Respiratory Drugs

Question 1

What is the major difference between asthma and chronic COPD?

Answer 1

Airflow limitation is:
asthma- reversible
COPD- irreversible

Question 2

What induces bronchoconstriction?

Answer 2

histamines, PGs, leukotrienes

Question 3

What induces inflammation?

Answer 3

eosinophils, leukotrienes

Question 4

What classically treats persistent inflammation of airways and reverse bronchoconstriction?

Answer 4

Bronchodilators

Question 5

What are two triggers of asthma?

Answer 5

• Environmental exposures

- Genetic characterisitcs

Question 6

What is the number one environmental cause of asthma?

Answer 6

pollen

Question 7

What is the secondary environmental cause of asthma?

Answer 7

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

Question 8

What is the big takeaway from environmental exposures causing asthma?

Answer 8

keep your bed unmade could keep you healthier

Question 9

What are symptoms of asthma?

Answer 9

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

Question 10

What are “attacks triggered by?

Answer 10

inflammatory responses

Question 11

Which receptor is important in asthma?

Answer 11

Beta receptor (B2)

Question 12

What is the physiological effect of the B2 receptor?

Answer 12

bronchodilation

Question 13

What drug groups exacerbate asthma?

Answer 13

Beta blockers

Question 14

What happens during stimulation of the b2 receptor?

Answer 14

bronchodilation

Question 15

What causes bronchodilation?

Answer 15

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

Question 16

Is bronchodilation a sympathetic or parasympathetic response?

Answer 16

Sympathetic

Question 17

What directly stimulates B2 receptors?

Answer 17

B-agonist

Question 18

What are two short acting B2 agonist?

Answer 18

• Albuterol

- Terbutaline

Question 19

What are two long acting B2 agonist?

Answer 19

• Salmeterol

- Formoterol

Question 20

What is the onset of effect for short acting?

Answer 20

immediate

Question 21

What is the onset of effect for long acting?

Answer 21

15-20 min

Question 22

What is duration of action for short acting?

Answer 22

4-8 hrs

Question 23

What is the duration of action for long acting?

Answer 23

12-24 hrs

Question 24

What is primarily used for a acute attack?

Answer 24

short acting B2 agonist

Question 25

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

Answer 25

oral

Question 26

Why is epinephrine no longer used for short acting?

Answer 26

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

Question 27

What are the sde effects of B2 agonists?

Answer 27

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

Question 28

What is used for a acute asthmaticus attack?

Answer 28

low-dose B2 agonist continuous nebulization therapy

Question 29

What can be used to treat hyperkalemia?

Answer 29

beta agonist

Question 30

What is used to treat chronic/prophylaxis asthma attacks?

Answer 30

long acting (LABA) + inhaled corticosteroid

Question 31

Which drug had a black box warning in 2003?

Answer 31

Salmeterol (LABA)

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

What FDA black box warning remains in effect?

Answer 34

LABA mono-therapy (single ingredient)

Question 35

What inhibits the release of PGs, leukotrienes?

Answer 35

Corticosteriods

Question 36

Corticosteroids up-regulates what gene?

Answer 36

Lipocortin

Question 37

Lipocrotin up regulation inhibits what?

Answer 37

Phospholipase A2 and ultimately Arachidonic acid

Question 38

Blocking what will take care of all inflammation?

Answer 38

Arachidonic acid

Question 39

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

Answer 39

- Budesonide | - Fluticasone

Question 40

What are 5 intranasal steroids used for adults?

Answer 40

- Beclomethasone - Dexamethasone - Flunisolide - Triamcinolone - Momestasone

Question 41

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

Answer 41

NOPE-they too slow

Question 42

T/F Will get systemic results if inhaled?

Answer 42

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

Question 43

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

Answer 43

Oropharyngeal Candidiasis

Question 44

How can you minimize the risk for candidiasis?

Answer 44

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

Question 45

What is pharmacological management for oral candidiasis?

Answer 45

Flucanozole

Question 46

What is a problem with taking flucanazole for candidiasis?

Answer 46

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

Question 47

Why is a spacer used?

Answer 47

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

Question 48

What oral problems are seen in corticosteroid use?

Answer 48

- dry mouth - increased caries - gingivitis - dysphonia (difficulty speaking)

Question 49

T/F Corticosteroids causes slow healing of cuts and bruises

Answer 49

True

Question 50

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

Answer 50

Long term use

Question 51

What are sde of corticosteroids long term effect?

Answer 51

- increase appetite - hyperglycemia - moon face - increase weight lost - fluid retention - hypertension - Osteoporosis - ocular effets (glaucoma, cataracts)

Question 52

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

Answer 52

adrenal function suppression

Question 53

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

Answer 53

Increase dose 2x3 maintenance dose

Question 54

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

Answer 54

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

Question 55

What causes adrenal crisis?

Answer 55

cold turkey corticosteroid stoppage

Question 56

What is the relationship between oral budesonide and fluvoxamine?

Answer 56

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.

Question 57

What replaced theophylline for children?

Answer 57

5-lipoxygenase inhibitor and Leukotreine Antagonist

Question 58

What drug causes 13% Headache and liver dysfunction?

Answer 58

Zileuton, Montelukast, Zafirlukast

Question 59

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

Answer 59

5-Lipoxygenase inhibitor and leukotriene Antagonists

Question 60

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

Answer 60

5-Lipoxygenase inhibitor and Leukotriene Antagonist

Question 61

What is the MOA of Theophylline?

Answer 61

Phosphodiesterase II and IV inhibitor.

Question 62

What are the side effects of Theophylline?

Answer 62

Seizures, nervousness, Tremors, DDI (erythromycin)

Question 63

Aminophylline?

Answer 63

IV Theophylline with ethylenediamine

Question 64

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

Answer 64

in smokers

Question 65

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

Answer 65

in viral illness