DRUGS ACTING ON THE RESPIRATORY SYSTEM

Question 1

• h1 blocker or h1 antagonist
• competes with histamine receptors
• chemical mediator of inflammation that increases secretions and constrict air passageway

Answer 1

antihistamine

Question 2

where is histamine synthesized and stored?

Answer 2

mast cells and basophils

Question 3

histamine release may be triggered by ___ and ___ mechanisms

Answer 3

allergic and non allergic

Question 4

2 major classes of histamine receptors

Answer 4

h1 and h2

Question 5

activation of ___ receptors causes vasodilation, increased capillary permeability, pain, itching, bronchoconstriction, and CNS effects

Answer 5

h1

Question 6

activation of ___ receptors causes release of gastric acid from parietal cells of the stomach

Answer 6

h2

Question 7

true or false: histamine is a major contributor to anaphylactic reactions

Answer 7

false

Question 8

h1 receptor antagonists what generation?

cause sedation and anticholinergic effects

Answer 8

first-generation

Question 9

h1 receptor antagonists what generation?

• non sedating antihistamine
• little or no effect of sedation
• fewer anticholinergic symptoms

Answer 9

second generation

Question 10

CNS depression from 1st gen h1 receptor antagonist can be intensified by ___

Answer 10

alcohol

Question 11

1st generation antihistamine that causes severe respiratory depression, especially in young patients. not used in children below 2

Answer 11

promethazine (phenadoz)

Question 12

antihistamines should be avoided during the ___ trimester of pregnancy and in nursing mothers and ____

Answer 12

3rd, newborns

Question 13

• used for nasal congestion
• dilates nasal vessels that may be caused by infection, inflammation, or allergy

Answer 13

nasal and systemic decongestant

Question 14

stimulate the alpha adrenergic receptor producing vascular constriction of capillaries within the nasal mucosa

Answer 14

nasal decongestant

Question 15

• epherine (ephidrine)
• phenylephrine
• pseudoephrine

SE: jittery, nervous, increased BP, increased BG

Answer 15

systemic decongestant

Question 16

___ (e.g., phenylephrine, pseudoephedrine) reduce nasal congestion by activating alpha1-adrenergic receptors.

Answer 16

sympathomimetics

Question 17

true or false: In patients with allergic rhinitis, sympathomimetics relieve only stuffiness.

Answer 17

true

Question 18

• treatment for allergic rhinitis
• decrease allergic rhinitis symptoms like: rhinorrea, sneezing, congestion

Answer 18

intranasal glucocorticoids

Question 19

• suppress cough reflex on the medulla oblongata
• narcotic and non-narcotic cough suppressants
• used when coughing becomes detrimental to pt’s progress

Answer 19

antitussive

Question 20

2 major groups of antitussives

Answer 20

opioid and non-opioid

Question 21

___ is the most effective cough suppressant available

Answer 21

codeine

Question 22

codeine should be employed with caution in patients with reduced ___

Answer 22

respiratory reserve

Question 23

___ is a structural analog of 2 local anesthetics: tetracaine and procaine
- suppresses cough by decreasing the sensitivity of respiratory tract stretch receptors

Answer 23

benzonatate

Question 24

what happens if you chew or suck benzonatate capsules?

Answer 24

laryngospasm, bronchospasm, and circulatory collapse

Question 25

___ is the most effective ITC nonopioid cough medicine, and the most widely used of all cough medicines

Answer 25

dextromorphan

Question 26

when dextromorphan is taken in high doses, it can cause ___

Answer 26

euphoria

Question 27

do not give ___ to patients after administration of antitussives

Answer 27

water

Question 28

when giving antitussives, always observe for signs of ___

Answer 28

dependency

Question 29

do not give antitussives to patients who have undergone ___ and ___ surgeries

Answer 29

thoracic and abdominal

Question 30

- add bulk or fluid to sputum or decrease the viscosity of bronchial secretions - loosen bronchial secretion so they can eliminate by coughing - stimulates the flow of secretions

Answer 30

expectorant

Question 31

doses of this expectorant should be higher than normally employed for it to be effective

Answer 31

guaifenesin

Question 32

- cause the breakdown of secretion or reduces the viscosity of mucus in the bronchial tree - react directly with mucus to make it less viscous

Answer 32

mucolytics

Question 33

two preparations of mucolytics

Answer 33

hypertonic saline and acetylcysteine

Question 34

avoid combining mucolytics with ___ to void formation of precipitates

Answer 34

drugs in the nebulizer

Question 35

provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation

Answer 35

bronchodilators

Question 36

bronchodilator + inhaled ___ for long term suppression of inflammation

Answer 36

glucocorticoid

Question 37

bronchodilator that increase cAMP causing dilation of bronchioles

Answer 37

sympathomimetics: alpha and beta 2 adrenergic agonist

Question 38

- the most effective drugs available for relieving acute bronchospasm and preventing EIB - minimally absorbed from the GI tract

Answer 38

beta2 agonists

Question 39

- taken PRN to abort an ongoing attack - In patients with EIB, they are taken before exercise to prevent an attack from occurring

Answer 39

SABA - short-acting beta2 agonists

Question 40

overdose of SABAs cause?

Answer 40

tachydysrhythmias, angina, seizures

Question 41

- patients who experience frequent attacks may be prescribed this for long-term control - dosing is done on a fixed schedule, not PRN - are preferred over SABAs for patients with stable COPD

Answer 41

LABA - long acting inhaled beta2 agonists

Question 42

true or false: LABA can be used alone in asthma

Answer 42

false - it must be used with a glucocorticoid to avoid asthma-associated deaths

Question 43

take bronchodilators ___ mins before exercise

Answer 43

30-60

Question 44

drug of choice for the treatment of acute bronchospasm, including that which is caused by anaphylaxis

Answer 44

epinephrine

Question 45

improve lung function by blocking muscarinic receptors in the bronchi, reducing bronchoconstriction

Answer 45

anticholinergics

Question 46

two agents of anticholinergic drugs

Answer 46

ipratopium and tiotopium

Question 47

- inhibits salivary and mucus glands secretions and dilating bronchial smooth muscle - relax the air passages to the lungs

Answer 47

ipratropium

Question 48

which anticholinergic agent has a longer duration of action and thus can be dosed less often

Answer 48

tiotropium

Question 49

- an atropine derivative administered by inhalation to relieve bronchospasm - the drug has FDA approval only for bronchospasm associated with COPD, but is often used off-label for asthma

Answer 49

ipratropium

Question 50

therapeutic effects of ipratropium begins within ___ and reach 50% of their maximum in ___

Answer 50

30 seconds, 3 mins

Question 51

- inhibit the phosphodiesterase thus increasing the cAMP - relaxing the bronchial smooth muscle

Answer 51

methyxanthine derivatives

Question 52

- has a direct effect on smooth muscles of the respiratory tract - stimulates the CNS - relieves bronchial asthma and reversal of bronchospasm - stimulation of respiration in cheyne-strokes respiration - treatment of apnea and bradycardia in premature infants

Answer 52

methyxanthine derivatives

Question 53

a theophylline salt that is considerably more soluble than theophylline itself

Answer 53

aminophylline

Question 54

therapeutic range of aminophylline

Answer 54

10-20 mcg/mL

Question 55

3T's of aminophylline

Answer 55

T - toxic range 20 mcg/mL T - tonic-clonic seizure T - tachycardia

Question 56

2 drugs that can cause toxicity along with aminophylline

Answer 56

cimetidine, ciprofloxacin

Question 57

what time of day is it ideal to take aminophyllines?

Answer 57

AM

Question 58

you need to stop aminophyllines before doing this procedure

Answer 58

cardiac stress test

Question 59

anti-inflammatory agents: what does SLM mean?

Answer 59

steroids, leukotriene, mast cells stabilizer cromalyn

Question 60

decrease the inflammatory response in airwary and decrease airway edema

Answer 60

steroids

Question 61

___ (e.g., budesonide, fluticasone) are the most effective drugs available for long-term control of airway inflammation.

Answer 61

glucocorticoids

Question 62

how does glucocorticoids decrease asthma symptoms?

Answer 62

- decreased synthesis and release of inflammatory mediators - decreased infiltration and activity of inflammatory cells - decreased edema of airway mucosa

Question 63

true or false: steroids are contraindicated for acute asthma attacks

Answer 63

true

Question 64

4S of steroids

Answer 64

swelling slow onset sugar increase sore in the mouth

Question 65

drug doses of steroids must not be missed and must be tapared off over a ___ days period

Answer 65

4-5

Question 66

chemical mediator that causes inflammatory changes in the lungs

Answer 66

leukotriene

Question 67

- suppress the effects of leukotrienes, which are compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses - in patients with asthma, these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion

Answer 67

leukotriene receptor antagonist

Question 68

true or false - all the leukotriene modifiers can cause adverse neuropsychiatric effects, including depression, suicidal thinking, and suicidal behavior

Answer 68

true

Question 69

luekotrienes are used for long term management of ___

Answer 69

asthma

Question 70

therapeutic range of leukotrienes

Answer 70

1-2 weeks

Question 71

- an inhalational agent that suppresses bronchial inflammation - used for prophylaxis—not quick relief—in patients with mild to moderate asthma

Answer 71

mast cell stabilizers

Question 72

you should take mast cell stabilizers ___ mins before exertion

Answer 72

15

Question 73

- suppresses inflammation; it does not cause bronchodilation - stabilizes the cytoplasmic membrane of mast cells, preventing release of histamine and other mediators

Answer 73

cromolyn