Respiratory Pharmacology Flashcards Preview

D&T 3 test 2 > Respiratory Pharmacology > Flashcards

Flashcards in Respiratory Pharmacology Deck (95):
1

In asthma, inflammatory cells release what

mast cells
eosinophils
T helper 2 cells

2

what bronchospastic mediators are released in asthma

histamine
leukotriene D4
Prostaglandin D2

3

what test/challenge is used to diagnose asthma

Methacholine

4

what inflammatory cells are increased in COPD

neutrophils
macrophages
cytotoxic T-lymphocytes

5

COPD can cause

progressive fibrosis
emphysema
ariway narrowing
excessive mucus

6

what is a risk factor for COPD

-smoking
- deficiency in alpha1-proteinase inhibitor

7

what is allergic rhinitis and what does it activate

nasal epithelium inflammation
- IgE mediated activation of mast cells, basophils

8

what are important mediators of inflammation that induce symptoms characteristic of allergic rhinitis

histamine
prostaglandins
leukotrienes

9

where do most of the drugs go if they are inhaled

80-90% swallowed

10

Name the drugs that are given orally

Corticosteroids
Adrenergic Agonists
Methylxanthine (theophylline)

11

MOA for adrenergic agnoists

stimulates B2-adrenergic receptors
- increases cAMP
- activates PKA
- induces bronchial smooth muscle cell relaxation

12

when do short-acting B2-adrenergic receptor agonists work

quick relief during asthma attack
- onset 1-5 minutes
-duration of action 4-6 hrs

13

Name3 long acting B2-adrenergic receptor agonists LABA

Salmeterol
Formoterol
Indacaterol

14

which B2-adrenergic receptor agonist for long acting, acts the longest and is it usually used for

Indacaterol
COPD

15

Why does Salmeterol have a longer duration of action than albuterol

Salmeterol has lipophilic side chain

16

Name B2- selective SABA

Albuterol
Terburtaline
Pirbuterol
Metaproterenol

17

what are B2-selective agonists SABA used for

all types of asthma attakcs
- not as effective in COPD

18

How often is B2- receptor selective agonists SABA used

- not to be used several times a day

19

when one overdoses on B2- receptor selective agonist SABA, what more is needed?

need for more anti-inflammatory therapy
( corticosteroids and Leukotriene inhibitor)

20

What can account for the diminshed activity (tolerance) of B2-receptor selective agnoist SABA

B2-recetpor downregulation

21

what are adverse effects of B2-receptor selective agonist SABA

Tremor
restlessness
tachycardia
hypokalemia
- more with oral dose than inhalation

22

Name 2 non-selective SABA

Isoproterenol and Epinephrine

23

MOA for Isoproterenol

nonselective B-agonist and potent bronchodilator

24

MOA for epinephrine

non-selective alpha, beta agonist and potent bronchodilator

25

How is Isoproterenol administered and how is it given to

acute asthma attack
-inhaled and oral

26

What is the law in the US for Isoproterenol

inhalation or sublingual administration is no longer marketed in the US

27

when is epinephrine used and how is it administered

acute asthma attack
- inhaled or subcutaneously - emergency circumstances

28

Name B2- selective agonists LABA

Salmeterol
Formoterol
Indacaterol

29

what is B2- selective agonists LABA used for

control (prophylaxis therapy) persistent asthma
- effective for asthma and COPD

30

when should one not take Salmeterol, Formoterol and Indacaterol

for acute asthma attack

31

what do B2- selective agonists LABA need to be taken with

anti-infammatory therapy ( corticosteroids, leukotriene, inhibitors )

32

Indacaterol can be specifically be used for what

COPD

33

Adverse effects of Salmeterol, Formoterol, and Indacaterol? how can this be helped

- airway tolerance to B2 agonists: potential problem
- Corticosteroids may prevent tolerance by increasing B2 receptor numbers within airway

34

Name 2 muscarinic antagonists

Ipratropium and Tiotropium

35

MOA of Ipratropium and Tiotropium

- reduces ACH -stimulated cyclic GMP
- inhibits mucus secretion

36

what is a popular combination inhaler

Ipratropium and Albuterol

37

Ipratroprium can specially be used for what

nasal discharge from rhinorrhea

38

What are adverse effects of Muscarinic antagonists

unpleasant bitter taste
dryness of mouth
cause glaucoma if sprayed in eye

39

MOA for methylxanthines

bronchodilator and anti-inflammatory activity

40

name a drug of Methylxanthines

Theophylline

41

MOA of Theophylline

-inhibits phosphodisterases
-functions as adenosine-receptor antagonist
-anti-inflammatory
-promotes contraction of diaphragmatic muscles

42

Theophylline is FDA-indicated for what

Asthma and COPD

43

Theophhylline is used as an adjunct with what in chronic severe asthma that are not controlled by what drugs

- inhaled corticosteroids
- solely with corticosteroids and B-receptor agonsits

44

Caffeine (Methylxanthine) used to treat what

apnea in preterm infants

45

what are routes of administration for Theophylline

- intravenous
- tablets
Not inhaled

46

What are adverse effects of theophylline

low therapeutic index
toxicity is dose dependant

47

low level toxicity of theophylline causes

nausea
vomiting
headache
restlessness

48

higher level toxicity of theophylline causes

cardiac arrhythmias and seizers

49

what enzyme increases the clearance of Theophylline

CYP1A2

50

Name corticosteroids

Beclomethasone
Triamicinolone acetate
Budesonide
Fluticasone propionate

51

MOA for corticosteroids

anti-inflammatory agents
- act through glucocorticoid receptor
- increases B2 receptors
- decreases cytokines

52

What is a use for corticosteriods?

inhaled corticosteroids are front-line therapy for persistent asthma
- less effective in COPD (reserved for COPD)

53

What are corticosteroid combination inhalers

Fluticasone/Salmeterol
Budesonide/formoterol

54

how do synergistic interactions between corticosterids and B2-agonists occur

corticosteroids up-regulate B2 receptor expression

55

nasal spray corticosteroid is used for what

allergic rihinits

56

What are adverse effects of Corticosteroids

Dysphonia
cough
oropharyngeal candidiasis

57

Leukotriene inhibitor is FDA indicated for what

asthma
not front-line therapy for asthma

58

name 3 Leukotriene inhibitors

Zafirlukast and Montelukast
Zileuton

59

MOA of Zafirlukast and Montelukast

Antagonize Leukotriene receptor (LT1)
- blocks cysteinyl leukotrienes
- inhibits bronchoconstriction and airway inflammation

60

When are leukotriene inhibitors used

potential alternative to medium-dose inhaled corticosteroids ( if corticosteroids are not tolerated) for prophylaxis of mild persistent asthma

61

what is Montelukast used for

allergic rhinitis

62

what is MOA for Zileuton

inhibits 5-lipooxygenase, (rate-limiting enzyme in leukotriene biosynthesis)

63

what is the dosing for Montelukast, Zafirlukast and Zileuton

Montelukast: once daily
Zafirlukast: twice daily
Zileuton: 4 times daily

64

how are anti-leukotrienes administered

oral

65

how are Montelukast, Zafirlukast and Zileuton metabolized

CYPs

66

what are adverse effects of Anti-leukotrienes

hepatic toxicity

67

drug interaction of Zafirlukast

Warfarin, causes headache

68

which anti-leukotriene does not inhibit hepatic CYPs

Montelukast

69

Name Mast cell stabilizers

Cromolyn and Nedocromil

70

MOA for Cromolyn and Nedocromil

inhibit mast cell degranulation and histamine release

71

Name an anti-IgE therapy

Omalizumab

72

MOA for Omalizumab

humanized monoclonal antibody against IgE.
- inhibits IgE binding to Ige receptors on mast cells

73

when are anti-IgE therapy used

- not font line asthma therapy
- reserved for severe asthma not controlled by corticosteroids

74

what is the dosing for Omalizumab

subcutaneous injection every 2-4 weeks

75

adverse effect of anti-IgE therapy

anaphylaxis

76

What is alpha-1 proteinase inhibitor FDA-indicated for

COPD patients with deficiency in alpha 1 proteinase inhibitor

77

what are the effects of alpha-1 proteinase inhibitor?

inhibits the activity of elastase
-excess elastase destroys lung parenchyma

78

name an opioid found in common cold medications

Hydrocodone and codeine

79

MOA for hydrocodone and codeine

suppresses cough by direct central action in medulla

80

what are opioids used for

high doses used for pain
lower doses used for antitussive effects

81

adverse effects of Hydrocodone and codeine

respiratory depression
constipation
dysphoria

82

what is Benzonatate used for and MOA

- cough
- peripheral action, targets cough receptors of vagal afferent fibers , located in respiratory passages, lungs and pleura

83

adverse effect of Benzonatate

Dizziness

84

what is Expectorant/Guaifenesin used for and adverse effect

- cough
-emetic

85

Name 2 Mucolytics that are used for cough

N-acetylcysteine
Dornase Alpha

86

what is Dornase Alpha FDA-indicated for

adjunct for cystic fibrosis

87

Antihistamines (H1-receptor blockers) are used for what

rhinitis

88

what Antihistamines (H1-receptor blockers) is used as sleep aid (Tylenol PM)

Diphenhydramine

89

what are adverse effects of Antihistamines (H1-receptor blockers)

caution with glaucoma and prostate hypertrophy
CNS effects

90

what are adverse effects of second generation antihistamines

lack significant anticholinergic actions
penetrate poorly into the CNS

91

what is Ipratropium used for

rhinitis

92

Name adrenergic agonists that treat Rhinitis

Oxymetazoline
pseudoephedrine
phenylephrine

93

MOA for oxymetazoline, pseudophedrine, and phenylephrine

Phanylephrine: selective alpha 1 receptor agonist
Oxymetazoline: alpha receptor ( alpha 1 and 2) agonist
Pseudoephedrine ( alpha and beta agonist)

94

Adverse effect of adrenergic agonist

rebound nasal congestion
tachycardia
hypertension

95

who should avoid Oxymetazoline, Pseudophedrine, and Phenylephrine

patients with uncontrolled hypertension or ischemic heart disease