Respiratory Pharmacology Flashcards
(137 cards)
1
Q
What percentage of oxygen is in the air we breathe in?
A
21%
2
Q
What percentage of carbon dioxide is in the air we breathe in?
A
0.04%
3
Q
What percentage of carbon dioxide is in the air we exhale?
A
4%
4
Q
What percentage of oxygen is in the air we exhale?
A
16%
5
Q
What two functions can respiratory diseases interfere with?
A
Moving air and exchanging gas
6
Q
About how many alveoli are in each lung?
A
450 million
6
Q
What is the surface tension in lungs with surfactant?
A
25 dyn/cm
7
Q
What is the main function of pulmonary surfactant?
A
Decreases surface tension in alveoli
8
Q
What is the normal water surface tension?
A
70 dyn/cm
9
Q
What does surfactant allow alveoli to do during inhalation?
A
Fully expand
10
Q
How does surfactant help during exhalation?
A
Prevents alveolar collapse
11
Q
How does surfactant help prevent pulmonary edema?
A
Prevents fluid buildup in the lungs
12
Q
hat immune role does pulmonary surfactant play?
A
Contributes to immune defense
12
Q
What are examples of acute respiratory diseases?
A
Pneumonia (viral, bacterial, fungal)
12
Q
What are examples of chronic respiratory diseases?
A
Asthma, COPD, Cystic Fibrosis
13
Q
What is the general treatment goal for chronic respiratory diseases?
A
Minimize acute attacks and symptoms
14
Q
Are treatments for chronic respiratory diseases typically curative?
A
No
15
Q
How are drugs typically delivered for chronic respiratory diseases?
A
Systemically or by inhalation
15
Q
What is the most important factor in inhalation delivery effectiveness?
A
Particle size
15
Q
What happens to particles smaller than 0.5 microns?
A
Exhaled without being deposited
15
Q
What happens to particles around 10 microns?
A
Deposited in mouth and throat
15
Q
What particle size range is best for delivery to small airways?
A
1–5 microns
16
Q
What does an MDI (Metered Dose Inhaler) deliver?
A
Aerosolized drug
17
Q
What are the challenges of using an MDI?
A
Requires coordination of activation and inhalation
17
What does a DPI (Dry Powder Inhaler) deliver?
Dry medication
18
How can MDI effectiveness be improved?
Use of a spacer
19
What are the hallmark symptoms of asthma?
Coughing, wheezing, shortness of breath, chest tightness
19
What is a benefit of nebulizers?
No coordination required
19
What is required for proper DPI use?
Rapid deep breath and 5–10 second breath-hold
19
What patient factors influence inhalation therapy success?
Breathing rate, breath-holding ability, coordination
20
What are downsides of nebulizers?
Slower, less efficient, less portable (requires power source)
21
What is the key characteristic of asthma pathogenesis?
Hyperreactivity of airways
22
Name common asthma triggers.
Pollens, drugs, cold air, exercise, stress
23
What causes airway constriction in asthma?
Bronchoconstriction, inflammation, and thick mucus
24
What part of the nervous system causes bronchoconstriction?
Parasympathetic (cholinergic)
24
What part of the nervous system causes bronchodilation?
Sympathetic (adrenergic)
25
What are the two main categories of asthma therapy?
Short-term relievers and long-term controllers
26
What is the role of short-term relievers?
Bronchial dilation during acute attacks
27
What is the role of long-term controllers?
Control airway inflammation
28
What receptor do β-agonists activate in the lungs?
β₂-adrenergic receptors
29
Are β₂-adrenergic receptors excitatory or inhibitory?
Inhibitory
30
What is the mechanism of β-agonists?
Inhibit bronchial smooth muscle contraction
31
What is an example of a short-acting β-agonist (SABA)?
Albuterol
32
What is the onset of action for albuterol?
Within 5 minutes
33
What is the duration of albuterol?
3–4 hours
34
What is an example of a long-acting β-agonist (LABA)?
Salmeterol
35
What is the onset of action for salmeterol?
About 20 minutes
36
What is the duration of salmeterol?
12+ hours
37
Can long-acting β-agonist be used for acute asthma attacks?
No
38
Do β-agonists have anti-inflammatory effects?
No
39
Do β-agonists prevent the late-phase response?
No
40
Do β-agonists decrease airway hyperresponsiveness?
No
41
What receptor do muscarinic antagonists block?
M₃ muscarinic receptors
42
Are M₃ receptors excitatory or inhibitory?
Excitatory
43
What effect do muscarinic antagonists have on the lungs?
Inhibit bronchial contraction
44
What do muscarinic antagonists allow to become more prominent?
Sympathetic (dilating) effect
45
What is an example of a short-acting muscarinic antagonist?
Ipratropium
46
What is an example of a long-acting muscarinic antagonist?
A
Tiotropium
47
How often is tiotropium typically dosed?
Once daily
48
What are two benefits of muscarinic antagonists?
Inhibit bronchial contraction and reduce mucus secretion
49
Are muscarinic antagonists ideal for acute asthma attacks?
No
50
When are muscarinic antagonists preferred?
In patients intolerant to β-agonists
51
What is a common combination therapy with muscarinic antagonists?
Ipratropium + albuterol
52
What is an example of an inhaled corticosteroid?
Fluticasone
53
What receptor do ICS bind to?
Glucocorticoid receptor
54
What is the mechanism of action of ICS?
Regulate gene expression—suppress immune genes, increase anti-inflammatory genes
55
Are ICS effective for acute asthma attacks?
No
56
What is the most effective long-term asthma treatment?
Inhaled corticosteroids
57
What is a common side effect of ICS use?
Increased risk of oral fungal infections
58
What is an example of a leukotriene inhibitor?
Montelukast
59
What receptor type do leukotriene inhibitors block?
G-protein-coupled leukotriene receptors
60
What effects do leukotriene inhibitors have?
Decrease edema, mucus production, and bronchoconstriction
61
Are leukotriene inhibitors as effective as corticosteroids?
No
62
Who are leukotriene inhibitors good for?
Steroid-intolerant patients or those who can't use inhalers
63
What warning did the FDA issue for montelukast in 2020?
Boxed warning for mood and behavior changes, including suicidal thoughts
64
What is an example of an asthma immunotherapy drug?
Omalizumab (Xolair)
65
What does omalizumab target?
IgE
66
How much does omalizumab reduce IgE levels?
By 90%
67
What are the effects of omalizumab on asthma?
Reduces mast cell activation, bronchoconstriction, and inflammation
68
How much can omalizumab reduce hospitalizations?
By 88%
69
What is the black box warning for omalizumab?
Increased cancer risk
70
What is COPD?
An umbrella term for inflammatory lung diseases that obstruct airflow
71
What two major conditions fall under COPD?
Chronic bronchitis and emphysema
72
What is chronic bronchitis?
Inflammation of bronchial tubes
73
What is emphysema?
Loss of alveoli
74
Is COPD more common in men or women?
Women (56% of cases)
75
What is the primary cause of COPD in developed countries?
Smoking
76
What causes COPD in developing countries?
Smoke from cooking and heating fires
77
Name some environmental exposures that can lead to COPD.
Coal dust, asbestos, irritating vapors
78
What genetic condition causes 1% of COPD cases?
Low levels of alpha-1-antitrypsin (A1AT)
79
What is used for intermittent or mild COPD?
Albuterol (short-acting β₂-agonist), ipratropium (short-acting antimuscarinic), or both
80
What is used for persistent COPD?
Salmeterol (long-acting β₂-agonist), tiotropium (long-acting antimuscarinic), or both
81
What is used for severe COPD?
Salmeterol + tiotropium + inhaled corticosteroid + PDE4 inhibitor
82
What is an example of a PDE4 inhibitor?
Roflumilast
83
What enzyme does roflumilast inhibit?
Phosphodiesterase-4
84
When is roflumilast used?
In most severe cases of COPD
85
What is the result of PDE4 inhibition?
Decreases cytokine and chemokine release
86
What are common side effects of roflumilast?
Diarrhea, weight loss, vomiting, abdominal pain, UTI, rhinitis, depression
86
What gene is mutated in cystic fibrosis?
CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)
87
What type of channel is CFTR?
cAMP-regulated ion channel on secretory epithelia
88
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
89
What does CFTR regulate?
Chloride ion transport
90
What happens when salt and water balance is disrupted in CF?
Thick, abnormal mucus
91
What are major lung effects of CF?
Thick mucus, clogged airways, inflammation, infection
92
What digestive system issues are seen in CF?
Malnutrition, GI cancers
93
What pancreatic problems occur in CF?
Diabetes, malnutrition
94
What is Type III CFTR mutation?
Gating defect (protein reaches membrane but doesn’t function)
95
What is the most common CFTR mutation type?
Type II – trafficking defect (protein doesn’t reach membrane)
95
What liver condition occurs in 30% of CF patients?
Liver disease
96
What drugs are used for inflammation in CF?
Bronchodilators (albuterol, ipratropium, inhaled corticosteroids)
97
What drugs are used to treat infections in CF?
Antibiotics
98
What drugs help clear mucus in CF?
Mucolytics – acetylcysteine, Dornase alfa
99
What is the role of potentiators in CF treatment?
Enhance function of CFTR channels at the membrane
100
What is an example of a CFTR potentiator?
Ivacaftor (Kalydeco)
101
Ivacaftor is used for which mutation?
G551D
102
What do CFTR correctors do?
Help the CFTR protein reach the membrane
103
How much does Ivacaftor improve channel function?
8x better
104
What is an example of a mucolytic?
Acetylcysteine
104
What three drugs are in Trikafta?
Elexacaftor, Tezacaftor (correctors), Ivacaftor (potentiator)
105
What is the mechanism of acetylcysteine?
Decreases mucus viscosity by breaking disulfide bonds in mucosal proteins
106
What are side effects of acetylcysteine?
Watery secretions, bronchospasm, nausea, possible airway obstruction
106
How is acetylcysteine administered?
Nebulizer inhalation
107
Should the cough reflex be fully suppressed?
No, it's protective
107
What are common uses of mucolytics?
COPD, cystic fibrosis, pneumonia, post-surgery
108
What is the purpose of antitussives?
Suppress cough
109
What do centrally acting antitussives target?
Brain stem (raise cough threshold)
110
What is a non-narcotic centrally acting antitussive?
Dextromethorphan
111
What is a narcotic centrally acting antitussive?
Codeine
112
What is an example of a peripherally acting antitussive?
Benzonatate
113
What is the mechanism of benzonatate?
Acts on stretch receptors in the respiratory tract
114
What is the FDA warning for benzonatate?
Fatal overdoses if chewed or sucked
115
What condition are surfactants used to treat?
Respiratory Distress Syndrome (RDS) in premature infants
116
Name one synthetic surfactant.
Colfosceril (Exosurf)
117
What medications should asthma patients avoid?
Aspirin and NSAIDs
118
What oral side effect should be monitored in patients using inhaled corticosteroids?
Oral fungal infections
119
What side effect is common with many inhaled respiratory drugs?
Dry mouth
120
Why should nitrous oxide be avoided in COPD patients?
Their oxygen levels are already low
