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pharmacology > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

1
Q

Names of Muscarinic antagonists

A

Ipratropium bromide (atrovent)
Atropine
Tiotrpium (spiriva)

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2
Q

Decreased airway conduction is caused by

A
  1. constriction of smooth muscle
  2. production of mucus
  3. inflammation
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3
Q

Muscarinic antagonists mechanism

A

competitive antagonists of Ach at the muscarinic
-inhibit Ach mediated constriction of bronchial airways

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4
Q

What does AcH do at muscarinic receptors

A

constricts bronchial airways

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4
Q

What patients are muscarinic antagonists good for?

A

for patients who are intolerant to sympathomimetics or methylxanthines
-variable in bronchodilation effectiveness

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5
Q

sympathomimetic

A

mimicking the sympathetic responses

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6
Q

Ipratropium characteristics

A

Quaternary amine
poorly absorbed
does not cross blood brain barrier
-aerosol
-low systemic absorption (limits adverse effects)
-SHORT ACTING
-used for COPD and asthma patients

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7
Q

Tiotropium

A

Spiriva
Long Acting muscarinic antagonist

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8
Q

Atropine sulfate

A

-readily absorbed in systemic circulation
-adverse effects
-limits the treatment of asthma

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9
Q

Atropine sulfate adverse effects

A

drowsiness
sedation
dry mouth
blurred vision

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10
Q

Glucocorticoids target was

A

inflammatory response
are FIRST LINE AGENTS for PERSISTENT ASTHMA

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11
Q

Types of glucocorticoids

A

Beclomethasone (Beclovent, Vanceril)
Triamcinolone acetate (Azmacort)
Budesonide (Rhinocort)
Flunisolide (AeroBid)
Fluticasone propionate (Flovent)

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12
Q

Important types of Glucocorticoids

A

Budesonide (rhinocort)
Fluticasone propionate (flovent)

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13
Q

What indicates the need for steroid treatment

A

inflammation is present
(COPD, asthma or other parts of the body)

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14
Q

Glucocorticoid Mechanism

A

Attenuating prostoglandin and leukotriene synthesis via Annexin A1
-this inhibits the immune response
-increases sympathomimetics and decreases inflammation

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15
Q

what do glucocorticoids do for other respiratory medications

A

give them access to work properly by “solving” inflammation

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16
Q

What part of the immune response do glucocorticoids inhibit

A

the production of cytokines and chemoattractants

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17
Q

Mast Cells

A

produce histamine in response to

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18
Q

How can glucocorticoids be administered

A

Oral, topical, inhalation

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19
Q

Inhalation of glucocorticoids are used for

A

initial treatment for asthma, you add agents as needed
-inflammation
-use prophylactically rather than to reverse acute attacks

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20
Q

Glucocorticoids side effects

A

hoarseness
oral candidiasis (thrush)
adrenal surpression (serious)
osteoporosis (serious)

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21
Q

considerations before prescribing glucocticoids

A

pt compliance
steroid use previously

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22
Q

names of Leukotriene inhibitors

A

zafirlukast (Accolate)
montelukast (Singulair)

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23
Q

Mechanism of Leukotriene inhibitors

A

agonists of leukotriene receptor (LT1).
Blocks cyst-leukotriene C4, D4, E4 (LTC4, LTD4, LTE4)

“try to stop the inflammatory response before it starts”

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24
Q

leukotrienes

A

chemicals your body releases when introduced to something youre allergic to

25
Q

Characteristics of Leukotriene inhibitors

A

reduces bronchoconstriction and inflammatory cell response
-alternative to medium dose inhaled glucocorticoids

26
Q

Adverse affects of Zafirlukast

A

headaches
elevation of liver enzymes

27
Q

Administration of Leukotriene inhibitors

A

orally 1-2 QD

28
Q

Zafirlukast interactions

A

inhibits the metabolism of warfarin

29
Q

Zileuton (Zyflo)

A

Inhibits 5-lipoxygenase
-immediate and sustained 15% improvement FEV1
-relieves bronchial constriction from exercise

30
Q

5-lipoxygenase

A

rate eliminating enzyme in leukotriene biosynthesis
-inhibited by Zilueton (zyflo)

31
Q

Administration of Zileuton

A

PO 4 times daily

32
Q

Side effects of Zileuton

A

Liver toxicity (monitor hepatic enzymes, elderly women at risk)
Flu like symptoms

33
Q

Zileuton interactions

A

inhibits P-450’s (in liver)
decreases the metabolism of warfarin and theophylline

34
Q

Types of Alfa-1 Protease Inhibitors

A

Aralast and Prolastin

35
Q

Mechanism of Alfa-1 protease Inhibitors

A

inhibits alpha-1 proteinase
-treats emphysema

36
Q

What does alpha-1 proteinase do?

A

a peptide that inhibits elastase release (elastase destroys the lungs parenchyma)

37
Q

Administration of Alfa-1 Protease Inhibitors

A

Via IV injection weekly
-treats for homozygous deficiency

38
Q

Anti-IgE antibody names

A

Omalizumab

39
Q

Anti-IgE antibody mechanisms

A

Binds to IgE high affinity receptor
-blocks the binding of IgE mast cells, basophils, allergic response cells
-lowers free serum IgE by up to 90%

40
Q

What does Anti-IgE antibodies do in the early and late phase

A

Reduces early phase degranulation (histamine) of mast cells

Reduces late phase release of mediators

41
Q

what to Anti-IgE antibodies not do

A

block allergen-antibody rxn
-leads to a reduction in allergen concentrations

42
Q

Target audience of Anti-IgE antibody

A

12+ years old
Refractory to inhaled glucocorticoid
Asthmatic patients with allergies

43
Q

Administration of Anti-IgE antibodies

A

Via SQ injection Q2-4 weeks

44
Q

Chromones names

A

Cromolyn sodium
Nedocromil

45
Q

What is Chromones used for

A

long term controller therapy that prevents asthma symptoms and improve airway functions

46
Q

Target audience of Chromones

A

Patients with mild, persistent, or exercise induced asthma

47
Q

Chromones Mechanism

A

Modulates the mast cell mediator release and eosinophil recruitment
-inhibits early and late asthmatic responses to allergen challenge and bronchospasm

48
Q

Side effects of Chromones

A

clinical response is less predictable than inhaled corticosteroids

49
Q

Rhinitis characteristics

A

congestion, increased mucus production, vasodilation, fluid accumulation in mucosal spaces

50
Q

Parasympathetic stimulation and Airway dilation are produced by

A

inflammatory mediators

51
Q

inflammatory mediators

A

histamine, leukotienes, prostaglandins, kinins

52
Q

what are Antihistamines

A

H-1 receptor antagonists
-preventative therapy (before reaction)

53
Q

1st generation Formulary of Antihistamines

A

Diphenhydramine
brompheniramine
chlorpheniramine2

54
Q

2nd generation formulary antihistamines

A

loratadine

55
Q

Antihistamines Actions

A

-reduce parasympathetic tone of arterioles
-decrease secretion through anticholinergic activity

56
Q

anticholinergics

A

are more effective but dose required produces systemic adverse affects

57
Q

Ipratropium bromide (atrovent) is also used for

A

nasal spray for rhinorrhea, rhinitis

58
Q

Alpha Adrenoceptor agonists

A

nasal decongestants

59
Q

Alpha adrenoceptor agonists names

A

Epinephrine and oxymetazoline (via nasal aerosols)
Pseudophendrine (PO)
Phenylephrine (PO or nasal)

60
Q

Administration of Alpha-Adrenoceptor agonists

A

aerosol- rapid onset, few systemic affects, rebound nasal congestion
oral- longer duration, increased systemic effects, less. potential for rebound congestion

pharmacology (19 decks)

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