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Pharm > Respiratory Pharm > Flashcards

Respiratory Pharm Flashcards

1
Q

describe asthma

A
  • Chronic inflammation of the airways
  • Bronchial hyperresponsiveness
  • Airflow obstruction
  • reversible
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2
Q

inflammation in airway secretion from asthma results in

A
  • Bronchiolar Smooth Muscle Spasm
  • Airway Hyperresponsiveness
  • Airway Edema
  • Increased Mucus Secretion
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3
Q

classify asthma based on severity

A
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4
Q

overview of drugs for asthma management

A
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5
Q

list the inhaled short-acting β2 adrenergic agonists (SABAs)

A

Albuterol
Terbutaline
Pirbuterol

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6
Q

list the Inhaled long-acting β2 adrenergic agonists (LABAs)

A

Salmeterol
Formoterol

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7
Q

describe the MOA of β2 Adrenergic Agonists

A
  • Binds/activates β2 adrenergic receptors on airway smooth muscle cells
  • Activation of β2 receptors stimulates adenylyl cyclase and increases formation of cAMP
  • cAMP activates protein kinase A which phosphorylates and inactivates myosin light chain kinase → relaxation of the airway smooth muscle cells and bronchodilation
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8
Q

___ are the DOC for relief of acute asthma symptoms and prevention of exercise-induced bronchospasm

A

SABAs are the DOC for relief of acute asthma symptoms and prevention of exercise-induced bronchospasm

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9
Q

LABAs are combined with ____ for long-term control in moderate and severe persistent asthma

LABAs shouldn’t be used as ___ for long-term control of asthma as they have no _____

Are LABAs used for treating acute asthma symptoms?

A

LABAs are combined with inhaled corticosteroids (ICS) for long-term control in moderate and severe persistent asthma

LABAs shouldn’t be used as monotherapy for long-term control of asthma as they have no anti-inflammatory action

LABAs are NOT used for acute astham symptoms

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10
Q

list AEs of β2 Adrenergic Agonists

A
  • tachycardia, tremor, and hypokalemia
    • ​reduced via inhalation administration
  • LABAs increase risk of serious asthma- related events (hospitalization, intubation, and death)
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11
Q

list the Inhaled Short-Acting Muscarinic Antagonists (SAMAs)

A

Ipratropium

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12
Q

list the Inhaled Long-Acting Muscarinic Antagonists (LAMAs)

A

Tiotropium

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13
Q

what is the MOA of ipratropium and tiotropium

A

block muscarinic receptors on the airways causing bronchodilation and reduction of respiratory secretions

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14
Q

Ipratropium is less effective than ____

but provides additive benefit to SABAs in the management of moderate to severe exacerbations of asthma

A

Ipratropium is less effective than SABAs

but provides additive benefit to SABAs in the management of moderate to severe exacerbations of asthma

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15
Q

____ is the DOC for β-blocker-induced bronchospasm

A

Ipratropium is the DOC for β-blocker-induced bronchospasm

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16
Q

____ may be added to ICS for long-term control of severe persistent asthma

A

Tiotropium may be added to ICS for long-term control of severe persistent asthma

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17
Q

list the Anticholinergic AEs

A
  • quaternary ammonium compounds
  • minor anticholinergic effects, e.g. xerostomia
  • may be safer than SABAs in patients with cardiovascular disease
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18
Q

Methylxanthines

A

Theophylline

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19
Q

Theophylline inhibits ____, increasing ____ evoking bronchodilation

A

Theophylline inhibits phosphodiesterase, increasing cAMP evoking bronchodilation

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20
Q

____ can be given orally or IV and is ___ therapy for patients with persistent asthma

A

Theophylline can be given orally or IV and is alternate therapy for patients with persistent asthma

21
Q

list the AEs of Theophylline

A
  • Largely replaced by β2 agonists and corticosteroids due to narrow therapeutic window, adverse effects, and potential for drug interactions
  • most common: headache, nausea, vomiting, abdominal discomfort, and restlessness
  • At high concentrations: cardiac arrhythmias and seizures
22
Q

list the inhaled corticosteroids (ICS)

A

Beclomethasone
Fluticasone
Flunisolide
Budesonide

23
Q

list the systemic corticosteroids

A

Prednisolone
Dexamethasone

24
Q

Glucocorticoids inhibit ____ and ____, resulting in reduced formation of leukotrienes and prostaglandins

A

Glucocorticoids inhibit phospholipase A2 and COX-2, resulting in reduced formation of leukotrienes and prostaglandins

25
Q

Prolonged use of SABAs results in β2 receptors desensitization…

____ prevent or reverse this desensitization

A

Prolonged use of SABAs results in β2 receptors desensitization…

corticosteroids prevent or reverse this desensitization

26
Q

____ are the most effective long-term control medication in the management of persistent asthma.

A

corticosteroids are the most effective long-term control medication in the management of persistent asthma.

27
Q

Oral ____may be added to ICS for long-term control of severe persistent asthma

A

Oral prednisolone may be added to ICS for long-term control of severe persistent asthma

28
Q

A short course of _____ is used for moderate and severe acute exacerbations of asthma to speed recovery and to prevent recurrence of exacerbations

A

A short course of systemic corticosteroids is used for moderate and severe acute exacerbations of asthma to speed recovery and to prevent recurrence of exacerbations

29
Q

list the AEs of inhaled ICS

A
  • Inhaled CS = lower bioavailability than systemic CS → less adverse effects
  • Local AEs:
    • oropharyngeal candidiasis
    • dysphonia, reflex cough and bronchospasm
  • Long-term use:
    • osteoporosis and cataracts
    • may cause deceleration of vertical growth in children
30
Q

Long term use of systemic glucocorticoids may result in ____ and _____

A

Long term use of systemic glucocorticoids may result in hypercortisolism and Cushing’s syndrome

31
Q

list the anti-inflammatory drugs: Release Inhibitors

A

Cromolyn
Nedocromil

32
Q

Cromolyn and Nedocromil act by inhibiting _____, and prevent both antigen- and exercise-induced bronchospasm in asthmatic patients

Are they useful in managing acute asthma attack?

A

Cromolyn and Nedocromil act by inhibiting mast cell degranulation, and prevent both antigen- and exercise-induced bronchospasm in asthmatic patients

NO- not useful for acute asthma attack! because they are not bronchodilators

33
Q

list AEs for release inhibitors: Cromolyn and Nedocromil

A
  • Throat irritation, cough, mouth dryness.
  • Rarely, chest tightness and wheezing
  • reversible dermatitis, myositis, or gastroenteritis, pulmonary infiltration with eosinophilia and anaphylaxis.
34
Q

____ is a monoclonal antibody and prevents binding of ____ to basophils and mast cells.

It is used for patients with ____ persistent asthma with evidence of allergy

A

Omalizumab is a monoclonal antibody and prevents binding of IgE to basophils and mast cells.

It is used for patients with severe persistent asthma with evidence of allergy

35
Q

Omalizumab AE?

A

Anaphylaxis

36
Q

list the:

  1. Leukotriene Receptor Antagonists (LTRAs)
  2. 5-Lipoxygenase inhibitors
A
  • LTRA: Montelukast, Zafirlukast
  • 5-LOX inhibitor: Zileuton
  • all taken orally
37
Q

what is the use for leukotriene-modifying agents?

A
  • Alternative therapy
  • prevention of exercise-induced bronchospasm
  • management of NSAID-exacerbated respiratory disease (NERD)
38
Q

list the AEs for leukotrine-modifying agents

A
  • Montelukast:
    • insomnia, anxiety, depression, suicidal thinking
  • Zileuton:
    • Hepatotoxicity
39
Q

describe ways to manage acute exacerbations of asthma

A
  • Inhaled SABAs
  • Inhaled SAMAs
  • Systemic corticosteroids
40
Q

describe long term management of asthma

41
Q

describe COPD

A
  • chronic, progressive
  • irreversible obstruction of the airflow
  • most important risk factor: Smoking
  • 3 cardinal symptoms of COPD:
    • dyspnea
    • chronic cough
    • sputum production
42
Q

overview of drugs to manage COPD

43
Q

drugs used for symptomatic relief and in management of acute exacerbations of COPD?

A
  • short acting bronchodilators:
    • SABAs
    • SAMAs
  • systemic cortisoids
    • Oral prednisolone
44
Q

drugs used for long-term control of COPD

A
  • long acting bronchodilators
    • LABAs
    • LAMAs
  • Inhaled corticosteroids:
    • Fluticasone and budesonide
45
Q

the mucolytic agent used in COPD ____ → breaks ___ linkages in mucus and lowers viscosity.

A

the mucolytic agent used in COPD N-Acetylcysteine → breaks disulfide linkages in mucus and lowers viscosity

46
Q

drugs for treating allergic rhinitis

A
  • Glucocorticoid nasal sprays (1st line)
  • Oral antihistamines
  • Cromolyn sodium
  • Montelukast
  • Nasal Decongestants- α adrenergic agonists
    • Phenylephrine
    • Pseudoephedrine
47
Q

list AEs of Glucocorticoids

A
  • local irritation of the nasal mucosa
  • nosebleed
  • nasal septal perforation
  • nasopharyngeal candidiasis
48
Q

oral antihistamines

49
Q

describe the drugs used for coughing

A

Codeine and dextromethorphan

  • Suppress cough reflex via a direct action on the cough center in the medulla of the brain
  • Adverse effects: constipation and drowsiness
  • Dextromethorphan = safer, lower abuse potential than codeine

Pharm (6 decks)

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