Unit 4 drugs

Question 1

Short acting beta 2 agonist

Answer 1

Albuterol inhalation(Proventil HFA, Ventolin HFA, ProAir RespiClick)

Levalbuterol (Xopenex)

Question 2

Long acting beta 2 agonist

Answer 2

Formoterol (foradil)
Salmeterol(Serevent)

Question 3

Bronchodilators MOA

Answer 3

Increase cyclic adenosine monophosphate by activation of adenyl cyclase, turning ATP to cAMP. Increased cAMP relaxes bronchial smooth muscle and inhibit release of mediators from mast cells.

Question 4

Albuterol absorption and distribution

Answer 4

Inhaled: Absorbed in bronchi, low systemic concentration

PO: Well absorbed in GI tract, widely distributed in body fluids and tissue. Unknown about breast milk

Question 4

Levalbuterol absorption and distribution

Answer 4

Minimally absorbed from respiratory tract and distribution is unknown

Question 5

Inhaled albuterol metabolism and excretion

Answer 5

Hepatic Metabolism.
Elimination: Renal 90%; Fecal 10%(w/in 24 hours

Question 6

PO albuterol metabolism and excretion

Answer 6

Hepatic Metabolism.
Elimination: Renal 90%; Fecal 10% (over 3 days)

Question 7

Levalbuterol Metabolism and excretion

Answer 7

Hepatic Metabolism.
Elimination: Renal 90%; Fecal 10%

Question 8

Beta 2 agonist side effects

Answer 8

Overuse of the beta2-agonist bronchodilators can lead to seizures, hypokalemia, anginal pain, and hypertension. May have some stimulant-like effects (e.g., increased heart rate, tremors) when they initially begin the medication

Question 9

Albuterol indication

Answer 9

Bronchospasm associated with asthma or COPD

Question 10

Levalbuterol indication

Answer 10

Bronchospasm in patients with reversible obstructive airway disease

Question 11

Formoterol absorption and distribution

Answer 11

inhaled dry powder capsule administered via a unique Aerolizer inhaler. The powdered medication is quickly absorbed in the lungs, with an onset of 1 to 3 minutes. No human studies of distribution into breast milk

Question 12

Formoterol metabolism and excretion

Answer 12

Hepatic metabolism, renal excretion

Question 13

Formoterol indication

Answer 13

Long-acting bronchodilator for preventing bronchospasm

Question 14

Salmeterol absorption and distribution

Answer 14

absorbed via the lungs in small amounts; undetectable amounts are found in the serum with recommended doses. With chronic administration, detected in the serum at very low levels. Is excreted in breast milk in small amounts

Question 15

Xanthine derivative

Answer 15

Theophylline

Question 16

Xanthine derivatives MOA

Answer 16

work directly by an unknown mechanism believed to be mediated by selective inhibition of specific phosphodiesterases (PDEs). This produces an increase in cAMP, which then leads to bronchial smooth muscle and pulmonary vessel relaxation.

Question 17

Theophylline absorption and distribution

Answer 17

Most commonly used in an oral form that is rapidly and completely absorbed from the GI tract. Distributes rapidly in nonadipose tissue and body water, including breast milk and cerebral spinal fluid. Theophylline crosses the placenta.

Question 18

Theophylline metabolism and excretion

Answer 18

metabolized primarily in the liver, with little or no first-pass effect. Metabolism is believed to occur over multiple parallel pathways, mediated by CYP450. Medications that induce CYP450 can significantly increase clearance of theophylline. CAFFEINE IS MINOR ACTIVE METABOLITE.
Renal excretion

Question 19

Theophylline ADR

Answer 19

Uncommon with low levels

Question 20

Theophylline toxicity

Answer 20

Patients who are having signs of toxicity may mistakenly think they have a viral illness. Toxicity symptoms to report include nausea, vomiting, insomnia, jitteriness, headache, rash, severe GI pain, restlessness, convulsions, or irregular heartbeat.

Question 21

Theophylline indication

Answer 21

Bronchospasm associated with asthma, COPD, and bronchitis

Question 22

Anticholinergics

Answer 22

Ipatropium bromide(oral inhalant) - Atrovent

Tiotropium(spiriva respimat, spiriva handihaler)

Question 23

Ipatropium MOA

Answer 23

Block the muscarinic cholinergic receptors by antagonizing the action of acetylcholine. Blocking the cholinergic receptors decreases the formation of cyclic guanosine monophosphate (cGMP), which leads to decreased contractility of the smooth muscle of the lungs

Question 24

Tiotropium MOA

Answer 24

Inhibits the muscarinic M3 receptors in the lungs, causing smooth muscle bronchodilation

Question 25

Ipatropium absorption and distribution

Answer 25

When inhaled poorly absorbed from both the lungs and the GI tract. Only 1% to 2% of a dose is systemically absorbed. Ipratropium penetrates the CNS poorly. It is unknown whether it crosses the placenta. Excreted into breast milk in minimal amounts.

Question 26

Ipatropium metabolism and excretion

Answer 26

Ester hydrolysis metabolism. Renally excreted

Question 27

Ipatropium precautions

Answer 27

contraindicated in patients with hypersensitivity to atropine or atropine derivatives and for those with bromide sensitivity

Question 28

Inhaled anticholinergics precautions

Answer 28

Should not be used as treatment for acute bronchospams. Should be avoided in patients with urinary retention, bladder neck obstruction, or prostatic hypertrophy because of the anticholinergic effects

Question 29

Ipatropium ADR

Answer 29

Cough, horseness, throat irritation, dysgeusia

Question 30

Tiotropium ADR

Answer 30

Dry mouth

Question 31

Ipatropium and tiotropium drug reactions

Answer 31

Ipratropium and tiotropium are minimally absorbed into the systemic circulation after inhalation; therefore, there are no major drug interactions

Question 32

Tiotropium absorption and distribution

Answer 32

Tiotropium is administered via dry powder inhaler, has a bioavailability of 19.5%, and is 72% protein bound in human plasma. Does not cross blood brain barrier, unknown if it is excreted in breast milk or whether if crosses the placenta.

Question 33

Tiotropium metabolism and excretion

Answer 33

Liver metabolism. Renal excretion

Question 34

Tiotropium indications

Answer 34

Bronchospasm associated with COPD and controller medication for asthma.

Not for children <6yrs.

Question 35

Leukotrine modifiers

Answer 35

Montelukast (singulair)

Question 36

Montelukast MOA

Answer 36

Inhibits the actions of LTD4 at the CysLT1 receptor. Cysteinyl leukotrienes contribute to the pathophysiology of asthma and allergy, including airway edema, smooth muscle constriction, and cellular changes associated with the inflammatory process

Question 37

Montelukast absorption and distribution

Answer 37

Rapidly absorbed after oral administration. More than 99% protein bound

Minimal distribution across the blood–brain barrier in rats; no human studies are available. Montelukast crosses the placenta in rats and is excreted in rat milk;

Question 38

Montelukast metabolism and excretion

Answer 38

Extensive hepatic metabolism. Excreted in bile

Question 39

Leukotrine modifiers precautions

Answer 39

Not to be used for primary treatment of acute asthma attack.

Montelukast tablets are contraindicated in patients with phenylketonuria because the product contains phenylalanine.

Question 40

Leukotriene modifier contraindication

Answer 40

Only true contraindication is hypersensitivity to any component of med

Question 41

Montelukast drug interaction

Answer 41

Phenobarbital, Rifampin