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424 Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Short acting Beta 2 agonists

Albuterol

Indications & Pharmacodynamics

A

Indications: asthma, COPD

Pharmacodynamics: acts on smooth muscle of bronchi to reverse bronchospasm, which decreases airway resistance and residual volume and increases vital capacity and airflow

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2
Q

Short Acting Beta 2 agonists

Albuterol

Caution/contraindications: when to avoid, caution, pregnancy, peds & adverse fx (6)

A
  • Caution/contraindications
    • Avoid: arrythmias that cause tachycardia and pheochromocytoma
    • Caution: CVD, DM, glaucoma and hyperthyroidism
    • Pregnancy: benefits outweigh the risks; Lactation: OK with infant monitoring
    • Peds: approved
  • Adverse drug effects: tachycardia, dizziness, palpitations, tremors, nervousness, headaches
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3
Q

Long acting beta 2 receptor agonists

Salmeterol

Indications & Pharmacodynamics

A

Indications: adjunctive therapy for asthma, COPD

Pharmacodynamics: relaxes bronchial smooth muscle by selective action on beta 2 receptors; onset is 30-45 minutes, not for rescue

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4
Q

Long acting beta 2 receptor agonists

Salmeterol

Caution/contraindications: other considerations, caution, pregnancy, peds & adverse fx (6)

A
  • Caution and contraindications
    • Other considerations: Use is contraindicated without the use of an asthma controller medication such as inhaled steroid
    • Caution:CVD, DM, hyperthyroidism
    • Pregnancy: benefits outweigh the risks; Lactation: OK with infant monitoring
    • Peds: 4+
  • Adverse drug effects: tachycardia, dizziness, palpitations, tremors, nervousness, headache
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5
Q

Which beta 2 agonist is preferred if needed during pregnancy?

A

Terbutaline

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6
Q

Xanthine derivatives

Theophylline

Indications & Pharmacodynamics

A
  • Indications: asthma, COPD (not first line)
  • Pharmacodynamics: inhibits specific phosphodiesterases which in turn increase cAMP, which leads to relaxation of bronchial smooth muscle and pulmonary vessel relaxation; increases force of contraction of diaphragmatic muscles; similar fx as caffeine d/t similar chemical structures
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7
Q

Xanthine derivatives

Theophylline

Caution/contraindications: avoid, pregnancy, peds, caution, monitoring, other considerations

A
  • Avoid: hypersensitivity to xanthine, PUD, seizure disorder
  • Pregnancy: Assess with OB risks vs. benefits
  • Peds: approved
  • Caution: Closely monitor in pts with HTN, ischemic heart disease, coronary insufficiency, CHF or hx of stroke and cardiac arrythmias
  • Monitoring: Narrow TI - routine monitoring needed when first starting, adding or removing any other medication
  • Other considerations
    • Elimination is influenced by diet
    • Smoking increases excretion
    • Volume of distribution altered in premature neonates, older patients, cirrhosis, pregnant women, critically ill patients
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8
Q

Xanthine derivatives

Theophylline

Adverse fx (including what happens with toxic levels) (16)

A
  • Adverse fx: tachycardia, palpitations, irritability, gastric irritation, HA
  • Toxicity (levels greater than 20mcg/mL): nausea, vomiting, diarrhea, headache, insomnia, irritability
  • Toxicity (greater than 35): hypotension, cardiac arrythmias, seizures, brain damage, death
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9
Q

Short acting anticholinergics

Ipratropium bromide (atrovent)

Indications & Pharmacodynamics

A
  • Indications: asthma exacerbation (with albuterol), COPD
  • Pharmacodynamics: blocks action of acetylcholine at the muscarinic cholinergic receptors in bronchial smooth muscle causing bronchodilation; onset within 15 min
    • Reduces the volume of sputum without changing the viscosity
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10
Q

Short acting anticholinergics

Ipratropium bromide (atrovent)

Caution/contraindications: avoid, pregnancy, peds & adverse fx (6)

A
  • Avoid: urinary retention, BPH, closed-angle glaucoma
  • Pregnancy: use if only clearly indicated; lactation: compatible
  • Peds: Approved
  • Adverse fx: cough, dry mouth, mouth and throat irritation, dyspepsia, nausea, vomiting
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11
Q

Long-acting anticholinergics

Tiotropium bromide (Spiriva)

Indications & Pharmacodynamics

A

Indications: asthma, COPD

Pharmacodynamics: inhibits muscarinic M3 receptors in the lungs leading to smooth muscle bronchodilation

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12
Q

Long-acting anticholinergics

Tiotropium bromide (Spiriva)

Caution/contraindications avoid, other considerations, pregnancy, peds & adverse fx (5)

A
  • Avoid: urinary retention, BPH, closed-angle glaucoma
  • Other considerations: Not for asthma exacerbation
  • Pregnancy: only if clearly indicated; lactation: approved
  • Peds: 6+
  • Adverse fx: dry mouth, pharyngitis, URI, HA, mouth irritation
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13
Q

Leukotriene modifiers

Montelukast

Indications & Pharmacodynamics

A

Indications: chronic asthma, allergic rhinitis

Pharmacodynamics: inhibits cysteinyl leukotriene receptor which is correlated with the patho of asthma, including airway edema and smooth muscle contraction

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14
Q

Leukotriene modifiers

Montelukast & Zafirlukast

Caution/contraindications (Zafirlukast: avoid, caution, peds; Montelukast: avoid, peds); both pregnancy & adverse fx (4)

A
  • Zafirlukast
    • avoid: active liver disease
    • caution: dose reduction in hepatic dysfunction
    • Peds 5+ ok
  • Montelukast
    • avoid: severe liver disease
    • peds: persistent asthma 12+ months, exercise-induced asthma 15+ years
  • Pregnancy: approved; lactation: caution
  • Adverse fx: headache, GI upset, myalgias, increase in respiratory infections
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15
Q

Leukotriene Modifiers

Zileuton

Indications & Pharmacodynamics

A

Indications: chronic asthma

Pharmacodynamics: inhibits 5-lipoxygenase from arachidonic acid - results in reduction of inflammation, edema, mucous secretion and bronchoconstriction

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16
Q

Leukotriene modifiers

Zileuton

Caution/contraindications: avoid, pregnancy, peds & Adverse fx (6)

A
  • Avoid: active liver disease
  • Pregnancy/lactation: avoid
  • Peds: persistent asthma 12+ years
  • Adverse fx: HA, dyspepsia, increased serum ALT, myalgia, URI
    • Reported in post-marketing studies: Neuropsychiatric events (hallucination, agitation, aggression, SI, insomnia, depression)
17
Q

Corticosteroids

Fluticasone

Indications & Pharmacodynamics (inhaled vs. intranasal)

A
  • Indications: asthma, COPD, allergic rhinitis
  • Pharmacodynamics: extremely potent vasoconstrictive and anti-inflammatory activity
    • Inhaled corticosteroids: inhibit IgE in mast cell migration of inflammatory cells into the bronchial
    • Intranasal: focuses on inflammation in the nasal mucosa alone
18
Q

Corticosteroids

Fluticasone

Caution/contraindications: other considerations, caution, pregnancy, peds

A
  • Other considerations: Not for asthma exacerbation
  • Caution in active infection
  • Pregnancy/lactation: OK
  • Peds: determine by age
19
Q

Corticosteroids

Fluticasone

Adverse fx (8) (includes intranasal specific sx [4])

A
  • Adverse fx: xerostomia, hoarseness, mouth and throat irritation, flushing, bad taste, oral candidiasis, rash, urticaria
  • Intranasal: nasal irritation, itching, sneezing, dryness
20
Q

Corticosteroids

Fluticasone

Patient education for inhaled (2) vs. intranasal (3)

A
  • Patient education: inhaled corticosteroids
    • Rinse mouth out after use to reduce risk of hoarseness and oral candida
    • Bronchodilator first then inhaled corticosteroid
  • Patient education: intranasal
    • Blow nose prior to application
    • Fx can take 3-7 days
    • Rinse out mouth to reduce risk of oral candida
21
Q

Inhaled anti-inflammatory agent

Cromolyn sodium

Indications & Pharmacodynamics

A
  • Indications: asthma, bronchospasm, prophylaxis, allergic rhinitis
  • Pharmacodynamics: mast cell stabilizer - inhibits antigen-induced bronchospasm and blocks the release of histamine by inhibiting mast cell degranulation
    • Prevents release of leukotrienes
    • Reduces bronchi hyper-reactivity to stimuli with sustained use
22
Q

Inhaled anti-inflammatory agent

Cromolyn sodium

Caution/contraindications: other considerations, pregnancy, peds & adverse fx (4) (include intranasal [2])

A
  • other considerations: Not for acute exacerbation
  • Pregnancy/lactation
    • Other inhaled agents preferred in pregnancy/lactation
    • Intranasal compatible with pregnancy/lactation
  • Peds: 2+
  • Adverse fx: throat irritation, cough, drowsiness, bronchospasm
    • Intranasal: nasal irritation, burning sensation in the nose
23
Q

Inhaled anti-inflammatory agent

Cromolyn sodium

Patient education

A

Intranasal cromolyn may take up to 4 weeks to show improvement if used for allergic rhinitis - start prior to onset of exposure

24
Q

First-generation antihistamines

Diphenhydramine

Indications & Pharmacodynamics

A

indications: allergic rhinitis, hypersensitivity reactions, urticaria and angioedema, insomnia, motion sickness antiemetic

Pharmacodynamics: competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels and respiratory tract - prevents responses mediated by histamine

25
Q

First-generation antihistamines

Diphenhydramine

Caution/contraindications: avoid, caution, pregnancy & adverse fx (9)

A
  • Caution/contra
    • Avoid: with CNS depressants, narrow-angle glaucoma, BPH, thickened respiratory secretions, premature infants and newborns
    • Caution: elderly patients and young children (risk for paradoxical reaction)
    • Alternative agents recommended in pregnancy; avoid in lactation
  • Adverse fx: drowsiness, sedation, confusion, ataxia, urinary retention, paradoxical excitation, dry mouth, tremor, blurred vision
26
Q

Second-generation antihistamines

Cetirizine, loratadine, fexofenadine

Indications & Pharmacodynamics

A

Indications: respiratory allergies, urticaria

Pharmacodynamics: competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels and respiratory tract

27
Q

Second-generation antihistamines

Cetirizine, loratadine, fexofenadine

1. How are these medications different from diphenhydramine?

2. Which one has the fastest onset and why?

3. What might cause higher peak plasma concentration when taking loratadine?

4. Which of these has more drug-drug interactions?

A
  1. Avoid crossing the BBB which is why they do not cause the CNS fx of benadryl
  2. Cetirizine has fastest onset, least metabolized by CYP450
  3. Chronic liver disease will have higher peak plasma concentration of loratadine
  4. Loratadine and fexofenadine have more drug-drug interactions
28
Q

Second-generation antihistamines

Cetirizine, loratadine, fexofenadine

Caution/contraindications: other considerations, pregnancy, peds & adverse fx (3)

A
  • Caution/contra
    • Other considerations: Additive drowsiness when combined with CNS depressants; Loratadine has lowest risk of CNS depression
    • Caution in pregnancy and lactation (loratadine is the best)
    • Children 6 months+ may take cetirizine; 2 years + may take loratadine, 6 years + fexofenadine
  • Adverse fx: headache, drowsiness, nervousness (children)
29
Q

Decongestants

Pseudophedrine, phenylephrine (oral), oxymetazoline (intranasal)

Indications & Pharmacodynamics

A
  • Indications: nasal congestion related to the common cold, allergic rhinitis
  • Pharmacodynamics: mimic the endogenous catecholamines of the SNS; alpha-adrenergic agonists that produce vasoconstriction by stimulating alpha receptors in the mucosa of the respiratory tract; temporarily reduces swelling and inflammation of the mucous membranes
    • Intranasal: vasoconstriction when applied to swollen mucous membranes in the nasal passage; shrinks membranes and provides immediate relief but shorter duration
30
Q

Decongestants

Pseudophedrine, phenylephrine (oral), oxymetazoline (intranasal)

Caution/contraindications: avoid, peds, pregnancy, interactions & adverse fx (8)

A
  • Avoid: severe hypertension and CAD (oral)
  • Peds: oral not recommended for children less than 4 (oral)
  • Pregnancy/lactation: avoid
  • interactions: beta-blockers
  • Adverse fx: anxiety, restlessness, HA, insomnia, psychological disturbances, tremors, HTN, tachycardia
    • Intranasal: nasal irritation, rebound congestion
31
Q

Antitussives

Dextromethorphan, codeine, benzonatate

Pharmacodynamics of each

A
  • Dextromethorphan: acts centrally in the medulla to elevate the threshold for coughing; structurally related to codeine
  • Codeine: direct fx on cough receptors in the medulla; metabolized by the CYP450
  • Benzonatate: related to anesthetic tetracaine and thought to anesthetize the stretch receptors in the respiratory passages, calming the cough
32
Q

Antitussives

Dextromethorphan, codeine, benzonatate

Caution/contraindications: general avoid; risks of combining codeine & dextromethorphan; Pedatric and pregnancy considerations for each

A
  • Avoid: persistent or chronic cough caused by smoking, asthma or emphysema; allergies to tetracaine or related compounds
  • Codeine and dextromethorphan combination
    • Risk of abuse with codeine and dextromethorphan (combination is a Schedule V medication)
    • CNS depressants when combined with codeine and dextromethorphan can cause additive CNS depression
  • Pregnancy/lactation
    • codeine: avoid
    • Dextromethorphan: Pregnancy ok
    • Bezonatate: avoid
  • Pediatrics
    • Codeine: 12+, but safest to wait until age 18
    • Dextromethorphan: 4+ ok
    • Benzonatate: 10+ ok
33
Q

Antitussives

Dextromethorphan, codeine, benzonatate

Adverse fx (Dextro, codeine 3; benzonatate 5)

A

Dextromethorphan, codeine: drowsiness, dizziness, GI upset

Benzonatate: chest numbness, dizziness, GI upset, HA, chilly sensation

34
Q

Expectorant

Guaifenesin

Indications & Pharmacodynamics

A

Indications: cough due to common cold or URI

Pharmacodynamics: increases output of respiratory tract, makes mucus more thin and loose

35
Q

Expectorant

Guaifenesin

Caution/contraindications: peds, pregnancy & adverse fx (5)

A
  • Caution/contra
    • Not for children under 4
    • Safe in pregnancy, not studied in lactation
  • Adverse fx: GI upset, nausea, vomiting, drowsiness and dizziness

424 Pharmacology (12 decks)

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