Exam 1- Respiratory, HTN, Anti-Angina Flashcards Preview

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Flashcards in Exam 1- Respiratory, HTN, Anti-Angina Deck (97)
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1

What are the 6 classes of asthma drugs

Adrenergic agonists, anticholinergics, leukotriene receptor antagonists, corticosteroids, cromolyn, methylxanthines/Theophylline

2

Difference between antagonist and agonist

Agonist: binds to receptor site and elicits a defined therapeutic response
Antagonist: Inhibits or blocks responses caused by an agonist

3

Two ways in which asthma medications act

relax bronchial smooth muscle, reduce inflammation

4

in the airways, .... tone causes bronchodilation, whereas .... tone causes bronchoconstriction

sympathetic (adrenergic); parasympathetic (cholinergic)

5

In general, adrenergic agonists do what

increase sympathetic tone and cause bronchodilation

6

3 Adrenergic agonists

Epinephrine, albuterol, salmeterol

7

Epinephrine is (selective/non selective)

Non selective

8

Main side effect of epinephrine

tachycardia (cardiac stimulation of beta-1 receptors)

9

What route is ineffective for epi?

Oral (main is sub-Q)

10

Albuterol belongs specifically to which class of adrenergic agonists?

Beta-2 agonist

11

How does Albuterol cause bronchodilation?

Via beta-2 adrenergic receptor stimulation, increasing cAMP levels, which results in bronchial smooth muscle relaxation

12

How quickly does Albuterol cause bronchodilation?

Inhaled: 15 mins (lasts 3-4hrs) PO: 30 mins (lasts 4-8hrs)

13

What class of drugs inhibit the activity of albuterol?

beta blockers

14

Does Albuterol have anti-inflammatory effects?

no

15

Why use a spacer with albuterol?

slower velocity of delivery so that a greater of volume of smaller, slower velocity particles reach the lung

16

What is a nebulizer?

device used to change liquid medication into an aerosol particulate form

17

What are the indications for Salmeterol and when should it NOT be used?

used for chronic treatment of asthma and bronchospasm. Should NOT be used for acute asthma symptoms

18

What is the onset of action and duration for Salmeterol?

20-30mins, lasts 12 hrs. Dosed 2x/day

19

Asthma drugs that are similar to atropine and effects are parasympatholytic

Anticholinergics

20

Poor systemic absorption of anti-cholinergic drugs results in

fewer cardiac side effects

21

What is MOA of anti-cholinergic drugs?

Competitive antagonists at muscarinic acetylcholine receptor sites

22

Anti-cholinergic's are similar in structure to what other drug?

Atropine

23

What effect do anticholinergics have on bronchial wall?

Anticholinergics are parasympatholytic, which means they are anti-parasympathetic

24

How is bronchodilation achieved with anticholinergics?

Acetylcholine receptors are blocked so that sympathetic tone becomes dominate and the SM can relax; SM relation = bronchi and bronchioles can dilate

25

Example of anticholinergic bronchodilator

Ipratropium/Atrovent

26

What is the MOA of leukotriene inhibitors?

Competitive antagonists of leukotriene receptors D4, E4 in bronchial smooth muscle

27

Example of leukotriene receptor antagonist

Zafirlukast/Accolate

28

Indication for Zafirlukast/Accolate

prophylaxis and tx of chronic asthma. NOT for reversal of acute asthma attack

29

What enzyme do glucocorticoids inhibit, thereby blocking the release of what substance from membrane bound phospholipids?

Corticosteroids inhibit phospholipase A2. Phospholipase A2 facilitates the release of arachidonic acid, which is the precursor to prostaglandins and leukotrienes

30

Example of an inhaled corticosteroid

Beclomethasone/Beclovent

31

Which class of asthma drugs has a narrow therapeutic window and has a potential for severe, life-threatening arrhythmias along with potential for multiple drug interactions?

Theophylline

32

Theophylline is a structural relative of what commonly ingested molecule?

Caffeine, which can also elicit bronchodilation

33

How do narcotics suppress cough?

Antitussives decrease the sensitivity of CNS cough centers. Occurs at a lower dose than required for analgesia

34

Which Antitussive is a synthetic derivative of morphine?

Dextromethorphan (DM)

35

Name 4 commonly used drugs in the tx of allergic rhinitis

antihistamines, corticosteroids, cromolyn, alpha adrenergic agonists

36

MOA for Benadryl

H1 receptor site blockade

37

Why does Benadryl cause sedation?

Readily crosses BBB

38

MOA for Claratin

H1 receptor antagonist

39

Why is Claritin non sedating?

Does not readily cross BBB

40

Example of alpha agonist nasal spray

Arrin, Oxymetazoline

41

Dopamine-norepinephrine reuptake inhibitor also found to act as partial nicotine receptor site antagonist

Bupropion SR/Wellbutrin, Zyban

42

Partial agonist of alpha4/beta2 nicotinic acetylcholine receptor sites

Chantix

43

Major Side effect of Chantix

nightmares or insomnia, depression and suicide ideation, increased agitation and rage

44

9 Classes of Anti HTN drugs

Diuretics, beta blockers, alpha blockers, calcium channel blockers, ACE inhibitors, Angiotensin 2 receptor antagonists, Centrally acting agents, direct vasodilators, renin antagonists

45

2 types of potassium wasting diuretics

Thiazides and Loop

46

2 Classifications of diuretics

Potassium wasting and potassium sparing

47

Best used in the initial treatment of mild HTN with chronic edema

Thiazide diuretics

48

Notable side effects of thiazide diuretics

Hypokalemia, hypomagnesemia, hypERcalcemia, hypERuricemia, glucose intolerance, hyponatremia (gout)

49

Order of diuretic drugs

lasiks, thiazides, least potent potassium sparing

50

preferred diuretic in pts with renal dz, HTN emergencies

loop diuretics (furosemide/lasix)

51

Also used to treat hypercalcemia

loop (Lasix), K sparing (Spironolactone)

52

Caution with gout, aspirin use, and pts prone to dehydration

loop diuretics

53

Example of a loop diuretic

furosemide/lasix

54

Drugs with sulfa moiety

HCTZ and Lasix

55

3 diseases in which to avoid using Potassium sparing diuretics

severe renal insufficiency, poorly controlled DM, Multiple Myeloma

56

Whenever possible, avoid using potassium sparing diuretics in combination with which drugs? (due to potential for hyperkalemia)

Potassium supplements, ACE Inhibitors, Angiotensin II Receptor Blockers

57

Example of potassium sparing diuretic

Spironolactone/Aldactone

58

Also used to treat hyperaldosteronism

Spironolactone/Aldactone

59

Has anti-androgenic properties, used for PCOS and hirsutism

Spironolactone/Aldactone

60

Direct agonist of aldosterone

Spironolactone/Aldactone

61

what hormone is used to reverse the bradycardic effects of beta blocker

glucagon

62

Cardio selective Beta-1 blocker

Atenolol/Tenormin

63

Never use in certain cardiac conduction abnormalities, severe asthma, severe COPD

Beta Blockers

64

Use cautiously in combo with calcium channel blockers

Atenolol/Tenormin

65

no longer considered first line agents in tx of HTN unless co morbid dz such as migraine, angina, or hx of MI

beta blockers

66

Can result in improved urine flow in BPH

Alpha blockers (Prazosin/Minipress)

67

Example of Alpha blockers

Prazosin/Minipress

68

Which drug is derived from rauwolfia alkaloid

Reserpine

69

Example of a calcium channel blocker

Verapamil/Isopten

70

Caution when using concurrently with beta blockers- potential increased risk for bradycardia and arrhythmias

calcium channel blockers

71

Example of Alpha blockers

Prazosin/Minipress

72

Which drug is derived from rauwolfia alkaloid

Reserpine

73

Example of a calcium channel blocker

Verapamil/Isopten

74

Caution when using concurrently with beta blockers- potential increased risk for bradycardia and arrhythmias

calcium channel blockers

75

Drug used especially for prinzmetal angina

Verapamil/Isopten (calcium channel blocker)

76

Side effects include hyperkalemia, dry cough, angioedema

ACE inhibitors (Lisinopril/Prinivil)

77

Least likely of the anti-HTN meds to cause sex dysfunction in males

ACE inhibitors (Lisinopril/Prinivil)

78

Side effects include angioedema, cough, hyperkalemia

ARBs

79

Drug of choice when treating diabetic pts with HTN

ACE inhibitors

80

Indication: HTN, diabetic neuropathy with proteinuria

Losartan/Cozaar

81

Generally reserved for severe HTN resistant to previous anti HTN tx (2)

Minoxidil/Loniten; Hydrazine/Apresoline

82

Direct vasodilator that can cause hirsutism

Minoxidil/Loniten

83

Example of ARB (Angiotensin II Receptor Blocker)

Losartan/Cozaar

84

Indication: HTN, diabetic neuropathy with proteinuria

Losartan/Cozaar

85

Generally reserved for severe HTN resistant to previous anti HTN tx (2)

Minoxidil/Loniten; Hydrazine/Apresoline

86

Direct vasodilator that can cause hirsutism

Minoxidil/Loniten

87

Direct vasodilator that can result in drug induced lupus syndrome

Hydrazine/Apresoline

88

New HTN drug, Renin Blocker, with side effects of hyperkalemia, angioedema

Aliskirien/Tekturna

89

Antidote to morphine

naloxone

90

Irreversibly inhibits COX enzyme

Aspirin

91

Used to reverse Heparin

Protamine sulfate

92

Used to reverse Enoxaparin/ Levenox (Low molecular weight Heparin)

Protamine sulfate

93

Antagonized Vit. K, interferes w/clotting factor II, VII, IX, X

Coumadin

94

Vitamin K may reverse

Coumadin

95

Thrombolytic (clot buster)

Streptokinase

96

Aminocaproic acid (amicar) is plasmin in-activator & antifibrinolytic

Streptokinase

97

Also used to treat hypocalcemia

HCTZ