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Pharmacology (Dale Turley) > Respiratory - Exam 4 > Flashcards

Respiratory - Exam 4 Flashcards

1
Q

Anticholinergics inhibit what type of nerve impulse?

A

parasympathetic

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2
Q

Anticholinergics work by ?

A

selectively blocking the binding of the neurotransmitter acetylcholine (ACH)

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3
Q

pneumonic for effects of anticholinergics?

A

hot as a car (increased body temp), blind as a bat (Mydriasis - dilated pupils), dry as a bone (dry eyes, mouth, decreased sweat), red as a beet (flushed face), mad as a hatter (delirium)

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4
Q

anticholinergics are divided into three categories in accordance with their ?

A

specific targets in the central and/or peripheral nervous system

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5
Q

anticholinergic three catergoies

A 
antimuscarinic ACH agents
ganglionic blockers (pre and post ganglionic of ANS)
neuromuscular blockers ( cause paralysis)
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6
Q

Anticholinergics cause and inhibit what

A

bronchodilation and inhibit nasal secretions

prevent acute bronchospasm in bronchitis, emphysema, rhinorrhea and COPD

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7
Q

Common inhaled Anticholinergics?

A

Ipratropium (Atrovent)
Tiotropium (Spiriva)
Ipratropium and albuterol combination ( Combivent)

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8
Q

what Anticholinergic do you have to watch for potential additive Anticholinergic effects
?

A

Tiotropium (Spiriva)

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9
Q

Ipratropium (Atrovent) dosage for COPD maintenance and an asthma exacerbation )mod-severe)

A

COPD - 2 puffs inhaled lid

asthma - 8 puffs inhaled q20 min prn

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10
Q

Combivent subclass?

A

Anticholinergics, Inhaled; Beta-2 Agonists : short acting inhaled

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11
Q

Three main respiratory disorders that are responsive to treatment?

A

allergic rhinitis
Asthma
Cough

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12
Q

Two main respiratory disorders that are less responsive to treatment?

A

COPD

Chronic bronchitis

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13
Q

Bronchodilators beta receptors

A

class of sympathomimetic agents which act upon the beta adrenoceptors

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14
Q

Beta adrenoreceptor agonist mimic the action of ?

A

epi and norepinephrine

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15
Q

Activation of _____ receptors induces ______ _________ )force of contraction of the heart), ____________ ______ (rate) of the cardiac mucle - leading to increased heart rate and blood pressure

A

Beta 1
Inotropic
Chronotropic output

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16
Q

secretion of _______ from the stomach (hunger hormone) - drives hunger response

A

ghrelin

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17
Q

_____ released from the kidneys (renal perfusion, increased BP)

A

Renin

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18
Q

Activation of _____ receptors causes ______ muscle relaxation in _____ __ and blood vessels and it also _________ heart rate and heart ______ ___________

A

Beta 2
smooth
lungs, GI
increased heart rate and heart muscle contraction

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19
Q

where are beta 3 receptors mainly located ? when they are activated what does it induce?

A

adipose tissue

it induces metabolism of lipids

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20
Q

what are bronchodilators also know as?

A

beta-2 receptor agonists or beta agonists

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21
Q

where are bronchodilators used?

A

they are used to treat the reversible bronchoconstriction seen in asthma

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22
Q

bronchodilators stimulate both _____ & _____ adrenergic receptors

A

beta 1 and beta 2

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23
Q

beta 2 stimulates can induce ______________ if given parenterally like inhaled or injection

A

adverse effects

tachycardia and palpitations

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24
Q

Some adverse effects of beta 2 agonists

A 
tremor
tachycardia
sweats
agitation
severe: pulmonary edema, myocardial ischemia and cardiac arrhythmia
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25
Q

ventricular arrhythmias may occur if the heart rate is greater than ___ beats/min

A

130

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26
Q

Prolonged administration or excessive dosing may result in _________ ________ due to increased serum lactic acid concentrations

A

metabolic acidosis (Tussmaul BS)

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27
Q

Why do we get increased lactic acid

A

increased glycolysis and pyruvate production

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28
Q

Patients using ___ formulations should wait - minutes between inhalations and shake the inhaler before use

A

MDI

3-5

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29
Q

Using a spacer allows for ?

A

better administration - especially in children

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30
Q

SABA’s stimulate _____ adrenergic receptors in the lung giving rise to a relaxation of bronchial smooth muscle

A

beta 2

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31
Q

clinical uses of SABA’s?

A

Acute asthma
COPD
exercise induced brochospasm

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32
Q

Examples of SABA’s

A 
Albuterol (Ventolin, Proventil)
Metaproterenol (Alupent)
Pirbuterol (Maxair)
Terbutaline (Brethren)
Levabuterol (Xopenex)
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33
Q

When are SABA’s contraindicated?

A

with preexisting arrhythmias, angina, palpitations, narrow angle glaucoma (increased IOP), or sensitivity to any component in the formulation

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34
Q

Pharmacokinetics of SABA’s?

A

gradually absorbed from bronchi in 15 min if inhaled

Rapidly absorbed from GI if ingested

Metabolized in liver and excreted in urine

HF - 2 to 3 hrs

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35
Q

Considerations when using SABA’s?

A

use of one MDI every 2 months increased risk of exacerbation

frequency of used is related to disease severity

Use more than twice a week means asthma is not controlled

EVERY PATIENT SHOULD USE A SPACE DEVICE

Can use in children under 6

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36
Q

If you are pregnant SABA’s should be used with caution because there is a risk of ?

A

fetal harm

interference w/ uterine contractility (drugs MOA)

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37
Q

Are SABA’s lactation safe?

A

YES

38
Q

Albuterol special note - strength clarification.

A

1 spray = 108 mpg albuterol sulfate equivalent to 90 mpg albuterol base

39
Q

Bronchospasm SABA dosage

A

2 puffs inhaled q4-6h prn

40
Q

Bronchospasm (exercise induced) SABA dosage?

A

2 puffs inhaled x1

start: 5-30 min before exercise

41
Q

Levalbuterol (Xopenex) subclass:

A

Beta-2 Agonists 1: (L-isomer)

Short acting Inhaled

42
Q

Levalbuterol (Xopenex) MOA?

A

selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle

43
Q

Levalbuterol (Xopenex) Metabolism?

A

GI tract, CYP450

44
Q

Levalbuterol (Xopenex) excretion?

A

urine 80-100%
feces <20%

HF: 3.3-4 hrs

45
Q

Levalbuterol (Xopenex) pregnancy and lactation?

A

preg - C
and lactation UKN
(24 vial, 3mL = 245.99$)

Generic 2013 controversy! b/c Xopenex went generic

“I like opened b/c it does not make the heart beat fast”

46
Q

LABA’s cause relaxation of bronchial, uterine and vascular ____________

A

smooth muscle

47
Q

Clinical uses of LABA’s?

A

control of reversible airway obstruction

Prevention of exercise-induced asthma

Prevention of bronchospasm in COPD

Emphysema

48
Q

LABA’s example?

A

Salmeterol (servant Diskus)
Bitolterol (Tornalate)
Formoterol (Foradil)
Fluticasone furcate ( Breo) - new combo

49
Q

When do you not use LABA’s?

A

LABA’s should not be used in an acute asthma attack

50
Q

When are LABA’s contraindicated?

A

preexisting arrhythmias, angina, palpitations, chest pain, narrow angle glaucoma or sensitivity to any component in the formulation

51
Q

you want to inhale salmeterol __ - __ min before exercise to prevent bronchospams

A

30-60 min

Max: 1 puff inhaled q12

52
Q

Salmeterol subclass:

A

beta 2 agonists

Long acting inhaled

MOA - activates beta 2 adrenoreceptors relaxing airway smooth muscle

HF 5.5 hrs

preg - C

UKN lactation

53
Q

Salmeterol meds usage?

A

> 4 y.o.

54
Q

make sure to rise your mouth after using inhaled medications cause you want to prevent_______________

A

fungal infection

55
Q

Salmeterol adverse reactions

A 
CV - palpitations, tachycardia
GI - nausea, heart burn
META - hypoglycemia
Neuro - tremor
PUL - cough, dry throat
56
Q

Salmeterol ( Servant Diskus) Conscientious considerations?

A

excessive use leads to tolerance, so evaluate risk benefit

do not consider as mono therapy - not a primary drug for asthma (make sure to add a ICS?)

Dosing is critical in children

57
Q

Xanthine derivatives ( methylated xanthines family) - affect what?

A

affect the airways but stimulate heart rate and force of contraction and cardiac arrhythmias at high concentrations

58
Q

When are Methylated xanthines used commonly?

A

treatment of in-patient COPD exacerbations when all other options have been exhausted

59
Q

Xanthine derivatives what do they do?

A

they directly relax smooth muscle in the bronchial airways and by relaxing pulmonary blood vessels

THEY ASLO INCREASE FORCE OF CONTRACTION OF DIAPHRAGMATIC MUSCLES

Positive Inotropic and Chronotropic activity ( increased heart contractility and increased rate)

60
Q

Examples of Xanthine derivatives?

A

Theophylline

Aminophylline

61
Q

What are the clinical uses of xanthine derivatives?

A

weak bronchodilators held in reserve for patients who are on maximal therapy with safer medications

IV and PO

IV = trouble but good treatment range but you get into early toxic levels faster and have side effects

62
Q

Theophylline subclass, MOA metabolism and excretion?

A

Subclass: other asthma

MOA: UKN, but increase cAMP; antagonizes adenosine receptors

Metabolism: liver, CYP450

Excretion: urine, HF - 8.2 hrs (HF altered by many concurrent illnesses)

63
Q

Theophylline MOA

A

antagonizes adenosine receptors and increases cAMP

64
Q

Theophylline Metabolism

A

aminophylline converted to theophylline active metabolites

65
Q

Theophylline asthma / COPD maintenance tx dosage?

A

300-600 mg/day PO divided qd-bid

66
Q

Xanthine derivatives toxicities are ____ related and occur near usual therapeutic dose.

A

dose

67
Q

Xanthine derivatives serious side effects can occur w/o any preceding signs of less _______ ________

A

serious toxicity

68
Q

what is required with giving Xanthine derivatives ?

A

monitoring of serum conc.

69
Q

ICS clinical uses?

A

prophylactic treatment of asthma
allergic rhinitis

steroid are adjunct treatment to asthma

70
Q

ICS examples?

A

Budesonide (Pulmicort)
Flunisolide (Aerobid)
Triamcinalone (Azmacort)

71
Q

Dosing considerations with ICS?

A

use the lowest possible dose of ICS that maintains asthma control

most effective for long term control - down regulation of receptors

“start low and go slow”

72
Q

Steroids Subclass?

A

corticosteroids, Inhaled

73
Q

Steroids MOA?

A

exact anti-inflammatory action is UKN; produces multiple glucocorticoid and mineralocorticoid effects

74
Q

Steroids metabolism?

A

liver extensively

HF 2-3 hrs

75
Q

Steroids Pregnancy and lactation?

A

B and probably safe

wow its a B! its because it promotes lung growth of the fetus so it is actually considered beneficial in pregnancy

76
Q

Intranasal steroids treatment?

A

acute allergic rhinitis and chronic rhinitis

43% allergic
23% non-allergic
34% mixed

77
Q

Examples for allergic rhinitis?

A

Triamcinalone (Nasacort)
Fluticasone (Flonase)
Beclomethasone (Beconase)
Ciclesonide (Omnaris)

78
Q

Allergic rhinitis treatment options?

A

Antihistamine - have no decongestant effects
Intranasal products
decongestants - pseudophedrine

79
Q

Clinical uses for ORAL corticosteroids?

A

Asthma - short term burst therapy
COPD
replacement therapy in adrenal insufficiency
Crohn’s disease (anti- inflammatory.)

80
Q

Oral Steroid examples?

A

Hydrocortisone (Solu-Cortef)
Prednisone ( Deltasone)
Methylprednisolone (solu-medrol)

81
Q

Oral Steroids contraindications?

A

contraindicated with serious fungal infections, viral or tubercle skin infection, hyperglycemia or DM (drives sugar through the roof with DM) 100-400 in a sec

82
Q

Hydrocortisone (solu-cortef) status asthmatics dosage?

A

300-400 mg/day IV divided q6h

83
Q

Beclomethasone dipropionate inhaled (Qvar) MOA?

A

selectively binds to cysteine leukotriene receptors (leukotriene inhibitor)

anti-inflammatory action is UKN, but it inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects

84
Q

Beclomethasone dipropionate inhaled (Qvar) class?

A

inhaled corticosteroid

85
Q

Beclomethasone dipropionate inhaled (Qvar) clinical uses?

A

asthma maintenance Tx
pre dosing based on age (chewable tablet)
Pregnancy (risk vs. benefit)

86
Q

Is a leukotriene inhibitor a steroid?

A

yes

87
Q

Montelukast (Singulair) clinical uses?

A

asthma maintenance tx
bronchospasm, exercise induced
Allergic rhinitis

88
Q

Examples of Leukotriene inhibitors ?

A

Montelukast (Singulair)

Zafirlukast (Accolate)

89
Q

Examples of Mast Cell Stabilizers?

A 
Cromolyn Inhaled (Intal)
Nedocromil (Tilade)
90
Q

Mast Cell Stabilizer MOA?

A

inhibits mast cell degranulation

91
Q

Mast Cell Stabilizers clinical uses?

A

Asthma maint. tx

Asthma, exercise induced

92
Q

Mast Cell Stabilizers are pregnancy and lactation safe.

T or F?

A

True

Pharmacology (Dale Turley) (31 decks)

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