Antidiabetics And Respiratory Drugs

Question 1

Asthma,cough,bronchitis,COPD

Aim of treatment of these conditions is to?-

Non productive cough is also called an irritative cough and coughs can be caused by obstruction true or false

Function of expectorant

Answer 1

reduce airway inflammation and bronchospams or bronchoconstriction

True

Enable the clogged airways to clear by reducing viscosity of mucus so it can easily flow or sometimes increase water content of mucus so it can easily flow

Question 2

Drugs used in management of respiratory disorders

Drugs used in treating asthma

What are the classes of bronchodilators

How best to use these drugs to treat asthma is complex. A guideline on the management of asthma (BTS/SIGN, 2012) specifies five therapeutic steps for adults and chil- dren with chronic asthma. Very mild disease may be con- trolled with short-acting bronchodilator (salbutamol or terbutaline) alone (step 1), but if patients need this more than once a day, a regular inhaled corticosteroid should be added (step 2). If the asthma remains uncontrolled, step 3 is to add a long-acting bronchodilator (salmeterol or formoterol); this minimises the need for increased doses of inhaled corticosteroid. Theophylline and leuko- triene antagonists, such as montelukast, also exert a corticosteroid-sparing effect, but this is less reliable. One or other is added (step 4) for patients who remain symp- tomatic and/or the dose of inhaled corticosteroid increased to the maximum recommended. Step 5 is addition of a regular oral corticosteroid (e.g. prednisolone). True or false

Answer 2

Beta agonists-Beta 2 receptors found on the lungs open up airways (bronchodilators)
Glucocorticoids to control
inflammation (corticosteroids)
Leukotriene inhibitors
Antimuscarinics(main compound used as a bronchodilator is ipra- tropium. It is seldom used on a regular basis in asthma but can be useful for cough caused by irritant stimuli in such patients.
Ipratropium is a quaternary derivative of atropine and also nitrogen
Antihistamine (H1receptors)

: bronchodilators and anti-inflammatory agents.(glucocorticoids)

B2 adrenoreceptor agonists
Methylxanthines
Antimuscarinics (M3 receptor antagonist)
Leukotriene modifiers

Question 3

sympa activation causes what in respiratory system (mechanism of action of beta 2 adrenoreceptor agonists)
Para activation causes what?

a glucocorticoid can be combined with a bronchodilator true or false

Answer 3

beta 2 adrenoceptors are activated to dilate bronchioles and relaxation of airway smooth muscle ,inhibition of mediator release from mast cells by preventing the degranulation of the mast cells cuz Degranulation of mast cells causes release of cytokines which will cause bronchoconstriction and cause inflammation
Increase Clearing of mucus (mucocilliary clearance)

causes increased secretions

True

Question 4

Drugs for cough and give examples

Surfactants are used to treat COPd true or false and give two examples

Side effects of antitussives are constipation true or false

Answer 4

Leukolytics: break down of components in mucus

Antitussives :cough suppressants such as codeine ,dextromethorphan,pholcodine which are both opioid analgesics

Demulcents :soothe the airways.sometimes they contain an antiseptic (losenges

Expectorant :example guaifenesin

Basal decongestants

Anti fibrotics(used in cystic fibrosis)

beractant and poractant alpha (surfactant examples)

Question 5

What are Bronchodilators

Name the types of Beta 2 agonists used in asthma
With examples
Tho adrenaline has effect on it we don’t use adrenaline
Why?

Give an example of methylxanthines and their mechanism of action
When are they given as injection
What are the side effects
Usually how are they given
They have A narrow therapeutic window and
Have positive chronotropic and inotropic effect on heart
True or false

Which drugs increase the half life of theophylline and which decrease it
You can give a beta 2 agonists with an antimuscarinic why?

Intravenously theophyllineis given (as aminophylline, a combination of theophylline with ethylenediamine to increase its solubility in water) in acute severe asthma true or false
Theophylline is given in addition to steroids true or false

Answer 5

Agents that give short term relief from bronchoconstriction by relaxing the airways smooth muscles

Long acting:tabeterol
Short acting:salbutamol and terbutaline
Terbutaline prodrug is bambuterol

SHORT-ACTING b2 ADRENERGIC AGONISTS
Albuterol
Levalbuterol
LONG-ACTING b2 ADRENERGIC AGONISTS
Arformoterol BROVANA
Formoterol FORADIL, PERFOROMIST
Indacaterol ARCAPTA
Salmeterol 
Adrenaline is non selective cause it has effects on the other adrenoreceptors
So while causing the dilation you’ll be causing other effects 

Antimuscarinics that act as bronchodilators and acting against airway obstruction in asthma cuz activation of para leads to construction of airways
Only quartenary ammonium derivatives that are used ;ipratropium bromide
Side effects: dry mouth(cuz of prevention of secretion),prevents urination by causing urinary retention

Theophylline
They cause relaxation of bronchial smooth muscles by inhibition of phosphodiesterase enzyme4 and they inhibit adenosine which is an endogenous bronchoconstrictor and has some anti inflammatory properties
It is not first line treatment cuz it has plenty effects. Given as injection only in emergencies as aminophylline
Administered orally
Activate adenylyl cyclase causing increase CAMp causing bronchodilator
Phosphodiesterase enzyme breaks down CAMp
Inhibit adenosine- potent vasoconstrictor

Side effects:tachycardia,tremors,tachyarrythmias
Stimulation of CNS,convulsions ,seizures,can interact w other drugs cuz it’s also metabolized by CYP450,cardiac dysrhythmia

True

g. some antibiotics) increase the half-life of theophylline, others (e.g. anticonvulsants) decrease it.

Cuz they act differently
Beta 2 is acting on its receptor
Antimuscarnic is acting on M3 receptor
So they’re acting on two different receptors to cause bronchodilation

Question 6

What are the classes of drugs used for their anti inflammatory effects on asthma ,their mechanism of action and examples

Give three examples of Corticosteroids usually used in asthma
How are they given
When are they given orally

What are the side effects of glucocorticoids

Patients with acute exacerbations of asthma may require intravenous hydrocortisone and oral prednisolone. True or false

What are the type of antihistamines with examples

Answer 6

Glucocorticoids or corticosteroids : • The mechanism of action involves decreased
formation of cytokines, particularly those generated by Th2 lymphocytes, decreased activation of eosinophils and other inflammatory cells.
Mast cell stabilizers : Drugs that prevent degranulation of mast cells: they stabilize mast cells examples: Cromoglicate and nedocromil,cromolyn

beclometasone, budeso- nide, fluticasone, mometasone and ciclesonide,These are given by inhalation with a metered-dose or dry powder inhaler, the full effect on bronchial hyper-responsiveness being attained only after weeks or months of therapy. Oral glucocorticoids .are reserved for patients with the severest disease.

Sometimes combine w beta 2 agonists in an inhaler

Prenisolone-side effects
Lead to Cushing’s syndrome
Can affect metabolism
It is withdrawn slowly cuz it has withdrawal effects

Sedating antihistamines example piritine
Non sedating antihistamine example

Question 7

Asthma

How it occurs
What is it

Antimuscarinic bronchodilators should be used w caution in patients BPH why?

Acute severe asthma
A medical emergency
Not easily reversed true or false

Answer 7

Increased airways smooth muscle size causing constriction of airways
Bronchial hyperreactivity

A chronic inflammatory condition in which there is recurrent reversible airway obstruction

Bronchodilators (plus all four classes)
Glucocorticoids
Is used in oral form and inhaler

Question 8

The aerosol is directed to the site of action cuz if given systemically it’ll keep long true or false
What is an aerosol

Tolerance develops when a beta 2 agonists is used for a long time that’s why it’s better to use SABA regularly and LABA in emergencies true or false

Answer 8

True

Contents are compressed in the container so when sprayed they come out in a mist or fog
They are formulated with a propellant

True

Question 9

Leukotriene modifiers

Mechanism of action

Leukotriene modifiers don’t affect underlying airway inflammatory disorders

Cysteinyl leukotriene receptor antagonists (e.g. montelukast) are third-line drugs for asthma. asthma. Theycompete with cysteinyl leukotrienes at CysLT1 receptors and are used mainly as add-on therapy to inhaled
corticosteroids and long-acting β2 agonists
True or false

Answer 9

Lipooxygenase pathway isn’t good for asthma or respiratory disorders

They prevent the pathway from happening 
Inhibit enzyme or block receptor 
Zinotin-lipooxygenase inhibitor
Leukotriene antagonist-montelukast 
The lukasts are taken by mouth, in combination with an  inhaled  corticosteroid.  

It’s a mechanism so if you’re taking these drugs and the products have already been formed it can’t have effect on the products that have already been formed

True

Question 10

Mast cell stabilizers
Mechanism of action
Give examples 
Which other class of drugs 
Effect of corticosteroids are not immediate so they’re not used as relievers but controllers  true or false 

Side effects of corticosteroids

Answer 10

Prevent mast cells from degranulation

Immunoglobulins and immunosuppressant

Occur due to prolonged use of Cushing’s syndrome:muscle wasting ,immunosupression,cataract,moon face,hypertension,buffalo eyes

Corticosteroids Are not started and stopped abruptly

Question 11

What happens to the body when we are hyperglycemic

Difference between diabetes and hyperglycemia

Answer 11

Increased blood glucose causes increased free fatty acids,insulin resistance,decreased insulin all leading to oxidative stress

Oxidative stress causes decreased nitric oxide ,increased endothelin-1, increased angiotensin II all leading to vasoconstriction causing hypertension,vascular smooth muscle cell growth

Oxidative stress also causes Decreased Nitric Oxide,increased Angiotensin ll,Activation of
activator protein -l
All causing 
Inflammation:
Release of chemokines
Release of cytokines
Expression of cellular
adhesion molecules

Oxidative stress also causes reduced Nitric oxide,increased Tissue factor,increased Plasminogen
 Activator,decreased Prostacyclin
Leading to 
Thrombosis:
Hyper coagulation
Platelet Activation
Decreased Fibrinolysis

Diabetes is the disease,hyper is the symptom

Question 12

Insulin counter glucose to keep body in a balanced way. It’s produced by beta cells of pancreas. True or false

How is diabetes diagnosed

What is HbA1C

What is the difference between type 1 and type 2 diabetes

What are the complications of type 1 diabetes

Oral anti diabetic drugs are not effective in type 1 but are given in type 2

Answer 12

True

Oral glucose tolerance test

What is a HbA1c?
It is a test that allows healthcare providers to see how diabetics have managed their blood glucose level over the last 2-3 months

Type 1
Lack of insulin production OR
Production of defective insulin
Affected patients need exogenous insulin
Insulin dependent diabetes

Type 2
Most common type
Caused by insulin deficiency and insulin resistance
Many tissues are resistant to insulin
◦Reduced number insulin receptors
◦Insulin receptors less responsive
◦These people respond to oral hypoglycemics

Complications
◦Diabetic ketoacidosis (DKA)
◦Hyperosmolar nonketotic syndrome

Cuz there is no insulin being produced so there’s no beta cell function for the orals to act on. The orals counter hyperglycemia which has increased due to insulin resistance or low levels of insulin being produced by causing increased secretion of insulin from beta cells

Question 13

Therapy in type 2 is supplemented w insulin . Especially in complications or when the orals aren’t working true or false

Signs and symptoms of type 1 and type 2 diabetes

When put on the Thiazolidinediones patients need to be put on liver function test to monitor the liver cuz it can cause damage. True or false

Answer 13

True

Type 1
Weight loss
Fatigue
Rapid onset
Increased frequency of infection

Type 2
Sedimentary lifestyle 
Familial tendency
History of high bp
Fatigue and low energy
Obese
Recurrent infections 
Polyuria
Polydipsia 
FBs-less than 126mg/dl

Question 14

What are the Classes of oral hypoglycemics

Answer 14

Sulfonylureas (oldest)
● Meglitinides
● Biguanide-metformin
● Thiazolidinediones

Question 15

When the agents stimulate production of insulin
It can cause hypoglycemia as a side effect
True or false

Answer 15

True

Question 16

Metformin has to be taken a lot and that’s a disadvantage true or false

Metformin doesn’t deal with insulin directly that’s why you can combine a biguanide use and a sulfonylurea drug true or false

They’re not given directly w insulin so they don’t cause an increase in insulin secretion
True or false

Answer 16

True
True
True

Question 17

Name five Comorbid conditions of type 2 diabetes

Answer 17

Several comorbid conditions
•metabolic syndrome OR insulin-resistance syndrome OR syndrome X

◦Obesity
◦Coronary artery disease
◦Dyslipidemia
◦Hypertension
◦Microalbuminemia (protein in the urine)
◦Enhanced conditions for embolic events (blood clots)
◦Insulin Resistance

Question 18

What is gestational diabetes

What is given to prevent birth defects

In gestational diabetes 4% of all pregnancies
◦Must be reclassified if it persists 6 weeks post-delivery
◦Usually subsides after delivery
◦30% of patients may develop Type 2 DM within 10 to 15 years true or false

Answer 18

Hyperglycemia that develops during pregnancy
◦Insulin must be given to prevent birth defects
◦

Question 19

What are the differences in treatment of type 1 and type 2 diabetes

When will insulin be given in type 2

Name five complications associated w diabetes Mellitus

Answer 19

Type 1
◦Exogenous insulin
◦Dietary control
•

Type 2
◦Lifestyle changes
•Dietary control
•Weight reduction
•Exercise
◦May require oral hypoglycemic therapy or exogenous insulin
◦

Insulin when oral hypoglycemic medications can no longer provide glycemic control

Cardiovascular disease, including hypertension
o Peripheral vascular disease
o Delayed healing
o Visual defects, including blindness
o Renal disease
o Infection
o Neuropathies
o Impotence

Question 20

Name three indications for oral hypoglycemics

Name three contraindications for oral hypoglycemics

Answer 20

They are used to lower blood sugar levels in patients that diet and exercise have failed.
The patient must have some pancreatic function left.
They can be used as a monotherapy or in conjunction with other oral hypoglycemics.

Known drug allergy
Active hypoglycemia
Usually not used during pregnancy subq insulins are used then.
Liver disease
Kidney disease
◦Depending on the metabolic pathways of the medication

Question 21

Name three first generation and second generation sulfonylurea drugs

Which is commonly used?

Which patients can’t take sulfonylurea drugs else it’ll cause hemolytic anemia

What is the mechanism of sulfonylurea drugs

Name four the adverse effects of sulfonylurea drugs

Answer 21

First generation:
◦chlorpropamide
◦tolazamide
◦tolbutamide
◦
Second generation:
◦glimepiride
◦glipizide
◦glyburide

The second generation

G6PD patients
Patients with sulphuric allergies can’t take sulfonylurea

Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels
Beta cell function must be present
Improve sensitivity to insulin in tissues
Result: lower blood glucose levels

Sulfonylureas
◦ Hypoglycemia
◦ hematologic effects
◦ nausea
◦ epigastric fullness
◦ heartburn
◦ many others

Question 22

What is the difference between meglitinide and sulfonylurea drugs

Name some examples of meglitinide drugs
Mechanism of action

Name five adverse effects of this drug

Answer 22

Meglitinide doesn’t have sulphur in it so can be given to patients with sulphur allergies

Meglitinides
◦repaglinide (Prandin)
◦ nateglinide (Starlix)

Meglitinides
◦Action similar to sulfonylureas
◦Increase insulin secretion from the pancreas

Meglitinides
◦Headache
◦Hypoglycemic effects
◦Dizziness
◦Weight gain
◦Joint pain
◦Upper respiratory infection or flu-like symptoms

Question 23

Biguanides can be given together with sulfonylurea drugs true or false

Give examples of this class of drugs

What is the mechanism of action
State five adverse effects

Biguanides do not cause hypoglycemia true or false

Answer 23

True

Biguanides
◦metformin (Glucophage)

Biguanides
◦Decrease production of glucose
◦Increase uptake of glucose by tissues
◦Does not increase insulin secretion from the pancreas (does not cause hypoglycemia)

Metformin
◦Primarily affects GI tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness,May also cause metallic taste, reduced vitamin B12 levels,Lactic acidosis is rare but lethal if it occurs

True

Question 24

Give some examples of Thiazolidinediones

These class of drugs are also known as?

What are the mechanisms of actions of these drugs
What are the adverse effects

Answer 24

Thiazolidinediones
◦pioglitazone
◦rosiglitazone
◦Also known as “glitazones”
Thiazolidinediones
◦Decrease insulin resistance
◦“Insulin sensitizing drugs”
◦Increase glucose uptake and use in skeletal muscle
◦Inhibit glucose and triglyceride production in the liver

Adverse effects:

Moderate weight gain
Edema
◦Mild anemia
◦Hepatic toxicity—monitor liver function tests

Question 25

Give some examples of Alpha-glucosidase Inhibitors

Mechanism of action and advert effects

Answer 25

Alpha-glucosidase inhibitors
◦acarbose (Precose)
◦miglitol (Glyset)

Alpha-glucosidase inhibitors
◦Reversibly inhibit the enzyme alpha-glucosidase in the small intestine
◦Result: delayed absorption of glucose
◦Must be taken with meals to prevent excessive postprandial blood glucose elevations (with the “first bite” of a meal)

Flatulence
◦ diarrhea
◦ abdominal pain

◦Do not cause hypoglycemia, hyperinsulinemia, or weight gain

Question 26

Name the three classes of newer oral agents for diabetes as long as their examples each

What is the function of GLP-1,dipeptidil peptidase-4 enzyme

Insulin is given subcut and it should be rotated like given at different places not one place at the same time

Answer 26

Glucagon-like peptide-1 (GLP-1) agonists (in type 2 DM): increase pancreatic secretion of insulin. Eg. Exenatide, Liraglutid

Inhibitors of Dipeptidil peptidase-4 (DPP-4): prevent degradation of incretin GLP-1. eg. Sitagliptin, Vildagliptin

Inhibitors of reabsorption of glucose (SGLT2 inhibitors): eg. Canagliflozin, dapagliflozin

GLP-1:
Endogenous molecule which causes increased insulin production ,increased uptake of glucose . Demerit:very short acting

Dipeptidil peptidase-4 enzyme degrades the GLP-1 making it short acting

Question 27

What is the mechanism of action of insulin

What are the goals of using insulin

Some Insulin is derived from porcine sources and new ones are human derived using recombinant DNA technologies true or false

What are the indications of insulin

What are the adverse effects

Answer 27

Substitute for & same effects as endogenous insulin
Restores the diabetic patient’s ability to:
◦Metabolize carbohydrates, fats, and proteins
◦Store glucose in the liver
◦Convert glycogen to fat stores

Goal: tight glucose control
◦To reduce the incidence of long-term complications

True

To treat both types of diabetes
Each patient requires careful customization of the dosing regimen for optimal glycemic control

Are all signs and symptoms of hypoglycemia including shock and death.

Question 28

What are the types of human based insulin and give examples each of them

Which insulin product is given IV or even IM

How is Rapid acting given

How is isophane insulin given

Which insulin is Slower in onset and more prolonged duration than endogenous insulin

Answer 28

Rapid-Acting
◦Most rapid onset of action
◦Shorter duration

aspart (Novolog)
lispro (Humalog)
glulisine (Apidra)

Short acting :
regular insulin (Humulin R, Novolin R)
Onset 30 – 60 minutes
◦The only insulin product that can be given by IV bolus, IV infusion, or even IM

Intermediate-Acting
◦isophane insulin suspension (also called NPH) (Humulin N, Novolin N)
Lispro protamine suspension (Humalog 75/25, Novolog Mix 70/30)
insulin zinc suspension (Lente, Novolin L)
◦Cloudy appearance
◦

Combination insulin products:
NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30)
NPH 50% and regular insulin 50% (Humulin 50/50)
insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog Mix 75/25)

Short acting

May be given SC or via continuous SC infusion
pump (but not IV)

isophane insulin suspension & insulin injection
(Humulin 50/50 , Humulin 70/30, Novolin 70-30)

Immediate acting insulin

Question 29

What are the early and Late signs of hypoglycemia which is an adverse effect of insulin

Which level of blood glucose is abnormally low

Mild cases of hypo is treated by?

What’s re the general signs of hypo

Answer 29

Early
◦Confusion, irritability, tremor, sweating

•Later
◦Hypothermia, seizures
◦Coma and death will occur if not treated

<50 mg/dL

Mild cases can be treated with diet—higher intake of protein and lower intake of carbs—to prevent a rebound postprandial hypoglycemia

Tachycardia 
Irritability 
Restlessness 
Excessive hunger
Diaphoresis 
Depression 
(TIRED)

Question 30

What is DKA

What causes it

DKA is a sudden onset true or false

Factors of DKA

What are the symptoms of DKA

These are the results for DKA:
Glucose >300 mg/dL
pH <7.35   /  Bicarbonate < 15 mEq/L
Na – low  / K+ >   /  Cr >1.5 mg/dL
Blood & Urine Ketones - Positive true or false

Answer 30

State of hyperglycemia with ketosis
Usually results from infection, environment, or emotional stressor
◦As a result of lack of Insulin, breakdown:
◦Fat – free fatty acids in liver – ketone bodies – ketones in urine
◦Protein – to form new glucose / increased BUN
◦Glycogen to glucose (decrease use of glucose because of decreased insulin)
◦Osmotic diuresis
◦Dehydration / Electrolyte Imbalance
◦Hyperosmolality Hemoconcentration
◦Acidosis
◦Death

True

Factors: infection, stressors, inadequate insulin

Kussmaul respiration / fruity odor to breath, nausea, abdominal pain
Dehydration, electrolyte imbalance, polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma

True

Question 31

Which drugs can damage the lung tissue

What are characteristics of asthma

Answer 31

amiodarone, methotrexate

inflammation of the airways • bronchial hyper-reactivity
• reversible airways obstruction.

Question 32

Name some sedating (1st generation)and non sedating (2nd generation)anti histamines

Answer 32

generation H1 antihistamines, such as chlorpheni- ramine [klor-fen-IR-a-meen], diphenhydramine, hydroxyzine hye- DROX-ee-zeenand promethazine,

2nd generation
Cetirizine.
Desloratadine. 
Loratadine.
Fexofenadine.

Question 33

Give some examples of inhaled corticosteroids, LONG-ACTING b2 ADRENERGIC AGONIST/CORTICOSTEROID, LONG-ACTING ANTICHOLINERGIC

Answer 33

INHALED CORTICOSTEROIDS
Beclomethasone 
Budesonide, 
Ciclesonide,,
Fluticasone 
Mometasone 
Triamcinolone 

LONG-ACTING b2 ADRENERGIC AGONIST/CORTICOSTEROID C
Formoterol/budesonide 
Formoterol/mometasone 
Salmeterol/fluticasone 
Vilanterol/fluticasone  

SHORT-ACTING
ANTICHOLINERGIC :Ipratropium
LONG-ACTING ANTICHOLINERGIC: Aclidinium bromide ,Tiotropium

Question 34

Which leukotriene modifiers is a selective and specific inhibitor of 5-lipoxygen- ase, preventing the formation of both LTB4 and the cysteinyl leu- kotrienes.

Which leukotriene modifiers are selective antagonists of the cysteinyl leu- kotriene-1 receptor

Food impairs the absorption of zafirlukast. The drugs are metabolized extensively by the liver. Zileuton and its metabolites are excreted in urine, whereas zafirlukast, montelu- kast, and their metabolites undergo biliary excretion. True or false

Answer 34

Zileuton

Montelukast
Zafirlukast

Question 35

The effects of corticosteroids are not intermediate so they’re used a preventers not relievers true or false

Theophylline is not soluble ,nor a first line treatment and can’t be given as an injection unless it’s given as aminophylline true or false

Answer 35

True

True