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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
Q

Common Ultra short acting catecholamine side effects

A

Tachycardia, increased BP

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25
Q

Good use for epinephrine or racemic epinephrine?

A

Reduce swelling in nose (decongestant) and larynx (croup, epiglottitis) and to control bleeding during bronchoscopic biopsy

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26
Q

Duration of action for short acting noncatecholamine agents?

A

4-6 hours

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27
Q

Long-Acting Adrenergic Bronchodilator Agents

A

Beta- 2
Salmeterol (Serevent Diskus)

Formoterol (Perforomist, Foradil, Foradil Certihaler)

Arformoterol (Brovana)

28
Q

Salmeterol

A

AKA Serevent Diskus

DPI: 50 micrograms/blister bid

29
Q

Formoterol

A

AKA Perforomist, Foradil, Foradil Certihaler

SVN: 20 microgram/ 2ml unit dose, bid
DPI: 12 microgram / inhalation, bid
DPI: 8.5 microgram/inhalation, bid

30
Q

Arformoterol

A

AKA Brovana

SVN: 15 mics/ 2ml unit dose, bid

31
Q

What is cool about Levalbuterol (Xoponex)?

A

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
Q

Adverse Effects of long acting bronchodilators

A

Tachycardia, palpitations, headache, insomnia, nervousness.

Dizziness, hypokalemia, loss of bronchoprotection, nausea, tachyphylaxis (tolerance) worsened V/Q ratio

33
Q

Anticholinergic Bronchodilators

A

Ipratropium bromide (Atrovent)

Ipratropium bromide and albuterol (Combivent and Duoneb)

Tiotropium bromide (Spiriva)

34
Q

What is the indication for anticholinergic bronchodilators?

A

For airflow improvement in COPD, including chronic bronchitis and emphysema.

35
Q

Ipratropium bromide

A

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
Q

Ipratropium bromide and albuterol

A

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
Q

Tiotropium bromide

A

Spiriva… 30 min onset, 3 hour peak, 24 hour duration

DPI: 18 ug/inhalation
one time daily

38
Q

Side effects of anticholinergic aerosol agents

A

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
Q

Mucus controlling agents

A

N-acetyl cysteine (NAC)- (mucomyst)

Dornase alfa (Pulmozyme)

Saline water

40
Q

N-Acetylcysteine

A

10% or 20% … SVN: 3-5 ml

Used to treat bronchitis

41
Q

Dornase alfa

A

Pulmozyme

SVN: 2.5 mg / ampule, 1x daily… Give 30 minutes before chest PT

Used to treat CF

42
Q

What is another use for N-acetylcysteine?

A

It is used to treat or prevent liver damage that can occur when a patient overdoses on acetaminophen.

43
Q

What do you give in addition to a mucoactive agent?

A

You give a BRONCHODILATOR because the agents cause bronchospams.

44
Q

What is the mode of action of mucolytics?

A

The mucolytics break the di-sulfide bonds within the mucus.

45
Q

Corticosteroids

A

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
Q

Beclomethasone

A

QVAR
MDI: 40 and 80 ug/puff
This dose is for pretty much everyone, sometimes up to 160 ug

47
Q

Fluticasone

A

Flovent

MDI: 44, 110, and 220 ug/puff bid

48
Q

Budesonide

A

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
Q

Mometasone

A

Asmanex Twisthaler
DPI: 220 ug/actuation, or 110 ug/actuation
Adults can go up to 440 or 880 daily

50
Q

Fluticasone propionate/ salmeterol

A

Advair Diskus or HFA

DPI: 100 ug fluticasone and 50 ug salmeterol, or 100/50, 500/50
HFA= 100/50

51
Q

Budesonide / formoterol

A

Symbicort

MDI: 80 ug budesonide/4.5 ug formoterol, 160/4.5, 320/9, 160/9

52
Q

Mometasone / formoterol

A

Dulera

MDI: 100 ug/5ug and 200/5

53
Q

Systemic hazards of aerosolized corticosteroids

A 
Adrenal insufficiency
Extrapulmonary allergy
Acute asthma
HPA suppression
Growth retardation
Osteoporosis (THANKS VINES)
54
Q

Local (Topical) hazards of aerosolized corticosteroids

A

Oropharyngeal fungal infection
Dysphonia
Cough/ Bronchoconstriction
Incorrect use of MDI

55
Q

Indication for nonsteroidal antiasthma drugs?

A

These are leukotriene modifiers. They are used as prophylactic management of persistent asthma.

56
Q

Nonsteroidal antiasthma drugs mode of action

A

These inhibit degranulation of mast cells in response to allergic and nonallergic stimuli. This prevents histamine release.

57
Q

Nonsteroidal antiasthma medications

A

Cromolyn sodium (mast cell stabilizer)– NasalCrom and Gastrorom

Montelukast (anti- leuk) Singulair

58
Q

Cromolyn Sodium

A

This is a mast cell stabilizer.
NasalCrom, Gastrocrom
SVN: 20 mg/ampule or 20 mg/2ml
Spray: 40 mg/ml

59
Q

Montelukast

A

Antileukotriene
Singulair
Tablets: adults 10 mg, children 6-14 get 5mg and children 2-5 get 4 mg packet of granules

60
Q

Inhaled anti-infective agents

A

Pentamidine (NebuPent)
Ribavirin (Virazole)
Tobramycin (TOBI)

61
Q

Pentamidine

A

300 mg powder in 6ml sterile water, once every 4 weeks

Used for prophylaxis of pneumocystis pneumonia

62
Q

Ribavirin

A

6 g powder in 300 ml sterile water every 12-18 hours via a SPAG

for treatment of RSV

63
Q

Tobramycin

A

300 mg/ 5 ml ampule

for treatment of cystic fibrosis

64
Q

Side effects of pentamidine

A

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
Q

Side effects of ribavirin

A

skin rash, eyelid erythema, conjunctivitis

66
Q

Side effects of tobramycin

A

auditory or vestibular damage with potential for deafness and nephrotoxicity

67
Q

Nitric oxide indications, mode of action, and adverse effects

A

Neonates with hypoxic respiratory failure.

Relaxes vascular smooth muscle

Contraindicated in neonates with dependent right to left shunts.

68
Q

Iloprost

A

Treats pulmonary hypertension. administered via nebulizer

May cause syncope and pulmonary edema

Intro To Respirary Care (5 decks)

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