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Pathopharmacology I > Wk 1 Obstructive Airway Pharmacology > Flashcards

Wk 1 Obstructive Airway Pharmacology Flashcards

1
Q

Three subcategories of bronchodilators

A

Beta2 Agonists
Anticholinergics
Xanthine derivatives

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2
Q

Three subcategories of anti-inflammatories

A

Leukotriene receptor antagonist (LTRAs)
Inhaled glucocorticoids
Mast cell stabilizers

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3
Q

Bronchodilators are used to treat __ respiratory diseases

A

ALL

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4
Q

Bronchodilators MOA

A

Relaxes bronchial smooth muscle which causes dilation of bronchi and bronchial airways

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5
Q

Beta-adrenergic agonists can be __-__ or __-__.

A

short acting or long acting

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6
Q

What is the suffix for beta2-adrenergic agonists (usually)?

A

-erol

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7
Q

What type of beta2-adrenergic agonist should be used in an asthma attack?

A

short-acting only

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8
Q

What are the short-acting beta2-adrenergic agonist drugs? (2)

A

albuterol and levalbuterol

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9
Q

What is the brand name of albuterol?

A

Proventil

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10
Q

What is the brand name of levalbuterol?

A

Xopenex

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11
Q

Albuterol can be given how?

A

PO or inhalant

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12
Q

Levalbuterol can be given how?

A

inhalant

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13
Q

All long-acting beta2-adrenergic agonist drugs are __.

A

inhalants

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14
Q

What are the two long-acting beta2-adrenergic agonist drugs?

A

salmetrol and formoterol

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15
Q

What is the brand name of salmetrol?

A

Servent

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16
Q

What is the brand name of formoterol?

A

Foradil

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17
Q

Albuterol is inhaled every __ hours.

A

4-6

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18
Q

Salmetrol is inhaled every __ hours.

A

12

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19
Q

Short-acting beta2-adrenergic agonist drugs are __ drugs.

A

RESCUE

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20
Q

Long-acting beta2-adrenergic agonist drugs are __ drugs.

A

preventer

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21
Q

Long-acting beta2-adrenergic agonist drugs are give how frequently?

A

12-24 hrs

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22
Q

What is the MOA of beta2-adrenergic agonist drugs?

A

Mimics the action of the SNS, fight or flight. Relaxes bronchial smooth muscle which causes dilation of bronchi and bronchial airways by stimulating beta 2 receptors throughout the lungs

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23
Q

What do non-specific adrenergic drugs stimulate?

A

beta1, beta2, AND alpha receptors

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24
Q

What is an example of a non-specific adrenergic drug?

A

epinephrine

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25
Q

What do non-selective beta-adrenergic drugs stimulate?

A

beta1 and beta2 receptors

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26
Q

What is an example of a non-specific adrenergic drug?

A

metaproterenol

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27
Q

Non-selective adrenergic drugs stimulate alpha receptors with =

A

vasoconstriction

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28
Q

Non-selective adrenergic drugs (ex: epinephrine) decrease what?

A

Edema/swelling in mucous membranes and limits the amount of secretions

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29
Q

Non-selective adrenergic drugs (ex: epinephrine) also stimulate which receptor?

A

beta1 and beta2

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30
Q

beta1 and beta2 receptors =

A

cardiovascular effects

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31
Q

What vital sign changes would you see with epinephrine adminstration?

A

Increased BP and increased HR

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32
Q

Epinephrine also decreases __

A

bronchoconstriction

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33
Q

If you give epinephrine for bronchodilation, what do you need to be aware of?

A

You will see other systemic effects such as increased BP and increased HR

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34
Q

Non-selective adrenergic drugs (ex: epinephrine) also stimulates what system?

A

CNS

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35
Q

If you stimulate the CNS, what symptoms might you see?

A

nervouness/tremors

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36
Q

What are beta2-adrenergic agonist drugs indicated for?

A

prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions

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37
Q

What are contraindications for beta2-adrenergic agonist drugs?

A

uncontrolled hypertension, cardiac dysrhythmias, or a patient at high risk for stroke

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38
Q

Beta2-adrenergic agonist drugs can be taken with __ __, but this may diminish effects

A

beta blockers

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39
Q

Avoid use of beta2-adrenergic agonist drugs with what two types of drugs?

A

MAOIs and sympathomimetics

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40
Q

Why should use of beta2-adrenergic agonist drugs be avoided with MAOIs and sympathomimetics?

A

Because they can cause hypertension

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41
Q

Why would diabetics need higher doses of their meds if on Beta2-adrenergic agonist drugs?

A

beta2-adrenergic agonist drugs can cause a raise in blood sugar

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42
Q

Non-selective adrenergic drugs have the most __ __ of adrenergic agonist drugs.

A

side effects

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43
Q

Beta2-adrenergic agonist drugs can cause __ OR __

A

hypertension or hypotension

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44
Q

What can you reverse effects of beta2-adrenergic agonist drugs with?

A

beta blockers but watch for bronchospasm

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45
Q

Most beta2-adrenergic agonist drugs have a very short __ __

A

half life

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46
Q

What are the side effects of beta2-adrenergic drugs?

A

Insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache

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47
Q

Why are beta2-adrenergic drugs almost always given inhaled?

A

It minimizes the systemic effects

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48
Q

What type of inhaler is a MDI?

A

Metered dose inhaler

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49
Q

What type of inhaler is a DPI?

A

Dry powder inhaler

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50
Q

Selective beta2-adrenergic agonist drugs are mostly used in __.

A

Asthma

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51
Q

Selective beta2-adrenergic agonist drugs are given through __ or __

A

MDI or nebulizer

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52
Q

What is the first line of treatment for an acute asthma attack?

A

beta2-adrenergic agonist drugs through MDI or nebulizer

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53
Q

Use of more than 1 cannula of albuterol per month indicates what?

A

Poor control of asthma and need for initiating anti-inflammatory therapy

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54
Q

How many actuations (puffs) per canister of albuterol?

A

200

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55
Q

What is not recommended for use of albuterol?

A

Regular scheduled daily use

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56
Q

Albuterol is often used to prevent __ __ __

A

Exercise induced asthma

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57
Q

__ is not for acute treatments, it’s a maintenance drug

A

Salmeterol

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58
Q

How often is salmeterol usually given?

A

BID inhalation

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59
Q

With salmeterol, what is more common in african americans?

A

Asthma related deaths

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60
Q

What are the indications for salmeterol?

A

Worsening of COPD or severe asthma

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61
Q

What is notable about salmeterol?

A

It’s always given with an inhaled corticosteroid, never given alone

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62
Q

Anticholinergics work on what type of receptors?

A

acetylcholine

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63
Q

Giving anticholinergics works by…

A

turning off the cholinergic response (PNS) and turning on the SNS

64
Q

When the SNS is turned on, what happens?

A

It opens airways, bronchodilation

65
Q

What type of drug is ipratroprium?

A

Anticholinergic

66
Q

What is the brand name for ipratroprium?

67
Q

What is the indication for ipratroprium?

A

Prophylaxis and maintenance therapy

68
Q

Ipratroprium is often given in conjunction with __.

69
Q

What drug is a combination of ipratroprium and albuterol?

70
Q

What are the anticholinergic adverse effects?

A 
urinary retention
dry throat/mouth
constipation
feeling hot, decreased sweating
tachycardia
blurry vision, dry eyes
sedation, dizziness, confusion, hallucinations
71
Q

What is the saying for the adverse anticholinergic effects?

A

dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter

72
Q

What type of drug is theophylline?

A

xanthine derivative

73
Q

What type of drug is aminophylline?

A

xanthine derivative

74
Q

Why are xanthine derivatives used as second line treatment?

A

Because of the high risk of toxicity and drug-drug interactions

75
Q

What does taking xanthine derivatives feel like?

A

A caffeine high

76
Q

What are the contraindications for xanthine derivatives?

A

cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers

77
Q

What can increase side effects for xanthine derivatives?

78
Q

What can decrease absorption for xanthine derivatives?

79
Q

Xanthine derivatives have a narrow __ __

A

therapeutic index

80
Q

What needs to be monitored for a patient taking xanthine derivatives?

A

serum levels and watch for toxicity

81
Q

How can toxicity be reversed for xanthine derivatives?

A

Activated charcoal

82
Q

What are some drug interactions with xanthine derivatives?

A

macrolide antibiotics, allopurinol, cimeidine, quinolones, flu vaccine, oral contraceptives

83
Q

What are leukotrienes?

A

Inflammatory mediators that cause inflammation, bronchoconstriction, and mucus production

84
Q

What is the MOA of leukotriene receptor antagonists?

A

LTRAs prevent leukotrienes from attaching to receptors located on immune cells and within the lungs

85
Q

What type of drug is montelukast?

A

Leukotriene receptor antagonist (LTRA)

86
Q

What type of drug is zafirlukast?

A

Leukotriene receptor antagonist (LTRA)

87
Q

What is the brand name of montelukast?

88
Q

What is the brand name of zafirlukast?

89
Q

What type of cell releases leukotrienes during the inflammatory response?

A

mast cells

90
Q

What route are leukotriene receptor antagonists given?

91
Q

Which leukotriene receptor antagonist (LTRA) can be given to kids over 12 months?

A

montelukast (Singulair)

92
Q

Which leukotriene receptor antagonist (LTRA) can only be given to children over the age of 5?

A

zafirlukast (Accolade)

93
Q

Both montelukast and zafirlukast can be __ __ or __.

A

chewable tablets or granules

94
Q

How long does it take to see improvement in asthmatic conditions after taking a leukotriene receptor antagonist?

A

about a week

95
Q

What is the indications for leukotriene receptor antagonist (LTRAs) drugs?

A

Oral prophylaxis, and chronic treatment of asthma in adults and children

96
Q

What else can leukotriene receptor antagonist drugs be given for?

97
Q

What are the adverse effects of leukotriene receptor antagonist drugs?

A

headache, nausea, dizziness, insomnia, diarrhea

98
Q

Montelukast has __ drug-drug interactions

99
Q

Zafirlukast has __ drug-drug interactions

100
Q

what type of drug is beclomethasone diproprionate?

A

inhaled corticosteroid

101
Q

What is the brand name for beclomethasone diproprionate?

102
Q

What type of drug is budesonide?

A

inhaled corticosteroid

103
Q

What is the brand name for budesonide?

A

Pulmicort Turbuhaler

104
Q

What type of drug is fluticasone?

A

inhaled corticosteroid

105
Q

What is the brand name for fluticasone?

106
Q

What is an example of a PO corticosteroid?

A

prednisone

107
Q

When would you take a PO corticosteroid?

A

When having a COPD exacerbation, or asthma

108
Q

When would a patient be put on an inhaled corticosteroid?

A

Not during an exacerbation, if they are chronically needing the corticosteroid

109
Q

What is the advantage of inhaled corticosteroids versus PO corticosteroids?

A

You limit the systemic effects and limit the effects primarily to the respiratory system

110
Q

Inhaled corticosteroids can be given via __ or __

A

Nebulizer or MDI

111
Q

What is the MOA of inhaled corticosteroids?

A

Reduce inflammation and enhance activity of beta agonists

112
Q

Inhaled corticosteroids are often used in conjunction with __ __.

A

beta agonists

113
Q

How long does it take to see effects of inhaled corticosteroids with continuous therapy?

A

Can take several weeks

114
Q

What are inhaled corticosteroids given for?

A

Prevention of persistent asthma attacks and long-term maintenance of severe COPD

115
Q

For patients with asthma, should they take their inhaled corticosteroid as needed or on a schedule?

116
Q

In what order should patients with asthma take their inhaled corticosteroids?

A

Take bronchodilator first to allow more thorough absorption of the steroids

117
Q

If a patient is on a beta agonist and an inhaled corticosteroid which one should they take first?

A

beta agonist to bronchodilate

118
Q

What are the adverse effects of inhaled corticosteroids?

A

Pharyngeal irritation, coughing, dry mouth, oral/fungal infections

119
Q

What is important to teach patients who are on inhaled corticosteroids?

A

Rinse mouth after use!

120
Q

What two medications can be combined to treat moderate to severe asthma?

A

Inhaled glucocorticoid and bronchodilators

121
Q

What type of drug is the combination of budesonide and formoterol?

A

Inhaled glucocorticoid and bronchodilators

122
Q

What is the brand name of the combination drug of budesonide and formoterol?

123
Q

What is another drug that is an inhaled glucocorticoid and bronchodilator combination?

A

fluticasone and salmeterol

124
Q

What is the brand name for the combo drug of fluticasone and salmeterol?

125
Q

What is the key teaching for inhaled glucocorticoid and brochodilator combo meds?

A

These are never for acute asthma attacks

126
Q

What medication should be used for an acute asthma attack?

127
Q

How fast does symbicort work?

A

within minutes

128
Q

How fast does budesonide and formoterol combo take to work?

A

within minutes

129
Q

How fast does Advair work?

A

a little longer than Symbicort

130
Q

How fast does fluticason and salmeterol combo take to work?

A

a little longer than the budesonide and formoterol combo drug

131
Q

What drug is a mast cell stabilizer?

132
Q

What is the brand name for cromolyn?

133
Q

What is the MOA for mast cell stabilizers?

A

Stabilizes membranes of mast cells and prevents release of bronchoconstrictive inflammatory substances

134
Q

What are mast cell stabilizers used for?

A

Prevention of acute asthma attacks

135
Q

When should cromolyn be used?

A

15-20 minutes before contact with known triggers

136
Q

What are mast cell stabilizers not used for?

A

Rescue drugs!

137
Q

What type of drug is omalizumab?

A

Monoclonal antibody anti-asthmatic

138
Q

What is the MOA for monoclonal antibody anti-asthmatics?

A

Monoclonal antibody which selectively binds to immunoglobulin IgE

139
Q

What is the end effect of monoclonal antibody anti-asthmatics?

A

Limits release of mediators of allergic response

140
Q

How is omalizumab given

141
Q

What generation is omalizumab?

A

The newest generation

142
Q

Omalizumab is an add-on medication. What does this mean?

A

It’s never given by itself

143
Q

What is a big risk for omalizumab?

A

Anaphylaxis

144
Q

Which drug is specifically for asthma only?

A

omalizumab

145
Q

What is the brand name for omalizumab?

146
Q

What type of drug is roflumilast?

A

Selective PDE-4 inhibitor

147
Q

What is the MOA of selective PDE-4 inhibitor drugs?

A

Selectively inhibitors PDE-4 enzyme in the lung cells and has potent anti-inflammatory effects within the lungs

148
Q

What is roflumilast indicated for?

A

Prevention of COPD exacerbations

149
Q

What does PDE-4 do?

A

Associated with inflammation

150
Q

PDE-4 inhibitor drugs do not work…

A

acutely/immediately

151
Q

How is roflumilast given?

152
Q

What do PDE-4 inhibitor drugs work best for?

A

Chronic bronchitis with a history of exacerbations

153
Q

What are the side effects of roflumilast?

A

N/V/D, headache, muscle spasms, decreased appetite, tremors

154
Q

What are the long-term control medications that are PREVENTERS for the treatment of asthma (6)

A

1) Anticholinergics
2) Xanthine derivatives
3) Inhaled corticosteroids
4) Leukotriene modifiers
5) Mast cell stabilizers
6) Long-acting beta agonists

155
Q

What are quick relief medications or rescue medications for the treatment as asthma? (2)

A

1) Short acting beta agonist

2) Albuterol/Proventil

Pathopharmacology I (33 decks)

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