Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Where a.w smooth muscle extends to

A

Terminal bronchioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SNS action and activation of which receptor

A

B2 adrenoreceptors mediate relaxation of smooth muscles in vessels, bronchi, uterus, bladder, and other organs. Activation= bronchodilation, increased cAMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Non adrenergic, non cholinergic nerves

Do what to a/w

A

Relax smooth muscle by releasing NO and VIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PSNS
Action
Receptors
Pathway

A

Stim vagus leads to bronchoconstriction. M3 receptors are pharmacologically most imp. In bronchial muscle, mediate constriction by activ of IP3 which increases intracellular Ca. Mediates mucus secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ANS impact on resp system through 2 things

A

Adrenergic B2: bronchial smooth muscle relaxation, bronchodilation
Cholinergic: smooth muscl contraction, increased gland secretion- constriction and inc mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Asthma results in what

S/s

A

Variable airflow obstruction that’s reversible.

Breathlessness, tight chest, wheeze, dyspnea, cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What you’re addressing w drugs in asthma

2 main classes

A

Inflammation and bronchoconstriction

  1. Anti-inflammatories- steroids, prednisone
  2. Bronchodilators- B2 agonists, albuterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which drugs taken for asthma daily for long term control

A 
Anti inflammatories 
Inhaled corticosteroids 
Cromolyns 
Leukotriene inhibitors 
Anti IgE antibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most important preventative tx for asthma

A

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Glucocorticoids

MOA

A

Suppress inflammation by altering genetic transcription

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Glucocorticoids

Target

A

Glucocorticoids receptor alpha in cytoplasm of a/w epithelial cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Glucocorticoid transcription effects: 3

A

Inc transcription of genes for: B2 receptors/responsiveness, anti-inflammatory proteins
Decreases transcription of genes for pro inflammatory proteins: decreases mucus production and edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Glucocorticoids

3 other effects than transcription

A

Induces apoptosis in inflammatory cells (eosinophils, th2, lymphocytes)
Indirect inhibition of mast cells over time
Reverses bronchial hyperreactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glucocorticoids
Use, what it doesnt do
Usual route

A

Suppressive therapy, not a cure

Inhalation. (IV and oral also available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Inhaled corticosteroids

Use

A

Long term prophylaxis in mod to severe asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inhaled steroids

Which nebulized for who

A

Budesonide, kids too young to use MDI or DPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Inhaled steroids

4

A

Budesonide
Beclomethasone
Triamcinolone
Fluticasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

IV steroids, use in asthma, 2

A

Hydrocortisone and methylprednisone, status asthmaticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Corticosteroids

PO- for what, 2 ex

A

Acute exac, chronic severe asthma.

Prednisone and prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Inhaled corticosteroid
How much reaches airway, what increases concentration in lung
Conc in lung compared to PO
Adrenal suppression compared to PO/iv

A

10-20%, beta 2 agonist before inhalation
Higher
Mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Inhaled corticosteroid

Side effects

A

Candidiasis
Hoarseness
Delayed growth kids
Osteopenia/porosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Systemic corticosteroids AE
When minor
Long term effects

A

<10 days

Weakness, adrenal suppression, infection risk, growth suppression, PUD, wt gain, edema, hypokalemia, hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Systemic corticosteroids

Give extra when or what

A

IV or PO during physiologic stress (surgery, trauma, infection) or pt could die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cromolyn

MOA

A

Stabilizes pulmonary mast cells. Inhibits antigen induced release of histamine, inflammatory mediators from: eos, neutro, mono, mac, lymph, Leuko. Inhib allergic response to antigen but not once its activated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cromolyn | Principle use
Bronchial asthma prophylaxis, prevents exercise induced bronchospasm. Not a rescue inhaler.
26
Cromolyn Route How much goes systemic Take how often
Inhalation 8-10% 4 times daily
27
Cromolyn SE Comparison to other asthma meds Route
Cough, bronchospasm, laryngeal edema, angioedema, urticaria, anaphylaxis Safest of them all, SE rare Neb or MDI
28
Leukotriene modifiers | How leukotrienes are synthesized, which we're concerned about and why
From Arachidonic acid when inflammatory cells are activated. C4, D4, E4. Promote bronchoconstriction, eosinophils, mucus, and airway edema
29
Leukotriene modifiers Comparison to glucocorticoids Not effective for Few what
Less effective Acute attacks Extrapulmonary effects
30
Leukotriene modifiers | 3 ex
Zyflo (zileuton) Accolate (zafirlukast) Montelukast/singular
31
Zileuton Class Action Uses
Leukotriene inhib. Lipoxygenase inhib, blocks leukotriene synth from arachidonic acid Bronchodilation, for asthma, long term improvement PFT
32
Zileuton Metab AE
``` Low bioavailability and low potency Hepatotoxic- monitor LFT early Neuro: depression, anxiety, halluc, suicidal thinking Interacts w CYP450 Not widely used ```
33
Montelukast | Action
Blocks bronchoconstriction and smooth muscle effects. Blocks binding to leukotriene 1 receptor. Improves bronchial tone, pulm function, and asthma symptoms
34
Montelukast | Use in who
Asthma in <1 y/o, exercised induced bronchospasm >15 y/o, allergic rhinitis
35
``` Montelukast Adverse effects Max effect when Metab What inc drug level ```
Placebo, rare psych effects 24 hrs after 1st dose 99% protein bound, by cyp 450, minimal interactions Phenytoin
36
Omalizumab Class Target
Anti IgE antibodies. Mouse monoclonal antibody. | IgE mediated allergic responses in asthma
37
Omalizumab | Action
Binds to IgE and inactivates it. Decreases overall amt, prevents IgE binding to mast cells. Down regulates receptors on mast/baso/dendritic cells. Reduces stim T2 lymph.
38
``` Omalizumab Downside Route Taken when 1/2 life ```
10k per year Sq Allergy induced asthma not tx by glucocorticoids 26 days
39
Omalizumab | SE
Injection site rxn, viral infec, URI, sinusitis, HA, pharyngitis, CV (inc MI and CVA, HF, dysrhythmias, thromboembolism risk), possible inc risk cancer
40
Omalizumab | Rare AE
Triggers anaphylaxis. Monitor 2 hrs after first three doses, then 30 min after all subsequent doses
41
Bronchodilators | How they work
Symptomatic relief, dont tx underlying cause of inflammation. Should also take glucocorticoids
42
Bronchodilators | 3 types
Beta adrenergic agonists Anticholinergics Methylxanthines
43
B adrenergic agonists | MOA
B adrenergic receptors coupled to stim G proteins. Activate adenylyl cyclase which inc cAMP, then bronchodil. Dec Ca inc K. Dilates bronchi, smooth muscle relax, inhib mast cell and inc mucus clearance
44
B adrenergic agonists | Most effective drugs for
Acute bronchospasm and prevention of exercise induced bronchospasm. Quick relief and long term control
45
B adrenergic agonists Receptor selectivity Short v long acting types
B2 200-400x more than b1 Short: albuterol, levalbuterol Long: salmetrol, terbutaline (po or iv)
46
B adrenergic agonists Onset Routes
15-30 min. Short or long acting Inhalation, aerosol Powder, neb Orally or sc
47
B adrenergic agonists | SE
Minimized by inhalation route. Tremor, inc HR, vasodilation, hyperglycemia, hypokalemia, hypomagnesemia
48
B adrenergic agonists | Oral preps excessive dose leads to
Angina and tacky dysrhythmias
49
Albuterol | Doses
MDI: 100 mcg/puff. 2 puffs q4-6 h Neb: 2.5-5 mg in 5 ml saline
50
Albuterol Duration Isomers
4 hrs, up to 8 hrs. R albuterol levalbuterol, more affinity B2. S albuterol, more affinity b1.
51
Metaproterenol Indic Route Max dose
Beta 2 agonist for asthma. MDI | 16 puffs a day
52
``` Bitolterol Class Duration AE Dose ```
Selective B2 lasts longer than albuterol Rare cv effects Metered dose 16-20 puffs a day. Each dose 270 mcgs
53
Terbutaline Class Routes Indic
B adrenergic agonist Oral, sc, inhalation Treats asthma
54
``` Terbutaline Sc admin resembles Sc dose peds Sc dose adults Medi dose and amt ```
``` Epi response 0.1 mg/kg 0.25 mg q15 min 16-20 puffs/day Each dose 200 mcgs ```
55
``` Salmetrol Class Other drug like it Duration For what Warning ```
Formoterol. Long acting b agonist 12-24 h, lipophilic side chains Prevention not flare up May inc risk of fatal asthma attack
56
Methylxanthines Class MOA
Bronchodilators, phosphodiesterase inhib Unclear. May inhib pdi isoenxymes and prevent camp degred in airway. Anti inflammatory. Possible adenosine receptor block
57
Methylxanthines Drug effect Clinical applic Types
Airway relaxation and bronchodilation COPD and asthma Theophylline and aminophylline
58
``` Methylxanthines Theophylline Downside Therap plasma level When toxic 1/2 life ```
Mult SE and narrow therapeutic index 10-20 mg/ml >20 mg/ml Wide variation, esp smokers who metab faster
59
Methylxanthines | Drug interactions
Cimetidine, cipro, and antifungals inc levels (cp450 inhib) Phenobarbital and phenytoin decrease levels Caffeine can inc levels and be toxic to cns and cv
60
Methylxanthines Metab and excretion Only in what form
Liver, kidney | Sustained release only
61
Methylxanthines | SE
Cv arrhythmias NV Irritable, insomnia, seizures, brain damage, hyperglycemia, hypokalemia, hypotension,death from cv collapse
62
Muscarinic receptor antagonists | MOA
Competitive antagonists at muscarinic acetylcholine receptors. Promotes smooth musc relax and decreased mucus secretion
63
Muscarinic receptor antag Which subtype most imp Uses
Muscarinic 3 | Tx COPD, secondary line of tx for asthma in pts resistant to beta agonist or significant cv disease
64
What m3 receptors do when stimulated
Drop inflammatory mediators
65
Atropine What it is Indic Dose
Naturally occurring alkaloid Used to be 1st line for asthma 1-2 mg diluted in 3-5 ml saline via neb
66
Atropine Absorption SE
Highly abs across respiratory epithelium | Systemic anticholinergic fx: tachycardia, nausea, dry mouth, gi upset
67
Ipratropium bromide What it is What it does
Quaternary ammonium salt, deriv of atropine. Anticholinergic Antagonists effect of ach at M3
68
``` Ipratropium Dose Onset Duration Absorption ```
40-80mcg MDI or in 2-4 puffs via neb 30-90 min 4-6 hours Not absorbed as well as atropine. Inadvertent oral abs can lead to gi upset and dry mouth
69
``` Tiotropium What it is Class Absorption Approved for ```
Quaternary ammonium salt Long acting anticholinergic Not abs sig in resp epithelium, less SE FDA approved for COPD
70
Glucocorticoid/LAB2A combos 2 types Indic for
Fluticason and salmetrol (advair) Budesonide and formoterol (symbicort) Long term maintenance in adults and kids. Reduces symptoms
71
Glucocorticoid and LAB2A combos Not for Black box warning
Initial therapy. Many pts controlled on inhaled glucocorticoid Asthma related death inc risk
72
Lab2a stands for what
Long acting beta 2 agonist
73
Asthma Source of allergens What can exac it
Dust mites, pets, cockroaches, mold Tobacco Smoke, wood smoke, household sprays
74
Drugs for severe asthma exac
Give o2 (hypoxia), Systemic glucocorticoid (inflam), neb high dose Saba (obstruc), neb ipratropium (obs)
75
COPD What drugs have ltd effect What reduces exac freq What modestly improves air outflow
Steroids Inhaled corticosteroids Bronchodilators- for pts w breathlessness worsened by exertion
76
COPD | Monotherapy started which of 3
Long acting beta 2 (salmetrol) Long acting anticholinergic (tiotropium) Inhaled glucocorticoid (budesonide) One of the 3. Bud- last choice
77
COPD | If monotherapy doesnt work then what
Add a second class of drug. Usually laba and a steroid
78
Roflumilast (daliresp) For what What it does
New COPD drug. Selective phosphodiesterase type 4 inhib, reduces exac
79
Daliresp | Moa
Inc cAMP levels resulting in reduced cough, inflammation, and mucus
80
Daliresp | SE
Diarrhea, wt loss, loss of appetite, nausea, HA, back pain, depression

Pharmacology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions