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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
ventricular arrhythmias may occur if the heart rate is greater than ___ beats/min
130
26
Prolonged administration or excessive dosing may result in _________ ________ due to increased serum lactic acid concentrations
metabolic acidosis (Tussmaul BS)
27
Why do we get increased lactic acid
increased glycolysis and pyruvate production
28
Patients using ___ formulations should wait _-_ minutes between inhalations and shake the inhaler before use
MDI | 3-5
29
Using a spacer allows for ?
better administration - especially in children
30
SABA's stimulate _____ adrenergic receptors in the lung giving rise to a relaxation of bronchial smooth muscle
beta 2
31
clinical uses of SABA's?
Acute asthma COPD exercise induced brochospasm
32
Examples of SABA's
``` Albuterol (Ventolin, Proventil) Metaproterenol (Alupent) Pirbuterol (Maxair) Terbutaline (Brethren) Levabuterol (Xopenex) ```
33
When are SABA's contraindicated?
with preexisting arrhythmias, angina, palpitations, narrow angle glaucoma (increased IOP), or sensitivity to any component in the formulation
34
Pharmacokinetics of SABA's?
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
35
Considerations when using SABA's?
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
36
If you are pregnant SABA's should be used with caution because there is a risk of ?
fetal harm | interference w/ uterine contractility (drugs MOA)
37
Are SABA's lactation safe?
YES
38
Albuterol special note - strength clarification.
1 spray = 108 mpg albuterol sulfate equivalent to 90 mpg albuterol base
39
Bronchospasm SABA dosage
2 puffs inhaled q4-6h prn
40
Bronchospasm (exercise induced) SABA dosage?
2 puffs inhaled x1 | start: 5-30 min before exercise
41
Levalbuterol (Xopenex) subclass:
Beta-2 Agonists 1: (L-isomer) | Short acting Inhaled
42
Levalbuterol (Xopenex) MOA?
selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle
43
Levalbuterol (Xopenex) Metabolism?
GI tract, CYP450
44
Levalbuterol (Xopenex) excretion?
urine 80-100% feces <20% HF: 3.3-4 hrs
45
Levalbuterol (Xopenex) pregnancy and lactation?
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
LABA's cause relaxation of bronchial, uterine and vascular ____________
smooth muscle
47
Clinical uses of LABA's?
control of reversible airway obstruction Prevention of exercise-induced asthma Prevention of bronchospasm in COPD Emphysema
48
LABA's example?
Salmeterol (servant Diskus) Bitolterol (Tornalate) Formoterol (Foradil) Fluticasone furcate ( Breo) - new combo
49
When do you not use LABA's?
LABA's should not be used in an acute asthma attack
50
When are LABA's contraindicated?
preexisting arrhythmias, angina, palpitations, chest pain, narrow angle glaucoma or sensitivity to any component in the formulation
51
you want to inhale salmeterol __ - __ min before exercise to prevent bronchospams
30-60 min Max: 1 puff inhaled q12
52
Salmeterol subclass:
beta 2 agonists Long acting inhaled MOA - activates beta 2 adrenoreceptors relaxing airway smooth muscle HF 5.5 hrs preg - C UKN lactation
53
Salmeterol meds usage?
> 4 y.o.
54
make sure to rise your mouth after using inhaled medications cause you want to prevent_______________
fungal infection
55
Salmeterol adverse reactions
``` CV - palpitations, tachycardia GI - nausea, heart burn META - hypoglycemia Neuro - tremor PUL - cough, dry throat ```
56
Salmeterol ( Servant Diskus) Conscientious considerations?
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
Xanthine derivatives ( methylated xanthines family) - affect what?
affect the airways but stimulate heart rate and force of contraction and cardiac arrhythmias at high concentrations
58
When are Methylated xanthines used commonly?
treatment of in-patient COPD exacerbations when all other options have been exhausted
59
Xanthine derivatives what do they do?
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
Examples of Xanthine derivatives?
Theophylline | Aminophylline
61
What are the clinical uses of xanthine derivatives?
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
Theophylline subclass, MOA metabolism and excretion?
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
Theophylline MOA
antagonizes adenosine receptors and increases cAMP
64
Theophylline Metabolism
aminophylline converted to theophylline active metabolites
65
Theophylline asthma / COPD maintenance tx dosage?
300-600 mg/day PO divided qd-bid
66
Xanthine derivatives toxicities are ____ related and occur near usual therapeutic dose.
dose
67
Xanthine derivatives serious side effects can occur w/o any preceding signs of less _______ ________
serious toxicity
68
what is required with giving Xanthine derivatives ?
monitoring of serum conc.
69
ICS clinical uses?
prophylactic treatment of asthma allergic rhinitis steroid are adjunct treatment to asthma
70
ICS examples?
Budesonide (Pulmicort) Flunisolide (Aerobid) Triamcinalone (Azmacort)
71
Dosing considerations with ICS?
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
Steroids Subclass?
corticosteroids, Inhaled
73
Steroids MOA?
exact anti-inflammatory action is UKN; produces multiple glucocorticoid and mineralocorticoid effects
74
Steroids metabolism?
liver extensively HF 2-3 hrs
75
Steroids Pregnancy and lactation?
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
Intranasal steroids treatment?
acute allergic rhinitis and chronic rhinitis 43% allergic 23% non-allergic 34% mixed
77
Examples for allergic rhinitis?
Triamcinalone (Nasacort) Fluticasone (Flonase) Beclomethasone (Beconase) Ciclesonide (Omnaris)
78
Allergic rhinitis treatment options?
Antihistamine - have no decongestant effects Intranasal products decongestants - pseudophedrine
79
Clinical uses for ORAL corticosteroids?
Asthma - short term burst therapy COPD replacement therapy in adrenal insufficiency Crohn's disease (anti- inflammatory.)
80
Oral Steroid examples?
Hydrocortisone (Solu-Cortef) Prednisone ( Deltasone) Methylprednisolone (solu-medrol)
81
Oral Steroids contraindications?
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
Hydrocortisone (solu-cortef) status asthmatics dosage?
300-400 mg/day IV divided q6h
83
Beclomethasone dipropionate inhaled (Qvar) MOA?
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
Beclomethasone dipropionate inhaled (Qvar) class?
inhaled corticosteroid
85
Beclomethasone dipropionate inhaled (Qvar) clinical uses?
asthma maintenance Tx pre dosing based on age (chewable tablet) Pregnancy (risk vs. benefit)
86
Is a leukotriene inhibitor a steroid?
yes
87
Montelukast (Singulair) clinical uses?
asthma maintenance tx bronchospasm, exercise induced Allergic rhinitis
88
Examples of Leukotriene inhibitors ?
Montelukast (Singulair) | Zafirlukast (Accolate)
89
Examples of Mast Cell Stabilizers?
``` Cromolyn Inhaled (Intal) Nedocromil (Tilade) ```
90
Mast Cell Stabilizer MOA?
inhibits mast cell degranulation
91
Mast Cell Stabilizers clinical uses?
Asthma maint. tx | Asthma, exercise induced
92
Mast Cell Stabilizers are pregnancy and lactation safe. T or F?
True

Pharmacology (Dale Turley) (31 decks)

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