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Intro To Respirary Care > Unit 7 Pharmacology > Flashcards

Unit 7 Pharmacology Flashcards

0
Q

Pharmacokinetic

A

the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination.

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1
Q

Drug administration

A

the method by which a drug dose is made available to the body.

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2
Q

Pharmacodynamic

A

describes the mechanisms of drug action

can be g-protein or intracellular receptors

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3
Q

Adrenergic drugs

A

stimulate receptors responding to norepinephrine or epinephrine

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4
Q

Antiadrenergic drugs

A

block receptors for epinephrine or norepinephrine

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5
Q

Cholinergic drugs

A

stimulate receptors for acetylcholine

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6
Q

Anticholinergic drugs

A

block receptors for acetylcholine

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7
Q

Muscarinic drugs

A

Stimulate acetylcholine receptors specifically at parasympathetic nerve ending sites

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8
Q

Beta- 1

A

Adrenergic (Nor or epi)

Causes increased heart rate and contractile force

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9
Q

Beta - 2

A

Adrenergic (Nor and epi)
Bronchiolar smooth muscle is bronchodilated
Pulmonary blood vessels are vasodilated
Bronchial blood vessels are vasodilated
Submucosal glands have increased fluid and mucin

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10
Q

BETA WHAT?

A

BETA DILATION

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11
Q

Alpha - 1

A

Adrenergic (nor and epi)
Pulmonary blood vessels - vasoconstriction
Bronchial blood vessels - vasoconstriction
Submucosal glands- increased fluid and mucin

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12
Q

ALPHA WHAT?

A

ALPHA CONSTRICTION

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13
Q

M2

A

Cholinergic (acetylcholine) at the heart

Causes decreased heart rate

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14
Q

Muscarinic- M3

A

Cholinergic (acetylcholine)
Causes bronchoconstriction in bronchiolar smooth muscle.
Causes vasodilation in pulmonary blood vessels
Submuscosal glands perform exocytosis and secretion.

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15
Q

When do you want to use adrenergic bronchodilators?

A

When you have REVERSIBLE AIRFLOW OBSTRUCTION.

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16
Q

Ultra short acting Adrenergic Bronchodilator agents

A

Alpha and beta receptors

Epinephrine (Adrenalin Chloride, Primatene mist)

Racemic Epinephrine (microNefrin, Nephron, S-2)

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17
Q

Epinephrine Brand names

A

Adrenalin Chloride (SVN: 1% soln, 0.25-0.5 ml, 2.5-5.0 mg, 4x daily)

Primatene Mist (MDI: 0.22 mg/puff prn)

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18
Q

Racemic Epinephrine brand names

A

microNefrin, Nephron, S-2

Use SVN: 2.25%, 0.25-0.5 ml (5.63-11.25mg) 4x daily

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19
Q

Short acting adrenergic bronchodilator agents

A 
Beta-2
Metaproterenol (Alupent)
Albuterol (Proventil, Ventolin, ProAir, Accuneb, VoSpire)
Pirbuterol (Maxair Autohaler)
Levalbuterol (Xopenex)
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20
Q

Metaproterenol brand name

A

Alupent
SVN: 0.4%, 0.6% tid or qid
Tab: 10 mg and 20 mg tid or qid
Syrup: 10 mg per 5 ml

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21
Q

Albuterol brand names

A

Proventil, Ventolin, ProAir, AccuNeb, VoSpire
SVN: 0.5% soln, 0.5 ml (2.5mg), 0.63 mg, 1.25 mg, and 2.5 mg unit dose
tid or qid

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22
Q

Pirbuterol brand name

A

Maxair Autohaler
MDI: 200 microgram/puff
2x puffs every 4-6 hours

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23
Q

Levalbuterol brand name

A 
Xopenex
SVN: 0.31 mg/ 3ml tid
0.63 mg/ 3ml tid
1.25 mg/ 3ml tid
or concentrate 1.25 mg/0.5ml tid
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24
Common Ultra short acting catecholamine side effects
Tachycardia, increased BP
25
Good use for epinephrine or racemic epinephrine?
Reduce swelling in nose (decongestant) and larynx (croup, epiglottitis) and to control bleeding during bronchoscopic biopsy
26
Duration of action for short acting noncatecholamine agents?
4-6 hours
27
Long-Acting Adrenergic Bronchodilator Agents
Beta- 2 Salmeterol (Serevent Diskus) Formoterol (Perforomist, Foradil, Foradil Certihaler) Arformoterol (Brovana)
28
Salmeterol
AKA Serevent Diskus DPI: 50 micrograms/blister bid
29
Formoterol
AKA Perforomist, Foradil, Foradil Certihaler SVN: 20 microgram/ 2ml unit dose, bid DPI: 12 microgram / inhalation, bid DPI: 8.5 microgram/inhalation, bid
30
Arformoterol
AKA Brovana SVN: 15 mics/ 2ml unit dose, bid
31
What is cool about Levalbuterol (Xoponex)?
Levalbuterol is a pure (R)- isomer of racemic albuterol. 0.63mg dose was comparable to 2.5mg racemic albuterol in onset and duration. Side effects of tremor and HR changes were less with single isomer formation
32
Adverse Effects of long acting bronchodilators
Tachycardia, palpitations, headache, insomnia, nervousness. | Dizziness, hypokalemia, loss of bronchoprotection, nausea, tachyphylaxis (tolerance) worsened V/Q ratio
33
Anticholinergic Bronchodilators
Ipratropium bromide (Atrovent) Ipratropium bromide and albuterol (Combivent and Duoneb) Tiotropium bromide (Spiriva)
34
What is the indication for anticholinergic bronchodilators?
For airflow improvement in COPD, including chronic bronchitis and emphysema.
35
Ipratropium bromide
Atrovent... 15 min onset, 1-2 hour peak, 4-6 hour duration MDI: 17mic/puff, 2 puffs qid SVN: 0.02% soln (0.2 mg/ml), 500 ug 3-4 daily Nasal: 21 ug or 40 ug, 2 sprays per nostril 2-4x daily
36
Ipratropium bromide and albuterol
Combivent and DuoNeb... 15 min onset, 1-2 hour peak, 4-6 hour duration MDI: Ipratropium 10ug/puff and albuterol 90ug/puff 2 puffs qid
37
Tiotropium bromide
Spiriva... 30 min onset, 3 hour peak, 24 hour duration DPI: 18 ug/inhalation one time daily
38
Side effects of anticholinergic aerosol agents
SVN, MDI, DPI: cough and dry mouth MDI (occasional): nervousness, irritation, dizziness, headache, palpitation, and rash. SVN and DPI: pharyngitis, dyspnea, flu-like, bronchitis, upper respiratory infections, nausea, occasional bronchoconstriction, eye pain, and urinary retention.
39
Mucus controlling agents
N-acetyl cysteine (NAC)- (mucomyst) Dornase alfa (Pulmozyme) Saline water
40
N-Acetylcysteine
10% or 20% ... SVN: 3-5 ml Used to treat bronchitis
41
Dornase alfa
Pulmozyme SVN: 2.5 mg / ampule, 1x daily... Give 30 minutes before chest PT Used to treat CF
42
What is another use for N-acetylcysteine?
It is used to treat or prevent liver damage that can occur when a patient overdoses on acetaminophen.
43
What do you give in addition to a mucoactive agent?
You give a BRONCHODILATOR because the agents cause bronchospams.
44
What is the mode of action of mucolytics?
The mucolytics break the di-sulfide bonds within the mucus.
45
Corticosteroids
Beclomethasone (QVAR) Fluticasone (Flovent) Budesonide (Pulmicort flexhaler and respules) Mometasone (Asmanex Twisthaler) Fluticasone propionate/ salmeterol (Advair diskus and HFA) Budesonide/ formoterol (Symbicort) Mometasone furoate (Dulera)
46
Beclomethasone
QVAR MDI: 40 and 80 ug/puff This dose is for pretty much everyone, sometimes up to 160 ug
47
Fluticasone
Flovent | MDI: 44, 110, and 220 ug/puff bid
48
Budesonide
Pulmicort Flexhaler/Respules DPI: 90 ug/actuation and 180 ug/actuation SVN: 0.25 mg/2ml, .5 mg/2ml, and 1mg/2ml Children usually do the .5 dose
49
Mometasone
Asmanex Twisthaler DPI: 220 ug/actuation, or 110 ug/actuation Adults can go up to 440 or 880 daily
50
Fluticasone propionate/ salmeterol
Advair Diskus or HFA DPI: 100 ug fluticasone and 50 ug salmeterol, or 100/50, 500/50 HFA= 100/50
51
Budesonide / formoterol
Symbicort | MDI: 80 ug budesonide/4.5 ug formoterol, 160/4.5, 320/9, 160/9
52
Mometasone / formoterol
Dulera | MDI: 100 ug/5ug and 200/5
53
Systemic hazards of aerosolized corticosteroids
``` Adrenal insufficiency Extrapulmonary allergy Acute asthma HPA suppression Growth retardation Osteoporosis (THANKS VINES) ```
54
Local (Topical) hazards of aerosolized corticosteroids
Oropharyngeal fungal infection Dysphonia Cough/ Bronchoconstriction Incorrect use of MDI
55
Indication for nonsteroidal antiasthma drugs?
These are leukotriene modifiers. They are used as prophylactic management of persistent asthma.
56
Nonsteroidal antiasthma drugs mode of action
These inhibit degranulation of mast cells in response to allergic and nonallergic stimuli. This prevents histamine release.
57
Nonsteroidal antiasthma medications
Cromolyn sodium (mast cell stabilizer)-- NasalCrom and Gastrorom Montelukast (anti- leuk) Singulair
58
Cromolyn Sodium
This is a mast cell stabilizer. NasalCrom, Gastrocrom SVN: 20 mg/ampule or 20 mg/2ml Spray: 40 mg/ml
59
Montelukast
Antileukotriene Singulair Tablets: adults 10 mg, children 6-14 get 5mg and children 2-5 get 4 mg packet of granules
60
Inhaled anti-infective agents
Pentamidine (NebuPent) Ribavirin (Virazole) Tobramycin (TOBI)
61
Pentamidine
300 mg powder in 6ml sterile water, once every 4 weeks Used for prophylaxis of pneumocystis pneumonia
62
Ribavirin
6 g powder in 300 ml sterile water every 12-18 hours via a SPAG for treatment of RSV
63
Tobramycin
300 mg/ 5 ml ampule for treatment of cystic fibrosis
64
Side effects of pentamidine
cough, bronchial irritation, bronchospasm, wheezing, SOB, fatigue, bad/metallic taste, pharyngitis, conjunctivitis, rash, CP. Decreased appetite, dizziness, rash, nausea, night sweats, chills, spontaneous pneumothoraces, neutropenia, pancreatitis, renal insufficiency, and hypoglycemia.
65
Side effects of ribavirin
skin rash, eyelid erythema, conjunctivitis
66
Side effects of tobramycin
auditory or vestibular damage with potential for deafness and nephrotoxicity
67
Nitric oxide indications, mode of action, and adverse effects
Neonates with hypoxic respiratory failure. Relaxes vascular smooth muscle Contraindicated in neonates with dependent right to left shunts.
68
Iloprost
Treats pulmonary hypertension. administered via nebulizer | May cause syncope and pulmonary edema

Intro To Respirary Care (5 decks)

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