Respiratory Medications - Quiz 5 Flashcards by Donny Le

What is the technique for using Inhalers?

Slow Deep Breath over 5 seconds, Hold for 10 seconds, then Blow all out

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What is the problem w/ using a Metered Dose Inhaler?

Only 12% gets to lungs, even less w/ ETT

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How much more med is needed w/ a Nebulizer vs. an MDI?

6-10x more needed

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How should Bronchodilators & Corticosteroids be adminstered?

Bronchodilators BEFORE Corticosteroids

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Which Muscarinic Receptors are Stimulatory?

M₁, M₃, M₅

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Which Muscarinic Receptors are Inhibitory?

M₂ & M₄

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What are the effects of Inhaled Atropine?

↓Airway Resistance

↑Dead Space

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Which COPD meds contain Glycopyrrolate?

Seebri

Lonhala

Bevespi

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When is Glycopyrrolate NOT indicated?

Acute COPD Symptoms

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Which meds are Short Acting Muscaranic Antagonists (SAMA)?

Atropine

Glycopyrrolate

Ipratropium

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What are the advantages of using Ipratropium?

Minimal Systemic Absorption

No Bronchodilator Tolerance

More effective for Chronic Bronchitis/Emphysema

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What are the disadvantages of using Ipratropium alone vs. a Beta Agonist?

Slower Onset (30-90 min)

Less Effective

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How does Tiotropium (Spiriva) work?

Blocks M₁ & M₃ Muscarinic Receptors

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What does Tiotropium (Spiriva) do?

Bronchdilation

↓Secretions

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How does Aclidinium compare to Tiotropium?

Faster Onset to Peak

Take BID vs Daily

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Aclidinium + Formoterol = ?

Duaklir

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Which meds are Long Acting Muscarinic Antagonist (LAMA)?

Tiotropium

Aclidinium

Umeclidinium

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What are side effects of Inhaled Anticholinergics?

Glaucoma

Urinary Retention

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What is the Gold Standard for treating Acute Bronchospasms?

Beta 2 Agonists

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What gives Beta-2 Agonist their long duration of action?

They’re Non-Catecholamines - resistant to COMT

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What is the advantage of using newer Inhaled Beta-2 Agonists at therapeutic doses?

Relax Bronchial Smooth Muscle WITHOUT stimulating the Heart

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What are Inhaled Beta-2 Agonists used for?

Treats & Prevents Acute Asthma

↑Airflow

↑Exercise Tolerance

Tocolytic Therapy

Treats Hyperkalemia

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How long do Short Acting Beta 2 Agonist (SABA) last?

3-6 hours

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How long do Long Acting Beta 2 Agonists (LABA) last?

> 12 hours

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Which pressors have Beta-2 effects, but also a lot of Non-Respiratory side effects?

Ephedrine & Epinephrine

Which med was reapproved to treat Mild Asthma?

Primatene Mist - Inhaled Epinephrine

What is the preferred Beta-2 Agonist for Acute Bronchospasms?

Albuterol Onset: 15 min Peak: 1 hour

What is the R-Enantiomer of Albuterol?

Levoalbuterol (Xopenex)

Which Beta-2 Agonists were used as Tocolytics?

Terbutaline & Ritodrine

Which meds are Long Acting Beta 2 Agonists (LABA)?

Salmeterol Vilanterol Formoterol Aformoterol

Which meds are Short Acting Beta 2 Agonists (SABA)?

Albuterol & Levoalbuterol

What are the side effects of Inhaled Beta 2 Agonists?

Tremors Tachycardia Hyperglycemia Hypokalemia Hypomagnesemia

What is the Black Box Warning for Long Acting Beta 2 Agonists?

**DONT USE ALONE -** ↑Asthma Death

What does Cromolyn do?

Prevents Histamine Release & Secretory Response Does **_NOT_** Relax Bronchial Smooth Muscle or treat **Acute** Asthma

Which meds are Methylxanthines?

Theophylline/Aminophylline Caffeine Theobromine

What do Methylxanthines do?

Stimulate CNS ↑BP ↑Contractility ↑HR Relax Smooth Muscles

How does Methylxanthines work?

Non-Selectively Inhibits PDE & Competes for Adenosine Receptors

What is Theophylline used for?

Treats Acute Asthma & Premie Apnea

What side effects would you see with Theophylline levels of 15-25 mcg/mL?

GI Upset & Tremors

What side effects would you see with Theophylline levels of 25-35 mcg/mL?

Tachycardia & PVCs

What side effects would you see with Theophylline levels over 35 mcg/mL?

V-Tach & Seizures

What does Caffeine do?

Stimulate CNS Cerebral Vasoconstrictor Secrete Gastric Acids

What is Caffeine clinically used for?

Premie Apnea PDPH Offset Sedation from Cold Medicine

What happens when Histamine binds to the H₁ Receptors?

GI & Respiratory Smooth Muscle Contraction Pruritis Sneezing Vasodilation ↓HR Coronary Vasoconstriction

What are the CV effects of activated H₁ & H₂ Receptors by Histamine?

↑Capillary Permeability Hypotension Tachycardia Flushing Headache

What happens when H₂ Histamine Receptors are activated?

↑cAMP ↑Gastric H⁺ Ion ↑Myocardial Contractility ↑HR Coronary Vasodilation

Which Histamine receptors need to be blocked to completely block Vasodilation?

H₁ & H₂

What is the Triple Response (Wheal & Flare) regarding Histamines?

Edema Dilated Arteries - Flare Pruritis

How does the H₁ Histamine Receptor affect the Airway?

Bronchial Constriction

How do H₂ Histamine Receptor affect the Airway?

Bronchial Relaxation

Histamine Receptor Antagonists are both _____ & \_\_\_\_\_\_

Histamine Receptor Antagonists are both **COMPETITIVE** & **REVERSIBLE**

How do Histamine Receptor Antagonist work?

Keeps the receptor in Inactive Form, but does NOT Inhibit Histamine Release

What are the differences b/t 1st Gen H₁ Blockers vs 2nd Gen H₁ Blockers?

**1st Gen**: Sedating & Non Selective **2nd Gen**: Non-Sedating

What are the effects of 1st Gen H₁ Blockers?

Sedation Anticholinergic Effects Tachycardia QT Prolongation Dysrhythmias

What are H₁ Blockers used for?

Allergies Pretreats Bronchospasms Itching Antiemetic Sedation

Which meds are 2nd Gen H₁ Blockers?

Cetirizine Levocetirizine Loratidine Fexofendaine

What is the Outer Layer of the Adrenal Cortex & What does it release?

Zona Glomerulosa - Releases Mineralocorticoids

What is the Middle Layer of the Adrenal Cortex & What does it release?

Zona Fascicula - Releases Glucocorticoids

What is the Inner Layer of the Adrenal Cortex & What does it release?

Zona Reticularis - Releases Weak Androgens

What causes a release of Cortisol?

Stress

What does Aldosterone do?

Mineralocorticoid that ↑K⁺ Excretion ↑Na⁺ & Water Retention ↑Blood Volume

Cortisol levels are ____ in the AM and ____ in the PM

Cortisol levels are **HIGH** in the AM and **LOW** in the PM

What is Addison's Disease?

Primary Adrenocortical Insufficiency - Adrenals dont secrete Cortisol or Aldosterone at all

How is Addison's Disease managed?

Replacement therapy including Glucocorticoids AND Mineralocorticoids

What causes Secondary Adrenocortical Insufficiency?

Chronic Steroid Use & Supressed HPA Axis

How is Secondary Adrenocortical Insufficiency managed?

Replacement therapy of ONLY Glucocorticoids

What do Corticosteroids INCREASE?

CO RR GLuconeogensis Pain Tolerance

What do Corticosteroids DECREASE?

Inflammation Immune System Digestion

What are Synthetic Glucocorticoids?

Prednisone, Prednisolone, Methylprednisolone Betamethasone Dexamethasone Triamcinolone

Which med is a Synthetic Mineralocorticoid?

Fludrocortisone

How much more potent is the Anti-Inflammatory effects of Dexamethasone & Betamethasone compared to Cortisol?

25x more Potent w/ ZERO Sodium Retaining effects

Which meds are Inhaled Corticosteroids?

Fluticasone Beclometasone Mometasone Budesonide Cicleonide

What are the Endocrine Side effects of Steroids?

HPA Axis Supression Cushing's Hyperglycemia

What are the CV Side Effects of Steroids?

Dyslipidemia HTN Thrombosis Vasculitis

What are the CNS Side Effects of Steroids?

Cataracts Glaucoma Mood Changes Psychosis Cerebral Atrophy

How do Steroids affect Fat Distribution?

Buffalo Hump Moon Face Skinny Arms & Legs

How do Steroids affect blood levels?

↑Hct & ↑WBC

How should steroids be prescribed to avoid HPA Axis Supression?

Every Other Day & Less than 3 Weeks