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Pharmacology > Respiratory- Exam 2 > Flashcards

Respiratory- Exam 2 Flashcards

1
Q

2 Medications utilized for Asthma

A

Anti-inflammatory medications and Bronchodillation medications

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2
Q

What is FEV1

A

An individuals proportion of vital capacity that they are able to expire in the 1st second of forced expiration / full forced vital capacity

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3
Q

Normal healthy adults FEV

A

70-85%

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4
Q

How is Gold Criteria rated for COPD Patients

A 
Gold 1 (Mild) -Gold IV (Very severe)
FEV1 greater     Less than 30% of 
than or equal    predicted normal 
to 80% of           value.
predicted
normal
value.
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5
Q

Two main pharmacological classes to treat asthma and COPD

A

Anti-inflammatory agents (Glucocorticoids) and Bronchodilators (Beta 2-agonists)

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6
Q

Generally anti-inflammatory agents are on what type of treatment regimen

A

Fixed schedule typically for chronic asthma and stable COPD

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7
Q

Typically bronchodilators will be administered on what type of treatment regimen.

A

Fixed or as needed for acute attacks

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8
Q

What are 3 advantage of administering anti-asthma drugs via inhalation route

A
  1. Delivery is directly to site of action
  2. Systemic effects on other body organs and sites are generally minimized
  3. Provides rapid relief of acute attacks
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9
Q

Dosage of MRI, and rule for administration as well as patient criteria

A

1 or 2 inhalations
Allow one minute BETWEEN inhalations
Takes hand breath coordination by the patient
Can allow to attach a spacer for the non-coordinated patient (Drug will just chill in the chamber and you breathe normally)

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10
Q

Advantage of MDI with Spacer in terms of delivery of medication

A

Utilizing a spacer will double the medication delivery to lungs. This can help with pediatric patients as well as older adults that just don’t have the coordination available for a MDI alone

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11
Q

Respimat

Delivery system, particle size, advantage, is there a propellant utilized?

A

Delivered through a fine mist with no propellant like the MDI, has extremely small particle size (Better delivery to lungs) and less drug is deposited in the mouth/oropharynx

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12
Q

DPI System

Form of drug in delivery, how to administer, Advantage

A

Dry-Powder Inhalers
Delivered as dry micronized powder directly to the lungs, breath activated so no coordination involved.
Same advantages as Respimat (Less drug deposited in oropharynx and more drug delivered to lungs compared to MDI)
Cant use a spacer for this

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13
Q

What is a Nebuilzer

A

Machine requires no coordinated effort to administer inhaled medication to- generally used with pediatric patient. Converts the drug solution to a fine mist that is inhaled though a hose/mask or mouthpiece. Less drug is deposited in the oropharynx and more drug is delivered to the lungs

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14
Q

Advantages of Nebulizer

A
  1. No coordination
  2. All sorts of attachments for less cooperative patients
  3. Can administer O2 and med simultaneous for hypoxic patient!
    Fun fact- Some meds are only able to be administered through a nebulizer
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15
Q

Disadvantages of Nebulizer

A
  1. Longer delivery for a dose
  2. Some units require power source
  3. Some units require compressed oxygen or air
  4. If not properly cleaned then higher risk of aerosolization of pathogens.
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16
Q

Beclomethasone, other name and type of drug

A

QVAR . Inhaled Glucocorticoid

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17
Q

Use of Beclomethasone

A

Maintenance treatment of asthma and long term control of COPD

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18
Q

MOA of Beclomethasone (3)

A
  1. Inhibits inflammatory cells (Eosinophils and Leukocytes)
  2. Inhibits Release of inflammatory mediators (Leukotrienes, histamines, prostaglandins)
  3. Decreases Edema of airway mucosa
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19
Q

Common side Effects of Beclomethasone

A

Headache, dysphonia (abnormal voice), Pharyngitis, oral candidiasis (thrush)

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20
Q

Serious adverse effects of Beclomethasone- a Glucocorticoid

A

Adrenal suppression (Possible adrenal crisis), Bronchospasm, Catarct, Glaucoma

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21
Q

Pre Assessment for Beclomethasone

A

Assess PFTs, check for growth in child to monitor for any stunting, and check for any active infection

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22
Q

MAR Beclomethasone (1)

A

Desmopressin- this treats Diabetes Insepidus, could cause severe hyponatremia

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23
Q

PMH- 3 Hard nos of Beclomethasone

A

Immunosuppression of any kind, Bone mineral density issues, Ocular disease

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24
Q

Administering Beclomethasone

A

Administer the bronchodilator first and allow 5 minutes to elapse before administering this steroid. This is not for an acute attack!

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25
Q

What can be done while taking Baclomethasone to minimize adverse effects

A

Mouth rinse and because of risk for adrenal suppression do not discontinue this drug randomly, tapering and start low and slow

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26
Q

Prednisone MOA (Predator gets in the zone)

A

The predator prednisone gets in the zone and corners leukocytes, not allowing them to perform their duties as well as reversing leakiness of capillary permeability

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27
Q

Prednisone Usage

A

Used for asthma when symptoms cannot be controlled by inhaled medications alone
Also prescribed for COPD exacerbations

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28
Q

A few common side effects of Prednisone (Any glucocorticoid medication and 1 unique)

A

Adrenal suppression, growth suppression, Possible Hyperglycemia!

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29
Q

Prednisone Pre-administration

A

BP (can cause elevated BP), Blood glucose (can cause hyperglycemia), growth chart for children, any current infection

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30
Q

MAR Prednisone- Multiple drug interactions and 1 hard no drug

A

Desmopressin (HARD NO), Nsaids, anti-diabetic agents, vaccinations, antacids

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31
Q

Prednisone is administered in _____ and given with _____.

A

Given in bursts (40-60mg/day x3 to 10 days. Taken with food or milk to decrease GI distress

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32
Q

Hard nos in PMH for Prednisone

A

GI disease, ocular disease, renal disease, hepatic disease

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33
Q

Eval and Intervention of Prednisone (typical of glucocorticoids)

A

Minimize possible bone loss with calcium and vitamin D intake
Don’t discontinue randomly
Monitor for adrenocortical insufficiency (fatigue, muscle weakness, loss of appetite, hypotension)

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34
Q

Zafirlukast brand name

A

Accolate

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35
Q

Accolate MOA

A

Antagonizes leukotienes (which mediate airway edema, smooth muscle constriction, altered cellular activity)

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36
Q

Zafirlukast Serious Hard no

A

Associated with causing depression (Recent finding)

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37
Q

Interaction of Accolate

A

Will inhibit isoenzymes of CYP450- suppressing metabolism of other drugs causing certain drug levels like theophylline and warfarin to elevate or remain in system longer

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38
Q

Accolate is a ____ line therapy and administered via what route

A

Second and oral

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39
Q

What is Cromolyn

A

A mast cell stabilizer, preventing release of histamine

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40
Q

Why would someone be prescribed Cromolyn

A

Alternate therapy if the glucocorticoids are causing issues

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41
Q

Cromolyn is prescribed for

A

Chronic asthma-mild, persistent, seasonal allergies and exercise induced asthma

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42
Q

Adverse effects of Cromolyn

A

Throat irritation, bad taste, coughing, wheezing

All adverse local effects directly correlate to route adminsitered

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43
Q

Phosphodiesterase-4 Inhibitors (PDE)

A

Roflumilast (Daliresp)

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44
Q

Use of Daliresp

A

Severe COPD patients, with history of chronic bronchitis to treat risk of exacerbations

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45
Q

MOA of Daliresp

A

Selective inhibitor of PDE4- AN enzyme in lung tissue that elevates cAMP in lung tissue but reduces neutrophils and eosinophils in the lungs.

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46
Q

Serious side effects of Daliresp

A

Suicidal thoughts and angioedema

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47
Q

Locations of Beta-2 Adrenergic Receptors

A

Lungs- Bronchial dilation
Uterus- Relaxation of uterine smooth muscle
Arterioles of heart, lungs, and skeletal muscles- vasodilation
Liver- Promote glycogenolysis (glycogen breaking down to glucose)
Muscle- promote glycogenolysis and enhance contraction

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48
Q

Albuterol Use

A

Short acting Beta2 agonist used as quick relief agent for acute bronchospasm and for prevention of exercise induced bronchospasm

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49
Q

MOA of Alubterol

A

Stimulate beta-2 adrenergic receptors in the smooth muscle of bronchi and bronchioles- promoting bronchodilation. Limited role in suppressing histamine release

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50
Q

Common side effects of albuterol

A

nervousness, restlessness, tremor, insomnia

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51
Q

Serious side effects of SABA

A

Angina, arrhythmias, HTN, paradoxical (Intitally cause) bronchospasm

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52
Q

Administering Albuterol considerations

A

Trigger factors, classification of control in how often to use, Caffeine use (can increase risk of adverse effects)

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53
Q

Utilizing Albuterol too much can cause what

A

Tolerance and paradoxical bronchospasms

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54
Q

MAR for Albuterol

A

Beta blockers, thyroid meds, theophylline (Bronchodilator)

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55
Q

What to be mindful of if patient starts albuterol and prescribed MAOI

A

Could cause hypertensive crisis

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56
Q

Hard nos of albuterol

A

Hard nos- Use of system beta agonist with DM, hyperthyroidism, Hypertension
Mindful of- Cardiac disease

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57
Q

Albuterol teaching on administration

A

Oral- inhaled, need a minute between inhalations, use before other inhalants

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58
Q

Ongoing evals and interventions of albuterol

A

monitor and record PFTs, monitor frequency of use to prevent serious side effects

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59
Q

Names for LABAs

A

Long Acting Beta 2 Agonists- Salmeterol (Servent diskus)

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60
Q

Use of Salmeterol

A

Controller of treatment of asthma to prevent bronchospasm and treat exercise induced asthma

61
Q

Salmeterol MOA

A

Provides accumulation of cAMP at beta2-adrenergic receptors, bronchial smooth muscle relaxation and mediators for immediate hypersensitivity is inhibited

62
Q

Are LABAs a first choice controlled med for treatment

A

No- glucocorticoids are the first choice med

63
Q

Can LABAs be taken in conjunction with SABA

A

Yes

64
Q

Severe adverse of LABA, one common adverse

A

Severe- Prolonged QT interval, asthma-related death when used as monotherapy
Common- headache

65
Q

What is Xanthine

A

Theophylline

66
Q

Use of Xanthene-Theophylline

A

Second line agent for long term control of reversible airway obstruction caused by asthma or COPD

67
Q

MOA of theophylline

A

Relax smooth muscles of bronchi by blocking receptors for adenosine

68
Q

Serious side effects of Theophylline

A

Narrow therapeutic range- toxicity issues

Afib, tachy, sezures, toxicity

69
Q

Precautions and Interactions of Theophylline

A

Cardiac arrhythmias, heart failure pxs, liver or kidney dysfunction, has multiple drug to drug interactions including caffeine

70
Q

Acetlycholine significance

A

Prominent parasympathetic neurotransmitter in the airway. Drugs binding at muscarinic receptor where ACTH acts creates a block that prevents bronchospasm from taking place.

71
Q

Ipratropium

A

Atrovent

72
Q

Theophyllne Onset of action and Route

A

Rapid and PO, PO-ER, IV

73
Q

Ipratropium onset of action and route

A

1-3 minutesm inhaled or intranasal

74
Q

MOA of Ipratropium

A

It is the primary anti-cholinergic and blocks the muscarinic receptors in the bronchi, preventing that spasm from occuring

75
Q

Use of Ipratropium

A

Maintenance therapy of reversible airway obstruction due to COPD (chronic bronchitis and emphysema) off label use for asthma

76
Q

Common adverse effects of Atrovent or Ipratropium

A

Dry mouth and irritation of pharynx. Raised intraocular pressure

77
Q

Contraindication of administration of Ipratropium

A

Do not administer during acute bronchospasm

78
Q

Precautions for Ipratropium

A

Due to anti-cholinergic effects want to be cautious with any patients who have some type of obstruction
Patients with prostatic hyperplasia, glaucoma, urinary retention

79
Q

LAMAs

A

Long Acting Antimuscarinic Antagonists

80
Q

Tiotropium brand name and what it is

A

Spiriva and LAMA

81
Q

Can I take LAMA and Ipratropium

A

NO

82
Q

MOA of LAMA- Tiotropium (spiriva)

A

Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways

83
Q

Use of Tiotropium (Spiriva)

A

Maintenance therapy of bronchoconstriction associated with chronic bronchitis and emphysema

84
Q

Serious side effects of LAMA

A

Open angle glaucoma, urinary retention, bowel obstruction, immediate hypersensitivity reaction

85
Q

Patient education for Spiriva

A

Any signs of angioedema (swelling of lips, tongue or throat) call health care professional, any glaucoma signs (eye pain blurred vision)
Repeat inhalation 2-3 times to ensure drug is inhaled- you should hear and audible flutter or rattle

86
Q

Taking Long acting beta-agonist and corticosteroid risk

A

risk is minimal

87
Q

Asthma treatment goal

A

Reducing use of SABA 2 days/week or less and preventing recurrent exacerbations

88
Q

Paradigm shift in asthma therapies

A

Not just single entity, complex biological network of distinct and intersecting inflammatory pathways

  • Distinct mechanistic pathways (endotypes- how to treat)
  • Variable clinical presentations (phenotypes)
89
Q

Intranasal Glucocorticoids MOA

A

Acts on cells and mediators of inflammation- most effective drug for seasonal allergies

90
Q

Use of intranasal glucocorticoids

A

Prevention and treatment of seasonal and perennial rhinitis

91
Q

Common side effect of intranasal glucocorticoids

A

Drying of nasal mucosa, sore throat, epistaxis and headache

92
Q

Serious side effects of Intranasal glucocorticoids

A

Adrenal insufficiency, decreased bone density, cataract, glaucoma

93
Q

Beware using Intransal glucocorticoids in patients with

A

Adrenal suppression, delayed wound healing, ocular disease

94
Q

Anti-histamines are

A

An antagonist to H1 receptor- prevent histamine from binding on receptor and acting on target tissues

95
Q

What is other name for Dipenhydramine

A

Benadryl

96
Q

Benadryl is a ____ generation _____ receptor antagonist

A

First-generation, H1

97
Q

Onset of action of Benadryl and route

A
  • 60 minutes, 30 minutes and rapid

- PO, IM, IV

98
Q

MOA of Benadryl

A

Antagonizes the effects on histamines at H1- receptor sites

99
Q

What is Benadryl used for

A

Hypersensitivity reactions (allergic rhinitis, conjunctivitis, dermatitis) motion sickness, insomnia

100
Q

Common Side effects of Benadryl

A

Drowsiness, dry mouth, confusion in older adults, urinary retention, constipation, blurred vision
Anti-cholinergic effects

101
Q

Because Benadryl is a an anti cholinergic- what are the precautions for administering this medication to a patient

A

Any type of obstruction will be worsened

Narrow angle glaucoma, prostatic hyperplasia, peptic ulcer, bladder neck obstruction

102
Q

What is the second generation H1 receptor Antagonist

A

Fexofenadine (allegra)

103
Q

Benadryl cannot cross the blood brain barrier, true or false?

A

False, it can

104
Q

Onset of action and route of Allegra

A

Within 1 hour and PO

105
Q

MOA of Allegra

A

Antagonizes the effects of histamine at peripheral histamine 1 (H1) receptors

106
Q

Use of Allegra

A

Relief for symptoms of seasonal allergies

107
Q

Compare Allegra to Benadryl

A

Histamine cannot cross the BBB so less sedative effect overall

108
Q

Common side effects of Allegra

A

Headache , dizziness, drowsiness, stomachache

109
Q

Precaution for patients taking Allegra

A

Impaired renal function

110
Q

Interactions of Allegra

A

Taking mag and aluminum containing antacids could decrease absorption and consequently decrease effective of Allegra

111
Q

What is MOA of Intranasal Cromolyn Sodium

A

Suppresses release of histamine and other inflammatory mediators from mast cells

112
Q

Use of intranasal Cromolyn Sodium

A

Allergic rhinitis prophylaxis

113
Q

Adverse effects of Cromolyn Sodium

A

Local effects, sneezing, stinging, headache, hoarseness

114
Q

Cromolyn Sodium is the _____ in treatment compared to _____, and make sure you do not use this medication to treat a sinus infection, asthma or upper respiratory infection

A

Second, glucocorticoids

115
Q

What is Pseudoephedrine

A

Sudafed- A topical decongestant

116
Q

Onset of action and Route of Sudafed

A

30 minutes and given PO- well absorbed- lasts longer

117
Q

MOA of Sudafed

A

Stimulates alpha and beta adrenergic receptors. Releases norepinephrine. Produces vasoconstriction in nasal mucous membranes

118
Q

Use of Sudafed

A

Temporary relief of symptoms associated with acute viral upper respiratory tract infection, will only reduce stuffiness in patients allergic rhinitis- will have no effect on sneezing, itching, or other allergic symptoms because it has no effect on inflammatory mediators.

119
Q

Serious side affects of Sudafed

A

Atrial fibrillation, MI, Premature ventricular contractions

120
Q

Do not give Sudafed to patients who have…..

A

Severe High BP -stimulating same receptors of BP and cardiac output
MAOI patients dont give
Severe Coronary artery disease
narrow angle glaucoma

121
Q

How long to take sudafed for ideally

A

Shouldnt use longer than a week, it relieves the symptoms, it is not a cure for the infection

122
Q

Pseudoephedrine: Legal requirements

A
  • Sale and purchase restricted to combat meth epidemic
  • Limited to behind the counter sales,
  • Require photo id and limit to amount purchased
  • Store will maintain record of purchaser for 2 years
  • Many products reformulated with alternate- Sudafed PE
123
Q

What is Oxymetazoline

A

Afrin- Topical- common cold relief

124
Q

Afrin MOA

A

Acts directly on alpha-2 receptors to produce vasoconstriction

125
Q

How long to use Afrin

A

3 days

126
Q

Side effects of Afrin

A

Rebound congestion (rhinitis medicamentosa) - discontinue use of the drug

127
Q

Drugs for Cough include (3)

A

Dextromethorphan, Guaifenesin, Acetlycysteine

128
Q

Dextromethorphan brand name

A

Delsym

129
Q

Onset of action and route of Delsym

A

Onset of action is 15-30 minutes, Given PO (liquid, lozeneges, syrup)

130
Q

MOA of Delsym

A

Depresses the cough center in the medulla

131
Q

Use of Delsym

A

Temp relief from dry, hacking, nonproductive cough that interferes with rest and sleep

132
Q

Contraindication drugs for Delsym

A

Patients taking MAOIs or SSRIs

133
Q

Should diabetic patients be mindful of Delsym

A

Yes, some contain sucrose can interfere with glucose levels

134
Q

People abuse Delsym how

A

Increased dosage causes hallucinogens and psych issues, possible liver damage (also interacts with acetaminophen).
Increased dose decreases O2 delivered to brain causing hypoxia
CAN RESULT IN DEATH FROM ABUSE

135
Q

Opiod Antitussive

A

Codeine

136
Q

MOA of Codeine

A

Depresses the medullary cough reflex in CNS

137
Q

Codeine used for

A

Cough suppression, Hydrocodone also used but it is more potent and can cause respiratory depression (increased risk making it not the go to)

138
Q

What is brand name for Guaifenesin

A

Robitussin or Mucinex

139
Q

Onset of action and route of Mucinex

A

30 minutes and given PO, PE-ER

140
Q

MOA of Mucinex

A

Reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid

141
Q

Specific use of Guaifenesin

A

Cough associated with viral Upper respiratory infection

142
Q

Do not give sudafed or mucinex to children less than

A

4 years old

143
Q

Precaution patients Mucinex

A
  • Cough lasting 1 week or longer accompanied by fever, rash, headache
  • Diabetic patients- some contain sugar
  • OTC and cold products containing this med should be avoided in children 4 years and younger
144
Q

Caffeine is sometimes added to certain medications to offset what

A

sedative effects

145
Q

Antihistamine medications can cause what

A

create environment conducive for bacteria to proliferate

146
Q

How long should cold take to subside

A

7-10 days, any longer and go see PCP

147
Q

Common symptoms of upper respiratory tract infection- viral

A

Rhinorrhea (runny nose), nasal congestion, cough, sneezing sore throat, hoarseness, malaise, and myalgia

148
Q

Herbal remedies to aid in cold

A

Vitamin C in adults does show effectiveness but less supportive research in children.
Zinc can aid in symptom relief

Pharmacology (6 decks)

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