QUIZ 1 FINALS

Question 1

Agent that blocks parasympathetic nervous fibers, which allow relaxation of smooth muscle in the airway.

Answer 1

Anticholinergic bronchodilator

Question 2

Same as anticholinergic bronchodilator—agent that blocks the effect of acetylcholine at the cholinergic site.

Answer 2

Antimuscarinic bronchodilator

Question 3

Agent that produces the effect of acetylcholine.

Answer 3

Cholinergic

Question 4

Same as cholinergic—agent that produces the effect of acetylcholine or an agent that mimics acetylcholine.

Answer 4

Muscarinic

Question 5

Blocking parasympathetic nervous fibers.

Answer 5

Parasympatholytic

Question 6

Producing effects similar to the parasympathetic nervous system.

Answer 6

Parasympathomimetic

Question 7

1. Are indicated as bronchodilators for maintenance treatment in COPD, including chronic bronchitis and emphysema.
2. is used and may
   be indicated in some individuals with asthma

Answer 7

• Ipratropium and tiotropium
• Ipratropium

Question 8

1. A combination anticholinergic and B agonist indicated for use in patients receiving regular treatment for COPD who require additional bronchodilation for relief of airflow obstruction.
2. also commonly used in severe asthma in addition to B agonists, especially bronchoconstriction that does not respond well to
   B agonist therapy.

Answer 8

• Ipratropium and Albuterol (combivert)
• Ipratropium

Question 9

is indicated for symptomatic relief of allergic and nonallergic perennial rhinitis and the common cold.

Answer 9

nasal spray formulation

Question 10

(anticholinergic, or antimuscarinic) agents that are given by aerosol include ipratropium, a combination of ipratropium and albuterol, and tiotropium.

Answer 10

Parasympatholytic

Question 11

Administered as a nebulized solution, using either the injectable solution or, preferably, solutions marketed for aerosolization; however, this agent is no longer aerosolized.

Dosages for children based on dose-response curves had been given as 0.05 mg/kg three or four times daily.1 Dosages for adults are based on a schedule of 0.025 mg/kg three or four times daily.

The drug is not recommended for inhalation as a bronchodilator because of its widespread distribution in the body and the availability of the approved agents ipratropium and tiotropium.

Answer 11

Atropine sulfate

Question 12

Is a nonselective antagonist of M1, M2, and M3 receptors.

is currently available in two formulations for bronchodilator use: as a hydrofluoroalkane propelled metered dose inhaler (HFA MDI) and the soft-mist, propellant-free Respimat inhaler.

As a quaternary ammonium derivative of atropine, _______ is fully ionized and does not distribute well across lipid membranes, limiting its distribution more to the lung when inhaled. It is approved specifically for the maintenance treatment of airflow obstruction
in COPD.

Answer 12

Ipratropium bromide (Atrovent)

Question 13

The onset of bronchodilation begins within minutes but proceeds more slowly to
a peak effect 1 to 2 hours after inhalation. B agonists can peak between 20 minutes and 30 minutes depending on the agent. In asthma, the duration of bronchodilator effect is about the same for ipratropium as for
B agonists. In COPD,
the duration is longer by 1 to 2 hours.

Answer 13

just read under Ipratropium bromide (Atrovent)

Question 14

is also available for treatment of rhinopathies and rhinorrhea, including nonallergic perennial rhinitis, viral infectious rhinitis (colds), and allergic rhinitis, if intranasal corticosteroids
fail to control symptoms.

The 0.03% strength is given as two sprays per nostril two or three times daily, and the 0.06% strength is given as two sprays per nostril three or four times daily.

Side effects with the nasal spray are largely local and have included nasal dryness, itching, and epistaxis in a few patients. Dry mouth and dry throat have also occurred. Systemic symptoms such as blurred vision or urinary hesitancy are rare.

Answer 14

Ipratropium bromide (Atrovent nasal spray)

Question 15

1. is a combination MDI product, with the usual doses of each agent (18 “g/ puff of ipratropium, 90 “g/puff of albuterol). The combination therapy has been shown to be more effective in stable COPD than either agent alone.
2. Another agent, DuoNeb, is available as a combination of ipratropium (0.5 mg) and albuterol base (2.5 mg). Another option for the delivery of _____t is the soft-mist, propellant-free, Respimat inhaler.

Answer 15

• Ipratropium and albuterol (Combivent)
• Combivent

Question 16

a muscarinic receptor antagonist, is a long-acting bronchodilator. It is a quaternary ammonium compound structurally related to ipratropium.
Similar to ipratropium, this is poorly absorbed after inhalation. Inhalation of a single dose gives a peak plasma level within 5 minutes, with a rapid decline to very low levels within 1 hour.

Answer 16

Tiotropium bromide (Spiriva)

Question 17

Are specifically parasympatholytic, that is, antimuscarinic agents, blocking the effect of acetylcholine at the cholinergic (muscarinic) receptors on bronchial smooth muscle.

Answer 17

Anticholinergic bronchodilators

Question 18

1. The only approved anticholinergic agents for inhalation as an aerosol at this time are ______ and ________.
2. Formulation of Ipratropium (atrovent):
3. Formulation of Tiotropium (spiriva)

Answer 18

• ipratropium (Atrovent) and tiotropium (Spiriva)
• SVN, Nasal spray (4-6hrs), MDI
• DPI

Question 19

Chemical structures of the two naturally occurring belladonna alkaloids, atropine and scopolamine (also called _____.

Answer 19

hyoscine

Question 20

Atropine, including its sulfate (atropine sulfate), and scopolamine are both _______.

They are easily absorbed in the in the blood stream, , distribute throughout the body, and in particular cross the blood-brain barrier to cause CNS changes.

Answer 20

tertiary ammonium compounds.

Question 21

Derivatives of atropine include atropine, ipratropium, glycopyrrolate, and tiotropium are ______.

Are fully ionized and poorly absorbed into the bloodstream or CNS.

Given by inhalation generally are poorly absorbed from the lung. They are not rapidly removed from the aerosol deposition site and do not cross the blood brain barrier as atropine sulfate does, giving them wider
therapeutic margin in relation to side effects.

Answer 21

Quaternary ammonium

Question 22

Another quaternary atropine derivative, which has been administered experimentally as a bronchodilator by aerosol, is _______.

Answer 22

glycopyrrolate (Robinul)

Question 23

Atropine sulfate, a prototype tertiary compound, inhibits and reduces mucociliary clearance, as shown by Groth and associates. Atropine seems to block hypersecretion stimulated by cholinergic agonists in both the lower airway and the nose (upper airway) more than basal secretion. Atropine relaxes airway smooth muscle, the basis for its use in asthma.

Answer 23

Respiratory tract effects

Question 24

Tertiary compounds cross the blood-brain barrier and produce dose-related effects. Small doses of 0.5 to 1.0 mg can cause effects that include restlessness, irritability, drowsiness, fatigue, or, alternatively, mild excitement. Increased doses can cause disorientation, hallucinations, or coma. Inhaled atropine has been reported to cause an acute psychotic reaction.

Answer 24

Central nervous system effects.

Question 25

Tertiary anticholinergic compounds given by inhalation distribute through the bloodstream and can affect vision. They block contraction of the iris to cause pupil dilation and paralyze the ciliary muscle of the lens to prevent thickening of the lens for near accommodation, causing blurred vision. These effects can increase intraocular pressure in glaucoma. Atropine like agents are contraindicated in narrow-angle glaucoma.

Answer 25

Eye effect

Question 26

Atropine in small doses causes minor slowing of the heart rate; larger doses increase heart rate through vagal blockade

Answer 26

Cardiac effects

Question 27

Anticholinergic agents generally cause dryness of the mouth as a result of inhibition of salivary gland secretions, and atropine is used for this effect to reduce upper airway secretions before surgery and anesthesia or when reversing neuromuscular blockade.

Answer 27

Gastrointestinal effects

Question 28

Atropine like agents can inhibit parasympathetic-controlled relaxation of the urinary sphincter. In men with prostate gland enlargement, this urinary sphincter relaxation can produce acute urinary retention. Atropinelike drugs can predispose to male impotency because penile erection is also under parasympathetic control. Ejaculation is a sympathetic function.

Answer 28

Genitourinary effects.

Question 29

Quaternary compounds, such as _______, are fully ionized and less absorbed in body tissues than tertiary compounds, such as ______. Consequently, side effects with quaternary compounds are localized to the site of drug exposure.

Answer 29

ipratropium atropine sulfate

Question 30

The anticholinergic agents ______ and _____ are indicated for the treatment of airflow obstruction in COPD.

Answer 30

- ipratropium and tiotropium

Question 31

It can cause vasodilation in the lungs.

Answer 31

M3

Question 32

It is for allergic rhinitis.

Answer 32

M1

Question 33

Has better MI Only short acting muscarinic antagonist in the market.

Answer 33

Ipratropium

Question 34

Formulation of IPRATROPIUM + SALBUTAMOL:

Answer 34

Combivent Duavent Multivent

Question 35

It is a quaternary compound Limited CNS effect and cardiac side effects

Answer 35

LAMA

Question 36

What is the prototype in LAMA? It is used in capsule, used as handihaler, spiriva (most famous), in Dpi form. Added as a management of asthma in stage 5 bronchial asthma.

Answer 36

Tiotropium

Question 37

They come in combination and given once a day.

Answer 37

Glycoperonium and Tiotropium

Question 38

The only LAMA + LABA that can be given in intubated patient MDI FORM Management for bronchial asthma Can not be used for accute exacerbation

Answer 38

Tiotropium + Olodaterolg