Thyroid agents/ Resp agents

Question 1

what tissues are thyroid hormone receptors found

Answer 1

pituitary
liver
skeletal msucle
heart
kidney
lung
intestine

Question 2

absorption of T4 vs T3

Answer 2

T4 best absorbed from duodenum and ileum (80%) aka best to give orally

t3 93% absorbed

Question 3

distribution of T3/4

Answer 3

most (99%) bound to thyroglobulin and only free= active

Question 4

metabolism of T3/4/ excretin

Answer 4

primarily through deiodination

excretion= half life of T4 is 7 days

have to wait 5 weeks before checking to see if meds working

Question 5

what is levothyroxine

Answer 5

synthetic T4

types

• synthroid
• levoxyl
• levothroid

Question 6

what is liothyronine (cytomel

Answer 6

synthetic T3

good for if ppl have hard time converting T3 to T4

Question 7

what is armour thyroid

Answer 7

desiccated pork of bovine thyroid- ground up animal thyroid

aka has both T3 and 4 in pill form

Question 8

what is asthma

Answer 8

hyper responsiveness associated directly with inflamm response within airway - airway collapses

can lead to ariway remodeling if chronic

Question 9

what is the airway innervated by

what are the receptors

Answer 9

innervated by symp, para, and noradrenergic inhibitory nerves

receptors:

1. beta 2 adrenergic produce bronchodilation
   - adrenaline binds
2. anticholinergics produce some bronchodilation

Question 10

what is the process of airway remodeling

Answer 10

hypertrophy/hyperplasia of airway smooth muscle

increased airway wall thickness

mucus hyper secretion (more viscous)

Question 11

what causes inflammation in airway

Answer 11

mast cells

alveolar macrophages

histamine - smooth muscle constriction

prostaglandins, thromboxanes, leukotrienes - bronchospasm / contriction/mucous

Question 12

what are the inhaled medications for asthma

Answer 12

beta 2 agonsists

corticosteriods

anticholinergics

combination prods

Question 13

beta 2 agonists

• what are they used for
• MOA

Answer 13

most commonly for asthma

significant beta 2 selectivity = significant bronchodilation

Question 14

beta 2 agonsits

-short acting vs long

Answer 14

short= effect seen as early as 5 mins, max effect = 30
lasts 3-4 hours

long acting

• more lipophilic=dissolve into smooth muscle membranes and= longer lasting
• onset action 30-60 mins
• distribution limited to resp tract

Question 15

what are the indications to use a beta 2 agonists

Answer 15

asthma
COPD
RAD (reactive airway disease)

Question 16

what are the side effects of beta 2 agonists

Answer 16

tachy- still some beta 1
tremors
hypokalemia- receptors involve Na/K ATPase
interacts iwth non selective beta blockers

Question 17

what is considered overuse for beta 2 agonists

Answer 17

MORE THAN ONE CANISTER A MONTH

Question 18

what are the short acting beta 2 agonists

Answer 18

albuterol

levalbuterol

Question 19

what are the long acting beta 2 agonists

Answer 19

salmeterol

aforometerol

not used alone because increases mortality does not actually help as much as though in decreasing bronchospasms

brushed by these

Question 20

what is the MOA of inhaled corticosteriods

Answer 20

inhaling hoping to have local affect to decrease cytokines and inflamm response and decrease mucous

inhibit inflamm component of asthma by reducing prod of cytokines

minimal distribution because only at site of lungs

onset of action = 3-4 days and max in few weeks

Question 21

what are the indications for inhaled corticosteriods

Answer 21

asthma

COPD

Question 22

what are the side effects for inhaled corticosteriods

Answer 22

headache
throat itch
wheezing
candida albicans 
- make pts rinse mouth after use !!!!!!!

Question 23

which drugs cause candida = thrush

Answer 23

corticosteriods

make them rinse mouth after use

true for all inhaled steriods

Question 24

what are the inhaled corticosteriods

Answer 24

fluticasone (flovent)
beclomethasone
budesonide

Question 25

how do anticholinergics inhaled work

Answer 25

competitively inhibit effect of acetylcholine at muscarinic receptors in airways blocking:

• airway constriciton
• airway mucus secretion

very little absorbed

Question 26

what are the indications for anticholinergics

Answer 26

chronic maintenance therapy in COPD

Question 27

agents in class of anticholinergics

Answer 27

ipratropium (atrovent)- short acting

tropropium (spiriva) - long acting lasts 24 hours

Question 28

what drugs can be used with nebulizer

Answer 28

beta agonists

anticholinergics

steriods

Question 29

what are H1 receptors and H2 receptors known for causing

Answer 29

H1= allergies- itchy, hives, scratchy throat
-located on endothelial + smooth muscle cells

H2= excessive acid disorders (GERD/PUD)

Question 30

what cells release histamine by immunologic responses

Answer 30

mast cells

Question 31

where are H1 receptors located and what happens when activated

Answer 31

located on endothelial + smooth muscle cells

when activated

• edema (increased perm of certain vessels)
• hives (release of histamine in skin)
• bronchoconstriction (pts with asthma very sens to histamine)

Question 32

where are H2 receptors located

Answer 32

parietal cells in GI

stimulate acid secreetion

Question 33

how do H1 receptor antagonists work

Answer 33

all h1 antagnists:

naturally (physiologic ones) are epinephrine !!

• we can inject for life threatening anaphylaxis
• not an antihistamine but causes all the right stuff like stops bronchconstriction/degranulation of mast cells
• block effects of histamine at receptor level competiviely

Question 34

what are h1 receptor antagonists good use for

Answer 34

treating

• rhinitis
• seasonal allergies
• perennial
• urticaria (hives)

Question 35

what are the classes that antihistamines are divided into

Answer 35

first generation - bind non selectively to H1 receptors = CNS depression or excitation
used in ER

second generation - selective for H1 recep

• less likely cause sedation due to decreased distribution in CNS
• longer half life / fewer side effects