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Respiratory Final > Pharmacology - COPD > Flashcards

Pharmacology - COPD Flashcards

(108 cards)

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1
Q

what is the greatest risk factor for COPD

A

smoking

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2
Q

COPD is often a mix of what 2 diseases?

A

chronic bronchiolitis and emphysema

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3
Q

what 3 cells predominate in COPD

A

neutrophils
macrophages
cytotoxic T cells

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4
Q

what’s the 1st COPD symptom to occur

what is the symptom that bothers people the most

A

chronic cough

the shortness of breath tends to bother people the most

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5
Q

in COPD, it may take longer to breathe ___ than ____

A

longer to breathe out then in

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6
Q

very advanced COPD leads to high pressure where? what does this cause?

A

on the lung arteries

strains the right ventricle of the heart - cor pulmonale - leg swelling and bulging neck veins

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7
Q

what actual structures are damaged in COPD

A

the alveoli (EMPHYSEMA too)
the airway is also inflamed and remodeled

IN EMPHYSEMA, the alveoli enlarge

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8
Q

unbalanced ____ is the major mechanism in which COPD results in emphysema

A

protease and antprotease activity

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9
Q

true or false

chronic bronchitis is a dry cough

A

false - productive with sputum

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10
Q

chronic bronchitis + emphysema =

A

COPD

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11
Q

____ deficiency makes a person genetically predisposed to emphysema

explain how

A

alpha 1 antitrypsin

this is a coating on the lungs. when it’s gone, the lungs are susceptible to neutrophil elastase - causing lung damage

not only this, but the alpha 1 antitrypsin is actually trapped in the liver - resulting in liver damage as well

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12
Q

in emphysema, ________ is activated

A

NFKB

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13
Q

tobacco produces ROS.
how do these ROS cause damage

A

they inactivate antiproteases

this is called functional alpha 1 antitrypsin deficiency

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14
Q

true or false

in chronic bronchitis, there is protease-antiprotease imbalance

A

false - emphysema

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15
Q

what are the 2 main sources of protease in the lungs

A

macrophages and neutrophils

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16
Q

5 pharmacotherapy categories for COPD

A

beta2 agonists
corticosteroids
PDE4 inhibitors
anticholinergics
methylxanthines

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17
Q

name 5 respiratory anticholinergics

A

glycopyrrolate
aclidinium
ipratropium
tiotropium
umeclidinium

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18
Q

what class is theophylline

A

a methylxanthine

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19
Q

what class is roflumilast

A

a PDE4 inhibitor

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20
Q

name 2 types of bronchodilators

A

beta agonists
anticholinergics

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21
Q

true or false

beta agonist + anticholinergic can NOT be combined because they are both bronchodilators

A

FALSE - they can bc they have different MOA

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22
Q

___ and ___ steroids are best for acute COPD flares

A

oral and IV

INHALED - maintenance

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23
Q

TRUE OR FALSE

PDE4 inhibitors are anti inflammatories

A

true

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24
Q

true or false

roflumilast is given IV

A

false - oral

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25
role of antibiotics in COPD patients
sometimes used to treat exacerbations but can also be used daily in some patients
26
____ replacement therapy is sometimes given to COPD patients
alpha-1
27
oxygen therapy in COPD
for pts with low resting O2 levels - when O2 is given long term it decreases mortality if pts just have low O2 when exercising, wearing the oxygen can increase the time that they're able to exercise
28
corticosteroids inhibit what enzyme
PLA2 (PHOSPHOLIPASE A2)
29
What is SRS-A
slow reactive substance of anaphylaxis mix of 3 leukotrienes (C4,D4,E4)
30
what is IKBA? what COPD drug is involved with it?
the inhibitor of NKFB corticosteroids increase the level of this to inhibit NFKB, the "on" signal for inflammation
31
true or false corticosteroids DECREASE the amounts of NFKB
true
32
true or false corticosteroids increase the number of inflammatory cells
FALSE - decrease. this is a disadvnatage
33
how are corticosteroids and B2 agonists related
corticosteroids increase the number of B2 receptors - enhancing the effects of B2 agonists
34
effect of corticosteroids on adhesion molecules such as ICAM-1
decreased ICAM1
35
effect of corticosteroids on inflammatory cytokines
decreased
36
effect of corticosteroids on enzymes such as COX2
decreased
37
effect of corticosteroids on HDAC2 (histone deacetylase) and what is the result
increased HDAC2, resulting in decreases inflammation
38
true or false corticosteroids help prevent B agonist tolerance
true
39
prednisone vs prednisolone
prednisone has to be metabolized to prednisolone before it can work
40
true or false in patients with severe liver disease, prednisone is preferred over prednisolone
FALSE - prednisolone preferred
41
what enzyme converts prednisone into its active form - prednisolone?
11 B hydroxydehydrogenase
42
SHORT TERM ADR of corticosteroids
stomach irritation bloating (fluid retention) hunger blurry vision agitation, sleeplessness yeast infection
43
PROLONGED USE ADR of corticosteroids
cataracts osteoporosis myopathy easily bruised skin facial hair growth (women) hair loss lipodystrophy weight gain anemia
44
*** SIDE EFFECTS OF CORTICOSTEROIDS ARE VERY IMPORTANT metabolic __ is a potential side effect of corticosteroids
alkalosis
45
corticosteroids may cause ____ retention
sodium
46
pirbuterol class
B2 agonist
47
side effects of theophylline
similar to caffeine - diuretic, and stimulant effects
48
effect of theophylline on IL10 secretion
increased
49
true or false theophylline decreases the apoptosis of inflammatory cells
false - increases
50
effect of theophylline on histone deacetylase
increased activity - which increases the efficacy of corticosteroids!
51
theophylline is a _____ receptor antagonist
adenosine (specifically A1, A2A, A2B)
52
true or false theophylline inhibits NFKB
true
53
true or false theophylline does not inhibit PDE
false - it does - but nonselective
54
effect of theophylline on phosphoinositide 3 kinase
inhibits
55
effect of theophylline on poly polymerase-1
decreased
56
controversial effect that theophylline has on respiratory muscles
reverses diaphragm fatigue-- increases contractility
57
3 drugs that are enzyme inducers and would enhance the clearance of theophylline
rifampin phenobarbital ethanol (alcohol!)
58
effect of smoking on theophylline levels
increased clearance, so decreased levels
59
a high __ and low ___ diet will increase the clearance of theophylline
high protein low carb
60
aminophylline is a methylxanthine bronchodilator composed of....
theophylline + ethylenediamine
61
aminophylline is a ____ ____ receptor antagonist and a _____ inhibitor
nonselective adenosine receptor antagonist phosphodiesterase inhibitor
62
name 4 selective PDE3 inhibitors
milrinone cilostazol imamrinone enoximone
63
name a selective PDE4 inhibitor
roflumilast
64
name 5 selective PDE5 inhibitors
tadalafil sildenafil vardafenil udenafil avanafil
65
name a PDE10 inhibitor
papaverine
66
MOA of PDE inhibitors
prevent cAMP from being degraded activate PKA activate phosphatases INACTIVATE MLCK inhibit inflammatory mediators due to increased cAMP
67
effect of PDE inhibitors on: HR CO BP
increased HR, CO, and BP
68
a side effect of PDE inhibitors is _____ acidity
hyper
69
true or false a side effect of PDE inhibitors is that is makes you pee less
FALSE - pee more (diuresis)
70
the PDE4 enzyme is mainly present where in our body?
in immune cells, epithelial cells, and brain cells
71
PDE4 modulates ________ is it intracellular or extracellular?
inflammation and epithelial integrity intracellular
72
cilomilast
PDE4 inhibitor
73
true or false roflumilast is NOT a bronchodilator
true it's more an anti inflammatory -- inhibits immune cells PKA inactivates transcription factors involved with inflammation
74
ADR of roflumilast
headache, weight loss, GI upset, insomnia, diarrhea possible psych symptoms
75
true or false ibudilast is a NONSELECTIVE PDE inhibitor
true
76
cilomilast is selective for....
PDE4D
77
anticholinergics do the _____ blockade
M3
78
in airways, tiotropium exerts its effect through inhibition of _______, facilitating bronchodilation and reducing mucus secretions
M1 and M3
79
AE anticholinergics
paradoxical bronchospasm acute narrow angle glaucoma headache, cough urinary retension
80
the M3 receptor is what kind
a Gq coupled GPCR
81
true or false ipratropium is an agonist at M3 receptor
false - antagonist
82
the 2 LABAS that last 12 hours (all the others are 24)
salmeterol formoterol
83
tiotropium lasts how long
24 horus
84
**ask for the in class questions he did
**
85
*name 5 LAMAS
tiotropium umeclidinium glycopyrronium aclidinium darotropium
86
anything ending with "ol" is....
a LABA
87
ciclesonide class
inhaled steroids
88
anoro*
umeclidinium and vilanterol
89
*combivent
albuterol and ipratropium
90
*stiolto
tiotropium and olodaterol
91
*utibron
indacanterol and glycopyrrolate
92
*advair
fluticasone and salmeterol
93
*symbicort
budesonide and formoterol
94
*breo
fluticasone and vilanterol
95
*dulera
mometasone and formoterol
96
true or false steroids inhibit the release of NFKB
true
97
true or false corticosteroids enhance many inflammatory cells
FALSE - inhibit
98
*effect of corticosteroids on cytokine mediators
decreased
99
*effect of corticosteroids on endothelial cell leakage
decreased
100
true or false corticosteroids decrease the amount of B2 receptors
false - increase
101
effect of corticosteroids on mucus secretion
decreased mucus secretion
102
*effect of inhaled corticostteroids on peptides like ET1
decreased
103
*effect of inhaled corticosteroids on enzymes like iNOS, COX2, and cPLA2?
decreased
104
cigarette smoke leads to _______ resistance
corticosteroid
105
aminophylline
NONSELECTIVE adenosine receptor antagonist and PDE4 inhibitor also a methylxanthine
106
true or false PDE4 inhibitors enhance the degradation of cAMP
false - prevent
107
how to remember if the antimuscarinic receptor is Gq or Gi
all odd receptors are Gq even receptors are Gi
108

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