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Question 1

Which cough should you suppress? Why?

Answer 1

Non-productive.

Productive cough helps to mobilize mucus.

Question 2

How do mucolytics work? What are examples? Which is the best?

Answer 2

They reduce the viscosity of secretions making cough more efficient.
-Guafifenesin, NAC/Mucomyst, WATER

Question 3

What are some cough suppressants?

Answer 3

codeine, DM, benzonatate (Tessalon Pearles)

Question 4

T/F Codeine and benzonatate are OTC.

Which one is also a local numbing agent?

Answer 4

F - Rx

B is local numbing agent

Question 5

Which suppressant is easily abused? Why does this make sense?

Answer 5

DM – cause hallucinations because it is centrally acting!

Question 6

What drug may induce cough?

Answer 6

ACE-i

Question 7

What happens to the lungs in asthma?

Answer 7

Hyperactive bronchi - chronic inflammation

Question 8

Why is asthma considered polygenic?

Answer 8

histamine, LTs, PGs all play a role in the inflammation process

Question 9

What is the basic approach to treatment of asthma?

Answer 9

1. Prevent allergen exposure
2. Reduce inflammation/hyperactivity
3. Dilate narrowed bronchi

Question 10

Which drug is the mainstay of asthma treatment (reduces bronchial hyperactivity and inflammation)?

Answer 10

Glucocorticoids

Question 11

How are glucocorticoids administered?

Answer 11

PO, IV, inhalation (1st)

Question 12

Should inhaled steroids be hydrophilic or lipophilic?

Answer 12

Hydrophilic so that they’ll stay in the lung (and not go into bloodstream).

Question 13

What is the AE of inhaled steroid? What are the advantages?

Answer 13

Thrush

no systemic effects and no risk HPA suppression

Question 14

Steroids as a family can cause?

Answer 14

Metabolic...
1. Hyperglycemia
2. Osteopenia
3. Growth suppression
Inflammatory...
3. Immune suppression
4. PUD (decrease Pg, decrease mucus)
Vascular - increase BP
Cushinoid signs...
5. Na retention
G. Hypokalemia

Question 15

What is HPA suppression and how does it affect steroid dosing?

Answer 15

Chronic steroid use suppresses the “need” for the hypothalamus to control the secretion of steroids. When D/Cing steroids, you need to taper them to allow the H to take over once again. Steroids are required for living!

Question 16

In addition to steady administration of steroids in adrenalectomized or Addison’s dz, what else do you have to do?

Answer 16

They need stress-dosing or “burst” dosing. Because everyone needs bursts in times of stress.

Question 17

Can inhaled steroids break acute asthma attacks? What do you use for status asthmaticus?

Answer 17

NOOOOO. They are only for maintenance/prevention.

IV steroids, Epi + maybe intubation

Question 18

How do you remember what Addison’s dz is? What is the opposite of Addison’s?

Answer 18

You have to ADD steroids.

CUSHING’s.

Question 19

When do you dose steroids?

Answer 19

In the AM. They are activating and involved in the wake-up cycle.

Question 20

Most steroid inhalers for normal asthma end in “-_____”. What is used for acute severe attacks?

Answer 20

“-one”

Question 21

How and when are Cromolyn are Nedocromil taken? In what patients are these MOST helpful in?

Answer 21

powder for inhalation -
Take on a regular basis
Exercise induced asthma or specific allergen-induced asthma.

Question 22

Can Cromolyn or Nedocromil treat acute asthma attacks?

Answer 22

no, they are only preventative therapy! it takes time to inhibit the histamine cascade

Question 23

How do Cromolyn and Nedocromil work?

Answer 23

mast cell stabilizer - reduces histamine release on exposure to allergans

Question 24

Beta 1 agonist vs beta 2 agonist?

Answer 24

Beta 1 - heart

Beta 2 - vasodilation and bronchodilation

Question 25

Is Epi or NE a more potent vasoconstrictor?

Answer 25

NE because it does not bind to Beta 2 receptors.

Question 26

Does NE or Epi bind to Beta 2?

Answer 26

Epi

Question 27

What kind of med is Albuterol? Long or short acting? Rescue agent?

Answer 27

Beta 2 agonist - Bronchodilator - short acting rescue agent

Question 28

What kind of med is Salmeterol? Long or short acting? Rescue agent? Why did it get bad press?

Answer 28

B2 agonist - long acting maintenance inhaler no rescue use only used in combo with steroids

Question 29

What kind of med is Formoterol? Long or short acting? Onset? Potency?

Answer 29

B2 agonist - Bronchodilator - long acting with faster onset and greater potency than Sameterol

Question 30

What are two other long-acting Beta 2 agonist bronchodilators?

Answer 30

Salbutamol, bambuterol

Question 31

Is PO albuterol used regularly? Why/why not? What side effect may occur?

Answer 31

No because it loses B2 selectivity, which can lead to tachycardia

Question 32

What kind of med is Terbutaline? Why is it special?

Answer 32

B2 agonist that is not lung specific! | it has potent smooth muscle relaxer - tocolytic - stops premature labor!

Question 33

What is the opposite of Terbutaline?

Answer 33

Misoprostel - which causes premature contractions

Question 34

Why are anti-cholingerics used for respiratory dz? what specific dz?

Answer 34

``` ACh is parasympathetic, which is a bronchoconstrictor. Blocking ACh will bronchodilate COPD mainly (adjuct in asthma) ```

Question 35

Ipatropium is what type of drug? What is the brand name?

Answer 35

Inhaled anticholinergic - Atrovent | ATROPINE is the father of AntiACh drugs

Question 36

-"tropium" is the name for what drugs?

Answer 36

antiACh drugs

Question 37

Leukotrienes have what effect on the lungs?

Answer 37

Bronchoconstriction

Question 38

Leukotriene receptor blockers are usually first or second line treatments? Are they inhalers or PO?

Answer 38

Second line | PO

Question 39

Name 2 leukotriene RB. Do they have many AEs?

Answer 39

Montelukast (Singulair) | Zafirlukast (Accolate)

Question 40

What cardio med should you NOT give asthmatics?

Answer 40

Propranolol - non selective beta blocker (blocking b2)

Question 41

How do Phosphodiesterase 4 (PDE-4) Inhibitors work?

Answer 41

They inhibit the PDE-4 enzyme that chews up cAMP. cAMP cause bronchodilation.

Question 42

What are the PDE-4 inhibitors used for?

Answer 42

COPD (chronic bronchitis - not emphysema)

Question 43

What are PDE-5 inhibitors?

Answer 43

Viagra! Vasodilation.

Question 44

GIve an example and dose of a PDE-4 inhibitor.

Answer 44

Roflumilast (Daliresp) - 500 mcg PO QD

Question 45

What is a side effect of PDE-4 inhibitors?

Answer 45

suicidal ideations

Question 46

What is status asthmaticus? How do you treat it?

Answer 46

Life threatening asthma emergency! Mucous plugs, refractoriness to B2 agonist (they don't work), respiratory acidosis (build up of lactic acid, CO2). Tx - IV steroid therapy, may need intubation first

Question 47

What does MDI stand for? CFC vs HFA propellants?

Answer 47

Meter Dose Inhaler -- drug is pressurized with a propellant. | We use HFAs now because CFCs are bad for the environment.

Question 48

How does someone use an MDI? | Children and eldery may need a _____ with MDIs.

Answer 48

Shake, exhale, slowly inhale and actuate MDI | spacers to delay expulsion

Question 49

What is the risk with inhaled steroids? What should you do to counteract this?

Answer 49

localized thrush | gargle with warm water following use

Question 50

How do nebulizers work?

Answer 50

Convert solution and suspensions of drugs into aerosols. They are usually driven by a gas or or ionization process (vibrations).

Question 51

What are Fluticasone propionate (Flovent) and Budesonide (Pulmicort)?

Answer 51

Inhaled corticoidsteroids.

Question 52

What is in Advair Diskus?

Answer 52

Fluticasone propionate (Flovent) + Salmeterol xinafoate (long acting B2 agonist)

Question 53

Are inhaled drugs hydrophilic or lipophilic?

Answer 53

hydrophilic - stay in lungs