Deja Ch 7 Pulmo Flashcards
(92 cards)
1
Q
What are the classifications of asthma severity?
A
Mild intermittent; mild persistent; moderate persistent; severe persistent
2
Q
What are the main classifications of drugs for asthma?
A
Bronchodilators; anti-inflammatory agents
3
Q
Name the drug class for each of the following medications: Albuterol
A
Short-acting _2-adrenergic agonist
4
Q
Name the drug class for each of the following medications: Epinephrine
A
Short-acting _2-adrenergic agonist
5
Q
Name the drug class for each of the following medications: Terbutaline
A
Short-acting _2-adrenergic agonist
6
Q
Name the drug class for each of the following medications: Salmeterol
A
Long-acting _2-adrenergic agonist
7
Q
Name the drug class for each of the following medications: Formoterol
A
Long-acting _2-adrenergic agonist
8
Q
Name the drug class for each of the following medications: Isoproterenol
A
Short-acting _-adrenergic agonist
9
Q
Name the drug class for each of the following medications: Metaproterenol
A
Short-acting _-adrenergic agonist
10
Q
Name the drug class for each of the following medications: Fluticasone
A
Inhaled corticosteroid
11
Q
Name the drug class for each of the following medications: Flunisolide
A
Inhaled corticosteroid
12
Q
Name the drug class for each of the following medications: Beclomethasone
A
Inhaled corticosteroid
13
Q
Name the drug class for each of the following medications: Triamcinolone
A
Inhaled corticosteroid
14
Q
Name the drug class for each of the following medications: Budesonide
A
Inhaled corticosteroid
15
Q
Name the drug class for each of the following medications: Methylprednisolone
A
Systemic corticosteroid
16
Q
Name the drug class for each of the following medications: Prednisone
A
Systemic corticosteroid
17
Q
Name the drug class for each of the following medications: Cromolyn
A
Mast cell stabilizer
18
Q
Name the drug class for each of the following medications: Nedocromil
A
Mast cell stabilizer
19
Q
Name the drug class for each of the following medications: Ipratropium
A
Inhaled anticholinergic
20
Q
Name the drug class for each of the following medications: Tiotropium
A
Inhaled anticholinergic
21
Q
Name the drug class for each of the following medications: Theophylline
A
Phosphodiesterase inhibitor; adenosine antagonist; methylxanthine
22
Q
Name the drug class for each of the following medications: Zileuton
A
5-Lipoxygenase inhibitor
23
Q
Name the drug class for each of the following medications: Zafirlukast
A
Leukotriene receptor antagonist
24
Q
Name the drug class for each of the following medications:Montelukast
A
Leukotriene receptor antagonist
25
How do _2-agonists help treat asthma?
Bronchodilation via _2-adrenoceptor-mediated smooth muscle relaxation
26
How do corticosteroids help treat asthma?
Decrease production and release of proinflammatory cytokines; decrease inflammatory cell activation, recruitment, and infiltration; decrease vascular permeability; decrease mucous production; increase number and sensitivity of _2-adrenergic receptors
27
How do mast cell stabilizers help treat asthma?
Prevent mast cell degranulation, thereby decreasing release of histamine, platelet activating factor, leukotrienes, and other mediators that cause bronchoconstriction. Therefore only useful before exposure to allergen.
28
How do inhaled anticholinergics help treat asthma?
Competitively inhibit muscarinic receptors, thereby inhibiting vagal-mediated bronchoconstriction; reduce mucous production
29
How do phosphodiesterase inhibitors help treat asthma?
Increase cAMP which causes bronchodilation
30
How do 5-lipoxygenase inhibitors help treat asthma?
Inhibits production of leukotrienes (LTC4, LTD4, LTE4) from arachidonic acid, thereby preventing bronchoconstriction
31
What _2-adrenergic agonist is commonly used as a tocolytic agent (stops premature labor by relaxing uterine smooth muscle)?
Terbutaline
32
What cation can be used as a tocolytic agent?
Mg2+ (Magnesium ion)
33
Is cromolyn used for treatment or prevention of an asthma attack?
Prevention
34
Is nedocromil effective during an acute asthma attack?
No
35
What are the side effects of mast cell stabilizers?
Bitter taste; throat irritation
36
What are the side effects of _2-adrenergic agonists?
Tachycardia; muscle tremors; anxiety; arrhythmias; hyperglycemia; hypokalemia; hypomagnesemia (systemic side effects are minimized when drug is delivered via inhalation)
37
What are the side effects of 5-lipoxygenase inhibitors and leukotriene antagonists?
Increased liver function tests (LFTs); headache; Churg-Strauss syndrome
38
What is the main nonsystemic side effect of inhaled corticosteroids?
Thrush
39
What is thrush?
Oropharyngeal candidiasis
40
How can you prevent thrush when using inhaled corticosteroids?
Use of a spacer device; rinse mouth with water after medication use
41
What is a possible systemic side effect of inhaled corticosteroids in children?
Decreased growth of long bones
42
If using an inhaled corticosteroid and _2-adrenergic agonist together, which do you use first?
_2-adrenergic agonist (bronchodilates the airways, thereby increasing amount of corticosteroid that is delivered to its site of action)
43
What are the side effects of theophylline?
Tachycardia; arrhythmias; nausea; diarrhea; central nervous system (CNS) excitation (narrow therapeutic index)
44
Give an example of a methylxanthine other than theophylline:
Caffeine; theobromine; aminophylline
45
Why do inhaled anticholinergics have a minimal side effect profile?
Quaternary ammonium derivatives of atropine, therefore, do not leave the pulmonary system and cannot cross the blood-brain barrier
46
What are examples of systemic anticholinergic side effects?
Dry mouth; dry eyes; constipation; urinary retention; blurred vision; mydriasis; drowsiness; tachycardia
47
How do you treat _-blocker-induced bronchospasm?
With anticholinergics such as ipratropium and tiotropium
48
Name two drugs used to treat an acute asthma attack:
1. Epinephrine 2. Albuterol
49
What is the IV form of theophylline called?
Aminophylline (2:1 complex of theophylline and ethylenediamine)
50
What is the term used to describe a severe asthma attack that does not respond to usual asthma therapy?
Status asthmaticus
51
How is status asthmaticus treated?
Oxygen; inhaled albuterol; intravenous or oral corticosteroids; inhaled anticholinergics
52
What is the drug of choice for mild asthma?
Short-acting _2-adrenergic agonist
53
What is the maintenance drug of choice for chronic asthma?
Inhaled glucocorticoid
54
How is theophylline primarily metabolized?
Hepatic cytochrome P-450 enzymes (CYP 1A2 and CYP 3A4)
55
Give examples of medications that can lead to increased theophylline levels when used concomitantly:
Cimetidine; erythromycin; fluoroquinolones
56
What drug can cause asthma, nasal polyps, and rhinitis?
Aspirin ("aspirin triad"); seen in the rare case of aspirin sensitivity where inhibition of cyclooxygenase (COX) leads to a buildup of leukotrienes
57
What disease processes fall under the category of chronic obstructive pulmonary disease (COPD)?
Asthma; chronic bronchitis; emphysema
58
State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Forced expiratory volume in 1 second (FEV1)
Decreased
59
State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Forced vital capacity (FVC)
Unchanged or increased
60
State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: FEV1/FVC
Decreased (
61
State whether the following pulmonary function tests (PFTs) will be increased, decreased, or remain unchanged in patients with COPD: Total lung capacity (TLC)
Unchanged or increased
62
What agents are used to treat COPD?
Inhaled anticholinergics; _2-adrenergic agonists; theophylline; inhaled corticosteroids
63
What are the first-line agents for treatment of COPD?
Inhaled anticholinergics (ipratropium)
64
Give examples of drugs that can suppress the CNS cough reflex:
Morphine; codeine; hydrocodone; hydromorphone; dextromethorphan
65
Which has greater antitussive (anticough) action, morphine or codeine?
codeine
66
When using opioids for cough suppression, are the doses required less than, equal to, or greater than the doses required for analgesic activity?
Less than
67
Which opioid is the drug of choice for cough suppression?
Dextromethorphan (no analgesic activity, no addiction risk)
68
What is a cough expectorant?
An agent that thins respiratory tract mucus and promotes its expulsion from the tracheobronchial system
69
Give an example of a cough expectorant:
Guaifenesin
70
What is/are the signs and symptoms of allergic rhinitis?
Inflammation of the nasal mucous membrane which is characterized by nasal itching, sneezing, rhinorrhea, and congestion
71
What causes allergic rhinitis?
Allergens interacting with IgE-coated mast cells leading to release of histamine, leukotrienes, and chemotactic factors
72
How do you treat allergic rhinitis?
Antihistamines; _-adrenergic agonists; intranasal corticosteroids; intranasal cromolyn; 5-lipoxygenase inhibitors; leukotriene antagonists
73
Give examples of antihistamines used in the treatment of allergic rhinitis:
Diphenhydramine; chlorpheniramine; loratadine; desloratadine; fexofenadine; cetirizine; astemizole
74
Name three nonsedating antihistamines:
1. Loratadine 2. Desloratadine 3. Fexofenadine
75
Why are loratadine, desloratadine, and fexofenadine nonsedating?
No CNS entry
76
Where are H1 histamine receptors located?
Smooth muscle; endothelial cells; heart; CNS
77
Histamine acting at H1 receptors does what to the following? Bronchiolar smooth muscle
Contraction
78
Histamine acting at H1 receptors does what to the following? Capillaries
Dilation; increased permeability
79
Histamine acting at H1 receptors does what to the following? Peripheral nociceptive receptors
Activation which leads to increased pruritus and pain
80
What are the major side effects of diphenhydramine?
Anticholinergic side effects, such as sedation, dry mouth, dry eyes, constipation, urinary retention, blurred vision, mydriasis, and tachycardia
81
Give examples of _-adrenergic agonists (nasal decongestants) used in the treatment of allergic rhinitis:
Phenylephrine; pseudoephedrine; oxymetazoline
82
How do _-adrenergic agonists help relieve signs and symptoms of allergic rhinitis?
Vasoconstriction of dilated arterioles in nasal mucosa; decrease airway resistance
83
What can happen when you discontinue use of long-term intranasal decongestants?
Rebound nasal congestion (only use these types of medications for short-term relief)
84
What causes neonatal respiratory distress syndrome?
Insufficient maturation of type II pneumocytes leading to decreased production of surfactant
85
What is the purpose of lung surfactant?
Reduce alveolar surface tension which allows alveoli to remain open for proper gas exchange
86
What medications can be used to accelerate fetal lung maturation?
Glucocorticoids; thyrotropin-releasing-hormone (TRH)
87
What is a marker of fetal lung maturity?
Lecithin to sphingomyelin ratio of at least 1.5:1
88
What pharmacologic options are available for treating neonatal respiratory distress syndrome?
Surfactant replacement therapy; nitric oxide (NO)
89
What can be used to reduce small airway accumulation of viscous mucus in cystic fibrosis patients?
N-acetylcysteine; DNase
90
How does N-acetylcysteine work in cystic fibrosis?
Acts as a mucolytic agent through its free sulfhydryl group which breaks disulfide bonds in mucoproteins, thereby lowering mucus viscosity
91
How does DNase work in cystic fibrosis?
Deoxyribonuclease that selectively cleaves polymerized DNA in pulmonary secretions, thereby reducing mucus viscosity
92
Patients receiving which radiologic enhancing compound can be given concomitant N-acetylcysteine to protect renal function?
Computed tomography (CT) contrast
