Exam 2 Flashcards by Alyssa Petersen

What are MDIs and how should they

be used?

Metered-dose inhalers. Small, hand-held, 
pressurized devices.  Begin slow 
inhalation before activation, hold 
medicine in lungs for 10 seconds, and 
wait 1 minute between activations.

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What are SMIs and how should they

be used?

Soft mist inhalers. Begin slow inhalation,
hold medicine in lungs for 10 seconds,
and wait 1 minute between activations.

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What is the advantage of DPIs?
Disadvantage? How fast should the
patient inhale?

No hand-lung coordination needed,
breath-activated. Must have adequate
inspiratory flow to inhale powder. Inhale
rapidly.

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What are SVNs and how are they

used? What are the advantages?

Small volume nebulizers. Converts a
solution into a mist. Does not require
timing of dose with inhalation, rapid deep
inspiration, or hand strength.

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List three ways glucocorticoids treat

asthma.

Suppress inflammation and bronchial
reactivity, decrease mucus production,
increase number and responsiveness of
beta-adrenergic receptors.

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What is the first-line treatment for

moderate to severe persistent asthma?

Inhaled glucocorticoids

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Discuss the proper way to
administer inhaled glucocorticoids.
Why?

Gargle & spit after use. Use the beta-
adrenergic inhaler first if one is used. The
beta-adrenergic inhaler opens the airways
so that the glucocorticoid can penetrate
deeper into the lungs. Gargling and
spitting decreases the chance of an
oropharyngeal infection.

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Why might oral glucocorticoids be
necessary during stress even if asthma
symptoms are controlled?

May need to supplement because stressful
events require bursts of steroids. The
patient may develop adrenal crisis without
supplementation.

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How does montelukast (Singular), a

leukotriene modifier, work?

Blocks leukotriene receptors.

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What are four mechanisms of

action for leukotriene modifiers?

Bronchodilation, decreased mucus,
decreased edema, and decreased
eosinophilic infiltration

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How does Cromolyn, a mast cell

stabilizer, work?

Prevents mast cells from lysing and

releasing histamine and other mediators.

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How long must mast cell stabilizers

be used to obtain a therapeutic effect?

May take several weeks.

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How does omalizumab (Xolair)
work? Why are patients asked to stay
in the clinic after injections?

Myoclonal antibody binds free IgE so that
it cannot bind to mast cells and cause their
lysis. Risk for anaphylaxis.

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Why are beta2-adrenergic agonists

used?

Relieve bronchospasm and prevent

exercise-induced bronchospasm.

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What are the three mechanisms of

action for beta2-adrenergic agonists?

Bronchodilation, suppression of histamine

release, increased ciliary motility.

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What is the difference between
short-acting and long-acting beta2-
adrenergic agonists?

Short-acting: lasts 3-5 hrs, immediate 
effect, used for relief of bronchospasm 
and before exercise.
Long-acting: given every 12 hrs, used to 
prevent bronchospasm.

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Discuss the adverse effects of beta2-

adrenergic agonists.

Tachycardia, angina, tremor,
hypokalemia, nervousness, insomnia,
seizures, paradoxical bronchospasm.

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Discuss three drug-drug
interactions of beta2-adrenergic
agonists.

Decreased potassium levels with diuretics, 
glucocorticoids, and methylxanthines.   
Beta-blockers block their therapeutic 
effects. Use of long-acting inhaled 
glucocorticoids may protect against 
increase in asthma-related deaths with 
inhaled long-acting beta2-adrenergic 
agonists.

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Explain how anticholinergic
inhalers work. List three
anticholinergic inhalers.

Interrupt parasympathetic response 
causing bronchodilation and decreased 
mucus.
Atrovent (ipratropium)
Spiriva (tiotropium)
Tudorza Pressair (aclidinium)

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How many minutes should elapse 
between 2 inhalations of a beta-
adrenergic agonist?  How long should 
the patient hold his breath?  In what 
order should you have the patient take 
two inhalations of an inhaled steroid 
and 2 inhalations of a beta-adrenergic 
agonist inhaler?

1 minute
Hold breath for 10 seconds
2 inhalations of beta-agonist, then 2
inhalations of inhaled steroid.

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How many times per week can a 
patient have symptoms and still be 
classified as mild intermittent asthma?  
How many night-time symptoms in a 
month?

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< 2 /week

< 2/month

A patient with daily asthma
symptoms is classified as having what
type of asthma?

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Moderate persistent

Explain the PEF zone system. If a
patient’s personal best is 1000 and the
PEF drops to 600, what zone is he in?
What drug should he use?

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Yellow 50-80%.

Use short-acting beta agonist.

In conscious persons with severe
asthmas exacerbations, which drugs
should be administered first?

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Beta-agonist and ipratropium (Atrovent)

inhalations in a SVN

What drug categories are used to | maintain patients who have COPD?

Long-acting beta2-adrenergic agonists or | anticholinergic inhalers.

What drugs categories are used initially for acute exacerbations of COPD?

Short-acting beta2-adrenergic agonists | alone or with an anticholinergic inhaler.

What two drugs may be added for | control of severe COPD?

Longterm inhaled glucocorticoids and | Roflumilast (Daliresp)

What Drug is for Respiratory Disorders:

Potassium (K)

Drugs for Upper Gastrointestinal Disorders:

- Complete blood count (CBC) with differential and platelets - potassium (K) - magnesium (Mg)

Drug ending -terol | What is the drug classification and an example?

Classification: Bronchodilator Example: Albuterol

List and explain the 4 defensive factors which protect the stomach and duodenum from self-digestion.

``` Mucus – forms a barrier to protect underlying cells from gastric acid and pepsin. Bicarbonate – neutralizes any acid which penetrates the mucus. Blood flow – maintains integrity or health of the mucosa Prostaglandins – Stimulates mucus and bicarbonate, vasodilates blood vessels, suppresses gastric secretion ```

``` Helicobacter pylori (H. pylori) – gram- negative bacillus which lives between the mucus layer and the mucosa. Produces CO2 and ammonia from urea which damages the mucosa. NSAIDs – decreases the production of prostaglandins which decreases blood flow, decreases bicarbonate and mucus secretion, and increases gastric acid. Gastric Acid – injures cells of the mucosa and activates pepsin. Pepsin – breaks down protein of the gut wall. Smoking – delays healing of ulcers and increases risk of recurrence. ```

What are three mechanisms of | action for antacids?

Binds gastric acid and forms a neutral salt, decreases pepsin if pH > 5, and stimulates prostaglandins.

How are antacids administered in relation to meals, sleep, or other drugs? If not eating, how often are they given?

1 and 3 hrs after meals and at bedtime, 1 hour before another drug, or every 2 hours if not eating

Which antacids can cause complications in heart failure and renal disease?

Aluminum hydroxide and sodium bicarbonate – heart failure, magnesium hydroxide – CNS toxicity in renal patients

How do histamine2 receptor | antagonists work?

Block H2 receptors on parietal cells which suppress gastric acid secretion and decrease the hydrogen ion concentration in gastric acid.

How are histamine2 receptor antagonists administered in relation to meals?

May be taken without regard to meals, | except take Tagamet with food

Which histamine2 receptor antagonist is noted for drug-drug interactions caused by inhibition of hepatic drug-metabolizing enzymes?

cimetidine (Tagamet)

Which histamine2 receptor antagonist is known for its ability to block androgen effects?

cimetidine (Tagamet)

Proton-pump inhibitors may decrease the absorption of antifungals by what action?

Decreased gastric acid production

When are proton pump inhibitors | given?

Esomeprazole (Nexium) is given one hour before a meal. Omeprazole (Prilosec) and lansoprazole (Prevacid) are given directly before a meal. Others may be given at any time.

``` How long does it take for full recovery of the H+, K+-ATPase pump after stopping a proton pump inhibitor? Why? How long for partial recovery? ```

Weeks due to irreversible inhibition. 3-5 | days

Why is misoprostol (Cytotec) used? | What are the mechanisms of action?

Prevention of NSAID-caused gastric ulcers. Stimulates the secretion of mucus and bicarbonate, vasodilates blood vessels, suppress gastric acid secretion. Replaces prostaglandins.

Why is misoprostol (Cytotec) not | given during pregnancy?

Stimulates uterine contractions.

How does sucralfate (Carafate) | work? When should it be given?

Polymerization and cross-linking occurs when the pH is < 4. It adheres to the crater for 6 hours. Given on an empty stomach.

How many hours must elapse between an antacid and sucralfate (Carafate)? Between other drugs and sucralfate (Carafate)?

1 hour between an antacid and sucralfate. | 2 hours between drugs and sucralfate.

In order to kill Helicobacter pylori, | what combination of drugs is given?

2-3 antibiotics with a proton pump inhibitor or histamine-2 receptor antagonist

How does bismuth (Pepto-Bismol) work? What are two common side effects?

Disrupts the cell wall of H. pylori, inhibits urease, and keeps H. pylori from adhering to the mucosa. Black tongue and stools.

At what pH will pepsin be | decreased?

> pH 5

What is the preferred drug category for the prevention of NSAID-induced ulcers?

Proton Pump Inhibitors

What are two signs of | gastrointestinal bleeding?

Black, tarry stools and coffee-ground | vomitus.

What is the acid-neutralizing | capacity (ANC)?

The number of mEq of hydrochloric acid that is neutralized by a given amount of the antacid.

Exam 2 Flashcards

(52 cards)