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Pharmacology > Pulmonary > Flashcards

Pulmonary Flashcards

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1
Q

Tidal volume for normal adults is _________. If normal adults take a deep breath, volume is ______.

A

1/2 L (500cc)

4-5L

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2
Q

3 predictors of lung volume

A

1) Gender
2) Height
3) Age

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3
Q

1 risk factor for COPD

A

smoking

80-90% of COPD in U.S. are linked to smoking. However, only 15-20% of smokers have COPD sx to degree that leads to MD visit

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4
Q

what are the implications of chronic mucous production in COPD?

A

leads to colonization of lungs with bacteria which induces neutrophilic inflammation, which responds less well to steroid therapy

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5
Q

Do steroids work better on eosinophils or neutrophils?

A

eosinophils

why we use steroids to tx asthma but not pneumonia

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6
Q

Do asthma pt. need to take medications daily?

A

Yes

it has been shown that there is not a big correlation btwn how lungs are doing and how pt. feels

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7
Q

You will prevent more fatal lung incidents if you __________ is asthmatics

A

monitor lung volume (can also have pt. do at home monitoring)

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8
Q

What are the two broad classifications of pharmacotherapy drugs used in lung dz?

A

1) Relievers: bronchodilate

2) Controllers: aimed at inflammatory pathways to control underlying dz

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9
Q

When using an inhaler, spacers help by

A

making sure more medicine actually gets into the lungs

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10
Q

With some inhalers you can put the device directly in your mouth if you are having trouble using the inhaler with spacing. However, do not do this with _______.

A

Steroids

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11
Q

When should you recommend a nebulizer?

A

pt. cannot use the handheld device well

(many downsides to nebulizers: device is big, particle size is bigger so doesn’t go to lungs as well, larger dose of drug is needed)

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12
Q

Metered-dose inhaler (MDI) is recommended when

A

pt. is >/= 5 y/o

if < 5 y/o can add a spacer or valved holding chamber mask

(in general MDIs are better than nebulizers)

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13
Q

Reliever medications include

A

1) Beta agonists (short and long acting)

2) anticholinergics

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14
Q

Short-acting beta agonist (SABA) MOA

A

relax bronchial smooth muscle

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15
Q

Short-acting beta agonist (SABA) pharmacokinetics

A

1) onset: 1-2 min

2) DOA: 3-6 hr

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16
Q

Which drugs is used in a rescue inhaler?

A

Short-acting beta agonist (SABA)

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17
Q

Albuterol (salbutamol) class

A

Short-acting beta agonist (SABA)

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18
Q

What is the MC Short-acting beta agonist (SABA)?

A

Albuterol (MC by far)

other SABA only make up 2-3% of what we use, and include: metaproterenol, pirbuterol, terbutaline

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19
Q

T/F: regular daily use of SABA is recommended

A

FALSE

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20
Q

T/F: if you need to use SABA > 2 days per week for sx relief, asthma is poorly controlled

A

TRUE

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21
Q

Short-acting beta agonist (SABA) ADRs

A
  • tachycardia
  • HTN (large doses)
  • “jitteriness” or mild anxiety with larger doses via nebulizer
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22
Q

T/F: Asthmanefrin is a new drug on the market that is very helpful in controlling asthma

A

FALSE

this literally is epinephrine, it works in 30 sec but only lasts 5 min

not a safe drug to use

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23
Q

Long-Acting Beta Agonists (LABA) come in ________ forms

A

inhaled and oral

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24
Q

Inhaled Long-Acting Beta Agonists (LABA)

A

Salmeterol (**MC)
Formoterol
Arformoterol

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25
Long-Acting Beta Agonists (LABA) are used for
exercise or adjunct to anti-inflammatory drugs; chronic tx of asthma or bronchospasm, not for acute exacerbations dosed at nighttime
26
Oral Long-Acting Beta Agonists (LABA)
albuterol, metaproterenol, terbutaline in SR tablets dosed at nighttime; can also come in syrup for children **Rarely, rarely done in practice
27
Long-Acting Beta Agonists (LABA) pharmacokinetics
1) onset: 20 min | 2) DOA: 12 hr
28
T/F: LABA are considered controllers in regards to asthma
FALSE they do not control disease progression, the FDA put a black box warning on LABA for asthma w/out a controller
29
Short acting inhaled anticholinergic
Ipratropium (Atrovent HFA)
30
Ipratropium (Atrovent HFA) MOA
blocking acetylcholine (Ach) in lungs relaxes bronchial smooth mm. (same clinical effect as beta agonist)
31
Ipratropium (Atrovent HFA) pharmacokinetics
1) onset: 5 min (slower than SABA) | 2) DOA: 4-8 hr (longer than SABA)
32
Ipratropium (Atrovent HFA) ADRs
- dry mouth | - blurred vision (local effect from aerosol)
33
Do SABA or short-acting anticholinergics have a greater role in tx COPD?
short-acting anticholinergics e.g. Ipratropium (Atrovent HFA)
34
long-acting anticholinergic
Tiotropium (Spiriva)
35
What does Tiotropium (Spiriva) primarily tx?
COPD (recently approved for asthma) this is a long-acting anticholinergic
36
T/F: The short-acting anticholinergic, Ipratropium, can be used as a rescue inhaler
FALSE relatively short-acting (5 min), but not as short-acting as albuterol (1-2 min)...asthma attack can cz death w/in 5 min
37
do inhaled anticholinergics cause anti-SLUD s/e?
No they have very, very low bioavailability, so s/e are only local (dry mouth; blurred vision from misfiring)
38
What is a benefit of long-acting anticholinergics over LABA?
pt. don't build a tolerance over time with anticholinergics (i.e. they have persistent LT effects) also with tiotropium you only need to do 1 puff per day (easier to use)
39
What types of drugs are considered controllers in asthma tx?
1) Inhaled steroids (MC) 2) Leukotriene antagonists 3) Misc.
40
Which drugs are inhaled corticosteroids used to control asthma?
1) Beclomethasone HFA (QVAR) 2) Budesonide HFA (Pulmincort) 3) Flunisolide HFA (Aerospan) 4) Fluticasone (Flovent and generic)
41
Inhaled corticosteroids ADRs
minimal since inhaled and given in very low doses - thrush (can prevent by rinsing mouth after inhale) - in COPD there is a slight incr. in pneumonia risk - in peds may have small effect on long bones and growth
42
Which inhaled steroid is the best tx for asthma/COPD?
one steroid is NOT better than another what matters is using the proper dose of whatever steroid you choose
43
How much of an MDI or DPI dose gets into the lung?
about 1/3 | if you use inhaler really well, about 1/2 can get to lungs
44
What happens to MDI or DPI dose that doesn't make it into lungs?
gets stuck in mouth or swallowed (absorbed in gut) however, we use such small doses, this isn't a big concern
45
Zileuton (Zyflo) class
Leukotriene Antagonist - lipooxygenase inhibitor (controller)
46
Zileuton (Zyflo) ADRs
rare liver toxicity and a lot of drug interactions so likely to never see in practice
47
Zafirlukast (Accolate) class
Leukotriene Antagonists - receptor blockers (controllers)
48
Montelukast (Singulair) class
Leukotriene Antagonists - receptor blockers (controllers)
49
Zafirlukast (Accolate) MOA
LTD4 and LTE4 antagonists
50
Zafirlukast (Accolate) pharmacokinetics
metabolized by CYP2C9 and CYP3A4
51
Zafirlukast (Accolate) drug interaction
warfarin | many other theoretical interactions
52
Montelukast (Singulair) MOA
LTD4 and LTE4 receptor antagonists
53
Montelukast (Singulair) pharmacokinetics
metabolized by CYP2C9 and CYP3A4
54
Montelukast (Singulair) ADRs
essentially non-existent; GI upset maybe a minor s/e
55
Zafirlukast (Accolate) ADRs
less liver toxicity than predecessor LTRA, but some reports
56
What is an advantage of leukotriene antagonists over inhaled steroids?
Pill is easier for some to use however, they are not as effective in controlling asthma
57
Roflumilast class
Phosphodiesterase inhibitor (controller)
58
Roflumilast MOA
block metabolisms of c-AMP to directly relax bronchiole sm. mm. *may reduce COPD exacerbations but no defined role is asthma
59
Theophylline class
methylated xanthine (bronchodilator)
60
Theophylline MOA
mild stimulant MOA for asthma improvement unclear (bronchodilation vs. antiinflammatory vs. diaphragmatic inotrope)
61
Theophylline ADRs
- toxicity (requires periodic concentration monitoring) - variability in dose based on age, other drugs, smoking, liver dz, and maybe HF - toxicity signs = hyperstimulation (diarrhea, GI cramping, tremor, tachycardia, seizures) **alternative bronchodilator that has a lot more s/e than other bronchodilators
62
Preferred controller drugs in (1) COPD and (2) asthma
inhaled steroids (ICS) for both!
63
When might you use oral or injectable steroids in pulmonary tx?
primary role is as "burst therapy" for exacerbations of asthma or COPD and may be a very last resort in chronic asthma
64
Which medication(s) can stop or slow the LT decline in lung fn or prolong survival in COPD ?
NONE - not even inhaled steroids | although medications can improve QOL
65
When would you choose to stop a COPD medication?
COPD meds are rarely stopped after being added b/c it is a progressive dz (unlike intermittent asthma)
66
When is dual bronchodilator therapy of beta-agonist + anticholinergic therapy usually seen?
tx of COPD b/c bronchodilation is the primary therapeutic approach
67
Tx of Stage 0 COPD
educate regarding avoidance of risk fx (smoking, flu vaccine)
68
Tx of Stage 1 COPD
add PRN short-acting bronchodilator (albuterol, ipratropium, combivent)
69
Tx of Stage 2 COPD
add one or more scheduled long acting bronchodilator (formoterol, arformoterol, salmeterol, tiotropium, theophylline SR)
70
Tx of Stage 3 COPD
add inhaled steroid, esp. if multiple acute exacerbations (beclomethasone, budesonide, fluticasone)
71
Tx of Stage 4 COPD
oxygen if indicated (PO2 < 88%) surgery (emphysema)
72
Frequent, severe EIB may indicate
poorly controlled asthma however, it is also true that exercise may be the only precipitant of asthma for a pt.
73
________ will prevent EIB in more than 80% of pt.
pretreatment before exercise of inhaled B2-agnosist (SABA or LABA)

Pharmacology (14 decks)

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