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Pharm Exam 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

asthma treatment algorithm

A

always assess administration, compliance, and environmental control

assess pt 2-6 weeks after each med adjustment

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2
Q

Fluticasone (Flovent)

A

inhaled corticosteroid

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3
Q

COPD 3 MAIN CRITERIA

A

-symptoms (breathlessness)
-FEV1 / FVC < 0.7
Exacerbation hx

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4
Q

anti-muscarinics

A 
Ipratropium bromide (Atrovent) ::: 
potent bronchodilators
minimal systemic absorption
given via inhalation route for ACUTE EPISODES
short-acting (give every 4 - 6 hours)

Enhanced bronchodilation when combined with albuterol ( Combivent) - useful for severe acute asthma attacks

Tiotropium (Spiriva) - long acting, once daily
more commonly used for COPD maintenance

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5
Q

ADE of B-2 agonists

A

transient tachycardia, palpitations, tremor, excitability, headache, hypokalemia …. overall well tolerated

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6
Q

Salmeterol / fluticasone (Advair

A

LABA

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7
Q

Leukotriene Pathway Inhibitors

A

leukotrienes are responsible for bronchoconstriction, bronchial reactivity and mucus secretion

inhibiting leukotriene synthesis (Zileuton (Zyflo))
inhibtiing leukotriene binding (Montelukast (Singulair))

improve control, reduce frequency of exacerbations
MAINTENANCE
given orally (good for kids)
Singulair - most commonly used, well tolerated
Zyflo - associated with liver toxicity

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8
Q

Zyflo

A

leukotriene pathway inhibitor

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9
Q

Corticosteroids

A

broad anti-inflamm properties
inhibit production of cytokines

reduce hyper-reactivity (not a bronchodilator)

give routinely via inhalation as MAINTENANCE THERAPY in moderate to severe asthma

many systemic side effects when give orally (prednisone) - reserved for severe acute episodes and refractory disease

common side effects: hoarseness and THRUSH
rinse mouth after each use

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10
Q

Formoterol / budenoside (Symbicort)

A

LABA

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11
Q

COPD treatment

A

similar pharm approach to asthma
long acting anit-muscarinics aka spiriva are seen more with COPD

IgE NOT used in COPD

antibiotics may be used if infection is present
pneumonia can cause an exacerbation

severe disease may require oxygen supplementation

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12
Q

B-2 agonists NOT used in asthma

A

epinephrine
ephedrine
isoproterenol

non-selective -» cardiac effects

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13
Q

Vilanterol / fluticasone (Breo Ellipta)

A

LABA

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14
Q

Bronchodilating agents

A

Sympathomimetic Agents (B-2 Agonists)
Methylxanthines (Theophylline)
Antimuscarinic Agents

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15
Q

Methylxanthines

A 
Theophylline ( and also caffeine etc)
Theophylline is most common
Given orally
Requires therapeutic drug monitoring 
Due to side effects and newer agents, now only used as add-on for refractory disease for maintenance therapy
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16
Q

Anti-inflammatory agents

A

Corticosteroids

Leukotriene Pathway Inhibitors

17
Q

Singulair

A

leukotriene pathway inhibitor

18
Q

Beclamethasone (QVAR)

A

inhaled corticosteroid

19
Q

Tiotropium (Spiriva)

A

anti-muscarinic (long-acting)

20
Q

Levalbuterol (Xopenex)

A

SABA

21
Q

IgE Monoclonal Antibody

A

Omalizumab (Xolair)

22
Q

Mometasone (Asmanex)

A

inhaled corticosteroid

23
Q

Albuterol (Proair, Ventolin)

A

SABA

24
Q

Ipratropium bromide (Atrovent)

A

anti-muscarinic (short-acting)

25
Q

Omalizumab (Xolair)

A

Anti-IgE Monoclonal Antibody

antibody that binds and inactivates IgE
reserved for severe, frequently exacerbated asthma
reduces severity and frequency of exacerbations
reduces glucocorticoid steroid requirements
used as MAINTENANCE THERAPY

26
Q

Theophylline ADE

A

normal to high levels of :
diuresis, tremors/nervousness, n/v, insomnia
very high levels of:
seizures, + chronotropic and inotropic

27
Q

LABAs

A

Salmeterol and Formoterol
long duration of action (~12 hours), 2x day
combined with corticosteroids (anti-inflamm)
Vilanterol
longer duration (~24 hours) - once a day dosing
combined with corticosteroid
*ONLY APPROVED FOR COPD

28
Q

SABAs

A

maximum bronchodilation achieved 15 mins after inhalation
duration of action ~4 hours
Levalbuterol more pure? more selective, less tachy and tremors (but not clinically significant)
nebulizer option
Albuterol also available as PO tablet - but increased side effects

29
Q

Budenoside (Pulmicort)

A

inhaled corticosteroid

30
Q

B2 agonists

A

some come oral but inhaled (topical) is preferred to prevent toxicities / systemic absorption

SABAs for rescue therapy
LABAs for maintenance

31
Q

Black box warning for LABAs

A

monotherapy of LABAs increases risk of asthma related events including hosptializations, intubations, and death

32
Q

Triamcinolone (Azmacort)

A

inhaled corticosteroid

Pharm Exam 3 (5 decks)

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