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Flashcards in Respiratory Deck (25):
1

3 types of asthma drugs

short term relievers
long term controllers
antihistamines

2

albuterol
(terbutaline)

beta-2 agonist
bronchial smooth muscle relaxation
short term reliever

G-protein ... cAMP

use:
acute episode
exercise / allergen-induced ... prophylaxis
COPD

3

salmeterol
(formoterol)

beta-2 agonist
bronchial smooth muscle relaxation
short term reliever

use:
maintenance therapy asthma
COPD
exercise-induced

ADR:
cross reaction beta-1 (cardiac stimulation)
hyperglycemia
hypoKalemia
muscle tremor

4

ipatropium

competitive M blocker (AntiCholenergic)
blocks broncho-restriction and mucus secretion
short term reliever

use:
COPD first line
enhances beta-2 agonist Rx

ADR:
anti-BLUSHPADS BBC

Bradycardia
Lacrimation
Urination
Salvation
Hypotension
Pinpoint pupils (miosis)
Accommodation
Defecation (GI motility)
Sweating
Bronchoconstriction
Bronchosecretion
CNS ataxia, confusion

5

theophylline
(aminophylline)

methylxanthines
unclear - think it blocks adenosine receptors
causes bronchodilation
increases force of diaphragm contraction
short term reliever

use:
2nd or 3rd line asthma
2nd or 3rd line COPD

ADR:
very narrow therapeutic index
CNS - headache. nervousness, seizures, insomnia
cardiac stim - palpitations, arrhythmias
GI irritation - abdominal pain, increases acid secretion, anorexia

6

name the options to manage emergent Sx of asthma

albuterol (DOC)
salmeterol (maintenace)
ipatropium (more about the mucus)
theophyline (very narrow therapeutic index)

7

beclomethasone
prednisone
fluticasone

corticosteroids
anti-inflammatory
promotes epithelial regeneration
long term controller

use:
chronic asthma therapy
rhinitis (allergic or non-allergic)
COPD

ADR:
if used oral - candidiasis (thrush), hoarseness
adrenal suppression - weakness, fatigue, muscle loss
slow growth rate in kids
cataracts, glaucoma
skin thinning, bruising
osteoporosis
immunosupression

(inhaled less ADR than oral)

8

montelukast
zafirlukast

leukotriene pathway inhibitors
blocks D4 receptor (edema, smooth muscle constriction)
long term controller

use:
asthma
added to inhaled steroid Tx
aspirin-induced asthma

9

zileuton

leukotriene pathway inhibitor
5-Lipo-Oxygenase
long term controller

use:
use:
asthma
added to inhaled steroid Tx
aspirin-induced asthma

10

cromolyn
nedocromil

blocks activation of mast cells
long term controller

use:
asthma
exercise induced asthma
nasal spray/ eye drops for allergic rhinitis / conjunctivitis

11

what Rx are used to prevent asthma attacks

corticosteroids (beclomethaasone, prednisone)
leukotriene pathway block (montelukast, zafirlukast, zileuton)
cromolyn, nedocromolyn

12

where would you find lots of stored histamine granules

in tissue exposed to outside world (lots of mast / basophil cells) -->
lung,
skin,
nose,
GI (+enterochromafin-like cells in stomach fundus)
mouth,
feet,
blood vessels

13

histamines negative feedback

histamine binding H2 receptor on mast cell

14

normal histamine release mechanism

IgE cross binding antigen

15

other methods to release histamine

Rx -
morphine,
muscle relaxants - depolarizing (blocks Nm receptors: succinylcholine (SUX suxamethonium), tubocurarine

x-ray contrast
venoms - bee, snake
radiation

16

mechanism of H1 receptor

Gq-protein
activates phosholipase-C => IP3, DAG
increase in intracellular Ca

17

dyphenhydramine

reversible-competitive blocker H1
penetrates CNS (so makes u sleepy due to anti cholenergic)

use:
rhinitis
conjuctivitis
urticaria (hives)
pruritis (the sleepy effect helps)

indirect use:
insomnia
motion sickness, vertigo, nausea
antiemetic
pregnancy morning sickness
parkinson extra-pyramidal effect Tx (anticholenergic effect)

ADR:
sedation
paradoxial CNS stimulation - infants, kids
fatigue, headache (vasodilation)
atropine like effect (blocks M)

18

chlorpheniramine

reversible-competitive blocker H1
penetrates CNS (so makes u sleepy due to anti cholenergic)

use:
rhinitis
conjuctivitis
urticaria (hives)
pruritis (the sleepy effect helps)

indirect use:
insomnia
motion sickness, vertigo, nausea
antiemetic
pregnancy morning sickness
parkinson extra-pyramidal effect Tx (anticholenergic effect)

ADR:
sedation
paradoxial CNS stimulation - infants, kids
fatigue, headache (vasodilation)
atropine like effect (blocks M)

19

dimenhydrinate

reversible-competitive blocker H1
penetrates CNS (so makes u sleepy due to anti cholenergic)

use:
rhinitis
conjuctivitis
urticaria (hives)
pruritis (the sleepy effect helps)

indirect use:
insomnia
motion sickness, vertigo, nausea
antiemetic
pregnancy morning sickness
parkinson extra-pyramidal effect Tx (anticholenergic effect)

ADR:
sedation
paradoxial CNS stimulation - infants, kids
fatigue, headache (vasodilation)
atropine like effect (blocks M)

20

promethazine

reversible-competitive blocker H1
penetrates CNS (so makes u sleepy due to anti cholenergic)

use:
rhinitis
conjuctivitis
urticaria (hives)
pruritis (the sleepy effect helps)

indirect use:
insomnia
motion sickness, vertigo, nausea
antiemetic
pregnancy morning sickness
parkinson extra-pyramidal effect Tx (anticholenergic effect)

ADR:
sedation
paradoxial CNS stimulation - infants, kids
fatigue, headache (vasodilation)
atropine like effect (blocks M)

21

fexofenadine

reversible competitive block H1-peripheral
penetrates CNS poorly

use:
rhinitis
conjunctivitis
urticaria
pruritis

ADR:
headache

22

cetirizine

reversible competitive block H1-peripheral
penetrates CNS poorly

use:
rhinitis
conjunctivitis
urticaria
pruritis

ADR:
headache

23

loratadine
desloratadine

reversible competitive block H1-peripheral
penetrates CNS poorly

use:
rhinitis
conjunctivitis
urticaria
pruritis

ADR:
headache

24

2 responses in asthma

early (bronchoconstriction)
late (inflammation)

25

FEV1 in asthma

EARLY:
contraction of airway smooth muscle FEV1 drop 1

LATE:
edema, inflammation, mucus hypersecretion, smooth muscle contraction FEV1 drop 2