opd pharm

Question 1

bronchodilators

Answer 1

beta 2 agonists
anticholinergics
xanthine derivatives

Question 2

antiinflammatories

Answer 2

LTRAs
inhaled glucocorticoids
mast cell stabilizers

Question 3

bronchodilators

Answer 3

all resp disease
work by stimulating beta 2 adrenergic receptors in lungs relaxing bronchial smooth muscle - cause dilation of bronchi/bronchioles and increased airflow
mimic sns (fight or flight)

Question 4

beta adrenergic agonists

Answer 4

long or short acting
-erol
asthma attack = short term only

Question 5

short acting beta

Answer 5

albuterol (PO/inhaled)
levalbuterol (inhalant)
q4-6hr, rescue drugs

Question 6

long acting beta

Answer 6

selmetrol
formoterol
all inhalant
q12 - 14hr, preventer

Question 7

non selective adrenergic drugs

Answer 7

stimulate beta 1 and 2 and alpha (epinephrine)
alpha: vasoconstriction (decrease edema/swelling in mucous membranes, limit secretions)
beta 1: CV effects - increased BP and HR
more SE with non selective
CNS stim - nervousness/tremors

Question 8

non selective beta adrenergic

Answer 8

stimulate beta 1 and 2
metaproterenol

Question 9

selective beta 2

Answer 9

albuterol
preferred med to treat pulmonary conditions

Question 10

beta adrenergic agonist: I

Answer 10

prevent or relieve bronchospasm related to asthma/bronchitis/other pulmonary conditions
and conditions outside the pulmonary system
CI: uncontrolled htn, cardiac dysrhythmias, high risk for stroke

Question 11

beta adrenergic agonist: nc

Answer 11

can be given with beta blockers but may diminish effects (prefer inhaled and selective, may need higher dose of BB)
avoid MAOIs and sympathomimetics bc htn (ephedrine)
diabetics may need higher doses of insulin bc raises bp

Question 12

beta adrenergic agonist: SE

Answer 12

non selective have most
beta 2 = htn or hypoT
can reverse overdose with beta blocker but watch for bronchospasm
short half life - effects go away quickly
insomnia, restlessness, anorexia, cardiac stim, hypergly, tremor, vascular HA

Question 13

why inhaled

Answer 13

minimize systemic SE (htn and HR issues)
MDI: inhale slow and deeply
DPI: breath activated, easier to use, better for cognitive issues and younger pt
neb: hospital, acute exacerbation

Question 14

albuterol

Answer 14

selective beta agonists
onset in minutes
inhale q4-6, rescue
MDI or neb, first line for acute asthma
I: asthma, bronchitis, emphysema; acute wheezing, chest tightness, SOA
>1 canister/mo = inadequate control of asthma, need to start or intensify anti inflam therapy, 200 pushes, regular scheduled daily use not recommended
also prevent EIA

Question 15

salmeterol

Answer 15

long acting beta 2 agonist agent
not for acute treatments - maintenance drug
2x/day via DPI
associated with increased asthma related deaths (AA)
I: worsening asthma or COPD
always given with inhaled corticosteroid not given alone

Question 16

anticholinergics

Answer 16

work on acetylcholine receptors
turn off pns and turns on sns (bronchodilates), increase perfusion to heart, lungs, brain
block acetylcholine and inhibit normal phys response - bronchoconstriction and increased mucus

Question 17

ipratroprium

Answer 17

anticholinergic
prophylactic and maintenance (not rescue)
usually given in combo with albuterol

Question 18

ipratroprium: SE

Answer 18

anticholinergic effects
sedation, dizzy, confusion, hallucinations, urinary retention, dry mouth and throat, constipation, feel hot, decreased sweating, tachy, blurred vision, dry eyes
dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter

Question 19

xanthine derivatives

Answer 19

theophylline and aminophylline
increase levels of cAMP enzyme by inhibiting phosphodiesterase - stimulate CNS and CVD system
second line bc high toxicity and drug interactions
prevent asthma attacks and COPD exacerbation (not rescue)

Question 20

xanthine derivatives: SE

Answer 20

toxicity: n/v/d, insomnia, HA, tachy, dysrhythmias, seizures (more common in elderly)

Question 21

xanthine derivatives: CI and interactions

Answer 21

CI: uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers
Interactions: caffeine may increase SE, smoking decreases abs; macrolide abx, allopurinol, cimetidine, quinolones, flu vax, oral contraceptives
narrow therapeutic index: monitor serum levels and watch for tox (reverse with activated charcoal)

Question 22

leuokotriene receptor antagonists

Answer 22

montelukast (>12 mo) and zafirlukast (>5yr)
leukotrienes cause inflam, chroncostriction and mucus production
moa: prevent leukotrienes (released from mast cells) from attaching to receptors on immune cells in lungs and prevent inflam
given PO - chewable tablets and granules, improve in 1 wk
prophylaxis and chronic, and allergies, not rescue

Question 23

leuokotriene receptor antagonists: SE

Answer 23

HA, n/d, dizzy, insomnia,
M: few drug drug interactions
Z: lots if I

Question 24

inhaled corticosteroids meds

Answer 24

beclomethasone diproprionate
budesonide
fluticasone

Question 25

inhaled corticosteroids

Answer 25

can be PO for COPD exacerbation and others unless getting worse limit systemic SE - neb or MDI moa: reduce inflam and enhance beta agonist (combo therapy) can take several weeks before full effect if inhaled, PO instant not rescue asthma - take on regular schedule, give bronchodilator first to allow more abs of steroid

Question 26

inhaled corticosteroids SE

Answer 26

pharyngeal irritation, cough, dry mouth, oral fungal infections - rinse mouth after

Question 27

combos: inhaled glucocorticoid and bronchodilator

Answer 27

mod - severe asthma (not acute attack!) budesonide and formoterol - minutes fluticasone and salmeterol - longer both have long half life

Question 28

mast cell stabilizer

Answer 28

stabilize membranes of mast cells and prevent release of broncho constrictive inflam substances used for prevention of attack 15 -20 min before known trigger, still not rescue cromolyn

Question 29

monoclonal antibody antiasthmatic

Answer 29

omalizumab newest gen of antiasthmatic add on therapy moa: selectively binds to immunoglobulin IgE -> limit release mediators of allergic response given via injection monitor closely for hypersensitivity reactions (anaphylaxis big risk)

Question 30

selective PDE 4 inhibitor

Answer 30

roflumilast moa: inhibit PDE4 in lung cells - anti inflam prevent COPD exacerbation - not acute oral good for chronic bronchitis w hx of lots of exacerbations SE: n/v/d, HA, muscle spasms, decreased appetite, uncontrollable tremors

Question 31

long term control meds

Answer 31

anticholinergics xanthine derivative inhaled corticosteroids leukotriene modifiers mast cell stabilizers LABA

Question 32

rescue meds

Answer 32

SABA albuterol