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Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

ASTHMA PATHO

A

chronic INFLAMMATORY disorder of airways

symptoms at night or in early morning

REVERSIBLE airway obstruction

INC responsiveness to stimuli

**each acute exacerbation causes structural remodeling of airways = thickening of bronchial/bronchiolar mucosa, submucosa, and smooth muscle layers

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2
Q

ASTHMA drug therapy

A

Beta 2 agonists
glucocorticoids
leukotriene modifiers
methylxanthines
anticholinergics
anti-IgE treatment

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3
Q

COPD drug therapy

A

choice of therapy dependent on:
1) availability of med
2) patient’s response

Inhaled therapy (preferred method)
anticholinergics
B2 agonists
glucocorticoids

other routes:
methylxanthines
phosphodiesterase-4 inhibitors

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4
Q

GOLD guidelines

A

GROUP A (MILD): bronchodilator

GROUP B: LAMA/LABA (if persists, combine both)

GROUP C: INC exacerbations = LAMA + (LABA or ICS)

GROUP D (VERY SEVERE): LAMA + (LABA + ICS + additional) (pulmonology referral)

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5
Q

BETA 2 Agonists MOA

A

stimulate B2 receptors in the airways

bronchodilation, smooth muscle relaxation, mast-cell membrane stabilization

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6
Q

BETA 2 Agonists Adverse effects

A

INC HR
Shakiness
Arrhythmias
Restlessness
Tremors
Dizziness
HA

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7
Q

BETA 2 Agonists Contraindications/Special considerations

A

ASTHMA: acute attacks
SABA = rescue
LABA = maintenance/control

COPD: subjective improvement; quality of life
SABA = acute exacerbations
LABA = sustained bronchodilation, more convenient dosing, no rescue use

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8
Q

BETA 2 Agonist Interactions

A

most common:
digoxin
tricyclic antidepressants (TCA)
MAOI
BB

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9
Q

BETA 2 Agonists Patient education

A

Meter-dosed inhaled forms use spacer = Children

PREGNANCY: terbutaline safe; albuterol best SABA; ICS for long-term control

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10
Q

Glucocorticoids medications

A

Inhaled:
beclomethasone MDI
budesonide MDI
flunisolide MDI
fluticasone MDI
mometasone - adult only
triamcinolone MDI

Systemic: PO
oral - prednisone and methylprednisolone

parenteral - methylprednisolone and dexamethasone

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11
Q

Glucocorticoids MOA

A

inhibit synthesis and release of inflammatory mediators

INC number and responsiveness of B2 receptors (improve lung function when combined w/ LABA in COPD)

DEC mucous production and hypersecretion

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12
Q

Glucocorticoids ASTHMA

A

Inhaled are preferred controller tx

step 2 preferred tx

systemic are used only for hard to control asthma; if introduced early in acute attacks can help to reverse inflammation and speed recovery

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13
Q

Glucocorticoids COPD

A

ICS

FEV1 <50% predicated and repeated exacerbations

reversible factors = acute inflammation d/t viral infection and pollutions

scarring and chronic inflammation in COPD are NOT reversible

only thing that helps stop the decline of FEV1 is to STOP SMOKING

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14
Q

Glucocorticoids Adverse effects

A

inhaled - oropharyngeal candidiasis and dysphonia

systemic - HPA axis suppression, growth retardation, DEC bone mineral density, hyperglycemia, steroid myopathy, weaken blood vessels, DEC skin thickness

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15
Q

Glucocorticoids Contraindications/Special considerations

A

Contraindications:
acute attacks
children, especially PO form

Interactions: Azoles

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16
Q

Glucocorticoids Patient education

A

rinse mouth after using inhaler

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17
Q

Leukotriene modifiers MOA

A

ALLERGY MANAGEMENT

inhibit action of leukotrienes

smooth muscle contractions, DEC inflammation, edema, mucus secretions
INC bronchodilation

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18
Q

Leukotriene modifiers medications

A

montelukast (singulair)
zafirlukast (accolate)
zileuton (zyflo)

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19
Q

Leukotriene modifiers ASTHMA

A

NO ACUTE ATTACKS

alternative tx in asthma

ADD to steps 3-4

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20
Q

Leukotriene modifiers COPD

A

NO ROLE IN TX

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21
Q

Leukotriene modifiers Adverse effects

A

HA
GI upset
Resp infections (older adults)

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22
Q

Leukotriene modifiers Contraindications/Special considerations

A

No inhaled, PO meds only

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23
Q

Leukotriene modifiers Patient education

A

montelukast - once daily, BEST in evening

zafirlukast - BEST on empty stomach

Zileuton - no regards to meals

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24
Q

Methylxanthines MOA

A

DEC mast cell mediator release

bronchodilation, enhance mucociliary clearance, INC contraction of fatigued diaphragm

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25
Q

Methylxanthines DOC

A

Theophylline

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26
Q

Methylxanthines ASTHMA

A

STEP 3-5

NOT for monotherapy

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27
Q

Methylxanthines COPD

A

mild bronchodilator

3rd line agent d/t NARROW TI

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28
Q

Methylxanthines Adverse effects

A

CNS, GI, CV

uncommon serum level below 20

see ADEs serum level 15-20

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29
Q

Methylxanthines Contraindications/Special considerations

A

Contraindications:
NO PREGNANCY - cross placenta
sensitivity to caffeine, xanthine
seizure disorders
PUD

Interactions: metabolized by CYP450

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30
Q

Methylxanthines Patient education

A

1) dosed by patient’s weight and serum level
2) NARROW TI = serum monitoring
3) risk of toxicity

Caffeine is methylxanthine

report sx

take med exactly as prescribed

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31
Q

Anticholinergics MOA

A

inhibit cholinergic receptors

inhibit parasympathetic action

produces bronchodilation, DEC mucous secretions

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32
Q

Anticholinergic meds

A

Ipratropium (atrovent) MDI = COPD

Tiopropium (spiriva) MDI = ONLY COPD

33
Q

Anticholinergic ASTHMA

A

alternative to SABA

NO chronic asthma

ACUTE ATTACKS

34
Q

Anticholinergic COPD

A

ALL STAGES COPD

Add to SABA in acute COPD

35
Q

Anticholinergics Adverse effects

A

CAN’T SEE, PEE, SHIT, SPIT

restlessness
dizziness
HA
GI distress
blurred vision
palpitations
urinary obstruction

36
Q

Anticholinergics Contraindications/Special considerations

A

contraindications:
hypersensitivity to ATROPINE, acute bronchospasm

Caution: narrow-angle glaucoma, BPH, Pregnancy, lactation

37
Q

Anticholinergics Patient education

A

MDI and neb forms

when inhaled, confined to mouth/airways

38
Q

Anti-IgE treatment meds

A

Omalizumab (xolair) injectable

39
Q

Anti-IgE treatment ASTHMA

A

STEP 5

IgE >30

allergic asthma if uncontrolled on standard tx

mod-sev asthma = ICS not effective

40
Q

Anti-IgE treatment Adverse effects

A

HA
injection site reaction
upper resp tract infection

41
Q

Anti-IgE treatment Contraindications/special considerations

A

NOT for acute asthma attacks

42
Q

Anti-IgE treatment Patient education

A

PREGNANCY SAFE

BLACK BOX: anaphylaxis

monitor for sx and improvement in QOL, use of rescue meds, Not serum IgE

dosed every 2-4 wks by body weight

dose/dose frequency are determined by pre-treatment IgE levels

43
Q

Allergic Conjunctivitis

A

DOC: ophthalmic H1 blocker Ketotifen

adults and children >3

dose: 1 drop in affected eye Q8-12 hours

OTC products: combine decongestant and antihistamine

44
Q

COPD PATHO

A

chronic bronchitis/emphysema

disease state characterized by airflow limitation that is NOT FULLY REVERSIBLE

usually progressive

associated w/ an abnormal inflammatory response of the lungs to noxious particles of gas

INC exacerbations = DEC baseline

45
Q

COPD Diagnostic criteria

A

determined by spirometry tests of lung function

positive diagnosis made when the ratio of FEV <70%

46
Q

COPD Stages

A

1) At risk (smokers, exposed to smoke, cough, dyspnea, sputum, family hx) = FEV1 >0.7 FEV1 > 80% of predicted

2) Mild = FEV1 <0.7; >80% of predicted

3) Moderate = FEV1 <0.7; 50% <FEV1 <80% of predicted

4) Severe = FEV1 <0.7; 30% < FEV1 < 50% of predicted

5) Very Severe = FEV1 <0.7; <30% of predicted, or FEV1 <50% of predicted plus chronic resp failure

47
Q

COPD Goals of therapy

A

1) address symptoms and quality of life
2) health education
3) pharmcotherapy

48
Q

COPD Patient education

A

1) smoking cessation
2) patho COPD understanding
3) medication skills
4) specific drug therapy
5) reasons for drugs being taken
6) drugs as part of the total treatment regimen
7) adherence issues

49
Q

COPD Vaccines

A

Influenza vaccine - annually; earlier the better

pneumococcal vaccine - every 6 years

50
Q

Smoking Cessation: Questions to ask

A

1) is patient ready to quit smoking?

51
Q

Smoking cessation: Nicotine

A

adjunct to smoking cessation program

MOA: vasoconstrictor

SE:
CNS: peripheral vasoconstriction, tachycardia, HA, paresthesia, fatigue, insomnia, nausea, hot flashes, **nightmares

GI: N/V/D, dry mouth, dyspepsia

Nasal spray: irritation, cough, sneezing

Patch: skin irritation, burning

CONTRAINDICATIONS:
NO PREGNANCY - cross placenta
NO LACTATION - in breast milk

**NOT used immediately after MI, those w/ arrhythmias, severe angina

MED admin: patch
21 mg >or= 1 ppd
14 mg = 1/2 ppd

Patient education:
1) AVOID smoking = overdose or toxicity
2) Be aware sleep disturbances
3) Inspect oral cavity = using gum
4) teach to use system correctly

52
Q

Smoking Cessation: Bupropion

A

Zyban (brand)
Wellbutrin - antidepressant

SE:
INC HR
HA
insomnia
dizziness
xerostomia
weight loss
nausea
pharyngitis

Contraindications: seizure disorders, eating disorders, MAOI use

Med admin:
1) dose 150mg/day x3 days, then BID
2) suggested use 12 wks
3) start 1 wk before quit date
4) DEC seizure threshold
5) INC libido

Patient education:
1)BLACK BOX: suicidal thinking
2) AVOID ETOH = INC depression
3) can combo w/ nicotine patches = BETTER
4) report resp difficulties, unusual cough, dizziness, or muscle tremors

53
Q

Smoking Cessation: Varenicline

A

Chantix (brand)

MOA: partial agonist w/ high affinity and selectivity for alpha4-beta2 nicotine acetylcholine receptor

SE: insomnia, HA, abnormal dreams

Precautions:
NO PREGNANCY
NO LACTATION
pre-existing psych disorders
NO children <18

Med admin:
1) 12 wk intervention program
2) dose adjustment for RENAL impairment
3) complete patient education program
4) start 1 wk before quit date
5) can DEC dose if experiencing ADEs

Patient education:
**Neuropsych sx reported w/ use and withdrawal of med = INC anger

give w/ food and water to DEC GI effects

54
Q

Why is it hard for smokers to quit?

A

nicotine addition

not ready to quit

55
Q

Respiratory ALLERGIES

A

antihistamines 1st GEN: benadryl
ADE: drowsiness
adult dose: 25-50 mg Q4-6 hours

IF patient cannot TOLERATE 1st Gen = 2nd GEN can be given

cetirizine
(children >12) = 5-10 mg/day daily
children 6-11 = 5-10 mg once daily

renal impairment = fexofenadine 60 mg once daily
renal/liver disease = loratadine 10mg every other day
renal/liver impairment = desloratadine given every other day

56
Q

When to use ORAL (eye/nasal) drugs

A
57
Q

When to use TOPICAL (eye/nasal) drugs

A
58
Q

COUGH: med types

A

antitussive
expectorant

59
Q

COUGH: Antitussives

A

dextromethorphan (DM)
codeine
benzonatate

60
Q

COUGH: Expectorants

A

guaifenesin

61
Q

ANTITUSSIVE: Dextromethorphan

A

INDICATION: dry, hacking, non-productive cough

works directly on cough center in medulla

chemically related to opiates

rapidly absorbed from GI

INTERACTIONS: CNS depressants, MAOI, fluoxetine, quinidine, sibutramine, ETOH

adolescent abuse; can overdose

Pregnancy: CAUTION near term

AE rare: N/V, irritability, serious drowsiness, dizziness

administer evenly spaced intervals

equally as effective as codeine

ALCOHOL/SUGAR content: CAUTION in DM, ETOH, taking FLAGYL

62
Q

ANTITUSSIVE: Codeine-scheduled drug

A

Works directly on cough center

Drying effect on mucous and can INC viscosity of secretions

metabolized by liver P-450

PREGNANCY - crosses placenta

NO LACTATION - enters breast milk

CONTRAINDICATIONS: other narcotics, those who NEED productive cough

abuse potential

CAUTION in children and elderly

AE: drowsiness, sedation, dry mouth, N/V, constipation

respiratory depression in HIGH doses

Interactions: antihistamines, barbiturates, histamine 2 blockers, phenothiazines

EDUCATION: measure correctly, do NOT share, warn about sedation

63
Q

ANTITUSSIVE: Benzonatate

tessalon perles - gel capsule

A

Non-narcotic

anesthetizes stretch receptors in resp tract to DEC cough reflex

no known interactions

PREGNANCY: caution, only if clearly indicated

NO LACTATION

NO CNS depression
adults and children >10
must swallow whole

AE: drowsiness, HA, dizziness, GI upset, pruritus, skin eruptions

64
Q

EXPECTORANT: Guaifenesin

robitussin
mucinex

A

Non-productive dry cough

MOA: enhances output of resp tract fluids; DEC stickiness and surface tension of fluids

THINS MUCUS

onset 30 mins
no drug interactions
PREGNANCY; CAUTION

may use in children >6
NO ETOH

AE: N/V, anorexia, HA, dizziness

take w/ full glass of water

65
Q

COUGH meds warnings

A

1) active ingredients are often mixed cough suppressant and expectorant
2) cancel each other out
3) patient may be taking multiple products w/ same active ingredients
4) WATCH acetaminophen and ETOH levels
5) NEVER use more than 3-7days
6) NOT recommended for children <6

66
Q

Antihistamines CONTRAINDICATIONS/PRECAUTIONS

A

CONTRAINDICATIONS: narrow angle glaucoma
LRI
PUD
BPH
MAOI

CAUTION:
urinary retention
asthma
hyperthyroidism
CV
HTN
ANTICHOLINERGIC EFFECTS

67
Q

Antihistamines 1st Gen MOA/USES

A

H1 receptor blockers: blocks action of histamine released during inflammatory response

restores normal airflow to the upper resp system

ALLERGIC RHINITIS

68
Q

Antihistamines 1st Gen DOC

A

Diphenhydramine (benadryl)

IM, IV, PO forms

indicated: allergic disorders where PO form is impractical or contraindicated

adjunct in anaphylaxis

allergic rxn to blood/plasma products

NOT recommended in neonates, premature infants, ACUTE ASTHMA

69
Q

Antihistamines 1st Gen what to know

A

oldest
sedating (cross BBB) = drowsiness

NO LACTATION = dry breast milk
NO children <6

can cause CNS stimulation (HYPER) in children

Interactions: MAOI, CNS depressants, TCAs, antimuscarinics

PREGNANCY SAFE

70
Q

Antihistamines 2nd Gen MOA/USES

A

seasonal and perennial allergic rhinitis

allergic conjunctivitis

urticaria

angioedema

**most effective before onset of sx (seasonal and perennial allergic rhinitis)

71
Q

Antihistamines 2nd Gen Meds

A

cetirizine (zyrtec)
fexofenadine (allegra)
loratadine (claritin)
desloratadine (clarinex)

72
Q

Antihistamines 2nd Gen what to know

A

longer acting
less sedating (no cross BBB)

enters breastmilk = NO LACTATION

do NOT given w/ CNS depressants, other H1 blockers, macrolides (torsades)

CAUTION: certain antibiotics, antifungals, children <6

give w/ or w/o food

**most effective before onset of sx (seasonal and perennial allergic rhinitis)

73
Q

Antihistamines INHALED

A

SEASONAL ALLERGIC RHINIITS AND VASOMOTOR RHINITIS

H1 blocker and inhibitor from mast cells

may interfere w/ histamine and leukotriene induced bronchospasm

SE: epistaxis, throat irritation, BAD taste

74
Q

Decongestants

phenylephrine
pseudoephedrine

A

DEC nasal congestion = opening

ALPHA ADRENERGIC AGONISTS

constrict nasal arterioles = DEC nasal swelling

may constrict GI/GU sphincters

HIGH abuse potential

Pregnancy C
Caution in children <12

contraindications: MAOI, BB, TCA

NO patient w/ HTN, CAD

AE: CNS related anxiety, restlessness, tremors, insomnia, convulsions, hallucinations

CV effects: INC BP, tachycardia, arrhythmias

extreme dryness of mucus membranes

PO no longer than 4 days use; topical 48-72 hours = risk rebound congestion

75
Q

NASAL Steroids

beclomethasone

A

ALLERGIC RHINITIS

work better than PO antihistamines

minimal systemic effects and AEs

long term or high dose may cause systemic reaction

ADEs: burning, itching, drying sensation

Dose on regular or PRN schedule

76
Q

Inhaled Mast Cell Stabilizer

A

intranasal Cromolyn sodium

shields mast cells lining nasal passage and prevents histamine release

use 4-6 xday

PREGNANCY SAFE

77
Q

Inhaled Anticholinergic Agents

A

intranasal Ipratropium bromide

DEC watery nasal secretions in upper resp passages

No significant relief for other sx

adults and children >6

pregnancy B

NO IF ALLERGY TO ATROPINE

AE: epistaxis, pharyngitis, nasal dryness or irritation

78
Q

Non-pharmacological decongestant therapies

A

nasal strips - hold open nasal passage

vapor inhaler - vasoconstrictor; will cause HTN, tachycardia

adults and children >2

no more than 7 days

Pharmacology (12 decks)

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