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Adv Pharm Faculty Page (Smoller/Bose) > Respiratory/HEENT > Flashcards

Respiratory/HEENT Flashcards

1
Q

In what drug class does Albuterol (ProAir) belong?

A

SABA - short-acting beta-2 receptor agonist

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2
Q

Albuterol (SABAs) Pharmacodynamics

A
  • acts on the smooth muscle of the bronchi to reverse bronchospasm by activating beta 2 receptors in the lungs increasing vital capacity and airflow
  • also has some effect on beta 1 receptors in the heart - causes side effects tachycardia, nervousness, etc.
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3
Q

Albuterol cautions/contraindications

A
  • avoid in arrhythmias that cause tachycardia and pheochromocytoma (adrenal tumor- increased sympathetic response)
  • can cause HTN
  • caution in pts with CV disease (CHF, HTN), diabetes, glaucoma, and hyperthyroidism
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4
Q

Albuterol/SABA ADRs (usually transient)

A

tachycardia, dizziness, palpitations, tremors, nervousness, headache - ** due to effect on beta 1 receptors in the heart**

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5
Q

Examples of other SABAs

A
  • terbutaline (Brethine, Brethaire)
  • metaproterenol (Alupent)
  • pirbuterol (Maxair)
  • levalbuterol (Xopenex)
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6
Q

Three drug classes used for asthma

A

SABA - short-acting Beta 2 receptor antagonists

LABA - long-acting Beta 2 receptor antagonists **not as monotherapy in asthma**

ICS - inhaled corticosteroids

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7
Q

Salmeterol (Serevent) [LABA] MOA

A
  • relaxes bronchial smooth muscle by selective action on beta 2 receptors

3 advantanges:

  • Quick onset of action
  • Long MOA- last longer
  • More selective to Beta-2 receptors which decreases the prevalence of side effects
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8
Q

Salmeterol (Serevent) drug class

A

Long-acting beta 2 receptor agonist (LABA)

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9
Q

Other examples of LABA medications

A
  • formoterol (Foradil) - taken Q 12 hrs
  • vilanterol (Breo Ellipta) - Ultra long acting - taken QD “Very easy to take”
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10
Q

LABA cautions/contraindications

A
  • NOT to be used as mono-therapy in patients with asthma (Serevent and Foradil) - causes downregulation of beta-2 receptors if used alone so in emergencies, short-acting beta-2 receptor antagonist medications (Albuterol) will not work - leads to increase in asthma intubations and death
  • caution in pts with cardiovascular dz, diabetes, hyperthyroidism, glaucoma
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11
Q

What drug class contains Theophylline?

A

Xanthine dervatives

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12
Q

Theophylline/xanthine dervatives MOA

A
  • general bronchodilator - leads to relaxation of smooth muscle
  • sympathamometic - works on the sympathetic nervous system: CNS stim., CV effects, increased fight/flight - has similar chemical structure to caffeine
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13
Q

Theophylline/Xanthine derivatives cautions/ contraindications

A
  • monitor closely in cardiovascular disease
  • avoid in pts w/ hx of seizures, peptic ulcer dz
  • educate patient to avoid smoking and caffeine
  • educate pt on the signs of toxicity
  • educate pt to maintain a steady diet
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14
Q

Ipratropium bromide (Atrovent) / SAMA MOA

A

selectively blocks M3 receptors in the lungs causing bronchodilation - muscarinic receptor antagonist

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15
Q

SAMA “-tropium” indictations and MOA

A

Mostly used for COPD - may be used in asthma exacerbation with albuterol (DuoNeb)

  • selectively block the muscarinic 3 receptors in bronchial smooth muscle causing bronchodilation
  • also have anticholinergic effects because muscarinic receptors are cholinergic receptors

Ipratropium bromide (Atrovent) = Immediate effects

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16
Q

Atrovent/Ipratropium bromide cautions/ contraindications

A
  • not used alone for acute bronchospasm
  • due to anticholinergic effects: avoid in pts with urinary retention, BPH, and closed-angle glaucoma

(Anticholinergic effects: patients can’t see, pee, spit, shit, or think)

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17
Q

Atrovent / SAMA adverse drug effects

A

cough, dry mouth, mouth and throat irritation, dyspepsia, nausea and vomiting

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18
Q

Atrovent/SAMA patient education

A
  • after use, rinse mouth and spit it out
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19
Q

Tiotropium bromide (Spiriva) Indications for use and MOA - LAMAs

A

Used primarily for COPD to control symptoms

Selectively block the muscarinic 3 receptors (muscarinic 3 receptor antagonist) in the lungs leading to smooth muscle bronchodilation

  • long acting anticholinergic/muscarinic agent
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20
Q

Tiotropium bromide (Spiriva) cautions/ contraindications

A
  • due to anticholinergic effects: avoid in pts with urinary retention, BPH, and closed-angle glaucoma
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21
Q

LAMA Adverse Drug Reactions

A
  • dry mouth, pharyngitis, upper respiratory infection, headache, mouth irritation - not approved for children < 12 years old
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22
Q

LAMA patient education

A
  • Rinse mouth after inhaling medication
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23
Q

Leukotriene Modifiers Indication and Examples

A

Allergies/allergic rhinitis with asthma - if pt is not well controlled during times when seasonal allergies are worse

Montelukast (Singular)

Zafirlukast (Accolate)

Zileuton (Zyflo)

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24
Q

Montelukast and Zafirlukast MOA

A

Leukotriene receptor antagonist (LTRAs) - blocks the cysteinyl leukotriene (CysLT1) receptor and decreases the inflammatory response in the lungs

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25
Zileuton (Zyflo) MOA
- prevents the synthesis of leukotrienes - inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid
26
Leukotriene Modifiers cautions/contraindications
- Zafirlukast and Zileuton- use with caution in patients with hepatic disease - Not to be used in acute asthma exacerbation
27
Leukotriene Modifiers ADRs
- headache, GI upset, myalgias - Neuropsychiatric: hallucinations, agitation, aggression, suicidal ideations and behavior, insomnia, depression - Zafirlukast and Zileuton/Zyflo: can cause hepatotoxicity
28
Clinical use of LTRAs
- Montelukast - persistent asthma in patients 1 year old and older - - Zafirlukast - chronic asthma in patients 5 years old and older - Zileuton - persistent asthma in patients 12 years old and older \*\*\* needs to be taken daily - takes 3-5 days to reach full effect
29
Fluticasone (Flovent/Flonase) drug class
Inhaled corticosteroids (ICSs) - pulmonary inhalers and intranasal Budesonide - another example of an ICS medication
30
ICSs indications
- Primarily used in asthma (2nd line if pt is using SABAs more than 2x/week) - can also be used in COPD to reduce exacerbations - keep pts out of the hospital
31
ICSs MOA
- potent anti-inflammatory and vasoconstriction action - inhaled: inhibit IgE in mast cell migration of inflammatory cells into the bronchioles - used in all ages - intranasal: focuses on inflammation in the nasal mucosa alone - used in patients 2 years and older
32
ICSs cautions/ contraindications
- NOT for asthma exacerbation - use caution in active infection - watch potassium levels, glucose, bone density, growth (high doses for a long time) Avoid in: Cushing syndrome, herpes, tuberculosis, nasal trauma or ulcers, untreated respiratory infection
33
ICSs ADRs
-dry mouth (xerostomia), hoarseness, mouth and throat irriation, flushing, bad taste, oral candidiasis, rash, **urticaria (rare)**
34
ICS Patient education
- rinse mouth and spit after use - keep taking as directed - the only way you know this is working is by less use of SABAs - if using the a bronchodilator - use the bronchodilator 1st and then after a few minutes use the ICS inhaler - nasal: blow nose prior to application - effects are not immediate - takes 3-7 days to see full effect
35
Cromolyn sodium drug class
Mast Cell stabilizers - decrease bronchi hyperactivity to stimuli such as allergies
36
Cromolyn sodium Indication
**Exercise induced bronchospasm (EIB)** - asthma - allergic rhinitis
37
Cromolyn sodium MOA
- inhibits antigen-induced bronchospasm and blocks the release of histamine by inhibiting mast cell degranulation - has no effect of beta receptors, but can help reduce the need for Albuterol - good for patients that have a need to SABA prior to athletics more than 2 times a week - use this instead
38
Cromolyn sodium cautions/contraindications
- not to be used for asthma exacerbation
39
Cromolyn sodium ADRs
- throat irritation, cough, drowsiness, bronchospasm (rare) - nasal irritation and burning sensation in the nose
40
Examples of Inhaled Antihistamines (intranasal)
- Azelastine (Astepro) - Olopatadine (Patanase)
41
Azelastine and Olopatadine indication for use
- seasonal allergies - allergic rhinitis and vasomotor rhinitis
42
Inhaled Antihistamines (Azelastine/Olopatadine) MOA
H1 blocker - Inhibit the release of histamine by competing with histamine at H1 receptor sites
43
Inhaled antihistamines cautions/contraindications
- do not combine w/ CNS depressants - approved in pediatrics
44
Inhaled antihistamines (Azelastine/Olopatadine) ADRs
- **somnolence (greater with azelastine)** - **bitter taste** - headache - nasal irritation - **burning sensation**
45
Leukotriene Modifiers Indication and Examples
Allergies/allergic rhinitis with asthma - if pt is not well controlled during times when seasonal allergies are worse Montelukast (Singular) Zafirlukast Zileuton (Zyflo)
46
Decongestant oral and nasal examples
Oral: Phenylephrine HCL, Pseudoephedrine (Sudafed) Nasal: Afrin
47
Oral decongestants MOA
Alpha 1 agonists (sympathomimetics) - they mimic the endogenous catecholamines of the sympathetic nervous system - produces vasoconstriction by stimulating the Alpha 1 receptors in the mucosa of the resp. tract, thus temporarily reducing swelling and inflammation \*\*used to treat symptoms
48
Decongestants cautions and ontraindications
- avoid in HTN and CAD - oral not recommended in children \< 4 years old - not recommended in pregnancy and lactation - avoid in combination with beta blockers - potentiate CV issues - topical/nasal: do not use for longer than 3 days (can cause rebound congestion)
49
Decongestants ADRs
- anxiety, restlessness, headache, insomnia, psychological disturbances, tremors, HTN, tachycardia (fight or flight symptoms) - topical: nasal irritation and rebound congestions with prolonged use
50
Examples of Antitussive medications
- Dextromethorphan - Codeine - Benzonatate
51
Dextromethorphan and Codeine MOA
-acts centrally in the medulla to elevate the threshold for coughing - affects serotonin - suppresses the cough reflex - risk for abuse
52
Benzonatate MOA
- thought to anesthetize the stretch receptors in the respiratory passages, calming the cough - numbs the lungs - makes lungs more relaxed - does cross blood-brain barrier
53
Antitussive medications cautions/ contraindications
- avoid in persistent/chronic cough caused by smoking, asthma, or emphysema - additive CNS depression when dextromethorphan or codeine is used with CNS depressants - can decrease respiratory drive - do not self-medicate for more than 7 days
54
Antitussive ADRs
- dextromethorphan and codeine - drowsiness, dizziness, and GI upset - benxonatate - chest numbness, dizziness, GI upset, headache, and "chilly" sensation
55
Expectorant / Mucinex MOA
- decreases the surface tension of mucus making the mucus more thin and loose for clearance
56
Expectorant/Mucinex indication for use
- for cough due to common cold or upper respiratory infections
57
Expectorant/Mucinex ADRs
- GI upset - diarrhea - nausea - vomiting - drowsiness - dizziness
58
Expectorant/Mucinex cautions/ contraindications
- do not use for persistent cough - do not use for cough r/t heart failure or ACE inhibitor therapy
59
Diphenhydramine (Benadryl) indications
- allergic rhinitis - hypersensitivity reactions - urticaria and angioedema - insomnia
60
Diphenhydramine Drug Class
1st Generation Antihistamine
61
Diphenhydramine MOA
- competitively antagonized the effects of histamine at the H1 receptor sites - has anticholinergic effects
62
Diphenhydramine Cautions/ Contraindications
- crosses the blood-brain barrier - not to be combined with CNS depressants - avoid in patients with glaucoma, BPH d/t anticholinergic effects - avoid in infants, newborns, elderly - Safe in pregnancy - avoid in lactation (dries up milk production)
63
1st Generation Antihistamines (Benadryl) ADRs
- sedation - dizziness - confusion - ataxia - urinary retention - paradoxical excitation - dry mouth - tremor - blurred vision - constipation (think anticholinergic effects and CNS effects) \*\*\*cross the blood-brain barrier\*\*\*
64
2nd Generation Antihistamines Examples
Cetirizine (Zyrtec) Loratadine Fexofenadine
65
2nd Generation Antihistamine (Zyrtec/ Loratadine/ Fexofenadine) indications
- respiratory allergies - urticaria
66
2nd Generation Antihistamine MOA (Zyrtec/ Loratadine/ Fexofenadine)
- competitively antagonizes the effects of histamine at the peripheral H1 receptor sites in the GI tract, blood vessels, and repiratory tract - in general- avoids crossing the blood-brain barrier - no anticholinergic effects
67
2nd Generation Antihistamines - Cetirizine, Loratadine, Fexofenadine cautions/ contraindications
- safe in pregnancy and lactation - may have some CNS effects and can cause drowsiness - not as much as with 1st gen. - Cetirizine ok for 6mo and older - Loratadine ok for \> 2 year olds - Fexofenadine ok for \> 6 year olds

Adv Pharm Faculty Page (Smoller/Bose) (32 decks)

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