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Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define asthma

A

reactive airway disease; inflammation of bronchoconstriction, airway inflammation

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2
Q

MoAs of Asthma Drugs

A

drug MoA: bronchodilation, anti-inflammatory

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3
Q

Goals of Asthma Treatment

A

goals: Decrease impairment, Decrease risks (good sx control, minimal adverse effects)

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4
Q

First line Asthma Treatment

A

first-line: SHORT acting beta 2 agonists, INHALED corticosteroids

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5
Q

Classifications of Asthma

A
  1. Intermittent (least severe); 2. mild persistent; 3. Moderate persistent; 4. Severe persistent
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6
Q

Describe Intermittent Asthma

A

Least severe - <2d/wk - near normal peak flow

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7
Q

Therapy for Intermittent Asthma

A

no daily meds/chronic tx - short-acting beta 2 agonist (quick relief)

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8
Q

Describe Mild Persistent Asthma

A

>2d/wk but not daily - near NL peak flow

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9
Q

Therapy for Mild Persistent Asthma

A

low dose inhaled corticosteroids - short-acting beta 2 agonist

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10
Q

Describe Moderate Persistent Asthma

A

daily attack; 60-80% NL peak flow

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11
Q

Therapy for Moderate Persistent Asthma

A

low-to-med dose inhaled corticosteroids AND long-acting beta 2 agonist - short-acting beta 2 agonist

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12
Q

Describe Severe Persistent Asthma

A

continual attacks (multiple each day); <60% NL peak flow

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13
Q

Therapy for Severe Persistent Asthma

A

high dose inhaled corticosteroids AND long-acting beta 2 agonist - short-acting beta 2 agonist

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14
Q

Describe COPD

A

chronic, irreversible obstruction of airflow due to a combo of emphysema, chronic bronchitis, airway hyper-reactivity; associate w/ smoking

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15
Q

First-Line COPD Treatment

A

anticholinergics; beta 2 adrenergic agonists

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16
Q

Mild COPD Management

A

mild COPD - FEV1 >80% - add short-acting bronchodilator when needed

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17
Q

Moderate COPD Management

A

moderate COPD - FEV1 50-80% - add regular tx c 1+ bronchodilator (when needed) + rehabilitation

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18
Q

Severe COPD Management

A

severe COPD - FEV1 30-50% - add inhaled corticosteroid if repeated exacerbations

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19
Q

Very Severe COPD Management

A

very severe COPD - FEV1 <50% c chronic respiratory failure - add long-term O2 therapy + consider sx

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20
Q

allergic rhinitis

A

Attack typically is initiated by inhalation of an allergen causing mast cells to release inflammatory/allergic mediators

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21
Q

Sx of allergic rhinitis

A

sneezing, ithcing eyes/noes, watery rhinorrhea, nasal congestion

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22
Q

Tx of allergic rhinitis

A

ANTIHISTAMINES, alpha -adrenergic agonists, corticosteroids, cromolyn, montelukast

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23
Q

Inflammatory/Allergic Mediators

A

HISTAMINE, leukotrienes, chemotactic factors

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24
Q

beta 2 agonist activity

A

Bronchodilation; drug of choice for mild/intermittent asthma and used in episodes of acute bronchoconstriction; no anti-inflammatory effects

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25
Q

beta 2 agonist Adverse Effects

A

TREMOR, tachycardia, hyperglycemia, hypokalemia, hypomagnesemia; minimized c INHALATION and c beta 2 SELECTIVE meds

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26
Q

inhaled adrenergic agonists

A

Short-acting beta 2 agonists; Long-acting beta 2 agonists

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27
Q

Short-acting beta 2 agonist

A

Onset - 5-30 minutes; Duration 4-6 hr; drug - Albuterol

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28
Q

LONG-acting beta 2

A

monotherapy contraindicated (Increase risk asthma-related death); Slower onset of action and duration of 12 hrs

29
Q

Other adrenergic agonists

A

Epinephrine

30
Q

Epinephrine

A

Used as the drug-of-choice for severe bronchoconstriction (status asthmaticus) and acute anaphylaxis

31
Q

Adverse Effects of Epinephrine

A

tachycardia; metabolic & GI abnormalities, CNS stimulation

32
Q

inhaled corticosteroids - MoA

A

Control airway inflammation by blocking synthesis of arachidonic acid by phospholipase & inhibition of the expression of COX & leukotrienes

33
Q

Most effective tx for long-term asthma control

A

Inhaled corticosteroids

34
Q

Drug of choice for any degree of persistent asthma

A

Inhaled corticosteroids

35
Q

Why use inhaled corticosteroids?

A

helps reduce the need for systemic use but results are technique dependent

36
Q

Why is proper technique important with inhaled corticosteroids?

A

proper technique improves outcomes, Decrease adverse effects; use spacers

37
Q

When and why are spacers used with inhaled corticosteriods?

A

Chamber reduces velocity causing deposit of large particles; Minimizes risk of adrenal suppression; RECOMMENDED FOR ALL PATIENTS, especially children and seniors

38
Q

Adverse Effects of Inhaled Corticosteroids & Prevention Methods

A

oropharyngeal candidiasis and hoarseness; swish and spit water to prevent

39
Q

Actions of Inhaled Corticosteroids

A
  1. Reverses mucosal edema 2. Decrease the capillary permeability 3. Inhibit the release of leukotrienes 4. Reduction of hyper-responsiveness of airway smooth muscle to stimuli
40
Q

Method of administration for Systemic Corticosteroids

A

Oral

41
Q

Describe discontinuation strategy for systemic corticosteroids and rationale

A

When symptoms are improved the medication is slowly discontinued for 1-2 weeks, due to HPA axi

42
Q

Indications for systemic corticosteroids

A

Severe exacerbations of asthma

43
Q

Adverse Effects of Systemic Corticosteroids

A
  1. CNS: emotional disturbances 2. Osteoporosis 3. Increased appetite/weight gain 4. Immunosuppression/Impaired wound healing 5. Hypertension, edema 6. Peptic ulcer disease 7. Hypokalemia 8. Hirsutism 9. Glaucoma 10. Stunted growth in pediatrics
44
Q

Anticholinergics for Asthma

A

Traditionally not effective for asthma patients unless they also have COPD

45
Q

Anticholinergics for COPD

A

1st line tx

46
Q

leukotriene receptor antagonists

A

inhibit leukotriene-induced bronchoconstriction and inflammation via Inhibition of 5-lipoxygenase (an enzyme required for leukotriene synthesis)

47
Q

Leukotrienes

A

inflammatory mediators causing bronchoconstriction, increased endothelial permeability, & mucus secretion

48
Q

leukotriene receptor antagonist uses

A

prophylactic, moderate to severe allergic asthma

49
Q

inflammatory cell stabilizers (*intranasal cromolyn) - MoA

A

inhibits mast cell degranulation and histamine release *blocking initiation of allergic rxn

50
Q

Inflammatory cell stabilizers - Actions

A

asthma - pretreatment blocks allergen and exercise-induced bronchoconstriction, may take 4-6wks for full effect

51
Q

methylxanthines

A

largely replaced by beta 2 agonists and corticosteroids

52
Q

Why are methylxanthines rarely used?

A

NARROW THERAPEUTIC INDEX; potential for many drug interactions; may lead to fatal arrhythmias in OD

53
Q

General MoA of Antihistamines

A

COMPETITIVE blockade of histamine-1 (H1) receptors

54
Q

1st Gen Antihistamines

A

often provide better control of sx

55
Q

Adverse Effects of 1st Gen Antihistamines

A

Increase sedation, Increase antocholinergic SE (xerostomia, urinary retention, blurred vision, sedation (drowsy, Decrease cognition)

56
Q

2nd Gen Antihistamines

A

may NOT provide optimal relief of sx

57
Q

Adverse Effects of 2nd Gen Antihistamines

A

Decrease sedation, Decrease ANTICHOLINGERGIC SE

58
Q

MoA of alpha -adrenergic agonists

A

constriction of dilated arterioles in nasal mucosa and reduction of airway resistance

59
Q

Uses of alpha -adrenergic agonists

A

short-term relief of nasal congestion

60
Q

Dosing & indications of alpha -adrenergic agonists

A

nasal sprays; rapid onset of action; use limited to 3 days to prevent rebound congestion (and addiction)

61
Q

Adverse Effects of alpha -adrenergic agonists

A

systemic - HTN; rebound congestion (with prolonged use)

62
Q

Rhinitis medicomentosa

A

Rebound nasal congestion

63
Q

Use of antitussives

A

analgesia, COUGH SUPPRESSANT (non-productive); Example - Benzonatate (Tessalon®)

64
Q

Use of expectorant

A

help loosen phlegm and thin bronchial secretions to make cough more productive. Examples - Guaifenisin (Robitussin, Mucinex®, etc.)

65
Q

Phospholipase

A

Enzyme converting phospholipids in cell membrane to Arachidonic acid

66
Q

Drug category inhibiting activation of phospholipase

A

corticosteroids

67
Q

Two enzymes acting on arachidonic acid

A

lipoxygenase; cycloxygenase (COX)

68
Q

Two products produced from arachidonic acid

A

leukotrienes; prostaglandins

69
Q

Inhibitors of arachidonic acid enzymes

A

NSAIDs; ASA (aspirin)

Pharmacology (12 decks)

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