Respiratory Drugs Flashcards
(115 cards)
1
Q
Describe a wide variety of medications mainly used to relieve, treat, or prevent respiratory diseases
A
RESPIRATORY DRUGS
2
Q
Acetaminophen + Doxylamine + Dextromethorphan
A
Nyquil
3
Q
Guaifenesin+Dextromethorphan Hydrobromide
A
Robitussin DM
Vick Pediatric Formula 44
4
Q
Acetaminophen + Chlorpheniramine maleate + Phenylephrine HCl + Dextromethorphan
A
Triaminic DM
5
Q
D-isomer of 3-methoxy-N-methylmorphinan, which is a synthetic analogue of codeine
A
Dextromethorphan
6
Q
L-isomer of 3-methoxy-N-methylmorphinan, which is an opioid analgesic
A
Levorphanol
7
Q
has no apparent analgesic or addictive properties and produces relatively mild opioid effects in overdose
A
Dextromethorphan
8
Q
Dextromethorphan is well-absorbed orally, and effects are apparent within _______
A
15-30 minutes.
9
Q
Dextromethorphan duration of action
A
3-6 hours
10
Q
3 glutamate receptors
A
NMDA, AMPA, Kainate
11
Q
major/primary excitatory neurotransmitter
A
Glutamate
12
Q
major inhibitory neurotransmitter
A
Glycine
13
Q
function of NMDA
A
Controls synaptic plasticity
14
Q
T/F: Dextromethorphan has anti-cholinergic properties.
A
TRUE
15
Q
What are the anticholinergic properties?
A
Dry mouth, constipation, urinary retention, bowel obstruction
16
Q
inhibits reuptake of serotonin and may lead to the serotonin syndrome in patients taking MAOi
A
Dextromethorphan
17
Q
Metabolizes or degrades the catecholamines
A
Monoamine Oxidase
18
Q
MAOi drugs (PITS)
A
● Isocarboxazid (Marplan)
● Phenelzine (Nardil)
● Selegiline (Emsam)
● Tranylcypromine (Parnate)
19
Q
BN of Isocarboxacid
A
Marplan
20
Q
BN of Phenelzine
A
Nardil
21
Q
BN of Selegiline
A
Emsam
22
Q
BN of Tranylcypromine
A
Parnate
23
Q
Toxic dose of Dextromethorphan
A
> 10 mg/kg
24
Q
Usual recommended ADULT daily dose of dextromethorphan is ______
A
60-120 mg/d
25
Usual recommended daily dose of dextromethorphan in CHILDREN AGE 2-5 years old
30 mg/d
26
Mild intoxication of Dextromethorphan produces
•Clumsiness
•Ataxia
•Nystagmus
•Restlessness
•Visual and auditory hallucinations
27
Has no apparent analgesic or addictive properties and produces relatively mild opioid effects in overdose.
Dextromethorphan
28
With Dextromethorphan severe poisoning:
–Stupor
–Coma
–Respiratory depression
–Pupils may be dilated or constricted
–Seizures
29
Co-ingestion of dextromethorphan with alcohol leads to
Respiratory depression
30
Seizures are reported after ingestions of how many mg of dextromethorphan?
20-30 mg/kg
31
Dextromethorphan with therapeutic doses taking MAOI
–Severe hyperthermia
–Muscle rigidity
–Hypertension
–Related to serotonin syndrome
32
Antidote for dextromethorphan toxicity
Naloxone, 0.06-0.4 mg
33
If the patient exhibits signs of opioid intoxication, administer
0.4-2 mg naloxone IV
34
widely used as an appetite suppressant
Phenylpropanolamine (PPA)
35
Banned in most countries and warnings are raised by the FDA because of having increased risk of stroke.
Phenylpropanolamine (PPA)
36
Direct alpha-adrenergic agonists
PPA and phenylephrine
37
produces mild β1-adrenergic stimulation and acts in part indirectly by enhancing norepinephrine release
PPA
38
Have both direct and indirect alpha- and beta-adrnergic activity
Ephedrine and pseudoephedrine
39
Ephedrine and pseudoephedrine produce more ____________ stimulation than PPA or phenylephrine
beta-adrenergic
40
Toxicity often occurs after PPA ingestion of just
2-3 times the therapeutic dose
41
slightly less toxic, with symptoms occurring after 45 times the usual therapeutic dose.
Pseudoephedrine
42
Clinical presentation of PPA & related decongestants toxicity
Hypertension
Headache
Confusion
Seizures
Intracranial hemorrhage
Bradycardia or AV block
Myocardial infarction
43
major toxic effect of PPA and other decongestants
Hypertension
44
Hypertension caused by PPA and other decongestants is treated with
Phentolamine (alpha-adrenergic antagonist) or Nitroprusside (vasodilator)
45
Treat hypertension if the diastolic pressure is higher than ________
100-105 mmHG
46
Arrhythmia caused by PPA and other decongestants is treated with
Propranolol (non-selective beta blocker) or Esmolol (ultrashort acting B1 blocker)
47
may be useful for initial treatment
Ipecac-induced emesis
48
may enhance the elimination of PPA, ephedrine, and pseudoephedrine
Urinary acidification
49
Urinary acidification may also aggravate myoglobin deposition in the kidney if the patient has ___________
rhabdomyolysis
50
the result from the death of muscle fibers and release of their contents into the bloodstream
rhabdomyolysis
51
Theophylline IUPAC name
1-3-dimethylxanthine
52
Caffeine IUPAC name
1,3,7-trimethylxanthine
53
Theobromine IUPAC name
3,7-dimethylxanthine
54
widely used for the treatment of asthma (and for COPD)
Methylxanthine
55
used to treat bronchospasm, congestive heart failure, and neonatal apnea
IV infusions of aminophylline
56
Commonly used orally in sustained-release preparations
Theo-Dur, Slo-phyllin, Theobid
57
Mechanism of toxicity of Theophylline
Inhibit phosphodiesterase at high levels, increasing cAMP
Stimulate beta-adrenergic receptors
Release endogenous catecholamines
An antagonist of adenosine receptors
58
antagonist of adenosine receptors
Theophylline
59
How many tablets of theophylline may cause toxic effects?
20-30 tablets
60
Acute single dose of 8-10 mg/kg will produce a therapeutic level of __________
15-20 mg/L
61
Acute oral overdose of more than 50 mg/kg may potentially result in a level _____________
above 100 mg/L
62
Therapeutic dose of theophylline
10-20 mg/L
63
Dose of theophylline used for bronchodilation only
5-10 mg/L
64
Acute single overdose of theophylline
–Tremor, Anxiety
–Tachycradia
–Hypokalemia, Hypophosphatemia
–Hyperglycemia
–Metabolic acidosis
–Ventricular arrhythmias
–Status epilepticus, seizures (serum levels > 100 mg/L)
65
Chronic intoxication of theophylline
–Vomiting is common
–Tachycardia
–Hypokalemia
–Hyperglycemia
–Hypotension (rare)
–Seizures (serum levels, 40-60 mg/L….)
66
T/F: Theophylline-induced seizures are resistant to most anti-seizure drugs
TRUE
67
Acute single overdose of theophylline causes seizure if the serum level is _______
>100 mg/L
68
Chronic intoxication of theophylline causes seizure if the serum level is _______
40-60 mg/L
69
Theophylline antidote
● Propanolol, 0.01-0.03 mg/kg IV
● Esmolol, 25-50 µg/kg/min
70
Use beta blockers cautiously in patients with a prior history of ____________
asthma or wheezing
71
First line in the tx of acute exacerbation of BA primary reliever medication
Short acting rapid onset
● Salbutamol
● Terbutaline
● Metaproterenol
72
Primary reliever medication
Short acting rapid onset
● Salbutamol
● Terbutaline
● Metaproterenol
73
Short acting rapid onset
● Salbutamol
● Terbutaline
● Metaproterenol
74
prophylactic agent (acute attacks)
for controlling nocturnal attacks
Long acting slow onset (Salmeterol)
75
Usually given through inhalation
Long acting with rapid onset (Formoterol)
76
Long acting with rapid onset
Formoterol
77
Long acting slow onset
Salmeterol
78
reserved for special situations (cardiac stimulation)
Bronchodilators – Non-selective
79
For severe asthma
Terbutaline
80
Epinephrine dose when inhaled
320g per puff
81
Epinephrine mechanisms
● activates alpha1→ vasoconstriction
● activates beta1→ increases the heart rate
● activates beta2→ increases the bronchodilation
82
Lower potency than epinephrine and isoproterenol.
Ephedrine
83
Stimulates adrenergic receptors by increasing the activity of norepinephrine
Ephedrine
84
Isoproterenol other name
isoprenaline
85
Isopropylamine analogue of epinephrine
Isoproterenol
86
Isoproterenol dose if inhaled
80–120 g
87
Common adr of isoproterenol
Tachycardia
88
prototype of anti-cholinergic
Atropine
89
competitively block the muscarinic receptors that prevent the binding of acetylcholine, thus blocking the contraction of the airway smooth muscle
Anticholinergic/Antimuscarinic
90
•more useful in COPD than in asthma
•has a better safety profile compared to β2 agonists
Anticholinergic/Antimuscarinic
91
Quaternary ammonium derivative of atropine
Ipratropium bromide (Atrovent)
92
Longer-acting selective anti-muscarinic agent
Tiotropium (Spiriva)
93
stabilizes the membrane of the mast cells by increasing inward conduction of membrane to chloride ions, thus inhibiting cellular activation
Mast cell stabilizers
94
Adr of mast cell stabilizers when given alone
Bronchospasm
95
Preadministration of ________ is needed to prevent bronchospasm
B2 agonist
96
Prophylaxis of exercised induced asthma
Cromolyn sodium
97
Also used in allergic rhinoconjunctivitis
Cromolyn sodium
98
are not for acute attacks or during the attack, only as prophylaxis
Mast cell stabilizers
99
inhibits 5 lipoxygenase, thereby preventing leukotriene synthesis
Zileuton (Zyflo)
100
Adr of Lipoxygenase inhibitor
Hepatotoxicity
101
prevents the binding of LTD4 and C4 to cysteinyl leukotriene 1 (CysLT1) receptor, thus inhibiting its effects on airways
Montelukast (Singulair) & Zafirlukast (Accolate)
102
used when leukotriene is released
Leukotriene receptor blockers
103
Adr of Leukotriene receptor blockers
Churg Strauss Syndrome
104
disorder marked by blood vessel inflammation
Churg Strauss Syndrome
105
acts as an anti-inflammatory agent by inhibiting phospholipase A2
Corticosteroids
106
the most effective way to decrease the systemic adverse effects of corticosteroid therapy
Aerosol treatment
107
helps in the production of Arachidonic acid that will be acted on by the COX enzymes
Phospholipase A2
108
Inhaled topical corticosteroids can cause
Oropharyngeal candidiasis
109
Beclomethasone average daily dose is
4 puffs twice a day
110
Beclomethasone: Average daily dose of 4 puffs twice a day is equivalent _____________ of oral prednisone for controlling asthma.
10-15 mg/day
111
Antagonize NMDA Receptor → anti-cholinergic activity
Dextromethorphan
112
Poisoned with DM then exhibits opioid intoxication
Give 0.4-2 mg IV of Naloxone.
113
ADR of Isoproterenol
Tachycardia
114
Dextromethorphan is the d-isomer of
3-methoxy-N-methylmorphinan
115
Oropharyngeal candidiasis management
Gargle water and spit after each inhaled treatment.
