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Pharm test 3 > Resp > Flashcards

Resp Flashcards

1
Q

Which cough should you suppress? Why?

A

Non-productive.

Productive cough helps to mobilize mucus.

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2
Q

How do mucolytics work? What are examples? Which is the best?

A

They reduce the viscosity of secretions making cough more efficient.
-Guafifenesin, NAC/Mucomyst, WATER

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3
Q

What are some cough suppressants?

A

codeine, DM, benzonatate (Tessalon Pearles)

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4
Q

T/F Codeine and benzonatate are OTC.

Which one is also a local numbing agent?

A

F - Rx

B is local numbing agent

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5
Q

Which suppressant is easily abused? Why does this make sense?

A

DM – cause hallucinations because it is centrally acting!

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6
Q

What drug may induce cough?

A

ACE-i

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7
Q

What happens to the lungs in asthma?

A

Hyperactive bronchi - chronic inflammation

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8
Q

Why is asthma considered polygenic?

A

histamine, LTs, PGs all play a role in the inflammation process

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9
Q

What is the basic approach to treatment of asthma?

A
  1. Prevent allergen exposure
  2. Reduce inflammation/hyperactivity
  3. Dilate narrowed bronchi
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10
Q

Which drug is the mainstay of asthma treatment (reduces bronchial hyperactivity and inflammation)?

A

Glucocorticoids

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11
Q

How are glucocorticoids administered?

A

PO, IV, inhalation (1st)

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12
Q

Should inhaled steroids be hydrophilic or lipophilic?

A

Hydrophilic so that they’ll stay in the lung (and not go into bloodstream).

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13
Q

What is the AE of inhaled steroid? What are the advantages?

A

Thrush

no systemic effects and no risk HPA suppression

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14
Q

Steroids as a family can cause?

A 
Metabolic...
1. Hyperglycemia
2. Osteopenia
3. Growth suppression
Inflammatory...
3. Immune suppression
4. PUD (decrease Pg, decrease mucus)
Vascular - increase BP
Cushinoid signs...
5. Na retention
G. Hypokalemia
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15
Q

What is HPA suppression and how does it affect steroid dosing?

A

Chronic steroid use suppresses the “need” for the hypothalamus to control the secretion of steroids. When D/Cing steroids, you need to taper them to allow the H to take over once again. Steroids are required for living!

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16
Q

In addition to steady administration of steroids in adrenalectomized or Addison’s dz, what else do you have to do?

A

They need stress-dosing or “burst” dosing. Because everyone needs bursts in times of stress.

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17
Q

Can inhaled steroids break acute asthma attacks? What do you use for status asthmaticus?

A

NOOOOO. They are only for maintenance/prevention.

IV steroids, Epi + maybe intubation

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18
Q

How do you remember what Addison’s dz is? What is the opposite of Addison’s?

A

You have to ADD steroids.

CUSHING’s.

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19
Q

When do you dose steroids?

A

In the AM. They are activating and involved in the wake-up cycle.

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20
Q

Most steroid inhalers for normal asthma end in “-_____”. What is used for acute severe attacks?

A

“-one”

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21
Q

How and when are Cromolyn are Nedocromil taken? In what patients are these MOST helpful in?

A

powder for inhalation -
Take on a regular basis
Exercise induced asthma or specific allergen-induced asthma.

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22
Q

Can Cromolyn or Nedocromil treat acute asthma attacks?

A

no, they are only preventative therapy! it takes time to inhibit the histamine cascade

23
Q

How do Cromolyn and Nedocromil work?

A

mast cell stabilizer - reduces histamine release on exposure to allergans

24
Q

Beta 1 agonist vs beta 2 agonist?

A

Beta 1 - heart

Beta 2 - vasodilation and bronchodilation

25
Q

Is Epi or NE a more potent vasoconstrictor?

A

NE because it does not bind to Beta 2 receptors.

26
Q

Does NE or Epi bind to Beta 2?

A

Epi

27
Q

What kind of med is Albuterol? Long or short acting? Rescue agent?

A

Beta 2 agonist - Bronchodilator - short acting rescue agent

28
Q

What kind of med is Salmeterol? Long or short acting? Rescue agent? Why did it get bad press?

A

B2 agonist - long acting maintenance inhaler
no rescue use
only used in combo with steroids

29
Q

What kind of med is Formoterol? Long or short acting? Onset? Potency?

A

B2 agonist - Bronchodilator - long acting with faster onset and greater potency than Sameterol

30
Q

What are two other long-acting Beta 2 agonist bronchodilators?

A

Salbutamol, bambuterol

31
Q

Is PO albuterol used regularly? Why/why not? What side effect may occur?

A

No because it loses B2 selectivity, which can lead to tachycardia

32
Q

What kind of med is Terbutaline? Why is it special?

A

B2 agonist that is not lung specific!

it has potent smooth muscle relaxer - tocolytic - stops premature labor!

33
Q

What is the opposite of Terbutaline?

A

Misoprostel - which causes premature contractions

34
Q

Why are anti-cholingerics used for respiratory dz? what specific dz?

A 
ACh is parasympathetic, which is a bronchoconstrictor.
Blocking ACh will bronchodilate
COPD mainly (adjuct in asthma)
35
Q

Ipatropium is what type of drug? What is the brand name?

A

Inhaled anticholinergic - Atrovent

ATROPINE is the father of AntiACh drugs

36
Q

-“tropium” is the name for what drugs?

A

antiACh drugs

37
Q

Leukotrienes have what effect on the lungs?

A

Bronchoconstriction

38
Q

Leukotriene receptor blockers are usually first or second line treatments? Are they inhalers or PO?

A

Second line

PO

39
Q

Name 2 leukotriene RB. Do they have many AEs?

A

Montelukast (Singulair)

Zafirlukast (Accolate)

40
Q

What cardio med should you NOT give asthmatics?

A

Propranolol - non selective beta blocker (blocking b2)

41
Q

How do Phosphodiesterase 4 (PDE-4) Inhibitors work?

A

They inhibit the PDE-4 enzyme that chews up cAMP. cAMP cause bronchodilation.

42
Q

What are the PDE-4 inhibitors used for?

A

COPD (chronic bronchitis - not emphysema)

43
Q

What are PDE-5 inhibitors?

A

Viagra! Vasodilation.

44
Q

GIve an example and dose of a PDE-4 inhibitor.

A

Roflumilast (Daliresp) - 500 mcg PO QD

45
Q

What is a side effect of PDE-4 inhibitors?

A

suicidal ideations

46
Q

What is status asthmaticus? How do you treat it?

A

Life threatening asthma emergency!
Mucous plugs, refractoriness to B2 agonist (they don’t work), respiratory acidosis (build up of lactic acid, CO2).
Tx - IV steroid therapy, may need intubation first

47
Q

What does MDI stand for? CFC vs HFA propellants?

A

Meter Dose Inhaler – drug is pressurized with a propellant.

We use HFAs now because CFCs are bad for the environment.

48
Q

How does someone use an MDI?

Children and eldery may need a _____ with MDIs.

A

Shake, exhale, slowly inhale and actuate MDI

spacers to delay expulsion

49
Q

What is the risk with inhaled steroids? What should you do to counteract this?

A

localized thrush

gargle with warm water following use

50
Q

How do nebulizers work?

A

Convert solution and suspensions of drugs into aerosols. They are usually driven by a gas or or ionization process (vibrations).

51
Q

What are Fluticasone propionate (Flovent) and Budesonide (Pulmicort)?

A

Inhaled corticoidsteroids.

52
Q

What is in Advair Diskus?

A

Fluticasone propionate (Flovent) + Salmeterol xinafoate (long acting B2 agonist)

53
Q

Are inhaled drugs hydrophilic or lipophilic?

A

hydrophilic - stay in lungs

Pharm test 3 (9 decks)

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