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Renal/Resp > Resp Pharm > Flashcards

Resp Pharm Flashcards

1
Q

mechanism N-acetlycysteine

A

mucolytic

opens disulfide bonds in mucoproteins to lower mucous viscosity

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2
Q

synergistic effect of beta2 agonists on steroids

A

beta2 enhance activity of GR recepotr > increased nuclear translocation > enhanced binding to DNA > enhanced steroid effect

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3
Q

most effective bronchodilators

A

beta2 agonists

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3
Q

oral steroid adverse effect

A

inhibit ACTH+cortisol secretion by negative feedback on pituitary

HPA axis suppression

(depends on dose, length of treatment)

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4
Q

indications ipratropium bromide

A

acute severe asthma (less effective than B2 agonists)

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4
Q

side effects ivacaftor

A

serious hepatic dysfunction

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5
Q

therapeutic use cromolyn sodium

A

chronic control of asthma,

porphylaxis bronchospasm

NOT a rescue medication

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5
Q

most effective and most prescribed treatment for chronic inflammation of asthma

A

beclomethasone (steroid)

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6
Q

metyhlxanthines (theophylline) mechanism

A

nonselective PDE inhibitor > elevation of cAMP and cGMP >increase PKA

AND PDE isoenzymes play role in SMC relaxation

AND adensosine receptor antagonism > prevents histamine+leukotriene release

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8
Q

adverse effects omalizumab

A

injection site reaction

anaphylaxis after first dose, sometimes longer than a year after treatment begins

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9
Q

three classes of broncho dilators

A

B2 adrenergic agonists (sympathomimetics)

Theophylline (a methylxanthine)

Anticholinergic agents (muscarinic antagonists)

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10
Q

mechanism Fornase alpha

A

dna-ase breaks down neutrophil released DNA

reduces viscosity > increases mucus clearance and reduces infection

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11
Q

treatment route leukotriene antagonists (zafirlukast, zileuton)

A

oral

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11
Q

indicated in cystic fibrosis

A

dornase alpha (rhDNAase)

Ivacaftor

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12
Q

oral steroids indicated in acute asthma is

A

lung function

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13
Q

reasoning for single dose of systemic steroids in morning

A

coincides with normal diurnal increaes in plasma cortisol > less adrenal suppression than would occur at night

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13
Q

indications leukotriene antagonists (zafirukast, zileuton)

A

mild-moderate asthma,

increases lung fxn, reduces need for B2 rescue

(less effective than ICS, may be added-onto ICS)

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13
Q

impact in COPD oral corticosteroids

A

generally no response

ICS are of reduced impact as well

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15
Q

mechanism of action omalizumab

A

prevents IgE binding to FceRI on mast cells and other inflammatory receptors on other cells (FceRII, CD23)

16
Q

indication systemic steroids

A

signal dose in morning, short course for exacerbations of asthma

18
Q

mechanism of action beta agonist bronchodilators

A

stimualate beta 2 >

activation Gs-adenyl cyclase-cAMP-PKA pathway

Pka phosphylates,

decrease calcium

19
Q

B2 agonist side effects

A

muscle tremor

tachycardia

hypokalemia (muscle uptake of K)

restlessness

hyoxemia

20
Q

side effects inhaled steroids

A

dermal thinning and skin capillary fragility

cataracts, osteoperosis (if also oral)

growth suppression in children

hoarsness (vocal cord atrophy)

(no evidence of atrophy to airway, increased lung infection)

21
Q

mechanism ivacaftor (specific indication)

A

for patients with mutation in G551D

increase Cl channel transport > impoves FEv1

22
Q

duration of action albuteral

salmeterol

A

3-6 hours

>12 horus

23
Q

pharmacokinetics Omalizumab

A

subQ

2-4week admin

24
Q

mechanism of action cromolyn sodium

A

mast cell stabilizer

26
Q

adverse effects ipratropium bromide

A

(anticholinergic)

dry mouth

constipation

blurred vision

dyspepsia

cognitive impairment

27
Q

adverse effects leukotriente antagonists (zafirlukast, zileuton)

A

hepatic dysfunction (monitor liver enzymes)

28
Q

leukotriene antagonists (and sub-class)

A

zilueton - 5-LO inhibitor

Zafirlukast (cys-LT1 receptor inhibitor)

30
Q

other B2 agonist effects in airways

A

prevent mast cell mediator release

prevent bronchial mucosal edema

enhance mucociliary clearance

reduce reflex cholinergic bonchoconstriction

31
Q

albuterol vs salmeterol

A

albuterol short acting

salmeterol longer acting (and slower onset)

32
Q

therapuetic action anticholinergics (ipratropium bromide)

A

relax airway smooth muscle

decrease mucus scretion

34
Q

other drugs indicated in COPD

A

Azithromycin antibiotics

N-acetyl cystein (mucolytic) (with albuterol)

35
Q

pharmacokinetics ipratropium bromide (anticholinergic)

A

inhaled

30-90minutes maximal response

last 4-6hours

37
Q

steroid (beclomethasone) side-therapeutic effect > enhance transcription of

A

B receptor gene > enhancing action of B2 agonists

38
Q

therapeutic impact zafirlukast, zileuton

A

(leukotriene mdoifiers)

block bronchorestriction

block airway hyperresonsiveness

black mucus secertion

block eosinophillic inflammation

block plasma exudation

39
Q

indication inhaled corticosteroids

dose schedule

A

first line for persisten ashthma

any pt who needs B2 agonist more than twice weekly

(twice daily)

40
Q

mechanism beclomethasone

A

bind GR, > translocate to nucleus to inhibit HAT activity (can no longer acetylate histones activitating inflammatory factors)

**ALSO **recruit HDAC2 > reverses acetylation and deactivates activated inflammatory genes

41
Q

inhaled B2 agonists

A

Albuterol

salmeterol

41
Q

indications for COPD

why?

A

anticholinergics (ipratropium bromide)

(greater relative impact in narrowed airways of COPD)

42
Q

contraindications n-acetylcysteine

A

asthmatics (side effect = bronchospasms)

43
Q

theophylline toxicity

A

headache

palpitation

dizziness, nausea,

hypotension, tachycarida

restlessness, seizures

44
Q

acute response actors in asthma response

long-term actors (hours)

A

acute - histamine leukotrienes, cytokines, proteases

long-term - cytokines, chemokines

45
Q

indications omalizumab

A

severe poorly controlled asthma

severe concomitant allergic rhinitis

Renal/Resp (43 decks)

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