respiratory system Flashcards
1
Q
3 regulatory factors
A
- mucous secretion
- vascular permeability
- bronchial muscle tone
2
Q
2 types of copd
A
- chronic obstructive bronchitis
- emphysema
3
Q
signs and symptoms of asthma
A
- wheezing
- cough
- shortness of breath
- difficulty breathing
- episodic
- triggers by allergens
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)
5
Q
asthma versus copd
A
- asthma is episodic, copd is progressive and irreversible
- asthma is younger, copd is older/elderly
6
Q
chronic bronchitis signs
A
- persistant cough
- sputum
- enlargement of mucous glands
7
Q
emphysema signs
A
-enlargement of air spaces (due to destruction of alveolar walls)
8
Q
example of mucokinetic drug
A
-guaifenesine
9
Q
what does mucokinetic drug do
A
- increase mucous production
- increase fluidity of mucous
- ciliary clearance
10
Q
what is mucokinetic drug used to treat
A
cough
11
Q
AE of mucokinetic drug
A
- headache
- nausea, vomiting
12
Q
example of mucolytic drug
A
N-acetylcysteine
13
Q
what is N-acetylcysteine used to tx
A
- antidote for acetaminophen toxicity
- copd
14
Q
how does N-acetylcysteine work
A
- breaks S-S bonds that hold glycoproteins together in mucous
- decrease mucous viscosity
15
Q
AE of N-acetylcysteine
A
- stomatitis
- nausea, vomiting
- rhinorrhea
- bronchospasm
16
Q
what does atropine (antimuscarinic) do in the lungs
A
-decrease fluid production
17
Q
tx indications for atropine (pre-op)
A
-reduce salivation and excessive respiratory secretions
18
Q
tx indications for atropine (peri-op)
A
-prevent cholinergic effects which result from vagal stimulation (bradycardia, hypotension, cardiac arrythmia)
19
Q
tx indications for atropine (post-op)
A
-with anticholinesterase agents to terminate curarization
20
Q
how does Beta 2 agonist cause bronchiole m relaxation
A
-activate PKA which will inactive MLCK
MLCK causes contraction
21
Q
what does theophylline do
A
inhibit bronchoconstriction
22
Q
asthma can be treated with a combination of __ and __
A
beta 2 agonist + corticosteroids
23
Q
tx indications for epi
A
- asthma
- anaphylactiv shock, hypersensitivity rxns
- cardiac arrest
- vasoconstrictor and LA
24
Q
terbutaline classification
A
selective beta 2 agonist
25
terbutaline AE
- tremor, palpitations, nervousness, headache
| - nausea, tachycardia, cardiac arrythmias
26
why does terbutaline affect the heart
because it still has affinity for beta 1 receptors
27
compare inhaler, oral, and iv for onset of action
- inhaler: fast
- oral: slow
- IV: very fast
28
compare inhaler, oral, and iv for duration
- inhaler: medium
- oral: long
- IV: short
29
AEs of salbutamol/albuterol
- nervousness, tremor
- hypotension (peripheral vasodilation)
- tachycardia
30
salmeterol classification
long-acting beta 2 agonist (LABA)
31
can salmeterol be used to treat asthma attack
NO! its a long-term, maintanence drug
32
AEs of salmeterol
nervousness, tremor, tachycardia
33
does salmeterol bind directly to beta 2
no, it has an exosite and couples/un-couples to the beta 2 receptor
34
formoterol classification
long-acting beta 2 agonist
35
does formoterol bind directly to beta 2
yes. it doesn't have exosite binding
36
can formoterol be used to treat asthma attack
NO! its a long-term, maintanence drug
37
AEs for formoterol
headache, palpitations, nervousness, tremor, tachycardia
38
**AE on oral health for salmeterol and formoterol
* * - xerostomia
- candidiasis
- tooth pain
39
are LABAs the first choice of drugs for asthma tx
no! lots of AE and deaths
40
how can muscarinic antagonists help treat asthma
- increase bronchodilation
| - decrease mucous secretion
41
name 3 muscarinic antagonists that can treat respiratory disease
- atropine
- ipratropium bromid
- tiotropium
42
which muscarinic receptors does ipratropium bromide have a higher affinity for
M1, then M3=M2
43
why is atropine not given for asthma
lot of AEs. also crosses BBB, so CNS AEs as well
44
ipratropium bromide is prefered over atropine because__
it doesnt pass BBB so no CNS AEs
45
ipratropium bromide is a ____derivative
4ry atropine
46
tiotropium
- long acting
- tx: COPD
- M3 affinity > M1 >> M2
47
example of methylated xanthine
theophylline
48
mechanism of action: theophylline
1. inhibits phosphodiesterase 3 and 4 -> increased cAMP -> increase PKA -> bronchoDILATION
2. adenosine receptor antagonism
3. anti-inflammatory
49
why is theophylline not commonly used
- narrow therapeutic index
| - inter-individual variation in liver metabolism
50
half life of theophylline can be increased with which drug interactions
- oral contraceptives
| - erythromycin
51
half life of theophylline can be decreased with which drug interactions
- phenytoin
| - barbiturates
52
name the anti-inflammatory drug classifications
- glucocorticoids
| - biologics (MABs): IL-5 and Leukotrine
53
what effect does glucocorticoids have on inflammatory response
they inhibit inflammatory response
54
name the 3 mechanisms of actions of glucocorticoids
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
are glucocorticoids for tx of asthma
not for acute asthma attacks
| -maintenance/chronic asthma (prevention of inflammation in asthma)
56
name the 2 glucocorticoid drugs for asthma
- fluticasone
| - ciclesonide
57
why does glucocorticoids lead to systemic AEs
-lots gets swallowed -> GI -> first pass (liver) _> systemic circulation
58
what can be taken to reduce systemic AEs with glucocorticoids
spacer or mouth wash
59
name all systemic AEs for glucocorticoids
- osteoporosis, stunt growth
- increase susceptibility to infection
- ulcer
- cushing's
- sodium retention and hypertension
60
name all oral AEs for glucocorticoids
1. xerostomia
2. candidiasis
3. glossitis
4. ulcerations
61
IL-5 modifying drugs involve MABs. what are MABs
monoclonal antibodies
62
IL-5 receptor is blocked by which drug
fasenra (benralizumab)
63
name an anti-IgE MABs
omalizumab
64
is omalizumab used for asthma attacks
no!
65
what are the AEs of omalizumab
- anaphylactic/ allergy
- cerebrovascular events
- malignancies
66
what are the oral AEs of omalizumab
- toothache
- candidiasis
- orofaryngeal pain
- sinusitis
67
leukotriene synthesis inhibitor (inhibits 5-lipoxigenase)
zileuton
68
leukotriene receptor antag (Cys-Lt1 antag)
1. montelukast
| 2. zafirlukast
69
can leukotriene receptor antag (Cys-Lt1 antag) be used to tx asthma
no. they are for prophylaxis or chronic tx of asthma
70
why is zafirlukast better than montelukast
- longer half life
- higher bioavailability
- only 1 cyp enzyme
- low oral AEs
71
what are the AEs on oral health for montelukast
- toothache
- increased bleeding
- thrombocytopenia
72
fenoterol (beta 2 ag) can be combined with which muscarinic antag
ipratropium bromide
73
salmeterol can be combined with which corticosteroid. can it be for acute asthma?
fluticasone. no
74
formoterol can be combined with which corticosteroid. can it be for acute asthma?
budesonide. no
75
systemic AEs for long acting beta 2 ag + corticosteroid
- upper resp. tract infection
- tachycardia, HT, arrythmmias, nervousness
- headache, sinusitis, migraine
76
oral AEs for long acting beta 2 ag + corticosteroid
- xerostomia
- candidiasis
- glossitis
- ulcerations
77
why should you be careful giving NSAID (like aspirin, ibuprophen) to someone with respiratory illness? What can you give instead?
NSAID leads to bronchoconstriction (AE). better to give acetominophen
78
why should you be careful giving propanolol to someone with respiratory illness? What can you give instead?
- non-selective
| - atenolol is selective to beta 1
79
why should you be careful giving ACE inhibitors and angiotension receptor blockers to someone with respiratory illness?
AE of them causes dry, hacking, nonproductive cough
80
ACE inhibitors
- captopril
| - benazepril
81
angiotensin receptor blockers
- losartan
| - candesartan
82
what are the 6 drugs you must have in your office for respiratory illnesses
- oxygen
- E
- nitroglycerin
- diphenhydramine / chlorpheniramine
- salbutamol
- ASA
