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respiratory drugs Flashcards

1
Q

ipratropium

A

anticholinergig drug used to counter the PNS bronchoconstriction in asthma or COPD (blocks M1,2 and 3 receptors of smooth muscle cells)

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2
Q

albuterol

A

B-2 agonist, used in an inhaled form by pt with asthma/COPD

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3
Q

txt for emphysema (5):

A
  1. inhaled bonchodilators (B2 agonist: albuterol, salmeterol OR anticholinergics: ipratropium, tiotropium)
  2. IV or PO cortico steroids during acute exacerbation w/longterm corticosteroids via inhaler for chronic disease
  3. supplemental O2 for pt with hypoxemia
  4. pulmonary rehab
  5. lungvolume reduction is almost never used!
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4
Q

how do you txt chronic bronchitis

A
  1. bronchodilators (B2 agonist: albuterol, salmeterol OR anticholinergics: ipratropium, tiotropium)
  2. inhaled corticosteroids
  3. supplemental O2- prevent hypoxemia, decrease hypoxic vasoconstriction and polythycemia, decrease pulm HTN
  4. chest physiotherapy
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5
Q

2 short-acting B2 agonists used in asthma

A
  1. albuterol

2. Terbutaline

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6
Q

side effects of short acting B2 agonists used for asthma (albuterol and Terbutaline)

A

mainly related to off-target agonism on B1 and alha receptors: HTN, angina, vomiting, vertigo, CNS stimulation, and drying/irritation of the oropharynx

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7
Q

side effects of ipratropium?

A

you mt see off-targeted anticholinergic effects (dry mouth, dry bronchial secretions, and urinary retention)

other side effects are rare bc chem modifications block systemic absorption

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8
Q

what are the oral and parenteral steroids taken for asthma?

A

prednisone and methylprednisolone

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9
Q

prednisone and methylprednisolone

A

oral/parenteral steroids taken for asthma

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10
Q

how do prednisone and methylprednisolone work in asthma pt?

A

reduce inflamm response by decreasing formation of cytokines, inactivating nuclear factor kappa light-chain enhancer of activated B cells (NF-Kb), inhibiting generation of vasodilators, decreasing microvascular permeability, and reducing mediator release from eosinophils

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11
Q

management of severe asthma attack:

A
  1. repeated administrations of albuterol +/- ipratropium
  2. 100% O2
  3. IV corticosteroids (prednisone, prednisolone)
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12
Q

if repeated administrations of albuterol +/- ipratropium, 100% O2, and IV corticosteroids (prednisone, prednisolone) fail in an acute asthma attack, what is the next step?

A

magnesium sulfate or epinephrine

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13
Q

last resort in severe asthma attack

A

intubation– but it’s very difficult to manage ventilation in severe obstruction!

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14
Q

6 groups of drugs used for LONG-TERM control of asthma

A
  1. inhaled cortico-steroids (fluticasone, beclomethasone)
  2. long acting B2-agonists (salmeterol)
  3. xanthines (theophylline, theobromine, caffeine)
  4. mast cell stabilizers (cromolyn)
  5. leukotriene blockers (zileuton, montelukast, zafirlukast)
  6. Omalizumab (monoclonal Ab that binds to circulating IgE)
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15
Q

what 2 inhaled corticosteroids are used for long-term asthma control? how do they work?

A
  1. fluticasone
    2, beclomethasone
    – reduce inflammation in the long-term– too slow acting for acute management
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16
Q

what long-acting beta agonist is used for asthma and sometimes COPD?

A

salmeterol

** similar to short acting beta agonists, but with a longer half life.

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17
Q

side effects of salmeterol (long acting Beta agonist used for asthma and sometimes COPD) (6)

A

coughing, tremor, arrhythmia, chest pain, HA, hives

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18
Q

three xanthines used to txt asthma

A
  1. theophylline
  2. theobromine
  3. caffeine
19
Q

how do theophylline, theobromine and caffeine (xanthines) prevent asthma?

A
  1. increase cAMP in smooth muscle cells though inhibition of phosphodiesterase isoenzymes, leading to airway dilation
  2. mt also have an inti inflamm. effect
20
Q

why are xanthines (theophylline, theobromine and caffeine ) rrely used?

A

drug interactions and side effect profile including cardiotoxicity and neurotoxicity

21
Q

what 2 mast cell stabilizer is used to txt asthma prophylactically

A

cromolyn and nedocromil

22
Q

what does cromolyn and nedocromil do to txt asthma longterm?

A

mast cell stabilizer– it inhibits the release of inflamm mediators from mast cells.

23
Q

side effects of cromolyn (mast cell stabilizer) used for asthma? (5)

A

throat irritation, cough, dry mouth, chest tightness and wheezing
- toxicity is rare bc poor absorption

24
Q

what are three leukotriene blockers that are often used to txt asthma longterm?

A
  1. zileuton
  2. montelukast
  3. zafirlukast
25
Q

how does zileuton work?

A

inhibits 5-lipoxygenase, which reduces the conversion of arachidonic acid into leukotrienes
** used as longterm asthma txt

26
Q

how do montelukast and zafirlukast work?

A

they’re cysteinyl leukotriene receptor 1 antagonists. Leukotriene inhibition helps to relax airways
** used as longterm asthma txt

27
Q

how does Omalizumab work in asthma?

A

monoclonal Ab that binds circulating IgE, reducing airway inflammation
NOTE: rarely used due to cost

28
Q

does an increase in cAMP lead to bronchodilation or bronchoconstriction?

A

bronchodilation (that’s why theophylines block phosphodiesterase which would turn cAMP into AMP)

29
Q 
isoprotenerol
- what class of drug is it?
A

nonspecific b agonist

30
Q

isoprotenerol

what does it do? what is the major adverse effect?

A

bronchodilation (nonspecific b agonist).

major adverse effect is tachycardia (B1)

31
Q

adverse effects of salmeterol (long acting prophylaxis in asthma)

A

tremor and arrhythmia

32
Q

3 txt for bronchiectasis

A
  1. inhaled bronchodilators for pt w/coexisting airway obstruction
  2. Abx to txt acute and chronic ifxns
  3. Bronchopulm drainage w/physical therapy
33
Q

In CF pt, what is given to help break up thick secretions found in bronchiectasis?

A

DNase

34
Q

txt of wegener’s granulomatosis (GPA)

A
  1. prednisone initially

2. cytotoxic agents like cyclophosphamide

35
Q

Txt for PE (3)

A
  1. supplemental O2 if hypoxemic
  2. anticoag therapy (usually IV heparin or LMW Heparin followed by oral warfarin for 3-6 months)
  3. thrombolytic therapy if massive PE + hypotension

Note placement of a filtering device in the IVC can be used in pt who can’t tolerate anticoag due to increased bleeding risk

36
Q

txt for pulm HTN

A
  1. supplemental O2
  2. vasodilators (sildenafil, endothelin receptro antagonists, prostacyclins)
  3. inhaled NO
  4. anticoag therapy
37
Q

Is surgery an option for small cell carcinoma?

A

not really bc it metastasizes very early in the disease process

38
Q

txt for small cell carcinoma?

A

chemo/radiation

- surg. not an option bc it metastasizes very early in the disease process

39
Q

txt for non-small cell lung cancer (NSCLC)

A

surgery, unless it’s already metastasized

40
Q

conventional chemo for lung cancer include

A
  1. platinum cross linkers ( cisplatin)
  2. intercalating agents (doxorubican)
  3. taxanes (paclitaxel)
  4. vinca alkaloids (vincristine)
  5. nucleoside analogs (gemcitabine)
41
Q

what is gefitinib and what is it used for?

A

targeted therapy for NSCLC that have EGFR mutations that inhibits epidermal growth factor receptor

42
Q

what type of drugs are generally not recommended for use in pt w/chronic resp disorders like asthma, emphysema and chronic bronchitis?

A

Beta blockers!

43
Q

If a beta blocker needs to be prescribed to a pt w/chronic resp disorders like asthma, emphysema or chronic bronchitis, what kind should be prescribed?

A

a beta-1 selective blocker, like Metoprolol

44
Q

why should Betal blockers be used cautiously in diabetic pt on insulin?

A

bc they can mask premonitory symp of hypoglycemia

Boards Respiratory (5 decks)

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