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Flashcards in Pharmacology - Pulmonary Deck (72):
1

Albuterol

SABA - used in Asthma and COPD to relieve acute symptoms and prevent exercise induced asthma.
Inhalation with rapid onset of action - minutes.
Duration for 4-6 hours.
bronchial smooth muscle dilation (beta agonist) and decreased respiratory secretion

2

LABA - Drug names

Salmeterol and Formoterol

3

LABA

Salmeterol and Formoterol for sustained release.
Used for treatment of Asthma, but not alone due to not being anti-inflammatory.
More standard of treatment for chronic COPD.

4

Prednisone

Systemic Glucocorticoide.
Inhibitis phospholipase I and cytokine syntheseis.
Used inc aute asthma (severe)
36-48 hour duration
Antiinflammaotry, vasoconstriction to decrease edema

5

Inhaled glucocorticoides - names

Flutacasone and Budensonide

6

ICS

inhaled corticosteroids
Preferred for long term treatment of asthma and severe forms of COPD.
inactivates NFKbeta the precursor for inflammatory TNFalpha and other agents.

7

Omalizumab

anti IgE immune modulator that inhibits IgE binding to Mast Cells to decrease allergic asthma response.
Used for Tx of allergic asthma that are not responding to ICS and LABA

8

Mepolizumab

Anti IL-5 (produced the Th2 and Mast cells to prevent the growth, differenetiation, recruitment, and activation of eosinophils.

9

Leukotriene Modifiers

Oral D4 antagonist and 5-Lipoxygenase inhibitor
blocks or modifies the luekotriene pathway to cause bronchodilation and anti-inflammation.
attenuates exercise induced asthma.

10

Anticholinergic Medications

Atropine, Ipratropium and Tiotropium

11

Atropine

anticholinergic receptor that causes bronchodilation due to Smooth muscle relaxation and inhibits respiraotry secretion.
used for COPD but not Asthma

12

Ipratropium

muscarinic agonsst/short term anti-cholinergic to cause bronchodilation

13

Tiotropium

Long term anti-cholinergic used for Asthma or COPD tx

14

Theophylline

Oral or IV that has 12-24 hr duration. Inhibits phosphodiesterase to increase cAMP for bronchodilation and some anti-inflammatory use.
not used anymore for asthma tx due to side effects - narrow theraputic window, seizure, neuro damage and DDI

15

Cormolyn Na

inhalation drug to inhibit mast cell release to prevent exercise induced asthma and prevent allergen induced asthma.

16

Nedocromil

inhalation drug to inhibit mast cell release to prevent exercise induced asthma and prevent allergen induced asthma.

17

Tx of Asthma vs COPD

both for mild: SABA PRN
Asthma: needs ICS before LABA (not alone)
COPD: LABA/LAMA before ICS

18

Muscarinic Receptor block

Used for Sedation, prevent N/V (motion sickness via block of M and H1) and blocks secretions in nonallergic rhinorrhea. (but may be drying effect like urinary retention, blurred vision, dry mouth, constipation)

19

Na Channel Block

diphenydramine - benedryl
acts like a local anesthetic and can ca be used topicallys

20

Affects of an alpha adrenergic Receptor block

although sparse in lung, cause vasocontriction in the lung. to cause orthostatic hypotension.

21

Pharmacokinetics of 1st gen antihistamines

Oral absorbtion with penetration into CNS. Metabolism in liver. Bind to non-H1 receptors.

22

Pharmacokinetics of 2nd gen antihistamines

Oral Absorption, not CNS penetration, renally elminiated.

23

Antihistamine uses

Allergic rxs (rhinitis, urticaria), cough suppression (na block), Motion sickness, N/V in pregnancy, sleep aid

24

Side effects of antihistamines

Sedation 1>2; of second gen Cetirizie is most sedative. Additive effect with EtOH or CNS depresseants.
Antimuscarinic Dry mouth
Postural hypotension

25

Duration of 1st vs 2nd generation antihistamines

1st: shorter 6-12 hours 2nd: longer 12;24 hours

26

Antiemetic 1st vs 2nd generation antihistamines

1st: med/ high 2nd: no effect

27

anticholinergic GI effects

1st: med/high 2nd: very low

28

Chlorpheniramine

1st gen antihistamine

29

Dimenhydrinate

1st gen antihistamine

30

Diphenhydramine

Bendryl
1st gen antihistamine

31

Cetirizine

Zyrtec
2nd get antihistamine

32

Fexofenadine

allegra
2nd gen antihistamine

33

Azelastine

inhaled 2nd gen antihistamine
Optivar

34

1st gen vs 2nd gen antihistamine uses

1st: allergy, motion sickness, sleep aid
2nd: allergy

35

Topical Decongestant mechanism

stimulate alpha adrenergic (alpha agonist) to cause vasoconstriction that in dilated vessled by histamine or bradykinin.
Increase drainage and aids in breathing.
Very rapid effect

36

S/E of topical decongestant

Rebound congestion (rhinitis medicamentosa) due to ischemia local irritation

37

Phenylephrine

Neosynephrine - most effect, but shorter duration
topical decongestant with 4 hr duration and high irritation

38

Oxymetazloine

afarin - topical decongestant with 6-12 hr duration. BID. Limited rebound congestion

39

Advantages of oral Decongestant (compared to topical)

Same mechanism with Alphe1 receptor vasoconstriction..
no rebound congestion, increased duration of action, unaffected by mucus characters,
less intense vasoconstriction, but longer duration of action compared to topical

40

Side effects of oral decongestants

headache, dizzy, nausea, increased BP-palpitations at chronic high dose.

41

Pseduoephedrine

Sudafed
oral decongestant
good vasocontrictor, but less effective vasopressor.
Less CNS stimulation, so safest and most effective decongestant

42

Phenylephrine

Sudafed PE
Oral decongestant
Hepatic MAO with variable interpatient blood levels

43

pathophysiology of histamine

Increases NO synthesis - Vasodilation of arterioles to cause hypotension, nasal congestion, increased HR
Increased capillary permeability - edema, shock, rhinorrhea, hives-urticaria.
Acts in the Gut to cause Smooth muscle contraction - cramping and Gastric acid secretion.
In lung: bronchoconstriction
Nerves: pain and itching

44

Anaphylactic Rxn

Type 1 where H1 receptors are stimulated to cuase urticaria, abdominal cramps, laryngospasm, bronchospasm, decreased BP and shock

45

Channels responsible for Allergic Rx treatment

H1 Receptor Block

46

Cough Supression channel block antihistamine

Na Channel Block

47

Motion sickness Tx - antihistamine channel blcoks

H1 and M

48

N/V in pregnancy Tx - antihistamine channel blcok

H1 and M

49

Sleep Aid tx - antihistamine block

H1 and M

50

Antihistamines are good for.... and not so good for

3+> for sneezing, pruritis, rhinorrhea
+ = congestion
- inflammation

51

Corticosteroids vs Antihistamine uses

Corticosteroids are good for Sneezing, Pruritis, Rhinorrha, congestion and inflammation
Antihistamines only for sneeze, pruritis, rhinorrhea
Steroids have delayed onset

52

target receptors for decongestants

Alpha, H1 and Bradykinin

53

Role of histamine in viral colds

Minor role!

54

uses of decongestants

equally effective for Allergic rhinitis as viral rhinitis

55

Allergic Rhinits vs. Viral rhinitis tx

Allergic - antihistmaine and decongestant
Vrial: only decongestant and analgesic

56

Antitussive mechanism

Decrease vagal afferent and efferent pathways to/from the central cough center in the brainstem to depress this signal.
Most effective: agonist at endogenous u-opioid receptors in brainstem
less effective - antihistaminic and/or local anesthetic actions

57

Antitussive uses

reduce frequency of cough - especially dry-nonproductive ones
Reduce excessive cough discomfort

58

Codeine, Hydrocodone, hydromorphone

opioid antitussives that are effective at low doses.
Adverse effects: nausea, drowsiness, constipation, allergic reactions (puruitus)

59

Dextromethorphan

Robitussin DM
Antitussive (most common OTC) with variable effectiveness.
Opiod agonists (blocks NMDA glutamate receptors) that does not depress respiration or predispose to addiction.

60

Side Effects of Dextromethorphan

Drowsy, GI Upset, at high dose can cuase PCP like effects called Robo-tripping and coma.

61

Destromethorphan four dose plateaux

Mild stimulation --> euphoria --> distorted visual/Loss of motor control --> dissociative sedation

62

Diphenhydramine

Benylin - antitussive
Safe and mostly effective, but greater propensity for sedation, anti-muscarinic effects than dextromehorphan

63

Acute Cough due to common cold

1st gen antihistmaine/decongestant
Naproxgen

64

Acute cough due to upper airway cough syndrome

PND
1st gen antihistamine/decongestant

65

Expectorants

no cough suppression
Increase respiratory secretions to think mucus and increase clearance.

66

Expectorants effectivity

not proven to be effective - increasing fluid intake, cool mist/vapor is as effective.

67

Guanifesein

expectorant that is safe and moderately effecitve

68

N-Acetyl Cysteine

Mucolytic that splits disulfide linkage between mucoproteins to decrease viscosity. Used to treat COPD and acetaminophen overdose.

69

Bosentan

antagonist of Endothelin R1 to decrease pulmonary vaso resistance

70

Sildenafil

inhibits cGMP PDE-5 to be vasodilatory to prolong the effect of NO. Tx: PH and erectile dysfunction

71

Epoprostenol

PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.

72

Iloprost

PGI2 mimic- vasodilator of pulmonary arterial vessels and decreases platelet aggregation.