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CDM Exam 3 > Respiratory PCOL > Flashcards

Respiratory PCOL Flashcards

1
Q

Organs the effect sympathetic action: contraction

A 
Radial Muscle (a1)
skeletal muscle (a)
sphincters (a1)
uterus (a)
Pilomotor smooth muscle (a)
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2
Q

Organs the effect sympathetic action: relaxing

A 
ciliary muscle (B)
skeletal muscle (M)
bronchiolar smooth muscle (B2)
smooth muscle walls (A2, B2)
bladder wall (B2)
uterus (b2)
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3
Q

Short Acting B2 Agonists MOA

A

Act on the β2 receptors, which activate cytoplasmic G proteins, which activate adenylyl cyclase to produce cyclic adenosine monophosphate (cAMP) which decreases unbound intracellular calcium, producing smooth muscle relaxation and mast cell membrane stabilization.

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4
Q

SABA meds

A

Epinephrine
Isoproterenol
Albuterol

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5
Q

SABA: Albuterol brand names

A

ProAir
Proventil
Ventolin

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6
Q

SABA: Albuterol supplied as

A

DPI, MDI, Nebs, Syrup, Tab

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7
Q

SABA: Albuterol onset

A

5-10 min

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8
Q

SABA: Albuterol duration

A

4-6 hr

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9
Q

SABA: Albuterol dosing

A

DPI (≥4 yoa):

  • -> 2 inhalations every 4 to 6 hours. In some patients, 1 inhalation every 4 hours may be sufficient
  • -> 2 inhalations 15 to 30 minutes before exercise for Exercise Induced Bronchospasm (EIB) prevention

MDI (≥4 yoa):

  • -> 1-2 puffs Q4-6h prn SOB
  • -> 2 inhalations 15-30 minutes prior to exercise for Exercise Induced Bronchospasm (EIB)

Neb: 2.5mg neb over 5-15 minutes 3-4 times daily prn

Tablet: 2-4mg PO 3-4 times daily; max 32mg/day in divided doses (IR syrup/tablets)

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10
Q

Tissue type: airways

Receptor: beta 2

A

Response: Smooth muscle relaxation (bronchodilation), increased ciliary beat, increased serous secretion, and inhibition of mast cell degranulation

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11
Q

Tissue type: airways

Receptor: alpha

A

Response:Smooth muscle contraction (bronchoconstriction?)

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12
Q

Tissue type: Heart

Receptor: B1

A

Response: Inotropic and chronotropic

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13
Q

Tissue type: Heart

Receptor: B2

A

Response: chronotropic (change HR)

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14
Q

Tissue type: Vasculature

Receptor: B2

A

Response: Vasodilation, decreased microvascular leakage

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15
Q

Tissue Type: Vasculature

Receptor: a

A

Response: Vasoconstriciton

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16
Q

Tissue Type: Skeletal

Receptor Type: B2

A

Response: Increased neuromuscular transmission (tremor and increased strength of contraction)

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17
Q

Tissue Type: Uterus

Receptor Type: B2

A

Response: Relaxation

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18
Q

Tissue Type: Metabolic

Receptor Type: a, B1

A

Response: Glycogenolysis, lipolysis

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19
Q

Tissue Type: Metabolic

Receptor Type: B2

A

Gluconeogenesis, hypokalemia, increased lactate production

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20
Q

SABA ADR

A 
Tremor
Anxiety
Tachycardia
Hypokalemia
Hypomagnesemia
Hyperglycemia
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21
Q

SABA drug interactions

A

Beta-blockers, diuretics, sympathomimetics

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22
Q

SABA monitor

A

Symptoms, HR, K

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23
Q

SABA pt education

A

Place in therapy, inhalation device technique

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24
Q

Short acting muscarinic antagonists (SAMA)

A

Competitive inhibition of muscarinic receptors in airways thereby preventing bronchoconstriction mediated by vagal nerve

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25
Q

SAMA treatment ipratropium brand name

A

Atrovent

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26
Q

Ipratropium: how it is supplied

A

MDI, Nebs

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27
Q

Ipratropium: Onset of action

A

15-30 min

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28
Q

Ipratropium: Duration of action

A

4-8 h

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29
Q

Ipratropium: Dose

A

2 puff four times daily

0.5 mg neb Q6-8h

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30
Q

SAMA precautions and ADR

A

Narrow-angle glaucoma, prostatic hyperplasia, bladder-neck obstruction

Dry mouth, abnormal taste

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31
Q

SAMA drug interactions

A

Anticholinergic medications

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32
Q

SAMA monitoring

A

Symptoms, urinary retention in older men

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33
Q

SAMA pt education

A

Place in therapy, inhalation device technique

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34
Q

SABA/SAMA Combination: Ipratropium/ Albuterol

A

Combivent, Respimat, Duoneb

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35
Q

Ipratropium/ Albuterol supplied

A

SMI, Nebs

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36
Q

Ipratropium/ Albuterol onset of action

A

15-30 min

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37
Q

Ipratropium/ Albuterol duration of action

A

4-8 h

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38
Q

Ipratropium/ Albuterol dose

A

1 puff four times daily in COPD

3mL neb Q6h

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39
Q

Long acting B2 agonists (LABA) MOA

A

Act on the β2 receptors, which activate cytoplasmic G proteins, which activate adenylyl cyclase to produce cyclic adenosine monophosphate (cAMP) which decreases unbound intracellular calcium, producing smooth muscle relaxation and mast cell membrane stabilization

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40
Q

LABA treatment options

A

albuterol, arfomoterol, formoterol, indacaterol, olodaterol, salmeterol

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41
Q

LABA Formoterol

A

Foradil Aerolizer, Perforomist

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42
Q

LABA Formoterol supplied

A

12 mcg Dry Powder Inhaler (DPI), Neb (20mcg/2mL)

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43
Q

LABA Formoterol onset on action

A

less than 5 min

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44
Q

LABA Formoterol duration of action

A

12 hr

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45
Q

LABA Formoterol dose

A

12mcg inhalation BID in kids ≥5 yoa in asthma
12mcg inhalation at least 15 minutes prior to exercise for EIB
12mcg inhalation BID in COPD
20mcg neb BID for COPD

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46
Q

LABA Olodaterol brand names

A

Striverdi, Respimat

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47
Q

LABA Olodaterol supply

A

2.5 mcg SMI

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48
Q

LABA Olodaterol onset of action

A

10-20 minutes

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49
Q

LABA Olodaterol duration of action

A

24 hr

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50
Q

LABA Salmeterol supplied

A

50 mcg DPI

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51
Q

LABA Olodaterol onset of action

A

less than 20 min

52
Q

LABA Olodaterol duration of action

A

12 hr

53
Q

LABA black box warning

A

increase risk of asthma related death

54
Q

LABA ADR

A

Tremor, anxiety, tachycardia, hypokalemia, hypomagnesemia, hyperglycemia, cough (indacaterol)

55
Q

LABA drug interactions

A

Other QTc prolonging medications

56
Q

LABA monitoring

A

Symptoms, ADR

57
Q

LABA pt education

A

Inhalation device training, rationale for use (controller therapy) and not for acute shortness of breath (potential exception with formoterol in the beclomethasone/formoterol combination which may be used as a maintenance and reliever treatment in asthma)

58
Q

Long Acting Muscarinic Antagonist (LAMA) MOA

A

Inhibition of M1-5 receptors, bronchodilation due to M3 activity in lungs

59
Q

LAMA Tiotropium brand names

A

Spiriva HandiHaler, Spiriva Respimat

60
Q

LAMA Tiotropium supplied

A

18 mcg DPI

  1. 5 mcg SMI
  2. .25 mcg SMI
61
Q

LAMA precautions and ADR

A 
Dryness of mouth
Bitter, metallic taste
Constipation
Urinary retention
Worsened narrow-angle glaucoma
62
Q

LAMA drug interaction

A

Anti-cholinergic medications

63
Q

LAMA monitoring

A

Symptoms, ADR

64
Q

LAMA pt education

A

Role in therapy, inhalation device training

65
Q

LAMA/LABA combination treatment: Tiotropium/Olodaterol

A

Stiolto Respimat

66
Q

Methylxanthine MOA

A

Smooth muscle relaxation/ bronchodilation via inhibition of phosphodiesterase (PDE) thereby decreasing the degradation of cAMP to AMP; potentially also mild anti-inflammatory activity via PDE4 inhibition; inhibition of adenosine receptors

67
Q

Methylxanthine: Theophylline

A

Theo-24, Theo-Dur

68
Q

Methylxanthine ADR

A

Headache, insomnia, nausea, heartburn, arrhythmias, grand mal convulsions

69
Q

Methylxanthine drug interactions

A

CYP 3A3/1A2

70
Q

Methylxanthine monitoring

A

Theophylline levels (5-15mcg/mL in adults; 5-10mcg/mL in children), symptoms

71
Q

Methylxanthine Pt Education

A

Place in therapy, side effects (signs and symptoms of toxicities)

72
Q

Systemic Corticosteroids moa

A

Modifies gene expression of cells leading to gene activation or suppression
Block late reaction to allergen and reduce airway hyperresponsiveness
Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation
Reverse β2 receptor down-regulation

73
Q

Systemic Corticosteroids treatments

A

Prednisone

74
Q

Systemic Corticosteroids ADR

A 
Adrenal suppression (HPA Axis)
Growth suppression
Osteoporosis
Cataracts
Myopathy
Increased appetite
Weight gain
Hyperglycemia
CNS side effects (psychosis, insomnia, emotional liability)
HTN
GI side effects (PUD, gastritis)
Cushingoid appearance
75
Q

Systemic Corticosteroids: Fluoroquinolones, oral-antidiabetics, CYP3A4 inhibitors

A

Fluoroquinolones, oral-antidiabetics, CYP3A4 inhibitors…

76
Q

Systemic Corticosteroids Monitoring

A

Clinical improvement, side effects (BP, blood glucose, mental status, electrolyte panels), growth, etc.

77
Q

Systemic Corticosteroids Pt Education

A

Side effects

78
Q

Inhaled Corticosteroids (ICS) ADR

A 
Cough
Dysphonia 
Thrush
Delayed childhood growth
Osteoporosis
Skin thinning
Bruising
Cataracts and glaucoma
Hyperglycemia
Pneumonia (we will discuss this in COPD specifically)
79
Q

ICS ADR interventions Spacers or valved holding chambers

A 
Spacers or valved holding chambers
Rinse mouth after inhalation
Monitor growth in children
Use lowest dose ICS possible
For adults, consider supplementing calcium + vitamin D
80
Q

ICS: Drug interactions

A

CYP450-CYP3A4
Protease inhibitors
Ketoconazole

81
Q

ICS monitoring

A

Growth

Disease outcomes

82
Q

ICS pt education

A

use spacer/holding chamber

Rinse mouth after inhalation

83
Q

ICS/LABA brand names
Budesonide/Formoterol
Fluticasone/Salmeterol

A

symbicort

Advair Diskus, HFA, Airduo, Respliclick, Wixela

84
Q

ICS/LABA/LAMA combination

Fluticasone furoate/Umeclidium/Vilsnterol

A

Trelegy Ellipta

85
Q

Macrolide Antibiotics MOA

A

Macrolide antibiotics bind to
the 50s ribosomal subunit preventing
protein synthesis, also has anti-
inflammatory effects

86
Q

Macrolide Antibiotics treatment options

A 
Asthma: 
Azithromycin 500mg po TIW for 
prevention of asthma exacerbations in 
the GINA guidelines
COPD:
• Azithromycin 500mg PO x1, then 250mg PO 
daily x 4 days for COPD exacerbations 
(AECOPD)
• Azithromycin x 52 weeks for prevention of 
COPD exacerbations
87
Q

Macrolide Antibiotics ADR

A

N/V/D, QTc prolongation,
increased LFTs, may worsen MG, may
cause antibiotic resistance

88
Q

Macrolide Antibiotics DDIs

A

CYP3A4 and QTc

prolonging agents

89
Q

Macrolide Antibiotics monitoring and pt education

A

QTc, hearing,
exacerbation rate

Educate on purpose, adverse effects

90
Q

Phosphodiesterase-4 Inhibitors

A

Roflumilast (Daliresp)

91
Q

Phosphodiesterase-4 Inhibitors MOA

A 
Roflumilast and active 
metabolite (roflumilast N-oxide) 
both inhibit phosphodiesterase-
4 (PDE-4) causing an increase in 
cAMP.
92
Q

Roflumilast: Warnings

A 
Acute bronchospasm
Psychiatric events
Weight decrease
Use with strong CYP inducers is 
not recommended
93
Q

Roflumilast contraindications

A

Child-Pugh

B/C liver impairment

94
Q

Roflumilast ADR

A 
Gastrointestinal disorders: 
abdominal pain, dyspepsia, 
gastritis, vomiting
Infections: rhinitis, sinusitis, 
urinary tract infection
Musculoskeletal: muscle spasm
Nervous System: tremors
Psychiatric: anxiety, depression, suicidality, sleep disturbances
95
Q

Roflumilast DDIs

A 
Extensive 
metabolism via CYP3A4 and 1A2
• CYP3A4
• Inducer: Rifampin, carbamazepine, 
phenytoin
• Inhibitor: Erythromycin, 
clarithromycin, azole antifungals, 
amiodarone, ketoconazole
• CYP1A2
• Inducer: Phenytoin
• Inhibitor: Ciprofloxacin
96
Q

Roflumilast monitoring

A

Weight, FEV1, COPD

exacerbations, depression

97
Q

Roflumilast pt education

A

Place in therapy,
side effects (weight loss,
insomnia, depression)

98
Q

Biologic agents

A

Mepolizumab (Nucala®)

Tezepelumab-ekko (Tezspire)

Dupilumab (Dupixent®)

Omalizumab (Xolair®)

99
Q

Biologics pathway IgE

A

Omalizumab (Xolair®)

100
Q

Biologics pathway IL-4/IL-13

A

Dupilumab (Dupixent®)

101
Q

Biologics pathway IL-5

A

Mepolizumab (Nucala®)

102
Q

Biologics pathway TLSP

A

Tezepelumab-ekko (Tezspire)

103
Q

Omalizumab (xolair) moa

A

A monoclonal antibody that binds to circulating IgE, preventing it from binding to high affinity receptors on basophils and mast cells

104
Q

Omalizumab precautions

A

Anaphylaxis (0.1% of patients, blackbox warning)
Malignancy (0.5% of patients)
Acute asthma symptoms
Eosinophilic conditions
Rare cases of systemic eosinophilic conditions
Churg-Strauss syndrome possible
Corticosteroid reduction
Fever, arthralgia, and rash
Similar constellation of symptoms to serum sickness
Discontinue if develops
Parasitic infection

105
Q

Omalizumab ADR

A

Pain and bruising at injection sites (5-20%)
Anaphylaxis (0.1%, blackbox warning)
Malignant neoplasm (0.5%)

106
Q

Omalizumab Monitoring

A

IgE levels (baseline), reduction in exacerbations and symptoms, improvements in FEV1, side effects (anaphylaxis)

107
Q

Omalizumab pt education

A

Recognition and treatment of anaphylaxis

108
Q

Mepolizumab (Nucala®) MOA

A

Humanized IgG1 monoclonal antibody against IL-5 preventing it from binding to its receptor on eosinophils thereby reducing blood, tissue, and sputum eosinophils

109
Q

Mepolizumab (Nucala®) ADR

A

Headache, nasopharyngitis, upper respiratory tract infections, sinusitis, injection site reactions

110
Q

Mepolizumab (Nucala®) monitoring

A

Improvements in symptoms

111
Q

Mepolizumab (Nucala®) pt education

A

Side effects (hypersensitivity)

112
Q

Dupilumab (Dupixent) MOA

A

Humanized monoclonal antibody against IL-4 and IL-1

113
Q

Dupilumab (Dupixent) ADR

A

Injection site reactions, conjunctivitis, herpes simplex infection

114
Q

Dupilumab (Dupixent) monitoring

A

Improvement in symptoms, exacerbations, FEV1, side effects

115
Q

Dupilumab (Dupixent) pt education

A

Store in the fridge, SQ injection training, sharps disposal, advise patients to discontinue and seek treatment if hypersensitivity symptoms

116
Q

Tezepelumab-ekko (Tezspire) MOA

A

TSLP signals the presence of danger and can trigger immune response

117
Q

Tezepelumab-ekko (Tezspire) ADR

A

Arthralgia, pharyngitis, hypersensitivity, back pain, helminth infection

118
Q

Tezepelumab-ekko (Tezspire) precaution

A

Avoid use of live attenuated vaccines, may put patients at risk of (parasite) infection

119
Q

Tezepelumab-ekko (Tezspire) monitoring

A

Asthma control

120
Q

Tezepelumab-ekko (Tezspire) pt education

A

Role in therapy, side effects, avoiding live vaccinations

121
Q

Asthma recuse meds

A

SABA
SAMA
ICS/Fomoterol
Systemic Corticosteroids

122
Q

COPD rescue meds

A

SABA
SAMA
Systemic Corticosteroids

123
Q

Asthma controller meds

A 
Bronchodilators
-->LABA
-->LAMA (tiotropium)
-->Theophylline
ICS
Mast Cell Stabilizers
Leukotriene Modifiers
Macrolide antibiotics
Biologics
Combination Therapies
124
Q

COPD controller meds

A 
LA Bronchodilators
-->LABA
-->LAMA
-->Theophylline
Anti-Inflammatory
-->Inhaled Corticosteroids
-->Phosphodiesterase 4 Inhibitors
-->Macrolide antibiotics
Combination Therapies
124
Q

COPD controller meds

A 
LA Bronchodilators
-->LABA
-->LAMA
-->Theophylline
Anti-Inflammatory
-->Inhaled Corticosteroids
-->Phosphodiesterase 4 Inhibitors
-->Macrolide antibiotics
Combination Therapies

CDM Exam 3 (8 decks)

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