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Advanced Pharmacology Exam 1 > Pulmonology > Flashcards

Pulmonology Flashcards

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1
Q

guaifenesin MOA

A

expectorant - increases volume of resp tract secretions to loosen phlegm/bronchial secretions

increases the efficacy of cough reflex

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2
Q

guaifenesin max dosage

A

maximum dose 2400 mg/day

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3
Q

guaifenesin AEs/drug interactions

A

generally well tolerated

N/V, dizziness, HA, rash

risk of kidney stone formation in high quantities –> hydration!

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4
Q

dextromethorphan (robitussin) MOA

A

antitussive - relieves throat irritation by cough suppression in medulla

most commonly used non-opioid agent for cough

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5
Q

dextromethorphan maximum dosage

A

adults and children >12 - 120 mg/day

children 6-12- 60 mg/day

children 4-5- 30 mg/day

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6
Q

dextromethorphan AEs/interactions

A

N, drowsiness, euphoric effect (robotripping)

avoid in asthma/COPD, hyperglc, bradypnea, pregnancy

interactions w/ MAOI - serotonin syndrome, quinidine

can cause + urine tox - PCP, opioids, heroin

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7
Q

benzonatate (Tessalon) MOA

A

peripherally anesthetizes stretch receptors in airways to reduce cough reflex

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8
Q

benzonatate AEs

A

sedation, HA, confusion, visual hallucinations, pruritis, N

*must be taken whole

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9
Q

benzonatate dosing

A

100-200mg TID

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10
Q

codeine dosing for cough

A

10-20 mg q4-6h

max dose 120 mg/day

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11
Q

codeine/hydrocodone AEs

A

constipation, sedation, N/V, dizziness

many drug interactions w CYP2D6

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12
Q

hydrocodone dosage for cough

A

5 mg q4-6h

max dose 30 mg/day

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13
Q

antihistamines MOA for cough

A

anticholinergic activity helps reduce post-nasal drip

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14
Q

AEs of antihistamines

A

dry mouth, dry eyes, blurred vision, constipation, bladder outlet obstruction, CNS impairment

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15
Q

what children should use OTC cough and cold products?

A

> 2 years

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16
Q

gabapentin MOA for cough

A

inhibits neutrotransmitter release to help reduce chronic refractory cough

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17
Q

gabapentin dosing

A

300 mg QD, increase as needed

max 600 mg TID

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18
Q

gabapentin AEs/precautions

A

CNS depression

adjust dose to renal function

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19
Q

intransal corticosteroids MOA for allergic rhinitis

A

most effective prevention and treatment of allergic rhinitis!

anti-inflammatory

reduces ocular symptoms (itching, tearing, redness)

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20
Q

intransasal corticosteroids AEs

A

dryness, irritation, burning, bleeding of nasal mucosa, sore throat, loss of smell

> 12 month use can stunt growth in children

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21
Q

most common OTC intransal corticosteroid

A

fluiticasone propionate

OTC and prescription

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22
Q

what generation is fluticasone propionate?

A

second generation intranasal corticosteroid

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23
Q

fluticasone propionate dosage

A

50 mcg/spray

4-6 years - one spray per nostril QD
>12 years - 2 sprays per nostril QD for 7d, than 1-2 sprays QD

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24
Q

first generation oral antihistamines examples

A

diphenhydramine (benadryl)

chlorpheniramine (chlor-trimeton)

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25
antihistamines AEs
sedation, CNS impairment anticholinergic hangovereffect
26
second generation oral antihistamines examples
fexofenadine (allegra) cetirizine (zyrtec) levocetirizine (xyzal) loratidine (claritin)
27
first vs second generation oral antihistamines
second generation - less sedating d/t limited bbb penetration preferred first line for allergic rhinitis less effective for nasal congestion cetirizine may cause sedation
28
most used second generation antihistamine
loratidine
29
loratidine dosing
10 mg QD - adults 5 mg QD - peds
30
* intransasal antihistamines example
azelastine 0.15% available OTC for ages 6 and older
31
pseudophedrine dosing
30-60 mg Q6h max dose 240 mg in 24 h
32
pseudoephedrine MOA
oral decongestant vasoconstriction in nasal mucosa stimulation of alpha 1 in venus sinusoids
33
pseudoephedrine use
relief of nasal congesion and itching, NOT sneezing tolerance sales restrictions
34
pseudoephedrine AEs/precautions
tachycardia, insomnia, excitability/palpitations use w caution in patients with HTN, cardiovascular disease, DM, hyperthyroid, glaucoma, bladder neck obstruction
35
oxymetazoline (Afrin) MOA
intransasal decongestant - stimulates A receptors in arterioles of the nasal mucosa to produce vasoconstriction OTC
36
* oxymetazoline AEs
stinging, burning, dryness of mouth less likely than PO to have systemic effects do not use as monotherapy >3 d - risk of rebound nasal decongestant
37
cromolyn sodium (nasalcrom) MOA
mast cell stabilizer intranasal cromolyn inhibits mast cell degranulation and mediator release less effective than intranasal corticosteroids and second generation antihistamines
38
mast cell stabilizer AEs
nasal stinging and sneezing may take 1-2 weeks to achieve maximum effect
39
alpha1-proteinase inhibitors MOA/use
congenital antitrypsin (AAT) deficiency leads to increase elastic damage in lungs causing emphysema these drugs render proteolytic enzymes seen in inflammation inactive
40
alpha1-proteinase inhibitors dosage
60 mg/kg IV infusion weekly
41
lung surfactants MOA
reduce surface tension in alveoli during ventilation in premature infants reduces mortality and pneumothoraces associated with respiratory distress syndrome
42
lung surfactant AEs
hypotension, bradycardia, decreased O2 saturation
43
corticosteroid AEs
adrenal insufficiency (cushings), osteoporosis, immunosuppression, fluid/electrolyte imbalance (d/t fluid retention), hyperglycemia, GI effects, CNS effects (psychosis), dermatologic effects
44
betamethasone (celestone soluspan) use
glucocorticoid used in preterm mothers to reduce the incidence of RDS used w surfactantI
45
SABA precautions
regularly scheduled use is not recommended - may lower effectiveness and increase airway hyperresponsiveness more than one canister per month suggests inadequate asthma control
46
albuterol MOA
SABA stimulates b-adrenergic receptors do not decrease airway inflammation
47
SABA/LABA AEs
tachycardia, skeletal muscle tremors, HA, palpitations, QT prolongation, insomnia, hypokalemia, hyperglc may develop tolerance
48
ipratropium MOA
SAMA
49
SAMA/LAMA AEs
dry mouth, urinary retention, blurred vision, tachycardia, increased intraocular pressure use w caution w glaucoma, BPH
50
when is a SAMA used?
pts unable to tolerate SABA and in combo w SABA for acute bronchoconstriction longer duration than albuterol
51
what is the most effective long-term control therapy for persistent asthma?
inhaled corticosteroids
52
ICS AEs
oral candidiasis, dysphonia *rinse mouth and use spacer! may increase risk for pneumonia with COPD
53
what is a LABA used?
ASTHMA - mainly ICS/LABA combinations not monotherapy, not for acute COPD - can be monotherapy to reduce frequency of severe exacerbations
54
LABA examplaes
salmeterol - asthma/COPD formoterol - asthma/COPD aformoterol - COPD olodaterol - COPD
55
formoterol dosing
nebulizer 20 mcg BID
56
tiotropium MOA
LAMA
57
when is a LAMA used?
added to ICS/LABA in poorly controled severe asthma COPD - helps s/s but does not improve lung function
58
tiotropium ISI dosing for asthma and COPD
asthma - 2 inhalations (2.5 mcg) QD COPD - 2 inhalations (5mcg) QD ihlalation spray
59
what is trelegy?
fluticosone furoate/umeclidinium/vilanterol ICS/LAMA/LABA
60
when are leukotriene modifiers used?
alternative to low-dose ICS not for acute
61
leukotriene modifiers AEs
hepatotoxicity w/ zafirlukast and zilueton requires monitoring black box warning w montelukast
62
commonly used leukotriene modifier & dosage
montelukast (singulair) 10 mg QD in evening
63
theophylline use & precautions
limited use bronchodilator w lots of AEs add on therapy for asthma and COPD hepatic monitoring required, drug monitoring, significant AEs, interactions w many drugs
64
concerning AEs w theophylline
convulsions and cardiac arrhythmias at high concentrations
65
what is the most effective agent for asthma exacerbation not responding to bronchodilators?
oral corticosteroids
66
prednisone dosing for asthma exacerbation
40 mg/day PO x 5-7 days may have 6-8 hour delay so should be considered early in treatment
67
omalizumab (xolair) use and MOA
patients >6 years not well controlled on ICS w/ documented sensitization to airborne allergens monoclonal antibody that prevents IgE from binding to mast cells and basophils
68
* omalizumab (xolair) AEs
injection site pain, bruising, black box anaphylaxis warning -->monitor!
69
Benralizumab (fasenra) MOA and use
IL-5 antagonist add on therapy for patients >12 w eosinophilic phenotype asthma not controlled w corticosteroids
70
IL - 5 antagonists
benralizumab (fasenra) reslizumab (cinqair) - IV Mepolizumab (nucala)
71
benralizumab (fasenra) AEs
HA, pyrexia, pharyngitis, hypersensitivity reaction
72
dupilumab (dupixent) MOA and use
IL-4 agonists add on therapy for patients >12 w moderate to severe eosinophilic phenotype
73
emergency astma mgmt
- SaO2 > 90% - albuterol/levalbuterol nebs continuous - inhaled ipratropium in ED if needed - systemic corticosteroids - PO prednisone
74
albuterol dosing for acute asthma exacerbation
nebulizer - 2.5-5mg q20 minutes, then 2.5-10 mg q 1-4h PRN MDI - 90 mcg/puff. 4-8 puffs q 20 mins, then ever 1-4h PRN
75
injections for asthma exacerbations
epinephrine 0.3-0.5 mg q 20 minutes SQ terbutatline .25 mg q 20 minutes SQ x 3 doses
76
ipratropium dosing for asthma exacerbation
0.5 mg q 20 minutes x3, then PRN MDI - 17 mcg/puff. 8 puffs q 20 m PRN
77
emphysema patho
permanent and destructive enlargement of airspaces distal to the terminal bronchioles without obvious fibrosis and with loss of normal architecture always involves clinically significant airflow "pink puffer"
78
chronic bronchitis patho
presence of a cough productive of sputum not attributable to other causes on most days for at least 3 months over 2 consecutive years may be present in the absence of airflow limitation "blue bloater"
79
duoneb dosing
2.5 mg albuterol/0.5 mg ipratropium QID PRN
80
* roflumilast (daliresp) use and MOA
oral phosphodisterase-4 inhibitor used for severe COPD associated w chronic bronchitis and hx of exacerbations tx can reduce hospitalizations
81
roflumilast (daliresp) AEs
changes in mood and behavior, weight loss
82
azithromycin MOA and use
macrolide antibiotic can decrease rate of COPD exacerbations 250 mg QD
83
azithromycin AEs
hearing loss, antimicrobial resistance, drug interactions
84
what COPD LAMA is available as a nebulizer?
revefenacin
85
what preparations is albuterol available?
MDI, nebulizer, DPI
86
LAMA examples
tiotropium umeclidinium revefenacin
87
which ICS is available as a neb?
budesonide
88
what formulation is trelegy?
DPI

Advanced Pharmacology Exam 1 (4 decks)

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