Respiratory meds Flashcards
1
Q
Two main classes of drugs for asthma
A
- Bronchodilators
- anti inflammatory agents
2
Q
Types of bronchodilators
A
- B2 adrenergic agonist
- Methylxanthines
- anticholinergics
3
Q
MoA B2 Adrenergic agonists
A
- relaxes smooth muscle –> bronchodilation
- increase ciliary motility –> mucus clearance
- suppress histamine release
- increase myocardial conductivity
4
Q
Albuterol
A
- short acting beta2 agonist ; inhaled
- quick relief of acute bronchospasm; prevention of exercise induced bronchospasm
5
Q
levalbuterol
A
- short acting beta2 agonist; inhaled
- quick relief of acute bronchospasm; prevention of exercise induced bronchospasm
6
Q
Terbutaline
A
- short acting beta2 agonist; inhaled
- SQ/IV for fetal distress, suppress pre-term labor
7
Q
Salmeterol
A
- long acting beta2 agonist; inhaled
- commonly used with fluticasone (ICS)
- decreases s/s and risk of exacerbations, improves lung fxn
8
Q
Formoterol
A
- long acting beta2 agonist; inhaled
- commonly used with budesonide (ICS)
- decreases s/s and risk of exacerbations, improves lung fxn
9
Q
AEs of B2 agonist (short acting)
A
- well-tolerated
- tachy, angina, tremors
10
Q
AEs of B2 agonist (long acting)
A
- must be combined with ICS in persistent asthma
- discontinue LABA is possible once asthma control achieved
11
Q
MoA of Methylxanthines
A
- release of Epi in adrenal medulla –> smooth muscle relaxation of bronchi
- improved resp muscle
- increases cardiac output and mucus clearance
- decreased airway inflammation
12
Q
Theophylline
A
- methylxanthine; inhaled
- narrow therapeutic index
- SE’s: insomnia, N/V, Toxicity = tachycardia and convulsions
13
Q
Theophylline toxicity risk
A
- increase risk of toxicity with CYP1A2 and 3A4 inhibitors
- ex. propranolol, ciprofloxacin, LT modifiers, caffeine
14
Q
MoA of anticholinergics
A
- block muscarinic receptors –> bronchodilation
- block bronchoconstriction
- off label asthma, mostly for COPD
15
Q
Ipratroprium bromide
A
- short acting inhaled anti-cholinergic agent
- used in combo with SABA albuterol
16
Q
Tiotropium Bromide
A
- long acting inhaled anti-cholinergic agent
17
Q
AEs of anticholinergic agents
A
- dry mouth
- constipation
- urinary retention
- blurred vision
- tachy
18
Q
Types of anti-inflammatory drugs
A
- steroidal/non-steroidal
- leukotriene modifiers
- biologics
19
Q
MoA of Corticosteroid
A
- decreased levels of inflammatory mediators
- decreased airway edema, mucus production/hypersecretion
20
Q
Fluticasone
A
- inhaled corticosteroid/glucocorticoid
- paired with LABA salmeterol
- most effective anti-asthma
21
Q
Budesonide
A
- inhaled corticosteroid/glucocorticoid
- paired with LABA formoterol
- most effective anti-asthma
22
Q
methylprednisolone
A
- oral glucocorticoid
- also injectable
23
Q
prednisone
A
- oral glucocorticoid
24
Q
AEs of glucocorticoid
A
- oropharyngeal candidiasis if inhaled improperly
- dysphonia
- growth suppression in children
to minimize = spacer, rinse mouth after admin, antifungal use
25
Q
Long term SEs of systemic steroids
A
- cushings syndrome
- adrenal insufficiency
- CNS effects (nervousness/depression)
- immunosuppression
- osteoporosis
- peptic ulcers
- growth retardation in children
- catracts/glaucoma
26
Q
MoA of leukotriene D4 receptor antagonist
A
- blocks D4 receptors
- bronchodilates, decreases mucus, exercise induced asthma prevention
27
Q
MoA of 5-Lipooxygenase Inhibitors
A
- prevent formation of leukotrienes
- leads to anti-inflammation/bronchodilation
28
Q
Zafirlukast
A
- PO
- leukotriene D4 receptor blocker
29
Q
Montelukast
A
- PO
- leukotriene D4 receptor blocker
- also for exercise induced asthma
30
Q
Zileuton
A
- PO
- 5-lipo-oxygenase inhibitor
- need to monitor LFTs
31
Q
Leukotriene Modifiers AEs
A
- headache
- Nausea/diarrhea
- BBW - neuropsychiatric events
- upper RTI
32
Q
Cromolyn (MoA, Use, Route, AEs)
A
- MoA: prevents release of inflamm. mediators (not bronchodilator)
- Uses: prophylaxis of exercise induced bronchospasm
- route: inhaled, nebulizer
- AEs: occasional cough/bronchospasm
33
Q
Anti-IgE Antibody MoA
A
- Prevents release of mediators of allergic response that cause bronchospasm
34
Q
AEs of Anti-IgE antibody
A
- BBW: anaphylaxis after 1st dose/delayed onset (>1 year)
35
Q
Omalizumab
A
- recombinant monoclonal antibody
- route: SubQ every 2-4 wks for 3 doses
- 2nd choice for allergy related asthma if all others fail
36
Q
Drugs used in the tx of COPD
A
- short acting/long acting bronchodilators
- Glucocorticosteroids
37
Q
Roflumilast (class/route/MoA/AE)
A
- Phosphodiesterase 4 inhibitor
- PO
- MoA: smooth muscle relaxation –> bronchodilation and decreased inflammation for severe COPD
- AE: weight loss, N/V, suicidal thoughts
38
Q
MoA of anithistamines
A
- inhibit histamine release
- histamine receptor antagonist
39
Q
Diphenhydramine (class/route/AEs)
A
- aka benadryl, 1st gen antihistamine
- oral, intranasal
- AEs: sedation, stimulant effect in some patients
- 2nd & 3rd gen have less SEs
40
Q
Mometasone
A
- intranasal corticosteroid in treatment in allergic rhinitis
41
Q
MoA of decongestants
A
- alpha 1 adrenergic agonist
- vasoconstriction –> less mucosal edema and exudation
- immediate effects
42
Q
Phenylephrine
A
- PO or nasal decongestant
- extensive 1st pass metabolism when PO
43
Q
Psuedoephedrine
A
- PO decongestant
- can be manipulated into methamphetamine
44
Q
Oxymetalozine
A
- intranasal decongestant
45
Q
AEs of decongestants
A
- rebound when used > 3-5 days
- irritability, anxiety, insomnia
- increased BP (caution for HTN/CAD patients)
46
Q
MoA of antitussives
A
- Central: suppress cough center in medulla
- peripheral: lessen irritation of respiratory tract
- not recommended for children under 6 (seizures)
47
Q
Dextromethorphan (DM)
A
- non-opioid antitussives, PO
- blocks the cough reflex center in the CNS
- abused if used in large quantities
48
Q
Diphenhydramine
A
- non-opioid antitussive, PO
- MoA: sedative/anticholinergic props, cough suppression
- AEs: sedation, dizziness, dry mouth
49
Q
Benzonatate
A
- non-opioid antitussive, PO
- decreases sensitivity of respiratory tract receptors
50
Q
Opioid antitussives (MOA)
A
- MoA: suppresses CNS cough center & inhibits sensory nerves in bronchi
- contain codeine
51
Q
Guaifenesin
A
- PO
- Expectorant
- decrease cough frequency, decrease phlegm thickness, removal of secretions
52
Q
Acetylcystine
A
- PO
- mucolytic
- breaks up respiratory mucoprotein into smaller strands; mucus more watery
- also for cystic fibrosis and overdose of acetaminophen
