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Pharmacology > respiratory system > Flashcards

respiratory system Flashcards

1
Q

3 regulatory factors

A
  1. mucous secretion
  2. vascular permeability
  3. bronchial muscle tone
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2
Q

2 types of copd

A
  • chronic obstructive bronchitis

- emphysema

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3
Q

signs and symptoms of asthma

A
  • wheezing
  • cough
  • shortness of breath
  • difficulty breathing
  • episodic
  • triggers by allergens
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4
Q

what causes copd

A
  • long term /chronic exposure to irritants (esp. pollution and smoking)
  • could also be short term/ acute (eg. e-cig, vaping)
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5
Q

asthma versus copd

A
  • asthma is episodic, copd is progressive and irreversible

- asthma is younger, copd is older/elderly

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6
Q

chronic bronchitis signs

A
  • persistant cough
  • sputum
  • enlargement of mucous glands
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7
Q

emphysema signs

A

-enlargement of air spaces (due to destruction of alveolar walls)

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8
Q

example of mucokinetic drug

A

-guaifenesine

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9
Q

what does mucokinetic drug do

A
  • increase mucous production
  • increase fluidity of mucous
  • ciliary clearance
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10
Q

what is mucokinetic drug used to treat

A

cough

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11
Q

AE of mucokinetic drug

A
  • headache

- nausea, vomiting

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12
Q

example of mucolytic drug

A

N-acetylcysteine

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13
Q

what is N-acetylcysteine used to tx

A
  • antidote for acetaminophen toxicity

- copd

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14
Q

how does N-acetylcysteine work

A
  • breaks S-S bonds that hold glycoproteins together in mucous
  • decrease mucous viscosity
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15
Q

AE of N-acetylcysteine

A
  • stomatitis
  • nausea, vomiting
  • rhinorrhea
  • bronchospasm
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16
Q

what does atropine (antimuscarinic) do in the lungs

A

-decrease fluid production

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17
Q

tx indications for atropine (pre-op)

A

-reduce salivation and excessive respiratory secretions

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18
Q

tx indications for atropine (peri-op)

A

-prevent cholinergic effects which result from vagal stimulation (bradycardia, hypotension, cardiac arrythmia)

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19
Q

tx indications for atropine (post-op)

A

-with anticholinesterase agents to terminate curarization

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20
Q

how does Beta 2 agonist cause bronchiole m relaxation

A

-activate PKA which will inactive MLCK

MLCK causes contraction

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21
Q

what does theophylline do

A

inhibit bronchoconstriction

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22
Q

asthma can be treated with a combination of __ and __

A

beta 2 agonist + corticosteroids

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23
Q

tx indications for epi

A
  • asthma
  • anaphylactiv shock, hypersensitivity rxns
  • cardiac arrest
  • vasoconstrictor and LA
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24
Q

terbutaline classification

A

selective beta 2 agonist

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25
Q

terbutaline AE

A
  • tremor, palpitations, nervousness, headache

- nausea, tachycardia, cardiac arrythmias

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26
Q

why does terbutaline affect the heart

A

because it still has affinity for beta 1 receptors

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27
Q

compare inhaler, oral, and iv for onset of action

A
  • inhaler: fast
  • oral: slow
  • IV: very fast
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28
Q

compare inhaler, oral, and iv for duration

A
  • inhaler: medium
  • oral: long
  • IV: short
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29
Q

AEs of salbutamol/albuterol

A
  • nervousness, tremor
  • hypotension (peripheral vasodilation)
  • tachycardia
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30
Q

salmeterol classification

A

long-acting beta 2 agonist (LABA)

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31
Q

can salmeterol be used to treat asthma attack

A

NO! its a long-term, maintanence drug

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32
Q

AEs of salmeterol

A

nervousness, tremor, tachycardia

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33
Q

does salmeterol bind directly to beta 2

A

no, it has an exosite and couples/un-couples to the beta 2 receptor

34
Q

formoterol classification

A

long-acting beta 2 agonist

35
Q

does formoterol bind directly to beta 2

A

yes. it doesn’t have exosite binding

36
Q

can formoterol be used to treat asthma attack

A

NO! its a long-term, maintanence drug

37
Q

AEs for formoterol

A

headache, palpitations, nervousness, tremor, tachycardia

38
Q

**AE on oral health for salmeterol and formoterol

A
      • xerostomia
  • candidiasis
  • tooth pain
39
Q

are LABAs the first choice of drugs for asthma tx

A

no! lots of AE and deaths

40
Q

how can muscarinic antagonists help treat asthma

A
  • increase bronchodilation

- decrease mucous secretion

41
Q

name 3 muscarinic antagonists that can treat respiratory disease

A
  • atropine
  • ipratropium bromid
  • tiotropium
42
Q

which muscarinic receptors does ipratropium bromide have a higher affinity for

A

M1, then M3=M2

43
Q

why is atropine not given for asthma

A

lot of AEs. also crosses BBB, so CNS AEs as well

44
Q

ipratropium bromide is prefered over atropine because__

A

it doesnt pass BBB so no CNS AEs

45
Q

ipratropium bromide is a ____derivative

A

4ry atropine

46
Q

tiotropium

A
  • long acting
  • tx: COPD
  • M3 affinity > M1&raquo_space; M2
47
Q

example of methylated xanthine

A

theophylline

48
Q

mechanism of action: theophylline

A
  1. inhibits phosphodiesterase 3 and 4 -> increased cAMP -> increase PKA -> bronchoDILATION
  2. adenosine receptor antagonism
  3. anti-inflammatory
49
Q

why is theophylline not commonly used

A
  • narrow therapeutic index

- inter-individual variation in liver metabolism

50
Q

half life of theophylline can be increased with which drug interactions

A
  • oral contraceptives

- erythromycin

51
Q

half life of theophylline can be decreased with which drug interactions

A
  • phenytoin

- barbiturates

52
Q

name the anti-inflammatory drug classifications

A
  • glucocorticoids

- biologics (MABs): IL-5 and Leukotrine

53
Q

what effect does glucocorticoids have on inflammatory response

A

they inhibit inflammatory response

54
Q

name the 3 mechanisms of actions of glucocorticoids

A
  1. block GRE: decrease TF for synthesis of CK
  2. more polypeptide lipocortin-1: decrease pro-infl. mediators
  3. less T cell synthesis (inhibit IL): decrease IgE, mast cells, eosinophils
55
Q

are glucocorticoids for tx of asthma

A

not for acute asthma attacks

-maintenance/chronic asthma (prevention of inflammation in asthma)

56
Q

name the 2 glucocorticoid drugs for asthma

A
  • fluticasone

- ciclesonide

57
Q

why does glucocorticoids lead to systemic AEs

A

-lots gets swallowed -> GI -> first pass (liver) _> systemic circulation

58
Q

what can be taken to reduce systemic AEs with glucocorticoids

A

spacer or mouth wash

59
Q

name all systemic AEs for glucocorticoids

A
  • osteoporosis, stunt growth
  • increase susceptibility to infection
  • ulcer
  • cushing’s
  • sodium retention and hypertension
60
Q

name all oral AEs for glucocorticoids

A
  1. xerostomia
  2. candidiasis
  3. glossitis
  4. ulcerations
61
Q

IL-5 modifying drugs involve MABs. what are MABs

A

monoclonal antibodies

62
Q

IL-5 receptor is blocked by which drug

A

fasenra (benralizumab)

63
Q

name an anti-IgE MABs

A

omalizumab

64
Q

is omalizumab used for asthma attacks

A

no!

65
Q

what are the AEs of omalizumab

A
  • anaphylactic/ allergy
  • cerebrovascular events
  • malignancies
66
Q

what are the oral AEs of omalizumab

A
  • toothache
  • candidiasis
  • orofaryngeal pain
  • sinusitis
67
Q

leukotriene synthesis inhibitor (inhibits 5-lipoxigenase)

A

zileuton

68
Q

leukotriene receptor antag (Cys-Lt1 antag)

A
  1. montelukast

2. zafirlukast

69
Q

can leukotriene receptor antag (Cys-Lt1 antag) be used to tx asthma

A

no. they are for prophylaxis or chronic tx of asthma

70
Q

why is zafirlukast better than montelukast

A
  • longer half life
  • higher bioavailability
  • only 1 cyp enzyme
  • low oral AEs
71
Q

what are the AEs on oral health for montelukast

A
  • toothache
  • increased bleeding
  • thrombocytopenia
72
Q

fenoterol (beta 2 ag) can be combined with which muscarinic antag

A

ipratropium bromide

73
Q

salmeterol can be combined with which corticosteroid. can it be for acute asthma?

A

fluticasone. no

74
Q

formoterol can be combined with which corticosteroid. can it be for acute asthma?

A

budesonide. no

75
Q

systemic AEs for long acting beta 2 ag + corticosteroid

A
  • upper resp. tract infection
  • tachycardia, HT, arrythmmias, nervousness
  • headache, sinusitis, migraine
76
Q

oral AEs for long acting beta 2 ag + corticosteroid

A
  • xerostomia
  • candidiasis
  • glossitis
  • ulcerations
77
Q

why should you be careful giving NSAID (like aspirin, ibuprophen) to someone with respiratory illness? What can you give instead?

A

NSAID leads to bronchoconstriction (AE). better to give acetominophen

78
Q

why should you be careful giving propanolol to someone with respiratory illness? What can you give instead?

A
  • non-selective

- atenolol is selective to beta 1

79
Q

why should you be careful giving ACE inhibitors and angiotension receptor blockers to someone with respiratory illness?

A

AE of them causes dry, hacking, nonproductive cough

80
Q

ACE inhibitors

A
  • captopril

- benazepril

81
Q

angiotensin receptor blockers

A
  • losartan

- candesartan

82
Q

what are the 6 drugs you must have in your office for respiratory illnesses

A
  • oxygen
  • E
  • nitroglycerin
  • diphenhydramine / chlorpheniramine
  • salbutamol
  • ASA

Pharmacology (17 decks)

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