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Fall Pharm Block 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Differentiate the management of dry cough vs wet cough.

A

Dry: suppressed only if it is exhausting the patient
Wet: never suppressed

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2
Q

State the mechanism of action of mucolytics/expectorants and describe their efficacy.

A

Drugs that liquefy the mucus so it is easier to mobilize. Efficacy = they are trash

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3
Q

What is the best mucolytic? List two others and state which is indicated for cystic fibrosis?

A

Best: water
Others: guaifenesin, NAC –> N-acetylcysteine
NAC indicated for CF

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4
Q

List three examples of cough suppressants.

A

Codeine, Dextromethorphan (DM), Benzonatate

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5
Q

Which cough suppressant is commonly abused and which acts by numbing the cough centers in the respiratory tree?

A

DM: abuse –. high doses cause hallucinations
Benzonatate: numbs respiratory tree cough centers

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6
Q

Describe the pathophysiology of asthma.

A

Hyperactive bronchi lead to chronic inflammation.

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7
Q

What is meant by saying asthma is a polygenic process?

A

Many substances contribute to the inflammation –> HST, Leukotrienes, and Prostaglandins

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8
Q

What are the three basic approaches to managing asthma?

A
  1. Prevent allergen exposure
  2. Reduce inflammation and hyperactivity
  3. Dilate narrowed bronchi
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9
Q

What drug class is the mainstay of asthma treatment and how do they act?

A

Glucocorticoids –> reduce bronchial hyperactivity and inflammation.

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10
Q

By what routes are glucocorticoids administered and which formulation is hydrophilic and why?

A

PO, IV, and Inhalation –> Inhaled steroids are hydrophilic so the drug stays where you put it.

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11
Q

What is a significant AE of inhaled glucocorticoids and why does this occur?

A

Thrush –> all glucocorticoids are immunosuppressive

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12
Q

What are AEs of PO and IV glucocorticoids? (7 total)

A

Hyperglycemia, osteopenia, ulcers, Na retenion, HypoK, immune suppression, increased appetite

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13
Q

Why are IV and PO glucocorticoids administered in short bursts and tapered slowly?

A

They suppress the hypothalamic-pituitary-adrenal axis. Short courses avoid H-P-A suppression

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14
Q

What is the minimum dose of PO/IV steroids to suppress the HPA axis and what are the usual dosing instructions?

A

Min: 20mg prednisone for 14 days
Inst: Take in AM to mimic normal peak cortical levels

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15
Q

What is the mechanism of action of Cromolyn and Nedocromil and by what route are they administered?

A

Mast cell stabilizers - reduce HST on exposure to allergens. Administered by inhalation only.

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16
Q

T/F: Glucocorticoids, Cromolyn, and Nedcromil can be used to terminate acute asthma attacks.

A

False

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17
Q

What type of asthma is cromolyn and nedcromil typically used for?

A

Exercise induced and allergic induced

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18
Q

What is the primary use of long acting B-2 agonists and what is the caution with their use?

A

Long acting drug for maintenance. Caution for possible increased cardiac M & M

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19
Q

What is primatine mist?

A

OTC dilute epi inhaler

20
Q

What is albuterol used for?

A

Short acting B-2 agonist used as a rescue agent

21
Q

What is salmeterol used for?

A

Long acting B-2 agonist used in combination with steroids (Advair) for maintenance

22
Q

What is the mechanism of formoterol?

A

Long acting B-2 agonist (faster and greater per dose potency than salmeterol)

23
Q

What is the mechanism of bambuterol and salbutamol and what is unique about salbutamol?

A

Both long acting B-2 agonists - salbutamol is available both PO and via MDI

24
Q

T/F: Albuterol is only available as an inhaled agent.

A

False: albuterol is available PO but it is rarely used.

25
Q

Which B-2 agonist is used as a tocolytic (decrease uterine contractions)?

A

Terbutaline

26
Q

Which anti-HTN medication should be avoided in asthmatics?

A

Non-selective beta blockers

27
Q

What is the result of administering a parasympatholytic in respiratory disease and which disease is it most used for?

A

Bronchodilation - used primarily in COPD and can be an adjunct in asthma

28
Q

List two anti-cholinergic agents and which is used more frequently?

A

Ipratropium - used more frequently

Tiotropium - long acting agent

29
Q

List five side effects of anti-cholinergic agents.

A

Tachycardia, sedation, dry mouth, constipation, urinary retention

30
Q

What class of drugs is a second-line agent in the management of asthma and what are their AEs?

A

Leukotriene Receptor Antagonists - relatively few and benign AEs

31
Q

What is the mechanism of PDE-4 inhibitors?

A

PDE-4 chews up cAMP in the lungs. PDE-4 inhibitors increase cAMP which result in bronchodilation.

32
Q

What is the primary indication for PDE-4 inhibitors?

A

COPD –> chronic bronchitis, NOT emphysema

33
Q

In addition to bronchodilation, what other effect results from PDE-4 inhibitor use?

A

Some anti-inflammatory properties

34
Q

T/F: PDE-4 inhibitors can be used for acute COPD exacerbations

A

False

35
Q

List a PDE-4 inhibitor and what is the caution with its use?

A

Roflumilast –> risk of suicidal ideations

36
Q

What two classes of respiratory drugs are used most in COPD?

A

Anticholinergics and PDE-4 inhibitors

37
Q

Describe the effects of and treatment for status asthmaticus.

A

Life threatening condition associated with mucus plugs, refractoriness to B-2 agonists, and respiratory acidosis. Treatment is epinephrine, IV steroids, and intubation if meds are ineffective.

38
Q

Describe the function of a metered dose inhaler.

A

Active ingredient (AI) is pressurized with a propellant. When activated, the MDI releases the AI and the propellant immediately evaporates

39
Q

What are the instructions to use a MDI?

A

shake –> exhale –> slowly inhale and activate the MDI

40
Q

Which patients typically use a spacer with their MDI?

A

Children

41
Q

How does the patient assess the quantity remaining in their MDI?

A

Water drop

42
Q

In addition to liquid, what other form of drug can be utilized in a MDI?

A

powder

43
Q

What is the function of a nebulizer?

A

Convert solutions or suspensions of drugs into aerosols and driven by a gas or ionization process.

44
Q

List some examples of inhaled corticosteroids.

A

Flunisolide, triamcinolone, beclomethasone, fluticasone, budesonide.

45
Q

What is the most hydrophilic inhaled corticosteroid and what is the clinical implication?

A

Triamcinolone –> stays where you put it

46
Q

What is the most lipophilic steroid?

A

Dexamethasone (not used as an inhaler)

47
Q

What is Advair a combination of?

A

Fluticasone (steroid) and Salmeterol (LABA)

Fall Pharm Block 3 (8 decks)

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