daily
- Faster onset to peak (2 days vs. 7 days)
24
Q
What adrenergic agents are beta agonist:
A
- Ephedrine
- Isoproterenol
- Albuterol
- Terbutaline
25
Ephedrine is an _______ acting synthetic noncatecholamine that stmulates ____ and ___ receptors.
- indirect
- alpha
- beta
26
What receptor does ephedrine work on to cause broncho-dilatation:
Beta 2
27
Ephedrine can be used as a ____ oral medication to treat bronchial asthma.
chronic
28
Isoproterenol act at which adrenergic receptor(s):
- Beta 1
| - Beta 2
29
What is unique about a beta 2 agonist:
- 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)
30
What are the uses of a beta 2 agonist:
- 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
31
An intermediate class of a beta 2 agonist would last for:
-3 to 6 hours
32
An long acting class of a beta 2 agonist would last for:
- greater 12 hours
33
What is a long acting beta 2 agonist:
-Salmeterol (>12 hours)
34
What is a intermediate acting beta 2 agonist:
- Albuterol
- metaproterenol
- Terbutaline
35
How much inhalation medication is delivered to the lung with inhalation technique.
-12%
36
What are the side effects of a beta 2 agonist:
- Tremor
- Tachycardia
- Metabolic Response
37
Where do the tremors come from on when using a beta 2 agonist?
-Stimulation of the beta 2 receptors on skeletal muscle
38
Where does the tachycardia come from on when using a beta 2 agonist
- Direct stimulation of receptors on the heart
| - REFLEX TACHYCARDIA due to Beta2 induced vasodilitation
39
What type of metabolic response would be seen with a beta 2 atagonist.
- Hyperglycemia
- Hypokalemia
- Hypomagnesemia
40
What is the preferred beta 2 agonist for bronchospasm?
Albuterol
41
What would be the side effect albuterol?
- tachycardia
| - hypokalemia
42
What is levoalbuerol?
-xopenex
43
Levoalbuterol is a ____________ of racemic albuterol.
(R)-enantiomer of racemic albuterol
44
T/F: Levoalbuterol has little or no clinically significant difference in adverse effects compared to albuterol.
TRUE
45
Metaproterenol is a selective _________ _______.
beta 2 agonist
46
Terbutaline has two uses what are they for:
- Treatment of asthma
| - Tocololytic
47
Terbutaline is a Selective ______ ______.
beta 2 agonist
48
What would salmeterol be given for:
Prophylaxis of asthma
49
What is a membrane stabilizer?
-Inhibits antigen induced release of histamine and other mediators from pulmonary mast cells during antibody mediated allergic responses
50
What drug would be a membrane stabilizer?
-Cromolyn Sodium (INTAL)
51
Does cromolyn sodium (Intal) have a use in ACUTE asthma attack.
NO
52
Cromolyn Sodium (_____) does ___ relax the bronchial or vascular smooth muscle.
- intal
| - NOT
53
What does cromolyn sodium (INTAL) suppress and what does in NOT interact with?
- Secretory response
| - Ag-Ab
54
What drugs are methylxanthines?
- Theophylline/aminophylline
- caffiene
- theobromine
55
What are the uses of methylxanthines?
- stimulate the CNS
- INCREASE B/P
- Increase myocardial contractility and heart rate
- Relax smooth muscle (airways)
56
Methylxanthines are a competitive antagonist of ______ receptor.
adenosine
57
Which of the methylxanthines is most active?
theophylline
58
What replaced theophyllines when treating an acute exacerbation of asthma.
-Beta 2 agonist
59
An infant has apnea how would you treat it:
Theophylline
60
Theophylline toxicity of 15-25 mcg/ml would cause:
- GI upset
- N/V
- tremor
61
Theophylline toxicity of 26 - 35 would cause:
- Tachycardia
| - PVC
62
Theophylline toxicity of >35 would cause:
- VTach
| - seizures
63
What are the effects of caffeine?
- CNS stimulant
- Cerebral vasoconstrictor
- Secretion of gastric acid
64
What are the uses of caffeine?
- apnea of prematurity
- post dural puncture headache
- Cold rememdies (offset sedation from antihistamines)
65
Ritodine is a ____.
Tocolytic
66
What is the mechanism of action for ritodine?
-beta 2 agonist stimulated and activates adenyl cyclase
67
T/F: Ritodrine has some beta 1 effects.
TRUE
68
T/F: Ritodrine is okay to use after the first trimester of a pregnancy.
FALSE (NO teratogenic effet when used after 20 weeks of EGA)
69
What are some side effect of ritodrine?
- Tachycardia
- Elevated cardiac output
- Increase in RENIN secretion
- Exaggerated systemic BP decrease
- Hyperglycemia in mother may cause reavtive hypoglycemia in fetus.
70
What will the renin increase do to the parturient which is on ritodrine?
- Decreased NA and water secretion
- Increase K and H loss (hypokalemia)
- Pulmonary edema may occur
71
What would be the definition of a histamine?
-Low molecular weight , naturally occurring hydrophilic endogenous amine that produces a variety of physiologic and pathologic responses
72
Where are histamine found?
- skin
- lungs
- GI tract
- circulating basophils
73
Histamine act through ______ couple membrane receptors.
G protein
74
Histamines are released to what kind of response:
- Certain drugs
| - AG-AB reaction
75
T/F: Histamine do no easily cross the blood brain barrier.
TRUE
76
H-1 receptors cause:
- 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
H-2 receptors cause:
- activates adenyl cyclase and increases intracellular cAMP
- Increase myocardial contractility and heart rate
- With H1 receptors increase capillary permeability and vasodilitation
78
An H-2 has what effect on the gastric parietal cells.
-causes them to secrete hydrogen ions
79
H-2 have a vasodilating effects on coronary vasculature that ______the vasoconstricting effects of H-1 receptors.
-opposes
80
What do both the H1 and H2 receptor histamines cause:
- Increased capillary permeability
- Hypotension
- Tachycardia
- Flushing
- Headache
81
Triple response (Wheal and Flare) is:
- Edema due to increased permeability
- Dilated arteries around the edema (FLARE)
- Pruitus due to histamine in the superficial layers of the skin
82
What will H1 receptor activation do within the lungs?
-Constricts bronchial smooth muscle
83
What will H2 receptor activation do within the lungs?
-Relax bronchial smooth muscle
84
H1 activation within the lung of a normal patient is usually ________.
negligible
85
H1 activation within the lungs of a asthmatic or bronchitis patient is more likely to develop increases in _____ _____.
-airway resistance
86
Other than H2 receptor what else can increase H secretions.
Vagal activity
87
Histamine receptor antagonists do ___ inhibit the release of histamine, but rather ___ to receptors and prevent the responses mediated by histamine.
- NOT
| - attach
88
H1 receptor antagonist have two generation, the first generation will cause ______ and may also activate ______, _______, or _________ receptors.
- SEDATION
- muscarinic
- serotonin
- alpha-adrenergic
89
The H1 receptor antagonist that is a first generation will do what to the CNS:
- Somnolence
- Decreased alertness,
- Slowed reaction time
- Impaired cognitive function
90
The H1 receptor antagonist that is a first generation will do what to anticholinergic:
- dry mouth
- blurred vision
- urinary retention
- impotence
91
The H1 receptor antagonist that is a first generation will do what to cardiovascular:
- tachycardia
- QT prolongation
- heart block
- cardiac dysrhythmias
92
The H1 receptor antagonist the is a second generation will have what effects:
-Unlikely to produce CNS side effects UNLESS recommended doses are exceeded
93
T/F: The H1 receptor antagonist that is a second generation enhancement of sedative or alcohol is unlikely.
TRUE
94
What are the H1 histamine receptor antagonist clinical uses:
- prevent and relieve the symptoms of allergic rhinoconjunctivitis
- Pretreatment may provide some protection against bronchospasm induced by various stimuli
- Antipruitic
- Sedative
- Antiemetic
95
Diphenhydramine (_____) is a H1 antihistamine which is a _ generation.
- Benadryl
| - 1st
96
Dimenhydrinate (______) is a H1 antihistamine which is a __ generation.
- Dramamine
| - 1st
97
What would Diphenhydramine be used for:
- sedative
- antipruritic
- antiemetic
- anaphylaxis
98
What would dimenhydrinate be used for:
-motion sickness
-PONV
-
99
How does dimenhydrinate work within the body:
-inhibits the integrative functioning of vestibular nuclei by decreasing vestibular and visual input.
100
List some H1 antihistamines that are 2nd generations:
- Zyrtex/xyzal = cetirizine/levovetirizine
- Claritin = Loratidine
- Allegra = fexofenadine
