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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
Q

Zileuton (Zyflo) MOA

A
  • prevents the synthesis of leukotrienes - inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid
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26
Q

Leukotriene Modifiers cautions/contraindications

A
  • Zafirlukast and Zileuton- use with caution in patients with hepatic disease
  • Not to be used in acute asthma exacerbation
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27
Q

Leukotriene Modifiers ADRs

A
  • headache, GI upset, myalgias
  • Neuropsychiatric: hallucinations, agitation, aggression, suicidal ideations and behavior, insomnia, depression
  • Zafirlukast and Zileuton/Zyflo: can cause hepatotoxicity
28
Q

Clinical use of LTRAs

A
  • 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
Q

Fluticasone (Flovent/Flonase) drug class

A

Inhaled corticosteroids (ICSs) - pulmonary inhalers and intranasal

Budesonide - another example of an ICS medication

30
Q

ICSs indications

A
  • 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
Q

ICSs MOA

A
  • 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
Q

ICSs cautions/ contraindications

A
  • 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
Q

ICSs ADRs

A

-dry mouth (xerostomia), hoarseness, mouth and throat irriation, flushing, bad taste, oral candidiasis, rash, urticaria (rare)

34
Q

ICS Patient education

A
  • 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
Q

Cromolyn sodium drug class

A

Mast Cell stabilizers - decrease bronchi hyperactivity to stimuli such as allergies

36
Q

Cromolyn sodium Indication

A

Exercise induced bronchospasm (EIB) - asthma - allergic rhinitis

37
Q

Cromolyn sodium MOA

A
  • 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
Q

Cromolyn sodium cautions/contraindications

A
  • not to be used for asthma exacerbation
39
Q

Cromolyn sodium ADRs

A
  • throat irritation, cough, drowsiness, bronchospasm (rare)
  • nasal irritation and burning sensation in the nose
40
Q

Examples of Inhaled Antihistamines (intranasal)

A
  • Azelastine (Astepro)
  • Olopatadine (Patanase)
41
Q

Azelastine and Olopatadine indication for use

A
  • seasonal allergies - allergic rhinitis and vasomotor rhinitis
42
Q

Inhaled Antihistamines (Azelastine/Olopatadine) MOA

A

H1 blocker - Inhibit the release of histamine by competing with histamine at H1 receptor sites

43
Q

Inhaled antihistamines cautions/contraindications

A
  • do not combine w/ CNS depressants
  • approved in pediatrics
44
Q

Inhaled antihistamines (Azelastine/Olopatadine) ADRs

A
  • somnolence (greater with azelastine)
  • bitter taste
  • headache
  • nasal irritation - burning sensation
45
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

Zileuton (Zyflo)

46
Q

Decongestant oral and nasal examples

A

Oral: Phenylephrine HCL, Pseudoephedrine (Sudafed) Nasal: Afrin

47
Q

Oral decongestants MOA

A

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
Q

Decongestants cautions and ontraindications

A
  • 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
Q

Decongestants ADRs

A
  • anxiety, restlessness, headache, insomnia, psychological disturbances, tremors, HTN, tachycardia (fight or flight symptoms) - topical: nasal irritation and rebound congestions with prolonged use
50
Q

Examples of Antitussive medications

A
  • Dextromethorphan
  • Codeine
  • Benzonatate
51
Q

Dextromethorphan and Codeine MOA

A

-acts centrally in the medulla to elevate the threshold for coughing - affects serotonin - suppresses the cough reflex - risk for abuse

52
Q

Benzonatate MOA

A
  • 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
Q

Antitussive medications cautions/ contraindications

A
  • 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
Q

Antitussive ADRs

A
  • dextromethorphan and codeine - drowsiness, dizziness, and GI upset
  • benxonatate - chest numbness, dizziness, GI upset, headache, and “chilly” sensation
55
Q

Expectorant / Mucinex MOA

A
  • decreases the surface tension of mucus making the mucus more thin and loose for clearance
56
Q

Expectorant/Mucinex indication for use

A
  • for cough due to common cold or upper respiratory infections
57
Q

Expectorant/Mucinex ADRs

A
  • GI upset - diarrhea - nausea - vomiting
  • drowsiness - dizziness
58
Q

Expectorant/Mucinex cautions/ contraindications

A
  • do not use for persistent cough
  • do not use for cough r/t heart failure or ACE inhibitor therapy
59
Q

Diphenhydramine (Benadryl) indications

A
  • allergic rhinitis
  • hypersensitivity reactions
  • urticaria and angioedema
  • insomnia
60
Q

Diphenhydramine Drug Class

A

1st Generation Antihistamine

61
Q

Diphenhydramine MOA

A
  • competitively antagonized the effects of histamine at the H1 receptor sites - has anticholinergic effects
62
Q

Diphenhydramine Cautions/ Contraindications

A
  • 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
Q

1st Generation Antihistamines (Benadryl) ADRs

A
  • 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
Q

2nd Generation Antihistamines Examples

A

Cetirizine (Zyrtec) Loratadine Fexofenadine

65
Q

2nd Generation Antihistamine (Zyrtec/ Loratadine/ Fexofenadine) indications

A
  • respiratory allergies - urticaria
66
Q

2nd Generation Antihistamine MOA (Zyrtec/ Loratadine/ Fexofenadine)

A
  • 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
Q

2nd Generation Antihistamines - Cetirizine, Loratadine, Fexofenadine cautions/ contraindications

A
  • 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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