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NR565 - Advanced Pharmacology > Week 6 - Final Review > Flashcards

Week 6 - Final Review Flashcards

1
Q

Who is at risk for toxicity when using methylxanthines and why?

A
  • Older adults are at higher risk as medication is metabolized by the liver
  • People with liver dysfunction
  • Heart disease (require lower doses)
  • Smoking causes increased clearance so if stop smoking levels will rise to toxic levels

INITIAL doses are based on age and weight.

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2
Q

What is the first line of treatment for asthma and COPD?

Manage with an inhaled ______________ as needed.

A

Glucocorticoid

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3
Q

What are the day/night symptoms associated with intermittent asthma?

A

Daytime
- Symptoms two days a week or less

Nighttime
- Symptoms two times per month or less

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4
Q

What are the day/night symptoms associated with mild persistent asthma?

A

Day
- Symptoms more than 2x per week but less than daily

Night
- 3-4 times a month

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5
Q

What are the day/night symptoms associated with moderate persistent asthma?

A

Day
- Symptoms daily

Night
- More than once per week but less than nightly

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6
Q

What are the day/night symptoms associated with severe persistent asthma?

A

Day
- Several times per day
Night
- Often nightly

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7
Q

Examples of SABAs

A
  • Albuterol
  • levalbuterol
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8
Q

Benefits of using SABAs

A
  • Taken to relieve an ongoing attack.
  • Quick acting
  • Can be taken prior to exercise to prevent an attack from occurring
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9
Q

Patient education for SABAs

A
  • Proper inhaler technique
  • Daily assessment of peak expiratory flow
  • Keep a record of symptoms, attacks, intensity, affect on normal activity and SABA useage
  • 1 minute between inhalations for metered dose or dry powder
  • Do not exceed prescribed doseage
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10
Q

Why is it important to know the frequency a patient is using their SABA?

A

So you can determine whether the dose is effective or whether you need to adjust their treatment.

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11
Q

Examples of LABAs

A
  • Aclidinium
  • Arformoterol
  • Formoterol
  • Indacaterol
  • Oladaterol
  • salmeterol
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12
Q

LABA

A

Long acting beta agonists

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13
Q

SABA

A

Short acting beta agonist

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14
Q

Benefits of using a LABA

A
  • Provide long term control of symptoms.
  • Dosing is on a fixed schedule (not PRN)

(Must be used with a glucocorticoid in asthma)

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15
Q

LABA use in COPD

A

Can be used without a glucocorticoid because it does not pose the same risk of death in COPD as it does in asthma.

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16
Q

Inhaled corticosteroid examples

A
  • budesonide
  • fluticasone
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17
Q

Benefits of using inhaled corticosteroids

A
  • Suppress inflammation
    —- reduce bronchial hyperreactivity and mucous production
  • Especially effective for asthma prophylaxis and management of COPD exacerbations
  • Significant long-term control of symptoms
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18
Q

At what point would an oral steroid be prescribed?

A

When symptoms cannot be controlled with a safer medication (inhaled glucocorticoid or beta2 agonist) due to potential for toxicity.

Generally prescribed for moderate to severe persistent asthma or COPD.

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19
Q

When would roflumilast be indicated for a COPD patient?

A
  • exacerbation prophylaxis
  • patients with severe COPD with a primary chronic bronchitis component
  • history of frequent exacerbations

Second line drug

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20
Q

How does nicotine replacement work?

A

Smoker receives a pharmaceutical source of nicotine to replace the nicotine in cigarettes and then gradually withdraw the replacement nicotine.

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21
Q

Patient education for nicotine patches.

A

Should be applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. The site should be changed daily and not used again for 1 week.

22
Q

Patient education for nicotine gum

A
  • Chew the gum slowly and intermittently for approximately 30 minutes
  • Patients should not eat or drink for 15 minutes before chewing and while chewing
  • Gum should only be used for a maximum of 6 months
23
Q

Patient education for nicotine nasal spray

A
  • Do not use other tobacco products.
  • Spray technique
  • 1 spray in each nostril
24
Q

Contraindications for Wellbutrin

A

Caution in patient with history of:

  • anorexia
  • alcohol withdrawal
  • cocaine use
  • psychiatric disease
  • seizure
25
Q

What is the recommended length of treatment for bupropion for smoking cessation?

A

12 weeks

26
Q

What is multi-drug resistant TB?

A

Resistant to isoniazid and rifampin

27
Q

What is extensive-drug resistant TB?

A

Resistant to isoniazid and rifampin and all fluoroquinolones and at least one injectable second line anti-TB drug

28
Q

Treatment of TB in a pregnant person, what all should be included?

A
  • Rifabutin is the safest during pregnancy.
  • CDC reports that benefits justify the risks for isoniazid, rifampin and pyrazinamide.
29
Q

What is a secondary use of isoniazid?

A

Prophylaxis for someone who has been exposed to TB.

30
Q

Examples of decongestants

A
  • Phenylephrine
  • Pseudoephedrine
  • Naphazoline
  • Oxymetazoline
  • Tetrahydrozoline
  • xylometazoline
31
Q

What drug class for allergic rhinitis, colds and coughs have no significant drug interactions?

A

Expectorants

32
Q

For asthma, a LABA has been prescribed, what other medication must a LABA be used with?

A

Glucocorticoid

33
Q

What are some benefits of using ICS?

A
  • Very effective
  • safer than systemic
  • usually minor adverse reactions
34
Q

What education can you provide a patient for ICS use?

A

Rinse mouth after use due to the risk of oropharyngeal candidiasis and dysphonia (hoarseness and difficulty speaking)

35
Q

What are some prevention strategies to prevent COPD exacerbations? (Select all that apply)

a. Pulmonary rehab
b. physical activity
c. pneumonia and flu vaccinations
d. Nutrition counseling

A

All of the answers are correct

36
Q

What are risk factors for fatal asthma attacks?

A
  1. Uncontrolled asthma
  2. Recent hospitalization
  3. Exposure to triggers
37
Q

At what point is a patient prescribed an oral glucocorticoid?

A

Moderate to severe persistent asthma or for management of acute exacerbation of asthma or COPD to bring symptoms under control.

38
Q

Roflumilast (select all that apply)

a) Reduces inflammation
b) Not intended during pregnancy
C) Approved for asthma
d) First-line drug for COPD

A

A&B

Approved only for COPD
Used as second line drug

Used for exacerbations prophylaxis in patients with severe COPD with a primary chronic bronchitis component.

39
Q

A patient has been have SOB/wheezing 2 days a week with nighttime awaking’s 2 times a month, and has had one exacerbation in the last year. She is currently using a her SABA and a low dose IGC. What are the next steps? Is she well controlled?

A

Well controlled, reevaluate her in 1-6 months.

Consider stepping down if well controlled for 3 months.

40
Q

MOA for a long acting B2RA

A

A sympathomimetic drug that activates B2 adrenergic receptors. This promotes broncho dilation and thus relieving bronchospasm. Has limited role in suppressing histamine release in the lung

41
Q

What is the first step (medication) in asthma and COPD control?

A

SABA

42
Q

A patient wakes up at night a few times a week, has been using his SABA DAILY, and has been experiencing symptoms DAILY, and states he cannot make it up a flight of stairs without trouble breathing. What is the severity of his asthma symptoms and what Step would he be considered?

A

He is step 3, Moderate persistent.

Not well controlled.

SABA prn, low dose IGC + LABA or Medium dose IGC

43
Q

Anti-inflammatory agents

A
  1. Glucocorticoid
  2. Cromolyn
  3. Monoclonal antibodies
  4. leukotriene receptor agonists
44
Q

Categories of Bronchodilators

A
  1. B2 Andrenergic agents
  2. Methylxanthines
  3. Anticholinergic
45
Q

Glucocorticoid most effective for…

A

long-term control of airway inflammation

46
Q

Cromolyn used for…

A

Prophylaxis for mild to moderate asthma.

47
Q

Monoclonal antibodies used for…

A

allergy-related asthma and eosinophilic asthma (high levels of WBCs in the lungs).

Omalizumab for allergy related and Ben ralizumab, mepliz, and resliz are for eosinophilic

48
Q

Leukotriene Receptor Antagonists are used as….

A

second line therapy to reduce inflammation and bronchoconstriction

49
Q

B2 Adrenergic Agonists are prescribed for…

A
  • exercise induced bronchoconstriction
  • COPD exacerbations
  • maintenance therapy
50
Q

Methylxanthines are used for…

A

Maintenance therapy for chronic stable asthma

Use ONLY if B2 or anticholinergics are not appropriate.

NR565 - Advanced Pharmacology (13 decks)

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