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Pharm > Respiratory and GI > Flashcards

Respiratory and GI Flashcards

1
Q

Classes of Drugs Used to Rx Respiratory Disease

A

*Antitussives
*Mucolytics & Expectorants
*Decongestants
*Antihistamines
*Bronchodilators
*General airway anti-inflammatory

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2
Q

Pathophysiology of Respiratory Disease

A

*Allergies and Upper RT hypersensitivity reactions
*Overt Infections –> Upper respiratory tract vs Pneumonia
*Obstruction lung disease (Asthma, Emphysema, Chronic bronchitis)
*Restrictive lung disease

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3
Q

What do Antitussives do?

A

suppress cough, allow patient to sleep, generally decrease cough reflex

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4
Q

Side effects of antitussives

A

sedation, but not habit forming

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5
Q

Dextromethorphan (Tussin):

A

centrally acting analgesic

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6
Q

What do Mucolytics do?

A

decrease the viscosity of mucous so it can be coughed up

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7
Q

Most common Mucolytic

A

Acetylcystine (Mucomyst):
* most common, given by inhalation or intratrachealinstillation
* breaks disulfide bonds and acts as antioxidant

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8
Q

What do expectorants do?

A

increase mucous production and ejection

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9
Q

Expectorant Medication

A

*Guaifenesin: FDA approved expectorant
Trade name: Mucinex

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10
Q

Mucinex DM

A

combined with dextromethorphan

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11
Q

Mucinex Sinus Max

A

combined with phenylephrine

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12
Q

What do decongestants do?

A

*Decrease airway resistance
*Constrict nasal and sinus blood vessels, thus decreasing blood flow
and fluid extravasation

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13
Q

Types of decongestants

A

Ephedrine
Oxymetazoline
Phenylephrine
Phenyylpropanolamine
Pseudoephedrine

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14
Q

Decongestants are all…

A

Alpha-adrenergic agonists that cause vasoconstriction of nasal blood vessels

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15
Q

common side effects of decongestants

A

tachycardia, nervousness, insomnia

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16
Q

which medications are locked up so you dont make meth?

A

decongestants

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17
Q

What do antihistamines do?

A

*Decrease nasal and sinus secretion
*Decrease mucosal irritation, discharge & cough
*Decrease conjunctivitis
*Decrease pressure, pain & edema

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18
Q

How do antihistamine work?

A

by blocking histamine receptors
*H1 receptors on respiratory and GI smooth muscle
* H1 R involved in blood vessel permeability and dilation
*H2 receptors on gastric mucosa (acid secretion)
*H3 receptors in CNS

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19
Q

Main side effect of antihistamines

A

*Drowsiness
*Sleepiness
*Newer antihistamines such as Claritin and Zyrtec are reported to cause less drowsiness

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20
Q

Airway obstruction is a problem in….

A

asthma, chronic bronchitis & emphysema

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21
Q

What are the 1st drugs used to treat obstructive pulmonary disease?

A

beta2 Agonists, Anticholinergics, Cromones & Xanthines

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22
Q

What other two drugs can be used treat obstructive pulmonary disease

A

Chromones and anti-inflammatories

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23
Q

Albuterol

A

Beta2 agonists given by metered dose inhaler (MDI) potent and rapid acting bronchodilator
-may be difficult to administer

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24
Q

Ipratropium (Atrovert)

A

new anticholinergic (anti-muscarinic)
-administered by inhaler so less systemic spread, fewer SE
-recent study shows it puts males at risk for urinary retension
*Blocks cholinergic-mediated PSNS bronchiolar
constriction
*Not as effective as beta2-agonists for asthma, but useful with other COPD conditions or combined with beta2-agonists

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25
Q

Theophylline (Theo-Dur)

A

bronchodilator, increases respiratory muscle strength, increases mucocilliary transport, decreases pulmonary artery P, decreases histamine release
-works by inhibiting PDE enzyme (inhibits break down of cAMP)
- Oral, extended release oral

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26
Q

see mechanism of action of bronchodilators

A

slide 13

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27
Q

Onset and duration of albuterol

A

on set: 5-15 mins
duration: 3-6 hrs

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28
Q

Ipratropium (Atrovent) side effects

A

similar to those seen with other
anticholinergics (constipation, dry moth, visual
disturbances, mental status changes, etc…)

29
Q

Cell targets of drugs for airway obstruction

A
  • Histamine
  • Leukotrines
  • Thromboxanes
  • Cytokines
  • White blood cells (neurtophils, T-cells and macrophages)
30
Q

Airway anti-inflammatories include:

A
  • drugs that block cellular & prostaglandin-
    mediated airway constriction and irritation
    *All are glucocorticoids
31
Q

side effects of airway anti-inflammatories

A

Catabolic effects
*breakdown of supporting tissues
*muscle wasting
*Other SE: glucose intolerance, cushingoid changes, HTN, osteoporosis, loss of adrenal fx
*Some can be given by inhalation to limit systemic effects

32
Q

Glucocorticoids - Cortisone

A
  • Trade name: Cortone
  • Oral and IM
33
Q

Generic names of glucocorticoids

A
  • Bethamethasone
  • Cortisone
  • Flunisolide
  • Triamcinolone
34
Q

Cromones - Cromolyn Sodium

A

*used prophylactically to prevent bronchospasm in asthma
*does not reverse bronchoconstriction in asthma attack
*mechanism u/k, but thought to prevent release of inflammatory mediators (prostaglandins, histamine)
*administered by MDI and nebulizer
*very few side effects
*frequently used to Rx asthma in children

35
Q

Side effects of Beta 2 agonists

A

tachycardia, nervousness, sleeplessness,
*chronic use- increased bronchospasm

36
Q

side effects of anticholinergic drugs

A

constipation, urinary retention, dry mouth,
blurred vision, tachycardia, confusion

37
Q

Side effects of Xanthines

A

CNS stimulators (Theophylline- caffeine like
compound w/ similar S.E.), sleeplessness, nervousness and toxicity: N&V, confusion, seizures, death* (with toxicity)
***Very narrow therapeutic window

38
Q

side effects of corticosteroids

A

even w/ inhalation, produce muscle
wasting, osteoporosis, exacerbation of DM, etc…

39
Q

Common GI conditions treated with drugs

A

heart burn, acid reflux, ulcers, constipation, diarrhea and nausea & vomiting

40
Q

Most GI problems fit into one of these categories:

A

*excessive GI motility/secretion
*heart burn, diarrhea, acid reflux, ulcer, some cases of N&V
*diminished GI motility/secretion
*constipation, some cases of N&V

41
Q

Gastrointestinal Agents - Antacids

A

decrease or neutralize stomach acid
* Ranitidine (Zantac): H2 blocker for ulcer & GERD

42
Q

Gastrointestinal Agents - Laxatives and Cathartics

A

slow and fast acting agents
used to promote bowel movement

43
Q

Gastrointestinal Agents - Antidiarreal

A

Loperamide (Imodium): slows GI tract
motility and secretion

44
Q

Gastrointestinal Agents - Emetics

A

induce vomiting: ipecac- central acting

45
Q

Gastrointestinal Agents - Antiemitics

A

inhibit vomiting: Ex: scopolamine

46
Q

Basic strategy of treatment of heart burn/acid reflux and ulcer

A

Antiacid + Hydrochloric acid → Salt + water

47
Q

H2 receptor blockers

A

*Used for dyspepsia, gastroesophageal reflux
*Few side effects and well tolerated
*Many were initially prescription, but now OTC.

48
Q

What are proton pump inhibitors

A

Newer class of drugs that specifically inhibit the K+/ H+ exchanger or “proton pump” that pumps H+ into the lumen of stomach

49
Q

What other effect does proton pump inhibitors have?

A

anti-bacterial effect against Helicobacter Pylori

50
Q

Adverse reaction to PPIs

A
  • Generally well tolerated. Common adverse effects: headache, nausea, diarrhea, abdominal pain, dizziness
51
Q

Adverse reactions to PPIs for longer term use

A
  • Decreased vitamin B12 absorption may occur with long-term use. It has been observed that gastric acid suppression, using H2-receptor antagonists and proton pump inhibitors, is associated with an increased risk of community-acquired pneumonia.
  • Increase risk of Clostridium difficile infection with even once daily use and even higher risk with > once/day use
  • Long-term use of proton pump inhibitors may increase risk of osteoporosis
52
Q

New guidelines for PPIs

A
  • Acknowledge that PPIs are frequently overused, and may be taken for longer that absolutely required
  • Stress appropriate PPI usage:
  • PPIs be taken at the lowest dose
  • shortest duration for the condition
53
Q

Laxatives and Cathartics Drugs

A
  • Psyllium (Metamucil): Bulk: fiber that absorbs water
  • Bisacodyl (Dulcolax): direct irritant to GI wall
54
Q

Anti-Diarrhea medications

A

Loperamide (Imodium) –> opioid

55
Q

What are antiemetics used for?

A

to help patients being treated with chemo
Rx or Radiation Rx experiencing N&V

56
Q

How to anti-emetics work?

A

by blocking histamine or
acetylcholine R’s or act centrally to diminish
dopamine neurotransmission

57
Q

Post GI resection CF:

A

Oral replacement of pancreatic
enzymes

58
Q

Crohn’s Disease and IBD

A
  • Glucocorticoids,
  • Anti-inflammatories
  • Adrenergic inhibitors
  • TNF inhibitors and biologics
59
Q

Most effective drugs for IBD and Crohn’s disease

A

tumor necrosis factor (TNF)-alpha inhibitors, or “biologics”
* Monoclonal antibodies that bind and neutralize TNF
* Examples include: Infliximab (Remicade), adalimumab (Humira) and golimumab
(Simponi)- Infliximab added to “DTK” list under “Biologics”

60
Q

How is infliximab given?

A

IV
but duration is 6-12 weeks

61
Q

what is infliximab used to treat?

A

RA, psoriatic arthritis, UC, Crohn’s disease, ankylosing spondylitis and psoriasis

62
Q

adverse effects of Infliximab

A

hypersensitivity reactions, HA, abdominal pain,
anemia, infection (especially respiratory) and flushing

63
Q

Adverse effects of orlistat

A

*Malabsorption of vitamins and minerals: Especially fat-soluble vitamins like A, D, E
*HA, flatulence with discharge, fatty stool, fecal incontinence, increased defecation, abdominal pain/discomfort
*Drug interactions: may interfere with warfarin dosage (increase need to check PT/INR)

64
Q

general side effects of antacids

A

All associated with “acid rebound”

65
Q

general side effects of H2 blockers

A

side effects rare except for Cimetidine

66
Q

General side effects for PPIs

A

few side effects, but caution with long term use

67
Q

General side effects of antidiarrheal agents

A

nausea, abdominal discomfort,
constipation, drowsiness, fatigue, dizziness, potential for addiction/tolerance

68
Q

general side effects of laxatives

A

nausea and cramps: prolonged use- lower GI
irritation, spastic colitis, water and electrolyte imbalance, acid-base imbalance, loss of normal bowel function & addiction

Pharm (12 decks)

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