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NP Adv Pharm_S21 > Respiratory/HEENT > Flashcards

Respiratory/HEENT Flashcards

1
Q

Class of Albuterol (ProAir) is ____

A

SABA - selective short-acting beta-2 receptor agonist (some minor beta 1 activity)

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2
Q

Albuterol (SABAs) : Pharmacodynamics

A
  • acts on beta 2 receptors of intracellular adenyl cyclase (thus increase cAMP conversation) in the lungs – increasing vital capacity and airflow –> Act on the smooth muscle of the bronchi to reverse bronchospasm and inhibit the release of hypersensitivity mediators from mast cell degranulation
  • some effect on beta 1 receptors in the hear –> SE: tachycardia, nervousness, etc.
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3
Q

Albuterol : cautions/contraindications

A
  • avoid in arrhythmias that cause tachycardia or heart blocks and pheochromocytoma (adrenal tumor- increased sympathetic response)
    • with pheochromocytoma –> severe HTN
  • caution in pts with CV disease (CHF, HTN), diabetes, glaucoma, and hyperthyroidism
    • may need to increase insulin dose in DM (d/t drug-induced hyperglycemia)
  • can decrease digoxin serum level
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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
  1. SABA - short-acting Beta 2 receptor agonists
  2. LABA - long-acting Beta 2 receptor agonists **not as monotherapy in asthma**
  3. ICS - inhaled corticosteroids (take bronchodilator before ICS)
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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

Other examples of LABA medications

A

- formoterol (Foradil) Q12h

- vilanterol (Breo Ellipta)

    • Ultra long-acting
  • taken QD“Very easy to take”
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9
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 an increase in asthma-related death
  • caution in pts with CVD, diabetes, hyperthyroidism, glaucoma
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10
Q

What drug class contains Theophylline?

A

Xanthine dervatives

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11
Q

Theophylline/Xanthine derivatives MOA

A
  • general bronchodilator –> inhibit PDE –> increase cAMP –> leads to relaxation of smooth muscle and pulmonary vessel relaxation

- sympathomimetic-–works on the sympathetic nervous system: CNS stim., CV effects, increased fight/flight

  • has a similar chemical structure to caffeine
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12
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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13
Q

Ipratropium bromide (Atrovent) / SAMA MOA

A

-selectively blocks M3 receptors in the lungs causing bronchodilation

- muscarinic receptor antagonist/anticholinergic gent

-a bronchodilator

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14
Q

SAMA “-tropium”: indications and MOA

A

Mostly used for COPD - prevent bronchoconstriction

  • may be used in asthma exacerbation with albuterol (DuoNeb)
  • selectively block the muscarinic 3 receptors in the bronchial smooth muscle causing bronchodilation
  • also have anticholinergic effects because muscarinic receptors are cholinergic receptors
  • (drying, confusion in elders, dry eyes, urinary retention)

Ipratropium bromide (Atrovent) = Immediate effects

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15
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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16
Q

Ipotropium [Atrovent]/ SAMA : ADR

A

cough, dry mouth, mouth and throat irritation, dyspepsia, n/v

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17
Q

Atrovent/SAMA patient education

A
  • after use, rinse mouth and spit it out
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18
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 antagonist agent

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19
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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20
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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21
Q

LAMA patient education

A
  • Rinse mouth after inhaling medication
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22
Q

Leukotriene Modifiers Indication and Examples

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

Montelukast (Singular)

Zafirlukast (Accolate)

Zileuton (Zyflo)

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23
Q

Montelukast and Zafirlukast MOA

A

Leukotriene receptor antagonist (LTRAs) - blocks the cysteinyl leukotriene (CysLT1) receptor and decreases the inflammatory response in the lungs (no mast cell degranulation)

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24
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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25
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

26
Q

Fluticasone (Flovent/Flonase) drug class

A

Inhaled corticosteroids (ICSs) - pulmonary inhalers and intranasal

Budesonide - another example of an ICS medication

27
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 to keep pts out of the hospital
28
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

29
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, TB, nasal trauma or ulcers, untreated respiratory infection

30
Q

ICSs ADRs

A

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

31
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
32
Q

Cromolyn Sodium: Drug class and MOA

A

Mast Cell stabilizers (Inhaled Anti-inflammatory agents)

*no bronchodilating activity

MOA:

  • Inhibit mast cell degranulation –> prevents the release of histamine and SRS-A
  • Continues used – decreased bronchi hyperactivity to stimuli such as allergies
  • 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
33
Q

Cromolyn sodium: Indications

A
  • Exercise induced bronchospasm (EIB) - prophylaxis
  • asthma (alternative long-term control for mild persistent)
  • allergic rhinitis (2nd line)
34
Q

Cromolyn sodium cautions/contraindications

A

Contraindications:

  • asthma exacerbation/acute bronchospasm
  • hypersensitivity to cromolyn

Cautions

  • breastfeeding

Safe for children as young as 2 yo (nebulizer)

35
Q

Cromolyn sodium ADRs

A

Generally well-tolerated, but inhaled cromolyn may cause bronchospasm, which can be avoided by administering a beta-agonist bronchodilator

  • throat irritation, cough, drowsiness, bronchospasm (rare)
  • nasal irritation and burning sensation in the nose
36
Q

Examples of Inhaled Antihistamines (intranasal)

A
  • Azelastine (Astepro)
  • Olopatadine (Patanase)
37
Q

Azelastine and Olopatadine indication for use

A
    • seasonal allergies
    • allergic rhinitis
  • vasomotor rhinitis
38
Q

Inhaled Antihistamines (Azelastine/Olopatadine) MOA

A

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

39
Q

Inhaled antihistamines cautions/contraindications

A

- do not combine w/ CNS depressants

  • approved in pediatrics
40
Q

Inhaled antihistamines (Azelastine/Olopatadine) ADRs

A
  • somnolence (greater with azelastine)
  • bitter taste
  • headache
  • nasal irritation - burning sensation
41
Q

Decongestant oral and nasal examples

A

Oral: Phenylephrine HCL, Pseudoephedrine (Sudafed)

Nasal: Oxymetazoline [Afrin]

42
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

43
Q

Decongestants: Cautions and Contraindications

A
  • avoid in HTN and CAD
  • Oral (PO) 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)
44
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
45
Q

Examples of Antitussive medications

A
  • Dextromethorphan
  • Codeine
  • Benzonatate
46
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
47
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 BBB
48
Q

Antitussives: cautions/ contraindications

A

- avoid in persistent/chronic cough caused by smoking, asthma, or emphysema

  • in asthma, antitussives may impair expectoration and thus cause increased airway resistance
  • 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
49
Q

Antitussive ADRs

A
  • dextromethorphan and codeine - drowsiness, dizziness, and GI upset

- benzonatate [Tessalon] - peripherally acting; no risk of CNS sedation

  • chest numbness,
  • dizziness,
  • GI upset,
  • headache, and
  • “chilly” sensation
50
Q

Expectorant / Mucinex: MOA

A
  • Thins respiratory secretions (decreases the surface tension of mucus) –> promotes ciliary action in the lungs

GUAIFENESIN

51
Q

Expectorant/Mucinex: INDICATIONS

A
  • for cough due to common cold or URI
  • For congested feeling
52
Q

Expectorant/Mucinex ADRs

A
  • GI upset : n/v/d
  • Drowsiness
  • Dizziness
53
Q

Expectorant/Mucinex: cautions/ contraindications

A
  • do not use for a persistent cough
  • do not use for cough r/t heart failure or ACE inhibitor therapy
54
Q

Diphenhydramine (Benadryl) indications

A
  • allergic rhinitis
  • hypersensitivity reactions
  • urticaria and angioedema
  • insomnia
55
Q

Diphenhydramine Drug Class

A

1st Generation Antihistamine

56
Q

Diphenhydramine MOA

A
  • competitively antagonized the effects of histamine at the H1 receptor sites
  • has anticholinergic effects
57
Q

Diphenhydramine Cautions/ Contraindications

A
  • crosses BBB

- 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)

58
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***

59
Q

2nd Generation Antihistamines Examples

A

Cetirizine (Zyrtec) Loratadine Fexofenadine

60
Q

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

A
  • respiratory allergies
  • urticaria
61
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 respiratory tract -
  • in general- avoids crossing the blood-brain barrier - no anticholinergic effects
62
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

NP Adv Pharm_S21 (25 decks)

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