PPT Flashcards
(1178 cards)
1
Q
Drug class? Block the action of histamine by binding to H1 receptors
A
antihistamines
2
Q
effect of antihistamines on capillary permeability?
A
Decreased
3
Q
what receptors do antihistamines bind to?
A
H1 receptors
4
Q
effect of antihistamines on respiratory muscle constriction?
A
decrease
5
Q
effect of antihistamines on vascular muscle constriction?
A
decrease
6
Q
effect of antihistamines on GI smooth muscle constriction?
A
decrease
7
Q
which generation of antihistamines bind non-selectively to central H1 receptors?
A
1st generation
8
Q
which generation of antihistamines bind selectively for peripheral H1 receptors?
A
2nd generation
9
Q
what receptors do 1st generation H1 receptors bind to?
A
central H1 receptors
10
Q
which generation of antihistamines binds to central H1 receptors?
A
1st generation
11
Q
which generation of antihistamines bind to peripheral H1 receptors?
A
2nd generation
12
Q
do 1st generation antihistamines bind non-selectively or selectively?
A
non-selectively
13
Q
do 2nd generation antihistamines bind non-selectively or selectively?
A
selective
14
Q
which generation of antihistamines bind to central H1 receptors?
A
1st generation
15
Q
which generation of antihistamines bind to peripheral receptors?
A
2nd generation
16
Q
where are antihistamines metabolized?
A
in the liver
17
Q
where are antihistamines excreted?
A
in the urine
18
Q
which generation of antihistamines is on the Beer’s criteria list?
A
1st generation
19
Q
1st generation antihistmines and BPH?
A
contraindicated
20
Q
1st generation antihistamines in narrow angle glaucoma?
A
contraindicated
21
Q
1st generation antihistamines in newborns and premature infants?
A
contraindicated
22
Q
why are 1st generation antihistamines contraindicated in newborns and premature infants?
A
convulsions
23
Q
which generation of antihistamines can cause paradoxical CNS stimulation in young children?
A
1st generation
24
Q
which generation of antihistamines is diphenhydramine?
A
1st generation
25
which generation of antihistamines is chlorpheniramine?
1st generation
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which generation of antihistamines is hydroxyzine?
1st generation
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three examples of 1st generation antihistamines?
diphenhydrame, chlorpheniramine, hydroxyzine
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which generation of antihistamine is cetirizine?
2nd generation
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which generation of antihistamine is levocetirizine?
2nd generation
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which generation of antihistamine is loratidine?
2nd generation
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which generation of antihistamine is desloratadine?
2nd generation
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which generation of antihistamine is fexofenadine?
2nd generation
33
brand name of diphenhydramine?
benadryl
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brand name of chlorpheniramine?
chlor-trimeton
35
brand name ot hydroxyzine?
atarax
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brand name of cetirizine?
zyrtec
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brand name of levocetirizine?
xyzal
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brand name of loratadine?
claritin
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brand name of desloratadine?
clarinex
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brand name of fexofenadine?
allegra
41
5 examples of 2nd generation antihistamines?
cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine
42
drug class? Used for the treatment of seasonal allergic rhinitis and vasomotor rhinitis
intranasal antihistamines
43
what are two indications for intranasal antihistamines?
seasonal allergic rhinitis & vasomotor rhinitis
44
what is the systemic oral bioavailability of intranasal antihistamines?
0.4
45
describe protein binding of intranasal antihistamines?
high levels
46
metabolism of intranasal antihistamines?
metabolized into active metabolites
47
excretion of intranasal antihistamines?
excreted in the feces
48
three side effects of intranasal antihistamines?
somnolence, nasal irritation, bitter taste
49
two examples of intranasal antihistamines?
azelastine & olopatadine
50
class? Azelastine
intranasal antihistamines
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class? Olopatadine
intranasal antihistamines
52
what is the MOA of nasal corticosteroids?
same as inhaled corticosteroids
53
class? Fluticasone
nasal corticosteroids
54
class? Budesonide
nasal corticosteroids
55
class? Triamcinolone
nasal corticosteroids
56
class? Ciclesonide
nasal corticosteroids
57
class? Mometasone
nasal corticosteroids
58
brand name? fluticasone
flonase
59
brand name? budesonide
rhinocort aqua
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brand name? Triamcinolone
nasacort AQ
61
brand name? ciclesonide
omnaris
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brand name? mometsone
nasonex
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what class are these? Fluticasone, budesonide, triamcinolone, ciclesonide, mometasone
nasal corticosteroids
64
specific class? Kaolin & pectin, bismuth subsalicylate
absorbent drugs
65
two examples of absorbent drugs?
kaolin and pectin; bismuth subsalicylate
66
specific class? Kaolin & pectin
absorbent drugs
67
specific class? Bismuth subsalicylate
absorbent drugs
68
specific class? Diphenoxylate w/ atropine
opiate antidiarrheals
69
specific class? Difenoxin with atropine
opiate antidiarrheals
70
specific class? Loperamide
opiate antidiarrheals
71
general class? Kaolin and pectin
antidiarrheals
72
general class? Bismuth subsalicylate
antidiarrheals
73
general class? Diphenoxylate with atropine
antidiarrheals
74
general class? Loperamide
antidiarrheals
75
two classes of antidiarrheal drugs used in crohn's and ulcerative colitis?
loperamide & anticholinergices
76
what is the action of pectin?
absorbs liquid in the stool and thickens the stool
77
when are kaolin/pectin usually used?
uncomplicated acute diarrhea
78
what antidiarrheal has antisecretory, antiinflammatory, and antimicrobial actions?
bismuth subsalicylate
79
what portion of bismuth subsalicylate is antisecretory?
salicylate portion
80
what portion of bismuth subsalicylate is antimicrobial?
bismuth portion
81
what antidiarrheal causes discoloration of stool and tongue?
bismuth
82
what antidiarrheal should not be given in febrile viral conditions?
bismuth subsalicylate
83
what antidiarrheal can precipitate Reye syndrome in febrile viral conditions?
bismuth subsalicylate
84
what color does bismuth subsalicylate change stools?
gray
85
what can stool discoloration with bismuth make patients think?
GIB
86
do diphenoxylate and difenoxin cause analgesia?
no
87
diphenoxylate- specific class?
opiate antidiarrheals
88
difenoxin- specific class?
opiate antidiarrheals
89
what is the second ingredient of diphenoxylate?
atropine
90
what is the second ingredient of difenoxin?
atropine
91
what is the main active metabolite of diphenoxylate?
difenoxin
92
what is the role of atropine with diphenoxylate or difenoxin?
antisecretory and slows peristalsis
93
drug? Slowing of peristalsis by binding of the drug to opioid receptors in the intestines
loperamide
94
what does loperamide do to the stool?
bulking & increased thickness; reduction in fecal volume
95
effect of loperamide on fecal volume?
reduction in fecal volume
96
drug? Used in mild cases of Crohn disease that is without any serious complications
loperamide
97
what class of antidiarrheals can cause toxic megacolon?
opiate antidiarrheals
98
children are especially prone to anticholinergic effects of what class of antidiarrheals?
opiate antidiarrheals
99
opiate antidiarrheals and narrow angle glaucoma?
contraindicated
100
opiate antidiarrheals and urinary obstruction?
contraindicated
101
why shouldn't diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
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why shouldn't diphenoxylate and difenoxin not be used in intestinal infections?
can worsen the condition
315
which two drugs should not be used with intestinal infection? (antidiarrheals)
diphenoxylate and difenoxin
316
children with Down syndrome are especially prone to anticholinergic adverse effects of what antidiarrheals?
opiate antidiarrheals
317
what type of glaucoma is a contraindication for opiate antidiarrheals?
narrow angle glaucoma
318
loss of WHAT in the GIT is prevented by loperamide?
fluid and electrolyte loss
319
what effect does loperamide have on peristalsis?
slowing
320
rebound constipation can progress to what?
serious impaction
321
what population is especially prone to serious impaction with rebound constipation?
older adults
322
general class? Eluxadoline
antidiarrheals
323
general class? Alosetron
antidiarrheals
324
drug? Mu and kappa opioid receptor agonist
eluxadoline
325
drug? Delta opioid receptor antagonist
eluxadoline
326
drug? Mu and kappa opioid receptor agonist and delta opioid receptor antagonist
eluxadoline
327
what antidiarrheal drug should be avoided in: hx of biliary disorders, pancreatitis, severe liver impairment, and heavy alcohol use?
eluxadoline
328
drug? Selective 5-HT3 receptor antagonist
alosetron
329
describe MOA of alosetron?
selective 5-HT3 receptor antagonist
330
drug? Decreased intestinal motility and secretions and a decrease in any associated abdominal pain
alosetron
331
what drug is used for females with diarrhea-predominant IBS not responsive to other therapies?
alosetron
332
when is alosetron used?
diarrhea-predominant IBS not responsive to other therapies
333
four examples of antihistamines used as antiemetics?
dimenhydrinate, diphenhydramine, hydroxyzine, meclizine
334
three examples of phenothiazine antiemetics?
prochlorperazine, perphenazine, promethazine
335
specific class? Prochlorperazine
phenothiazine antiemetics
336
specific class? Perphenazine
phenothiazine antiemetics
337
specific class? Promethazine
phenothiazine antiemetics
338
general class? Prochlorperazine
antiemetics
339
general class? Perphenazine
antiemetics
340
general class? Promethazine
antiemetics
341
can sedative-hypnotics be used as antiemetics?
antiemetics
342
general class? Dronabinol
cannabinoids
343
example of cannabinoid antiemetics?
dronabinol
344
specific class? Dronabinol
cannabinoid antiemetics
345
four examples of 5HT3 receptor antagonists? (antiemetics)
palonosetron, ondansetron, dolasetron mesylate, granisetron
346
general class? Palonosetron
antiemetics
347
general class? Ondansetron
antiemetics
348
general class? Dolasetron mesylate
antiemetics
349
general class? Granisetron
antiemetics
350
specific class? Palonosetron
5-HT3 receptor antagonists
351
specific class? Ondansetron
5-HT3 receptor antagonists
352
specific class? Dolasetron mesylate
5-HT3 receptor antagonists
353
specific class? Granisetron
5-HT3 receptor antagonists
354
example drug of anticholinergic antiemetic?
scopolamine
355
general class? Scopolamine
antiemetics
356
specific class? Scopolamine
anticholinergic antiemetics
357
general class? Aprepitant
antiemetic
358
specific class? Aprepitant
substance P/neurokinin 1 receptor antagonist
359
example of substance P/neurokinin 1 receptor antagonist?
aprepitant
360
example of a miscellaneous antiemetic?
trimetobenzamide
361
specific class? Most useful for motion sickness N/V due to slowing of neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
362
what class of antiemetics bind to histamine-1 receptors?
antihistamine antiemetics
363
antihistamine antiemetics; binding to histamine-1 receptors causes decreased what?
secretions in mouth and eyes
364
antihistamine antiemetics- binding to central cholinergic receptors causes what?
decreased nausea and vomiting
365
do antihistamine antiemetics cause anticholinergic effects?
yes
366
why should antihistamine antiemetics be avoided in the older adult population?
because of anticholinergic effects
367
what class of antiemetics can cause unexpected agitation in the pediatric population as opposed to sedation in adults?
antihistamine antiemetics
368
antihistamine antiemetics in hepatic dysfunction?
avoid
369
why should antihistamine antiemetics be avoided in hepatic dysfunction
because of liver metabolism
370
use of antiemetics in pregnancy and lactation?
weight risk benefit ration
371
which class of antiemetics is most useful for motion sickness?
antihistamine antiemetics
372
what class of antiemetics slows neuronal communication in the vestibulocerebellar areas
antihistamine antiemetics
373
where do antihistamine antiemetics slow neuronal communication?
vestibulocerebellar areas
374
indication for phenothiazine antiemetics?
prevent and treat N/V
375
what is the MOA of phenothiazine antiemetics?
antagonist at dopamine receptors in the chemoreceptor trigger zone (CTZ) (bind at multiple other receptors as well)
376
where are phenothiazines an antagonist?
dopamine receptors
377
where do phenothiazines antagonize dopamine receptors?
in the chemoreceptor trigger zone
378
what is the ultimate action of phenothiazine antiemetics?
decreased nausea and vomiting
379
extrapyramidal side effects are associated with what class of antiemetics?
phenothiazine antiemetics
380
who is at highest risk for EPS with phenothiazine antiemetics?
pediatric population
381
what is the pediatric population at risk for with phenothiazine antiemetics?
EPS
382
what is the black box warning with phenothiazine antiemetics?
respiratory depression in the pediatric population
383
which specific class of antiemetics has black box warning for respiratory depression in the pediatric population?
phenothiazine antiemetics
384
what class of antiemetics can cause agranulocytosis with long term use?
phenothiazine antiemetics
385
how many months does it take to see agranulocytosis with phenothiazine antiemetics?
four months or more
386
phenothiazines and Parkinson disease?
contraindicated
387
phenothiazines and narrow-angle glaucoma?
contraindicated
388
phenothiazines and bone marrow depression?
contraindicated
389
phenothiazines and cardiovascular disease?
contraindicated
390
what reflex is decreased with phenothiazine antiemetics?
cough reflex
391
what class of antiemetics can decrease the cough reflex?
phenothiazine antiemetics
392
what patients are at risk due to decreased cough reflex with phenothiazine antiemetics?
COPD or those prone to aspiration
393
phenothiazines and pregnancy?
avoid
394
what class of antiemetics can cause changes to urine color?
phenothiazine antiemetics
395
what color can phenothiazines antiemetics change urine?
pink to reddish brown
396
most adverse effects of phenothiazine antiemetics are not likely with only what?
short term use
397
what kind of glaucoma is contraindicated with phenothiazine antiemetics?
narrow-angle glaucoma
398
specific class? Used to treat N/V due to chemotherapy when other agents have failed; appetite stimulation
cannabinoid antiemetics
399
where do cannabinoid antiemetics act?
at cannabinoid receptors centrally
400
are cannabinoid receptors involved centrally or peripherally?
centrally
401
describe adverse effects of cannabinoid antiemetics
THC-like adverse effects
402
two possible mood changes with cannabinoid antiemetics?
euphoria; depression
403
dronabinol may cause what effect on sensory experience/level?
increase
404
describe changes to thoughts with dronabinol?
unusual
405
effect of dronabinol on concentration?
problems with concentration
406
effect of dronabinol on memory?
memory alterations
407
effect of dronabinol on time?
loss of time
408
what antiemetic can cause seizures?
cannabinoid antiemetics
409
why can dronabinol cause seizures?
lowering of the seizure threshold
410
three CV adverse effects with dronabinol?
palpitations, tachycardia, hypotension
411
effect of dronabinol on BP?
decreased blood pressure (hypotension)
412
effect of dronabinol on heart rate?
increased heart rate (tachycardia)
413
patients with a hx of an allergy to sesame oil should not take which antiemetic?
dronabinol
414
415
history of seizures and dronabinol?
avoid
416
cardiovascular disease and dronabinol?
avoid
417
can patients abuse dronabinol?
yes
418
what specific class? Pretreatment to prevent chemotherapy-induced N/V
5-HT3 receptor antagonists
419
specific class? Serotonin receptor blockade peripherally and centrally so that the enhanced release of serotonin due to chemotherapy is blocked
5-HT3 receptor antagonists
420
where do 5-HT3 receptor antagonists block serotonin receptors?
centrally and peripherally
421
two possible stool changes with 5-HT3 receptor antagonists?
constripation or diarrhea
422
what are three rare CV effects with 5-HT3 receptor antagonists (antiemetics)?
tachy/bradycardias; hypotention; QTc prolongation
423
what class of antiemetic may make ileus asymptomatic?
5HT3 receptor antagonists
424
what class of antiemetic may contain aspartame and must be avoided in PKU?
5-HT3 receptor antagonists
425
can 5-HT3 receptor antagonists be used in pregnancy?
yes
426
specific class? Scopolamine
anticholinergic antiemetics
427
drug? Bella donna alkaloid anticholinergic
scopolamine
428
what kind of drug is scopolamine?
bella donna alkaloid anticholinergic
429
what receptors does scopolamine antagonize?
muscarinic
430
in which branch of the nervous system does scopolamine act?
parasympathetic
431
drug? May also block transmission of signals from the cholinergic nerves in the reticular center to the vomiting center
scopolamine
432
effect of scopolamine on salivation?
decreased
433
effect of scopolamine on GI motility?
decreased
434
what are the adverse effects of scopolamine?
anticholinergic effects
435
why should scopolamine be used with caution in older adults?
anticholinergic effects
436
what are the two primary anticholinergic risks for older adults taking scopolamine?
sedation and risk of falls with serious injury
437
scopolamine in pregnancy?
avoid
438
which glaucoma is contraindicated with scopolamine?
narrow-angle glaucoma
439
which glaucoma is a caution for scopolamine?
open-angle glaucoma
440
drug? Mydriasis may affect vision significantly and cause light sensitivity
scopolamine
441
why should patients wear sunglasses with scopolamine?
mydriasis may affect vision significantly and cause light sensitivity
442
what is the primary indication for scopolamine?
prevention of N/V due to motion sickness
443
which antiemetic drug is used to prevent N/V due to motion sickness?
scopolamine
444
which antiemetic class is used for prevention of N/V due to chemotherapy?
substance P/neurokinin 1 receptor antagonist
445
specific class? Blockade of the substance P/neurokinin 1 receptor
substance P/neurokinin 1 receptor antagonist
446
specific class? Used as adjunctive therapy with the 5-HT3 receptor antagonists and dexamethasone
substance P/neurokinin 1 receptor antagonist
447
fatigue, dizziness, and hiccups- adverse effects of what specific class?
substance P/neurokinin 1 receptor antagonist
448
three lab changes that may indicate adverse effects of substance P/NK1 receptor antagonists?
elevation of AST, ALT, and BUN
449
why are many drug-drug interactions possible with substance P/NK1 receptor antagonists?
it is an inhibitor of CYP3A4
450
substance P/NK1 receptor antagonists in pregnancy?
avoid
451
substance P/NK1 receptor antagonists in pediatrics?
not approved in pediatric population
452
which antiemetic class is associated with hiccups?
substance P/neurokinin 1 receptor antagonist
453
what is the main contraindication to substance P/NK1 receptor antagonists?
history of hypersensitivity to any part of the formulation
454
what are the two drugs that substance P/NK1 receptor agonists often used adjunctively with?
5HT3 receptor antagonists and dexamethasone
455
5HT3 receptor antagonists and dexamethasone are often used alongside which class?
substance P/neurokinin 1 receptor antagonist
456
what antiemetic can cause elevation of AST, ALT, and BUN?
substance P/neurokinin 1 receptor antagonist
457
what is the miscellaneous antiemetic drug?
trimethobenzamide
458
what is the indication for trimethobenzamide?
therapy to treat N/V
459
what is the MOA of trimethobenzamide?
the CTZ is inhibited from inducing N/V from the central vomiting center due to its antagonist action on dopamine-2 receptors
460
what receptors does trimethobenzamide antagonize?
dopamine 2 receptors
461
drug? The CTZ is inhibited from inducing N/V from the central vomiting center due to its antagonist action on dopamine-2 receptors
trimethobenzamide
462
what are the three CNS adverse effects of trimethobenzamide?
depression, EPS, and headache
463
what is the adverse effect that can occur with IV administration of trimethobenzamide?
hypotension
464
what is the GI adverse effect associated with trimethobenzamide?
diarrhea
465
what class of antiemetics is not as efficacious as other drug classes?
miscellaneous (trimethobenzamide)
466
what antiemetic drug is not as efficacious as other antiemetic classes?
trimethobenzamide
467
specific class? Bind to beta2 smooth muscle cells in the airway
beta 2 receptor agonists
468
specific class? Stimulates smooth muscle cell relaxation causing bronchodilation via cyclic AMP pathway
beta 2 receptor agonists
469
specific class? Inhibits release of hypersensitivity mediators- especially from mast cells
beta 2 receptor agonists
470
do beta 2 receptor agonists have beta 1 activity?
yes, they all do
471
what causes many of the side effects of beta 2 receptor agonists?
they all have some beta 1 receptor activity
472
what pathway is involved with beta 2 receptor agonists?
cyclic AMP
473
do beta 2 receptor agonists cause bronchodilation?
yes
474
what do beta 2 receptor agonists inhibit the release of?
hypersensitivity mediators
475
release of hypersensitivity mediators from WHAT CELLS is accomplished by beta 2 receptor agonists?
mast cells
476
what is stimulated by beta 2 receptor agonists?
smooth muscle cell relaxation
477
beta 2 receptor agonists stimulate relaxation of what?
smooth muscle cell
478
where are beta 2 receptor agonists absorbed?
bronchi
479
where are beta 2 receptor agonists metabolized?
in the liver
480
where are beta 2 receptor agonists excreted?
in the urine
481
how do beta 2 receptor agonists come?
in multiple forms and delivery systems
482
two main side effects of beta 2 receptor agonists?
tachycardia, tremors
483
what three conditions warrant caution with beta 2 receptor agonists?
arrhythmias, cardiovascular disease, hyperthyroidism
484
albuterol- specific class?
short acting beta agonists (SABA)
485
levalbuterol- specific class?
short acting beta agonists (SABA)
486
pirbuterol- specific class?
short acting beta agonists (SABA)
487
terbutaline- specific class?
short acting beta agonists (SABA)
488
salmeterol- specific class?
long acting beta agonists (LABA)
489
fomoterol- specific class?
long acting beta agonists (LABA)
490
arfomoterol- specific class?
long acting beta agonists (LABA)
491
indacaterol- specific class?
ultra long acting beta agonists (ULABA)
492
olodaterol- specific class?
ultra long acting beta agonists (ULABA)
493
vilanterol- specific class?
ultra long acting beta agonists (ULABA)
494
how long do SABAs last?
4-6 hours
495
how long do LABAs last?
12 hours
496
how long do ULABAs last?
24 hours
497
how long does albuterol last?
4-6 hours
498
how long does levalbuterol last?
4-6 hours
499
how long does pirbuterol last?
4-6 hours
500
how long does terbutaline last?
4-6 hours
501
how long does salmeterol last?
12 hours
502
how long does fomoterol last?
12 hours
503
how long does arfomoterol last?
12 hours
504
how long does indacaterol last?
24 hours
505
how long does olodaterol last?
24 hours
506
how long does vilanterol last?
24 hours
507
brand name for Albuterol?
proair, ventolin, proventil
508
brand name for levalbuterol?
xopenex
509
brand name for pirbuterol?
maxair
510
brand name for terbutaline?
brethine
511
brand name for salmeterol?
serevent
512
brand name for fomoterol?
foradil
513
brand name for arfomoterol?
brovana
514
brand name for indacaterol?
arcapta neohaler
515
brand name for olodaterol?
striverdi respimat
516
brand name for vilanterol?
breo ellipta
517
specific class? Block muscarinic cholinergic receptors by antagonizing acetylcholine
inhaled anticholinergics
518
what receptors do inhaled anticholinergics block?
muscarinic cholinergic receptors
519
what do inhaled anticholinergics antagonize?
acetylcholine
520
what respiratory med decrease the formation of cyclic GMP?
inhaled anticholinergics
521
what respiratory class decreases the formation of cyclic GMP?
inhaled anticholinergics
522
what respiratory class causes decreased contractility of smooth muscle in the lungs?
inhaled anticholinergics
523
what do inhaled anticholinergics do to contractility of smooth muscle in the lungs?
decreased contractility
524
what muscle do inhaled anticholinergics act on?
smooth muscle of the lungs
525
describe absorption of inhaled anticholinergics?
poorly absorbed from lungs and GIT
526
what percentage of inhaled anticholinergic dose is swallowed?
0.9
527
where are inhaled anticholinergics excreted from?
feces
528
10% of inhaled anticholinergics are metabolized by WHAT?
hydrolysis
529
what drug class involves metabolism via hydrolysis?
inhaled anticholinergics
530
what do inhaled anticholinergics decrease the formation of?
cyclic GMP
531
what specific class involves cyclic GMP with MOA?
inhaled anticholinergics
532
what does the decreased formation of cyclic GMP cause with inhaled anticholinergics?
decreased contractility of smooth muscle in the lungs
533
three common side effects of inhaled anticholinergics?
dry mouth, cough, headache
534
which glaucoma needs to be avoided with inhaled anticholinergics?
closed-angle glaucoma
535
what specific drug class should not be used for acute bronchospasm unless in combination with albuterol?
inhaled anticholinergics
536
inhaled anticholinergics in urinary retention?
no
537
inhaled anticholinergics in BPH?
no
538
inhaled anticholinergics in closed-angle glaucoma?
no
539
what must you combine inhaled anticholinergics with in order to use for acute bronchospasm?
albuterol
540
can you use inhaled anticholinergics on their own for acute bronchospasm?
no
541
what does SAMA stand for?
short acting muscarinic antagonists
542
what does LAMA stand for?
long acting muscarinic antagonists
543
how long do SAMAs last?
4-6 hours
544
specific class? Ipratropium bromide
short acting muscarinic antagonists
545
ipratropium bromide/albuterol- specific class?
short acting muscarinic antagonists
546
tiotropium bromide-specific class?
long acting muscarinic antagonists
547
aclidinium bromide- specific class?
long acting muscarinic antagonists
548
umeclidinium bromide- specific class?
long acting muscarinic antagonists
549
revefenacin- specific class?
long acting muscarinic antagonists
550
which LAMA is the only one that can be nebulized?
revefenacin
551
what is the brand name for revefenacin?
yupelri
552
how long does revefenacin (yupelri) last?
24 hours
553
how long does umeclidinium bromide (incruse ellipta) last?
24 hohurs
554
how long does aclidinium bromide (tudorza pressair) last?
12 hours
555
how long does tiotropium bromide (spiriva) last?
24 hours
556
what is the brand name for ipratropium bromide?
atrovent
557
what is the brand name for ipratropium bromide/albuterol?
combivent
558
what is the brand name for tiotropium bromide?
spiriva handihaler/spiriva respimat
559
what is the brane name for aclidinium bromide?
tudorza pressair
560
what is the brand name for umeclidinium bromide?
incruse ellipta
561
what is the first long acting nebulized LAMA?
revefenacin
562
specific class? Preferentially bind to M3 receptors which are the primary muscarinic receptor involving bronchoconstriction in COPD
glycopyrrolates (LAMAs)
563
two examples of glycopyrronium bromide?
seebri neohaler & breztri (in combination with LABA and ICS)
564
which receptors are the primary muscarinic receptor involving bronchoconstriction in COPD?
M3 receptors
565
broad class of glycopyrrolates?
inhaled anticholinergics
566
specific class of glycopyrrolates?
long acting muscarinic antagonists
567
how long does seebri neohaler last?
12 hours
568
example of methylxanthine drug?
theophylline
569
theophylline- specific class?
methylxanthine
570
class? Inhibit phosphodiesterases that lead to an increase in cyclic AMP
methylxanthine
571
effect of theophylline on bronchial smooth muscle?
relaxation
572
effect of theophylline on pulmonary vessels?
relaxation
573
what does theophylline inhibit?
phosphodiesterases
574
inhibition of phosphodiesterases lead to an increase of what?
cyclic AMP
575
describe absorption of theophylline?
well and fully absorbed orally
576
describe first pass with theophylline?
very little
577
where is theophylline metabolized?
in the liver
578
four common side effects of methylxanthines?
headache, irritability, gastric irritation, N/V
579
describe drug interactions with methylxanthines?
multiple
580
what respiratory drug requires monitoring with serum drug levels to prevent toxicity?
theophylline
581
what are decongestants used for?
used to relieve nasal congestion
582
what two forms do decongestants come in?
oral and topical (nasal spray) forms
583
class? Alpha-adrenergic receptor agonists
decongestants
584
class? Stimulate alpha receptors of vascular smooth muscle, constricting dilated arterioles within the nasal mucosa
decongestants
585
what receptors do decongestants simulate?
alpha receptors
586
where do decongestants stimulate alpha receptors?
vascular smooth muscle
587
where do decongestants constrict dilated arterioles?
within the nasal mucosa
588
general class? Pseudoephedrine
decongestants
589
specific class? Pseudoephedrine
alpha-adrenergic receptor agonists
590
describe absorption of pseudoephedrine?
well absorbed from GI tract
591
describe distribution of pseudoephedrine?
widely distributed
592
does pseudoephedrine cross the BBB?
yes
593
describe metabolism of pseudoephedrine?
partially metabolized in the liver
594
describe excretion of pseudoephedrine?
excreted in urine with up to 75% as an active metabolite
595
what is pseudoephedrine used for?
to relieve nasal congestion
596
what are three adverse effects with oral decongestants?
anxiety, restlessness, tremors
597
what are four adverse effects with topical decongestants?
burning, stinging, dryness, sneezing
598
oral decongestants in severe HTN?
contraindicated
599
oral decongestants in cardiovascular disease?
contraindicated
600
what is the absolute contraindication to oral decongestants?
patients on MAOIs
601
can you take MAOIs with oral decongestants?
no (absolute contraindication)
602
can kids younger than 4 years take oral decongestants?
no
603
what age of children should not take topical decongestants?
younger than 6 years
604
what age of children should not take oral decongestants?
younger than 4 years
605
two examples of oral decongestants?
pseudoephedrine & phenylephrine
606
pseudoephedrine & phenylephrine are what type of drugs?
oral decongestants
607
does phenylephrine have an oral form?
yes
608
does phenylephrine have a topical form?
yes
609
does phenylephrine come in oral and topical forms?
yes
610
does pseudoephedrine have a topical form?
no
611
is oxymetazoline an oral or topical decongestant?
topical
612
is tetrahydrozoline an oral or topical decongestant?
topical
613
how is oxymetazoline given?
topical
614
how is tetrahydrozoline given?
topical
615
what are antitussives used for?
to suppress cough
616
general class? Used to suppress cough- but should be used judiciously
antitussives
617
two examples of nonopioid antitussives?
benzonatate and dextromethorphan
618
benzonatate- specific class?
nonopioid antitussive
619
dextromethorphan- specific class?
nonopioid antitussive
620
drug? D isomer of codeine analogue that acts in medulla to increase cough threshold
dextromethorphan
621
drug? Chemically related to tetracaine that acts by anesthetizing the cough receptors in the lungs
benzonatate
622
drug? Directly acts on receptors in the cough center of the medulla
codeine
623
example of opioid antitussive drug?
codeine
624
codeine-specific class?
opioid antitussive
625
where does dextromethorphan act?
in the medulla
626
what does dextromethorphan do in the medulla?
increase cough threshold
627
what does dextromethorphan do to the cough threshold?
increase cough threshold
628
what antitussive is chemically related to tetracaine?
benzonatate
629
what receptors does benzonatate act on?
cough receptors in the lungs
630
what does benzonatate do to cough receptors in the lungs?
anesthetizes them
631
what receptors does codeine act on?
receptors in cough center of the medulla
632
describe absorption of antitussives?
all well absorbed from GIT
633
describe distribution of codeine?
widely distributed including CNS
634
where is dextromethorphan metabolized?
liver
635
where is dextromethorphan excreted?
in the urine
636
where is codeine metabolized?
liver
637
where is codeine excreted?
in the urine
638
metabolism of benzonatate?
unknown
639
excretion of benzonatate?
unknown
640
can codeine cause dependence?
yes
641
can dextromethorphan cause dependence?
yes
642
when is benzonatate contraindicated?
patients who are allergic to any "caine" compound
643
patients who are allergic to any "caine" compound should not take what drug?
benzonatate
644
should antitussives be used in patients with respiratory disease with chronic cough?
no
645
what two antitussive drugs can cause dependence?
codeine and dextromethorphan
646
three side effects of antitussives?
drowsiness, dizziness, nausea
647
class? Used to reduce the viscosity of thick sputum in the symptomatic treatment of cough due to respiratory infections
648
what is the only FDA approved expectorant?
guaifenesin
649
thick bronchial secretions are composed of what?
mucins
650
what cells produce mucins?
goblet cells
651
what glands produce mucins?
submucosal glands
652
where are the submucosal glands located?
in the airways
653
what drug decreases mucin production from goblet cells?
guaifenesin
654
what drug indirectly stimulates GI vagal afferent nerves
guaifenesin
655
drug? Decreases mucin production from goblet cells and indirectly stimulates GI vagal afferent nerves that trigger reflex parasympathetic glandular secretion from submucosal cells and goblet cells increasing hydration of mucus layer for more effective mucociliary clearance
guaifenesin
656
what are the potential GI side effects of guaifenesin?
GI upset- N/V/D
657
should guaifenesin be taken with asthma?
no
658
should guaifenesin be taken with COPD?
no
659
should guaifenesin be taken with HF?
no
660
should guaifenesin be taken with ACE inhibitor therapy?
no
661
what drug class is first-line therapy in the management of HTN and HF?
diuretics
662
are diuretics first-line therapy in HTN?
yes
663
are diuretics first-line therapy in HF?
yes
664
pathophysiologic effects of HTN and HF?
increased sodium and water retention
665
pathophysiologic effect of HTN and HF on ECF volume?
increased
666
effect of diuretics on cardiac output?
decreased
667
effect of diuretics on plasma volume?
decreased
668
how do diuretics reduce cardiac output?
by decreasing plasma volume
669
do the effects of diuretics stay the same over time?
no- they are reduced
670
do diuretics always decrease peripheral resistance?
yes
671
effect of diuretics on peripheral resistance?
decreased
672
effect of diuretics on afterload?
decreased
673
effect of diuretics on BP?
decreased
674
general class? Carbonic anhydrase inhibitors
diuretics
675
general class? Osmotic diuretics
diuretics
676
general class? Aldosterone antagonists
diuretics
677
general class? Loop diuretics
diuretics
678
general class? Thiazides
diuretics
679
risk with diuretics re: potassium?
hypokalemia
680
risk with diuretics re: calcium?
hypercalcemia
681
risk with diuretics re: sodium?
hyponatremia
682
risk with diuretics re: magnesium?
hypomagnesemia
683
hypo or hyperkalemia with diuretics?
hypokalemia
684
hypo or hypercalcemia with diuretics?
hypercalcemia
685
hypo or hypernatremia with diuretics?
hyponatremia
686
hypo or hypermagnesemia with diuretics?
hypomagnesemia
687
what kind of diet exacerbates potassium loss with diuretics?
high sodium diet
688
what happens with a high sodium diet on diuretics?
exacerbates potassium loss
689
adverse effect associated with hypokalemia on diuretics?
metabolic alkalosis
690
what causes metabolic alkalosis with diuretics?
hypokalemia
691
effect of diuretics on uric acid?
elevated
692
what two diuretic classes are most likely to cause glucose intolerance?
loop and thiazide
693
glucose intolerance on diuretics is directly linked to what?
potassium level
694
potassium level is directly linked to what with diuretics?
glucose intolerance
695
what causes hypotension with diuretics?
decreased fluid volume
696
decreased fluid volume causes what adverse effect with diuretics?
hypotension
697
describe drug interactions with diuretics?
multiple
698
what is the MOA of loop diuretics?
inhibit sodium reabsorption in the ascending loop of Henle
699
where do loop diuretics act?
the ascending loop of Henle
700
what do loop diuretics inhibit in the ascending loop of Henle?
sodium reabsorption
701
which loop do diuretics act on?
ascending loop of Henle
702
class? Inhibit sodium reabsorption in the ascending loop of Henle
loop diuretics
703
what is the effect of loop diuretics on potassium?
increase potassium excretion
704
are loop diuretics short or long-acting?
short acting
705
are loop diuretics weak or powerful?
powerful
706
do loop diuretics cause small or large natriuresis?
large natriuresis
707
describe absorption of oral loop diuretics?
well-absorbed orally
708
describe distribution of loop diuretics?
widely distributed
709
where are loop diuretics metabolized?
liver
710
describe excretion of loop diuretics?
excreted unchanged in the urine
711
class? Inhibit sodium reabsorption in the distal renal tubule
thiazide diuretics
712
describe the MOA of thiazide diuretics?
inhibit sodium reabsorption in the distal renal tubule
713
where do thiazide diuretics act in the kidney?
distal renal tubule
714
effect of thiazide diuretics on potassium?
increase potassium excretion
715
do loop diuretics effect potassium?
yes
716
do thiazide diuretics effect potassium?
yes
717
are thiazide diuretics short or long-acting?
longer lasting
718
describe diuresis with thiazide diuretics?
less diuresis
719
describe thiazide diuretic absorption?
well-absorbed orally
720
what is the only diuretic to enter intracellular spaces?
thiazide diuretics
721
which diuretic class can be used in refractory edema?
thiazide diuretics
722
describe distribution of thiazide diuretics?
widely distributed
723
why can you use thiazide diuretics in refractory edema?
only diuretic to enter intracellular spaces
724
where are thiazide diuretics metabolized?
liver
725
where are thiazide diuretics excreted?
unchanged in urine
726
which diuretic class can cause hyperlipidemia?
thiazide diuretics
727
which diuretic class can cause photosensitive reactions?
thiazide diuretics
728
how long can photosensitivity secondary to thiazide diuretics last?
years after discontinuing the drug
729
are increased lipid levels permanent with thiazide diuretics?
elevations are transient
730
class? Inhibit excretion in the distal tubule of the kidney
aldosterone antagonists
731
describe MOA of aldosterone antagonists?
inhibit excretion in the distal tubule of the kidney
732
are aldosterone antagonists weak or strong diuretics?
weak diuretics
733
where do aldosterone antagonists act in the kidney?
distal tubule of the kidney
734
what class of diuretics are most often used with thiazide diuretics?
aldosterone antagonists
735
why are thiazide diuretics and aldosterone antagonists used together?
decrease potassium loss
736
aldosterone antagonists are most often used with what class of diuretics to decrease potassium loss?
thiazide diuretics
737
describe absorption of aldosterone antagonists?
absorption rates vary
738
describe distribution of aldosterone antagonists?
widely distributed
739
where are aldosterone antagonists metabolized?
liver
740
where are aldosterone antagonists excreted?
unchanged in urine
741
gynecomastia is associated with what class of diuretics?
aldosterone antagonists
742
gynecomastia occurs in 50% of patients taking what drug?
spironolactone
743
spironolactone- specific class?
aldosterone antagonists
744
impotence is a side effect of what specific class?
aldosterone antagonists
745
furosemide- specific class?
loop diuretics
746
furosemide- general class?
diuretic
747
bumetanide- specific class?
loop diuretics
748
chlorthalidone- specific class?
thiazide diuretics
749
hydrochlorothiazide- specific class?
thiazide diuretics
750
indapamide- specific class?
thiazide diuretics
751
metolazone- specific class?
thiazide diuretics
752
spironolactone- specific class?
aldosterone antagonists
753
triamterene- specific class?
aldosterone antagonists
754
amiloride- specific class?
aldosterone antagonists
755
eplerenone- specific class?
aldosterone antagonists
756
what are the four goals of GERD therapy?
prevent/decrease symptoms; heal esophagitis or any erosive esophageal lesions; prevent complications; prevent recurrent symptoms
757
esophageal carcinoma is a potential complication of what condition?
GERD
758
smoking cessation is what?
a nonpharmacologic intervention for GERD
759
weight loss to ideal body weight is what?
a nonpharmacologic intervention for GERD
760
when should HOB be elevated with GERD?
at night or if lying down
761
how long should patients remain supine after eating or drinking?
three hours
762
do not overeat- is what?
a nonpharmacologic intervention for GERD
763
how long should bending over be avoided after eating?
three hours
764
how long should strenuous exercise be avoided after eating?
three hours
765
class? Can be used as adjunctive therapy for frequent symptoms, as needed, and for non-frequent symptoms as needed
antacids
766
class? Considered first line therapy for most patients with frequent GERD symptoms or other serious complications
proton pump inhibitors
767
are PPIs first line therapy?
yes
768
are histamine-2 receptor antagonists first line for GERD?
not first line in most cases
769
when are drugs that improve the LES tone used?
adjunctively with a drug that is suppressing the production of HCL
770
when are prokinetic agents used?
reserved for use in those who still experience symptoms after maximal acid suppression therapy and max lifestyle modifications
771
why are cytoprotective agents mostly used only in PUD?
since they affect the gastric mucosa
772
which GERD drugs have serious potential adverse effects?
prokinetic agents
773
what do H2RAs stand for?
histamine-2 receptor antagonists
774
can antacids be used in GERD?
yes
775
can antacids be used in PUD?
yes
776
can antacids be used in hypersecretory states?
yes
777
can antacids be used in calcium deficiency?
yes
778
can antacids be used in hyperphosphatemia?
yes
779
what are the five indications for antacids?
GERD, PUD, hypersecretory states, hyperphosphatemia, calcium deficiency
780
class? Weak bases that form salt and water when they interact with HCL
antacids
781
what do antacids do to HCL?
neutralize
782
what do antacids do to gastric ph?
increase
783
what do antacids do to duodenal bulb ph?
increase
784
what are the components of antacids?
metallic cation plus basic anion
785
what effect do antacids have on pepsin?
inhibit pepsin's proteolytic activity
786
do antacids affect the LES tone?
yes
787
what effect do antacids have on LES tone?
improve
788
do aluminum based antacids affect gastric motility?
yes
789
what is the effect of aluminum based antacids on gastric motility?
slowed
790
how do aluminum based antacids affect gastric motlity?
via inhibition of smooth muscle contraction locally in the stomach
791
which type of antacid is the only type that affects gastric motility?
aluminum-based
792
which two types of antacids are used in renal failure?
calcium-based and aluminum-based antacids
793
why are antacids used in renal failure?
to bind phosphates and lower blood phosphate levels
794
which two types of antacids can cause constipation?
aluminum-based and calcium-based
795
diarrhea is caused by which type of antacids?
magnesium-based antacids
796
when might alkalosis occur with antacids?
usually only in patients with renal failure
797
patients with renal failure are at risk for what adverse effect of antacids?
alkalosis
798
are antacids used as monotherapy for signficant disease?
no
799
are antacids used as monotherapy for esophagitis?
no
800
are antacids used as monotherapy for frequent symptoms?
no
801
antacids can be used as needed in concert with what?
an acid suppressive drug
802
can you use antacids without knowing the cause of abdominal pain?
no
803
can you use antacids in the setting of severe abdominal pain of undetermined cause?
no
804
can you use calcium-based antacids if a patient has hypercalcemia?
no
805
can you use calcium-based antacids if a patient has a history of renal stones?
no
806
hypercalcemia is a contraindication to what type of antacids?
calcium-based
807
renal stones are a contraindication to what type of antacid?
calcium-based
808
what two types of antacids should not be used in renal failure?
magnesium or aluminum-based antacids
809
why should you not use magnesium-based antacids in renal failure?
hypermagnesemia
810
why should you not use aluminum-based antacids in renal failure?
worsened osteomalacia
811
worsened osteomalacia in patients with renal failure can occur with use of which type of antacid?
aluminum-based
812
when should high sodium-containing antacids NOT be used?
in settings where fluid overload will exacerbate a condition
813
describe drug interactions with antacids?
many drug interactions re: absorption- check drug information
814
when should a patient call provider re: antacids?
if symptoms continue or worsen within two weeks; if new symptoms arise
815
are PPIs used with GERD?
yes
816
are PPIs used with PUD?
yes
817
are PPIs used with hypersecretory states?
yes
818
Zollinger-Ellison syndrome is an example of what?
hypersecretory state
819
are PPIs used with Zollinger-Ellison syndrome?
yes
820
what are three indications for PPIs?
GERD, PUD, hypersecretory states (e.g. Zollinger-Ellison syndrome)
821
specific class? Suppression of gastric acid secretion by parietal cells by preventing the H+/K+ATPase enzyme system from secreting hydrogen ion needed to form hydrochloric acid
PPIs
822
what do PPIs suppress?
gastric acid secretion by parietal cells
823
what cells do PPI suppress?
parietal cells
824
what system is involved in PPIs?
H+K+ATPase enzyme system
825
what class of GERD medications can result in achlorhydria?
proton pump inhibitors
826
term? No gastric acid
achlorhydria
827
less gastric acid results in decreased/increased blood flow to gastric antrum?
decreased
828
less gastric acid results in decreased/increased blood flow to the pylorus?
decreased
829
less gastric acid results in decreased/increased blood flow to the duodenal bulb?
decreased
830
what effect does decreased gastric acid have on pepsinogen levels?
increased
831
less gastric acid results in decreased/increased pepsinogen levels?
increased
832
less gastric acid results in decreased/increased pepsin activity?
decreased
833
what effect does less gastric acid have on pepsin activity?
decreased
834
less gastric acid results in a compensatory increase in what?
gastrin levels
835
are there any clinically significant effects with compensatory increase in gastric levels?
no
836
what are four GI adverse effects with PPIs?
nausea, abdominal pain, flatulence, constipation/diarrhea
837
what are two CNS type adverse effects with PPIs?
dizziness and drowsiness
838
acute interstitial nephritis is associated with what GERD class?
proton pump inhibitors
839
deficiences of what four nutrients can occur with PPIs?
iron, magnesium, vitamin B12, calcium
840
what GERD medication has potential risk for hip fracture?
proton pump inhibitors
841
acute kidney injury and chronic kidney disease can occur with long-term use of what GERD class?
proton pump inhibitors
842
even short-term use increases the risk of pneumonia with what GERD drug class?
proton pump inhibitors
843
what is the potentially respiratory consequence with even short-term use of PPIs?
pneumonia
844
C diff infection can occur with what GERD class?
proton pump inhibitors
845
what GERD class may pose a risk for gastric cancer?
proton pump inhibitors
846
what GERD class is associated with chronic atrophic gastritis?
proton pump inhibitors
847
chronic atrophic gastritis with PPIs may increase risk for what?
gastric cancer
848
what GERD class has concern re: development of dementia?
proton pump inhibitors
849
PPI effect on overall mortality?
potential increased risk
850
PPIs in hepatic dysfunction?
cautious use
851
PPIs in older patients?
cautious use
852
PPIs in pregnancy?
avoid in pregnancy unless needed (requires favorable risk/benefit)
853
PPIs in lactation?
cautious use only
854
are any PPIs safe and effective in pediatrics?
some drugs in class
855
any drug therapy for GERD must be combined with what?
ongoing lifestyle modifications
856
if PPI response is not adequate, what should I do?
check for compliance with medication and with lifestyle modifications
857
what class is almost always preferred over H2RAs?
proton pump inhibitors
858
what are three indications for H2RAs?
GERD (w/ or w/o erosive esophagitis); PUD; hypersecretory states
859
can H2RAs be used for GERD?
yes
860
can H2RASs be used for GERD with erosive esophagitis?
yes
861
can H2RAs be used for GERD without erosive esophagitis?
yes
862
can H2RAs be used for PUD?
yes
863
can H2RAs be used for hypersecretory states
yes
864
is ranitidine still used?
no
865
why is ranitidine no longer used in the USA?
due to nitrosodimethylamine being found in the formulations
866
what does NDMA stand for?
nitrosodimethylamine
867
what is the problem with nitrosodimethylamine?
likely a human carcinogen
868
specific class? Blockade of the histamine-2 receptor on gastric parietal cells
histamine-2 receptor antagonists
869
less/more HCL is produced with H2RAs?
less
870
effect of H2RAs on gastric PH?
increased
871
do H2RAs have effect on LES pressure?
yes- varied
872
do H2RAs have effect on speed of gastric emptying?
yes-varied
873
do H2RAs have effect on volume of gastric secretion?
yes-varied
874
do H2RAs have effect on hydrogen ion concentration?
yes-varied
875
which H2RA medication is the most potent at lowering gastric acid secretion?
famotidine
876
is there any clinical benefit of famotidine's potency at lowering gastric acid secretion?
unclear
877
famotidine is the most potent at doing what?
lowering gastric acid secretion
878
what GERD class can cause gynecomastia and erectile dysfunction?
histamine-2 receptor antagonists
879
what GERD medication can cause gynecomastia and erectile dysfunction?
cimetidine
880
what are two antiandrogenic side effects of cimetidine?
gynecomastia and erectile dysfunction
881
oral and IV forms of what GERD drug class can cause potential rhythm and conduction abnormalities?
histamine-2 receptor antagonists
882
can oral H2RAs cause rhythm and conduction abnormalities?
yes
883
can IV H2RAs cause rhythm and conduction abnormalities?
yes
884
the following are CNS ADEs with what drug class (GERD)? Alterations of cognitive function, agitation, psychosis, depression, headache, seizures
histamine-2 receptor antagonists
885
CNS adverse effects with H2RAs are more likely to occur in who?
renal and/or hepatic dysfunction
886
why should H2RAs be avoided in older population?
due to cognitive effects
887
what is the hematologic adverse reaction to H2RAs?
individual cell line deficiencies to pancytopenia
888
individual cell line deficiencies to pancytopenia can occur with what GERD drug class?
histamine-2 receptor antagonists
889
why should we monitor CBC with H2RAs?
risk for individual cell line deficiencies to pancytopenia
890
hepatic cell injury can occur with what GERD medication?
nizatidine
891
why should we monitor LFTs with H2RAs?
hepatic cell injury (nizatidine)
892
nizatidine is associated with what?
hepatic cell injury
893
what is the vitamin deficiency that can occur with long-term use of H2RAs?
vitamin B12
894
what can happen to vitamin B12 with long-term use of H2RAs?
deficiency
895
vitamin B12 deficiency can cause what two consequences? (H2RAs)
anemia and neurologic deficits
896
neurologic deficits with H2RAs can be due to what?
vitamin B12 deficiency
897
three immune-related adverse effects with H2RAs?
polymyositis, nephritis, immune-related rashes
898
immune-related rashes can occur with what GERD class?
histamine-2 receptor antagonists
899
polymyositis can occur with what GERD class?
histamine-2 receptor antagonists
900
nephritis can occur with what GERD class?
histamine-2 receptor antagonists
901
fever can occur with what GERD class?
histamine-2 receptor antagonists
902
do H2RAs block histamine-1 receptors?
no
903
why are H2RAs not anticholinergic?
they do not block the histamine-1 receptors
904
are H2RAs anticholinergic drugs?
no
905
H2RA use in pregnancy?
not well studied, avoid (weigh risk benefit)
906
H2RA use in lactation?
avoid (weight risk benefit)
907
H2RA use in pediatrics?
yes
908
drug? Used for lower tiers of therapy due to serious adverse effects possible
metoclopramide
909
EPS are possible with what GERD medication?
metoclopramide
910
pediatric patients taking metoclopramide are at higher risk for what?
EPS
911
is metoclopramide used as monotherapy for GERD?
no
912
does metoclopramide have prokinetic properties?
yes
913
does metoclopramide affect LES tone?
improves LES tone
914
does metoclopramide help heal esophageal lesions?
no
915
is bethanechol used as GERD monotherapy?
no
916
what two drugs are mostly used for gastroparesis therapy re: GI disorders?
metoclopramide and bethanechol
917
what is the primary use for metoclopramide?
gastroparesis therapy re: GI disorders
918
what is the primary use for bethanechol?
gastroparesis therapy re: GI disorders
919
does bethanechol have prokinetic properties?
yes
920
does bethanechol help heal esophageal lesions?
no
921
these are the goals of what? Eliminate H pylori (main cause of PUD); reduction/elimination of any symptoms; healing of ulcer; avoid complications; prevent recurrent disease
PUD
922
what is the main cause of PUD?
H pylori
923
what organism causes PUD?
H pylori
924
what are three potential complications of PUD?
bleeding, perforation, carcinoma
925
why are H2RAs rarely used for PUD?
because the PPIs are much more effective at gastric acid suppression
926
what is the main class of antisecretory medication used in PUD treatment?
proton pump inhibitors
927
what are the seven antimicrobials used for H pylori?
clarithromycin; amoxicillin; metronidazole; tetracycline; doxycycline; nitazoxanide; levofloxacin
928
is bismuth subsalicylate used in PUD treatment?
yes
929
is clarithromycin used in PUD treatment?
yes
930
is amoxicillin used in PUD treatment?
yes
931
is metronidazole used in PUD treatment?
yes
932
is tetracycline used in PUD treatment?
yes
933
is doxycycline used in PUD treatment?
yes
934
is nitazoxanide used in PUD treatment?
yes
935
is levofloxacine used in PUD treatment?
yes
936
is vancomycin used in PUD treatment?
no
937
is erythromycin used in PUD treatment?
no
938
why might treatment failure occur in H pylori treatment?
microbial resistance to antibiotics
939
what is the treatment regimen for H pylori?
various three and four-drug combinations with PPIs
940
drug? Binds to the ulcer site to shield the area from HCL, pepsin, and bile salts
sucralfate
941
can you use sucralfate in children?
safety not established
942
what three things does sucralfate shield from?
HCL, pepsin, and bile salts
943
drug? Inhibits formation of cAMP that occurs due to histamine stimulation?
misoprostol
944
misoprostol MOA?
inhibits formation of cAMP that occurs due to histamine stimulation
945
what does misoprostol do to gastric acid secretion?
inhibits
946
what effect does misoprostol have on gastric mucus?
promotes formation
947
what effect does misoprostol have on bicarbonate?
promotes production
948
does misoprostol protect mucosa?
yes
949
what PUD medication can induce uterine contractions?
misoprostol
950
what PUD medication is absolutely contraindicated in pregnancy?
misoprostol
951
why is misoprostol absolutely contraindicated in pregnancy?
can induce uterine contractions
952
misoprostol in renal dysfunction?
cautious use
953
misoprostol in pediatrics?
safety not established in < 18 years of age
954
indication for misoprostol?
primarily used for prevention of NSAID-induced PUD
955
what drug is primarily used for prevention of NSAID-induced PUD?
misoprostol
956
class? Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
inhaled corticosteroids
957
which immunoglobulin is affected with inhaled corticosteroids?
IgE
958
what phase of allergic reaction is affected by inhaled corticosteroids?
late-phase allergic reaction
959
in what two places are inhaled corticosteroids absorbed?
lungs and GI tract
960
describe speed of absorption of inhaled corticosteroids?
rapid
961
how much of inhaled corticosteroid dose is deposited in the lungs?
less than one-fourth
962
less than one-fourth of dose of what class is deposited in the lungs?
inhaled corticosteroids
963
what happens to swallowed portion of inhaled corticosteroid dose?
undergoes extensive first-pass metabolism
964
where are inhaled corticosteroids excreted?
in urine and feces
965
migration of inflammatory cells with inhaled corticosteroids are mediated by what?
mast cells
966
how do inhaled corticosteroids come?
in multiple forms and delivery systems
967
what are five potential adverse effects of inhaled corticosteroids?
xerostomia; hoarseness; mouth irritation; dysgeusia; oral candidiasis
968
oral candiasis can occur with what class of respiratory medication?
inhaled corticosteroids
969
HPA suppression is a risk with what class of respiratory medication?
inhaled corticosteroids
970
can inhaled corticosteroids be given in status asthmaticus?
no
971
high-dose of what class of respiratory medication in children may inhibit growth?
inhaled corticosteroids
972
highest potency inhaled corticosteroid?
fluticasone furoate
973
what is the brand name for fluticasone furoate?
arnuity ellipta
974
specific class? Fluticasone furoate
inhaled corticosteroids
975
specific class? Mometasone furoate DIP
inhaled corticosteroids
976
specific class? Fluticasone propionate DIP
inhaled corticosteroids
977
specific class? Beclomethasone dipropioate
inhaled corticosteroids
978
specific class? Ciclesonide MDI
inhaled corticosteroids
979
specific class? Budesonide DPI
inhaled corticosteroids
980
what is the brand name of mometasone furoate DPI?
asmanex twisthaler
981
what is the brand name for fluticasone propionate DPI?
armonair digihaler
982
what is the brand name for beclomethasone dipropionate?
QVAR redihaler
983
four examples of stimulant laxatives?
cascara, senna, bisacodyl, castor oil
984
specific class- cascara?
stimulant laxative
985
specific class- senna?
stimulant laxative
986
specific class- bisacodyl?
stimulant laxative
987
specific class- castor oil?
stimulant laxative
988
four examples of osmotic laxatives?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
989
specific class- magnesium hydroxide?
osmotic laxative
990
specific class- magnesium citrate?
osmotic laxative
991
specific class- sodium phosphate?
osmotic laxative
992
specific class- polyethylene glycol 3350?
osmotic laxative
993
three examples of bulk-producing laxatives?
psyllium, methylcellulose, polycarbophil
994
specific class- psyllium?
bulk-producing laxative
995
specific class- methylcellulose?
bulk-producing laxative
996
specific class- polycarbophil?
bulk-producing laxative
997
example of lubricant laxative?
mineral oil
998
specific class- mineral oil?
lubricant laxative
999
example of surfactant laxative?
docusate
1000
specific class- docusate sodium?
surfactant laxative
1001
specific class- docusate calcium?
surfactant laxative
1002
specific class- docusate potassium?
surfactant laxative
1003
what are the three types of docusate?
docusate sodium, docusate calcium, docusate potassium
1004
two examples of hyperosmolar laxatives?
glycerin and lactulose
1005
specific class- glycerin?
hyperosmolar laxative
1006
specific class- lactulose?
hyperosmolar laxative
1007
example of chloride channel activator laxative?
lubiprostone
1008
specific class- lubiprostone?
chloride channel activator laxative
1009
example of opioid receptor antagonist laxative?
methylnaltrexone
1010
specific class- methylnaltrexone?
opioid receptor antagonist laxative
1011
what is the one class of laxatives that does not have abuse/dependency potential?
bulk-producing laxative
1012
do stimulant laxatives have abuse/dependency potential?
yes
1013
do osmotic laxatives have abuse/dependency potential?
yes
1014
do bulk-producing laxatives have abuse/dependency potential?
no
1015
do lubricant laxatives have abuse/dependency potential?
yes
1016
do surfactant laxatives have abuse/dependency potential?
yes
1017
do hyperosmolar laxatives have abuse/dependence potential?
yes
1018
do chloride channel activator laxatives have abuse/dependency potential?
yes
1019
do opioid receptor antagonist laxatives have abuse/dependency potential?
yes
1020
electrolyte alterations, fluid alterations, steatorrhea, osteomalacia, vitamin/nutrient deficiences- can occur with what general class?
laxatives
1021
tartrazine sensitivity can occur with what general class?
laxatives
1022
what is an example of a tartrazine sensitivity reaction?
bronchospasm
1023
tartrazine sensitivity is associated with sensitivity to what?
aspirin
1024
can you give laxatives when nausea, vomiting, and/or abdominal pain of unknown cause are present?
no
1025
when might you especially want to avoid giving laxatives?
n/v or abdominal pain of unknown cause, especially if may have bowel obstruction
1026
can all laxatives be given in pregnancy?
no
1027
specific class? Thought to possible cause stimulation/irritation of the myenteric nerves
stimulant laxative
1028
specific class? Irritation of intestinal smooth muscle
stimulant laxative
1029
effect of stimulant laxatives on peristalsis?
increased
1030
do stimulant laxatives affect peristalsis?
yes
1031
specific laxative class? Increased prostaglanding release and an increase in cAMP concentration?
stimulant laxative
1032
what nerves are effected by stimulant laxatives?
myenteric nerves
1033
effect of stimulant laxatives on prostaglandin release?
increased
1034
effect of stimulant laxatives on cAMP concentration?
increased
1035
effect of stimulant laxatives on electrolyte secretion?
increased
1036
why do stimulant laxatives cause increased electrolyte secretion?
increased prostaglandin release and an increase in cAMP concentration
1037
four adverse effects of stimulant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1038
why should castor oil not be used in pregnancy?
can stimulate uterine contractions
1039
which stimulant laxative can stimulate uterine contractions?
castor oil
1040
which stimulant laxative can cause diarrhea in lactating infants?
cascara
1041
cascara can cause what in lactating infants?
diarrhea
1042
cardiovascular disease is a relative contraindication to which stimulant laxative?
bisacodyl
1043
cascara should not be used if the patient cannot ingest WHAT?
alcohol
1044
why should cascara not be used if the patient cannot ingest some alcohol?
cascara contains some alcohol
1045
can bisacodyl be used in pregnancy?
yes
1046
which stimulant laxative can be used in pregnancy?
bisacodyl
1047
can castor oil be used in pregnancy?
no
1048
what are two indications for osmotic laxatives?
constipation and bowel prep
1049
specific class? Increased intraluminal pressure due to water being drawn more inside the intestines
osmotic laxative
1050
effect of osmotic laxatives on peristalsis?
increased
1051
do osmotic laxatives affect peristalsis?
yes
1052
four side effects of osmotic laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1053
why should magnesium-containing laxatives be avoided in renal dysfunction?
kidneys may not be able to excrete the magnesium adequately
1054
what effect on magnesium happens if magnesium-containing laxatives are used in renal dysfunction?
hypermagnesemia
1055
magnesium-containing laxatives should not be used in patients with what calcium imbalance?
hypocalcemia
1056
what cardiac issues contraindicate magnesium-containing laxatives?
cardiac dysrhythmias or conduction disturbances
1057
cardiac dysrhythmias or conduction disturbance contraindicate laxatives containing what?
magnesium hydroxide, magnesium citrate, sodium phosphate, PEG 3350
1058
pediatric use of PEG 3350?
caution
1059
why do osmotic laxatives cause increased intraluminal pressure?
water being drawn more inside the intestines
1060
what laxative class can be used in chronic, watery diarrhea?
bulk-producing laxative
1061
why are bulk-producing laxatives used in chronic, watery diarrhea?
to bulk the stool
1062
specific class? Act physiologically like increased fiber in the diet would by combining with water in the intestines
bulk-producing laxative
1063
specific class? Mechanical distention of the intestinal wall
bulk-producing laxative
1064
do bulk-producing laxatives affect peristalsis?
yes
1065
effect of bulk-producing laxatives on peristalsis?
increased
1066
do side effects of bulk-producing laxatives dissipate with time?
usually
1067
can bulk-producing laxatives be used in pregnancy?
yes
1068
can bulk-producing laxatives be used if a bowel impaction?
no
1069
why should bulk-producing laxatives not be used in a bowel impaction?
feces cannot get around impacted stool
1070
specific class? Some may be contraindicated in clinical settings where either salt or sugar is restricted
bulk-producing laxative
1071
what specific class of laxatives may contain salt or sugar?
bulk-producing laxative
1072
what specific class of laxatives should be used cautiously when patient may have strictures or other narrowing of esophagus or intestine?
bulk-producing laxative
1073
what specific class of laxatives may be used long-term for simple, chronic constipation?
bulk-producing laxative
1074
what are four potential adverse effects of bulk-producing laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1075
specific class? Used to soften impacted stool
lubricant laxative
1076
what is the main component of lubrican laxatives?
mineral oil
1077
MOA of lubricant laxatives?
used to soften impacted stool
1078
what is the purpose of lubrication with these laxatives?
to help stool move more easily via the presence of mineral oil
1079
what are four potential adverse effects of lubricant laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1080
which specific laxative class can cause decreased absorption of fat-soluble vitamins if used chronically?
lubricant laxative
1081
decreased absorption of what can occur with chronic use of lubricant laxatives?
fat-soluble vitamins
1082
which specific laxative class can cause lipid pneumonia if aspirated?
lubricant laxative
1083
who is at risk for lipid pneumonia with lubricant laxatives?
very young and any patient at risk for aspiration
1084
which class of laxatives would you not want to give in someone with impaired swallowing?
lubricant laxative
1085
can lubricant laxatives be taken in pregnancy?
no
1086
why shouldn't lubricant laxatives be taken in pregnancy?
fat-soluble vitamins may not be absorbed as well
1087
which class of laxatives can cause vitamin K deficiency in newborns?
lubricant laxative
1088
which class of laxatives can cause hypoprothrombinemia in newborns?
lubricant laxative
1089
what is another name for surfactant laxatives?
stool softeners
1090
what is the class name for stool softeners?
surfactant laxative
1091
specific class? Used to soften stool and prevent constipation, especially stool that is dry and difficult to evacuate and when straining at stool must be stopped
surfactant laxative
1092
which laxative class is useful when stool is dry and difficult to evacuate?
surfactant laxative
1093
which laxative class is useful when straining at stool must be stopped?
surfactant laxative
1094
specific class? Assist with lipids and water being mixed into stool
surfactant laxative
1095
what is the MOA of surfactant laxatives?
assist with lipids and water being mixed into stool
1096
do surfactant laxatives have precautions?
no
1097
do surfactant laxatives have contraindications?
no
1098
which class of laxatives? Usually well-tolerated and without precautions or contraindications
surfactant laxative
1099
can surfactant laxatives be used in pregnancy?
yes
1100
which class of laxatives are used for fecal impaction and neurogenic bowel?
hyperosmolar laxative
1101
which class of laxatives is indicated with neurogenic bowel?
hyperosmolar laxative
1102
which class of laxatives is used with chronic constipation and increased excretion of ammonia in the stool?
hyperosmolar laxative
1103
specific class? Glycerin
hyperosmolar laxative
1104
specific class? Lactulose
hyperosmolar laxative
1105
drug? Bacteria in the gut transform this dissarchide into lactic, acetic, and formic acids
lactulose
1106
drug? Local colonic irritation and more water drawn into the stool
glycerin
1107
what are the four adverse effects of hyperosmolar laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1108
what patient population is at risk for dehydration with hyperosmolar laxatives?
older adults
1109
what laxative class is associated with dehydration risk in older adults?
hyperosmolar laxative
1110
when should you monitor blood glucose with lactulose?
those taking lactulose chronically and acutely in patients with diabetes mellitus
1111
which laxative drug involves blood glucose monitoring?
lactulose
1112
hyperosmolar laxatives in lactation?
avoid
1113
lactulose in pregnancy?
only when benefits > risks
1114
glycerin in pregnancy?
no
1115
why do older adults get dehydration with hyperosmolar laxatives?
intravascular volume depletion
1116
specific class? Activation of CIC-2 chloride channels in the intestinal epithelium
chloride channel activator laxative
1117
effect of chloride channel activators on chloride secretion?
more chloride is secreted
1118
what helps soften the stool and improve intestinal movement with chloride channel activators?
increased chloride
1119
three indications for chloride channel activators?
chronic constipation d/t unknokwn cause; chronic constipation d/t IBS; opioid-induced constipation
1120
these are indications for what laxative class? Chronic constipation d/t unknown cause; chronic constipation d/t IBS; opioid-induced constipation
chloride channel activator laxative
1121
what channels do chloride channel activators activate?
CIC-2
1122
what part of GIT do chloride channel activators work in?
intestinal epithelium
1123
four potential adverse effects of chloride channel activators?
diarrhea, flatulence, abdominal cramping, bloating
1124
how can you avoid nausea with chloride channel activators?
avoid by giving the drug with a meal
1125
which laxative class is associated with dyspnea?
chloride channel activator laxative
1126
chloride channel activators in pregnancy?
avoid
1127
indication for opioid receptor antagonist laxatives?
chronic constipation due to opioids
1128
this is an indication for which laxative class? Chronic constipation due to opioids
opioid receptor antagonist laxative
1129
what receptors do opioid receptor antagonists act on?
mu opioid receptors
1130
where are the mu opioid receptors located that opioid antagonist laxatives act on?
in the gut
1131
effect of opioid receptor antagonist laxatives on peristalsis?
increased
1132
do opioid receptor antagonist laxatives cross the BBB?
no
1133
do opioid receptor antagonist laxatives cause analgesia?
no
1134
four adverse effects of opioid receptor antagonist laxatives?
diarrhea, flatulence, abdominal cramping, bloating
1135
can opioid receptor antagonists induce opioid withdrawal?
yes
1136
what is the concern with abdominal pain and constipation?
concern for bowel rupture
1137
when is opioid withdrawal syndrome more likely with opioid receptor antagonist laxatives?
if alterations of the BBB have occurred
1138
specific class? Antagonist at the mu-opioid receptors in the gut-- speeds up peristalsis
opioid receptor antagonist laxative
1139
what are leukotrienes?
inflammatory mediators
1140
a type of inflammatory mediator?
leukotrienes
1141
what two types of cells produce leukotrienes?
eosinophils and mast cells
1142
what are the three potential effects of leukotrienes?
bronchospasm, airway hyperresponsiveness, and vascular leakage
1143
what substance can cause bronchospasm, airway hyperresponsiveness, and vascular leakage?
leukotrienes
1144
specific class? Montelukast
leukotriene receptor antagonists
1145
drug? Inhibits the cysteinyl leukotriene receptor
montelukast
1146
drug? Blocks action of LTD4
montelukast
1147
what is a component of SRS-A?
LTD4
1148
what is the MOA of montelukast?
inhibits the cysteinyl leukotriene receptor- blocks action of LTD4
1149
what does montelukast block the action of?
LTD4
1150
what is LTD4?
a component of SRS-A
1151
drug? Inhibits 5-lipoxygenase
zileuton
1152
what is 5-lipoxygenase?
enzyme responsible for the formation of leukotrienes from arachidonic acid
1153
name? enzyme responsible for the formation of leukotrienes from arachidonic acid
5-lipoxygenase
1154
what does zileuton inhibit?
5-lipoxygenase
1155
specific class? Zileuton
5-lipoxygenase pathway inhibitors
1156
example of 5-lipoxygenase pathway inhibitor?
zileuton
1157
example of leukotriene receptor antagonist?
montelukast
1158
general class? Montelukast
leukotriene modifiers
1159
general class? Zileuton
leukotriene modifiers
1160
what are two examples of leukotriene modifiers?
montelukast and zileuton
1161
describe absorption of the leukotriene modifiers?
rapidly from the GI tract
1162
describe the protein binding of the leukotriene modifiers?
highly protein bound
1163
describe the metabolism of the leukotriene modifiers?
extensively metabolized in the liver
1164
describe the excretion of the leukotriene modifiers?
in the urine
1165
what two enzyme systems metabolize montelukast?
CYP3A4 & CYP2C9
1166
what three enzyme systems metabolize zileuton?
CYP1A2, CYP2C9, CYP3A4
1167
which leukotriene modifier is metabolized by CYP3A4 and CYP2C9?
montelukast
1168
which leukotriene modifier is metabolized by CYP1A2, CYP2C9, & CYP3A4?
zileuton
1169
two side effects of montelukast?
headache, sore throat
1170
one side effect of zileuton?
dyspepsia
1171
what respiratory drug class is associated with post-marketing neuropsychiatric events?
leukotriene modifiers
1172
these are symptoms of what type of adverse effect? Irritability, agitation, tremors, insomnia, depression, suicidality
neuropsychiatric events
1173
leukotriene receptor antagonists and severe liver disease?
avoid
1174
can montelukast chewable tabs be given in PKU?
no
1175
why shouldn't montelukast chewable tablets be given in PKU?
they contain phenylalanine
1176
which leukotriene modifier (chewable form) shouldn't be given in PKU?
montelukast
1177
can 5-lipoxygenase pathway inhibitors be given in active liver disease?
no, contraindicated
1178
examples of neuropsychiatric event symptoms associated with leukotriene modifiers?
irritability, agitation, tremors, insomnia, depression, suicidality
