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Pharmacology 2 > Respiratory Drugs > Flashcards

Respiratory Drugs Flashcards

Emphasis on Anti-asthmatic

1
Q

What is the major difference between asthma and chronic COPD?

A

Airflow limitation is:
asthma- reversible
COPD- irreversible

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2
Q

What induces bronchoconstriction?

A

histamines, PGs, leukotrienes

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3
Q

What induces inflammation?

A

eosinophils, leukotrienes

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4
Q

What classically treats persistent inflammation of airways and reverse bronchoconstriction?

A

Bronchodilators

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5
Q

What are two triggers of asthma?

A
  • Environmental exposures

- Genetic characterisitcs

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6
Q

What is the number one environmental cause of asthma?

A

pollen

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7
Q

What is the secondary environmental cause of asthma?

A

House dust mites (living in bedding) and their fecal droppings

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8
Q

What is the big takeaway from environmental exposures causing asthma?

A

keep your bed unmade could keep you healthier

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9
Q

What are symptoms of asthma?

A

wheezing, breathlessness, chest tightness, nighttime or early morning coughing.

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10
Q

What are “attacks triggered by?

A

inflammatory responses

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11
Q

Which receptor is important in asthma?

A

Beta receptor (B2)

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12
Q

What is the physiological effect of the B2 receptor?

A

bronchodilation

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13
Q

What drug groups exacerbate asthma?

A

Beta blockers

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14
Q

What happens during stimulation of the b2 receptor?

A

bronchodilation

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15
Q

What causes bronchodilation?

A

an increase in cAMP, which inhibits contraction of airway smooth muscle

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16
Q

Is bronchodilation a sympathetic or parasympathetic response?

A

Sympathetic

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17
Q

What directly stimulates B2 receptors?

A

B-agonist

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18
Q

What are two short acting B2 agonist?

A
  • Albuterol

- Terbutaline

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19
Q

What are two long acting B2 agonist?

A
  • Salmeterol

- Formoterol

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20
Q

What is the onset of effect for short acting?

A

immediate

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21
Q

What is the onset of effect for long acting?

A

15-20 min

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22
Q

What is duration of action for short acting?

A

4-8 hrs

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23
Q

What is the duration of action for long acting?

A

12-24 hrs

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24
Q

What is primarily used for a acute attack?

A

short acting B2 agonist

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25
Q

What has the most likelihood of ADR, inhaled or oral?

A

oral

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26
Q

Why is epinephrine no longer used for short acting?

A

it is a mixed agonist, stopped due to its effect on B2>B1>Alpha receptors. Beta agonist doesn’t have the ALPHA effect compared.

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27
Q

What are the sde effects of B2 agonists?

A

tremor (dose-limiting), restlessness, insomnia, increase HR, Hypokalemia (high doses)

28
Q

What is used for a acute asthmaticus attack?

A

low-dose B2 agonist continuous nebulization therapy

29
Q

What can be used to treat hyperkalemia?

A

beta agonist

30
Q

What is used to treat chronic/prophylaxis asthma attacks?

A

long acting (LABA) + inhaled corticosteroid

31
Q

Which drug had a black box warning in 2003?

A

Salmeterol (LABA)

32
Q

What was the problem with the Black box warning placed on salmeterol?

A

data collected for the study was done before long acting B2 agonists + inhaled steroid was standard of care.

33
Q

Why did the FDA drop the black box warning on salmeterol?

A

the study in 2018 found that when combined with a ICS it decreased the asthma related deaths.

34
Q

What FDA black box warning remains in effect?

A

LABA mono-therapy (single ingredient)

35
Q

What inhibits the release of PGs, leukotrienes?

A

Corticosteriods

36
Q

Corticosteroids up-regulates what gene?

A

Lipocortin

37
Q

Lipocrotin up regulation inhibits what?

A

Phospholipase A2 and ultimately Arachidonic acid

38
Q

Blocking what will take care of all inflammation?

A

Arachidonic acid

39
Q

What two drugs have a high-first pass rate in children?

A
  • Budesonide

- Fluticasone

40
Q

What are 5 intranasal steroids used for adults?

A
  • Beclomethasone
  • Dexamethasone
  • Flunisolide
  • Triamcinolone
  • Momestasone
41
Q

T/F Corticosteroids can be used for a acute attack?

A

NOPE-they too slow

42
Q

T/F Will get systemic results if inhaled?

A

YES- quite a bit is absorbed and other 50% is GI tract absorbed.

43
Q

What disease is associated with chronic use and high dosage of corticosteroids?

A

Oropharyngeal Candidiasis

44
Q

How can you minimize the risk for candidiasis?

A
  • rinse mouth and throat with water after use, then spit it out
  • use spacer or nebulizer w/ mouthpiece
  • pharmacological management
45
Q

What is pharmacological management for oral candidiasis?

A

Flucanozole

46
Q

What is a problem with taking flucanazole for candidiasis?

A

DDI w/ P450 enzyme 3A4, 2C9 metabolism of Warfarin drug

47
Q

Why is a spacer used?

A

allows the pt to draw in as much particle into the lung slowly

48
Q

What oral problems are seen in corticosteroid use?

A
  • dry mouth
  • increased caries
  • gingivitis
  • dysphonia (difficulty speaking)
49
Q

T/F Corticosteroids causes slow healing of cuts and bruises

A

True

50
Q

When are you likely to see the most ADR effects of Cortiocosteriods?

A

Long term use

51
Q

What are sde of corticosteroids long term effect?

A
  • increase appetite
  • hyperglycemia
  • moon face
  • increase weight lost
  • fluid retention
  • hypertension
  • Osteoporosis
  • ocular effets (glaucoma, cataracts)
52
Q

What worse thing we worry about the most with long term high dose oral corticosteroids?

A

adrenal function suppression

53
Q

If a patient is experiencing stress what should you do to dosage?

A

Increase dose 2x3 maintenance dose

54
Q

If a patient stress has passes what should you do to dosage?

A

decrease dose over several days or alternate day regimen to previous maintenance level

55
Q

What causes adrenal crisis?

A

cold turkey corticosteroid stoppage

56
Q

What is the relationship between oral budesonide and fluvoxamine?

A

fluvoaxamine is a SSRI and inhibits the CYP450 enzyme that gets rid of budesonide through first pass in the liver. This increases the F and decreases first pass rate. Accumulating this corticosteroid in the body causing iatrogenic Cushing syndrome.

57
Q

What replaced theophylline for children?

A

5-lipoxygenase inhibitor and Leukotreine Antagonist

58
Q

What drug causes 13% Headache and liver dysfunction?

A

Zileuton, Montelukast, Zafirlukast

59
Q

What class of drugs can be used with steroids to allow lower steroid dose?

A

5-Lipoxygenase inhibitor and leukotriene Antagonists

60
Q

What is often used to treat the side effects of anti-cancer drugs?

A

5-Lipoxygenase inhibitor and Leukotriene Antagonist

61
Q

What is the MOA of Theophylline?

A

Phosphodiesterase II and IV inhibitor.

62
Q

What are the side effects of Theophylline?

A

Seizures, nervousness, Tremors, DDI (erythromycin)

63
Q

Aminophylline?

A

IV Theophylline with ethylenediamine

64
Q

What patients do you have to increase the dose of Theophylline?

A

in smokers

65
Q

What patients do you have to decrease the dose of Theophylline?

A

in viral illness

Pharmacology 2 (9 decks)

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