Respiratory Pt. 2 - Exam 4

Question 1

Pseudoephedrine (Sudafed) MOA?

Answer 1

stimulates smooth muscle alpha adrenergic receptors, producing vasoconstriction and reducing nasal congestion (sympathomimetic) - mimics the sympathetic nervous system

Question 2

Pseudoephedrine is the sympathomimetic drug of the ______________ & ___________ chemical classes

Answer 2

phenethylamine

amphetamine

Question 3

Indications to used Pseudoephedrine ?

Answer 3

nasal congestion

Question 4

avoid using Pseudoephedrine during the ___ trimester

Answer 4

1st

caution advised in the 2nd and 3rd trimesters due to possible risk of teratogenicity

Question 5

Serious reactions with Pseudoephedrine ?

Answer 5

Arrhythmias

HTN

Question 6

Common reactions with Pseudoephedrine ?

Answer 6

Insomnia
Urinary Retention
Tachycardia
Tremor

Others: HA, CNS stimulation, Palpitations, Increased BP, Anxiety, Dizziness, Nausea

Question 7

Peds dosing of Pseudoephedrine is based on?

Answer 7

age

Question 8

Never give a child under __ years old any kind of cough or cold product containing decongestants or AH, w/o seeking advice of a HCP - it is bad for the kidneys

Answer 8

2

use nasal saline, honey in water

Question 9

Antihistamines MOA?

Answer 9

decrease histamine-mediated contraction of smooth muscle of the bronchi, intestine, and uterus

Question 10

Antihistamines clinical use?

Answer 10

prevent allergic responses mediated by histamine, such as rhinitis and urticaria

Question 11

First Generation Antihistamines H-1 examples?

Answer 11

Diphenhydramine ( Benadryl)

Chlorpheniramine

Question 12

Second Generation Antihistamines H-2 examples?

Answer 12

Certirizine (Zyrtec)

Desloratadine ( Clarinex)

Question 13

Antihistamines with _______ & _________ see decrease in absorption.

Answer 13

calcium and magnesium

Question 14

Antihistamines pharmacokinetics ?

Answer 14

rapidly absorbed in 15-30 min, 60-70% protein bound, metabolism is minimal, excretion in feces and urine; HF: wide range

Question 15

Antitussives (codiene, dextromethorphan) act on the cough center in the _______ by elevating its threshold for the cough reflex

Answer 15

medulla

Question 16

Clinical uses of Antitussives ?

Answer 16

cough suppression, throat irritation

often combined with benzocaine in thrust lozenges to block the pain from throat irritation when coughing

Question 17

Examples of Antitussives ?

Answer 17

Dextromethorphan (Delays)

Guaifenesin/hydrocodone (Hycotuss, and antitussive/expectorant)

Diphenhydramine/dextromethorphan (Duratuss DM, an antihistamine/antitussive)

Question 18

Antitussives potentiate _____ , as psych medication for bipolar or depression - mood stabilizer) by increasing the risk of toxicity; do not use concurrently

Answer 18

MAOI’s - monoamine oxidase inhibitors

Question 19

_______ & Antitussives potentiate each other; possibility of respiratory distress

Answer 19

alcohol

Question 20

Codeine _________ - pill and liquid form

Answer 20

phosphate

Question 21

Benzonatate - ________ ______ - great for cough and not a narcotic

Answer 21

Tessalon Perles

Question 22

Codeine Phosphate MOA?

Answer 22

binds to various opioid receptors, producing analgesia, sedation and antitussive effects )opioid agonist)

Schedule Drug controlled

Question 23

Codeine Phosphate Black Box warning

Answer 23

death related to ultra-rapid metabolism of codeine to morphine - respiratory depression and death have occurred in children who receive codeine post-tonsillectomy and/or adenoidectomy

Question 24

Antitussives have risks from concomitant use with _______________, ___ ___________

Answer 24

Benzodiazepines, CNS Depressants

Question 25

When codeine is ingested , it is converted to ________ in the liver by CYP2D6

Answer 25

morphine Some people have DNA variations that make this enzyme more active, causing codeine to be converted to morphine faster and more completely than in other people.

Question 26

_____-_____ ____________ are more likely to have higher than normal amounts of morphine in their blood after taking codeine

Answer 26

ultra-rapid metabolizers

Question 27

indications for antitussives ?

Answer 27

cough

Question 28

Codeine/Guaifenesin liquid is a cough suppressant and ___________ combination

Answer 28

expectorant - which work by loosening mucus

Question 29

_____ using antitussives in pregnant and lactation.

Answer 29

avoid

Question 30

Serious reactions when using antitussives ?

Answer 30

respiratory depression CNS depression Others: Hypotension, orthostatic, Bradycardia, Syncope, seizures, bowel obstruction

Question 31

Hydrocodone/ Homatropine trade name is ?

Answer 31

Hycodan

Question 32

Hydrocodone is a ________ cough medicine

Answer 32

narcotic

Question 33

____________ is a drug that works against the narcotic to prevent an overdose of this medication

Answer 33

Homatropine

Question 34

Hycodan (hydrocodone/homatropine) is a ______________ & ________ cough suppressant combination

Answer 34

anticholinergic and narcotic

Question 35

The anticholinergic properties of Hycodan ( hydrocodone/homatropine) work by ?

Answer 35

drying up secretions Homatropine is the anticholinergic

Question 36

The narcotic properties of Hycodan ( hydrocodone/homatropine) work by ?

Answer 36

depressing the cough reflex in the brain

Question 37

Homatropine is an _____________

Answer 37

anticholinergic

Question 38

Homatropine is an anticholinergic medication that is an antagonist at __________ _____________ receptors and thus the PNS.

Answer 38

muscarinic acetylcholine

Question 39

Homatropine is also used in the eyes as a ___________ and as a _________.

Answer 39

cycloplegia and mydriatic

Question 40

Benzonatate (Tessalon Perles) MOA?

Answer 40

anesthetizes respiratory passage, lung, and pleural stretch receptors, reducing cough reflex (ester local anesthetic)

Question 41

A __________, chemically related to other ester local anesthetics such as procaine and tetracaine used in the eye

Answer 41

butyl amine Benzonatate safe because it acts more locally

Question 42

Indications for Benzonatate?

Answer 42

cough

Question 43

Xanthine Derivatives stimulate the ___________ center?

Answer 43

respiratory

Question 44

Xanthine Derivatives such as aminophylline and theophylline interact with ________, ____________, _______ by increasing levels

Answer 44

caffeine, St. Johns wort, ephedra

Question 45

Anticholinergics inhibit muscarinic cholinergic receptors , like ________ or ________ which acts longer and my have ________ effects with other anticholinergics

Answer 45

Tiotropium (Spiriva)

Question 46

Examples of inhaled anti-inflammatory agents?

Answer 46

Leukotriene receptor agonists (LTA) Oxygenase inhibitors Monoclonal ABS Mast Cell Stabilizers (sodium chromoglycates , Leukotriene modifiers)

Question 47

Leukotriene receptor agonists inhibit enzyme responsible for producing inflammatory response to leukotrienes by ________ the leukotriene's receptor that makes __________________ possible

Answer 47

blocking,bronchoconstriction

Question 48

Used in long-term control and prevention of symptoms in mild persistent asthma

Answer 48

Leukotriene receptor agonists

Question 49

____________ are used as a combination therapy with inhaled corticosteroids for moderate persistent asthma

Answer 49

Leukotriene receptor agonists NOT FOR COPD

Question 50

Examples of Leukotriene receptor agonists?

Answer 50

Zafirlukast (Accolate) | Montelukast (Singulair)

Question 51

what must be taken regularly, even during symptom-free periods

Answer 51

Leukotriene receptor agonists must take it every day whether they have active dyspnea or not

Question 52

Zafirlukast (Accolate) and Montelukast (Singulair) need to be taken every single day to build up levels in the body to get ___________ effect

Answer 52

therapeutic

Question 53

Persistent asthma or asthma caused by allergies, cats, grass, pollen and environment type things take singular if __ months or older and ________ if __ years or older

Answer 53

singular if 12 months age and older and | Accolate if 5 years or older

Question 54

Class of Oxygenase inhibitors

Answer 54

mast cell stabilizers

Question 55

Example of oxygenate inhibitors?

Answer 55

Zileturon (Xyflo) 600 mg PO BID

Question 56

MOA of Zileturon (Xyflo)?

Answer 56

inhibits 5-lipoxygenase, interfering w/ leukotriene formation (leukotriene inhibitor)

Question 57

Clinical uses of Zileturon (Xyflo)?

Answer 57

long term control of mild persistent asthma in those older than 12 y.o.

Question 58

Zileturon (Xyflo) is used with ___ in moderate persistent asthma as combination therapy

Answer 58

ICS

Question 59

What do you want to monitor when taking long term oxygenate inhibitors ?

Answer 59

LFT periodically during the first year cause these medications make LFT increase

Question 60

The idea of a "_____ ______" was first proposed by ____ _______ in the 20th century

Answer 60

magic bullet | paul ehrlich

Question 61

"a compound could be made that selectively targeted a disease-causing organism, then a toxin for that organism could be delivered along with the agent of selectivity" who said this?

Answer 61

paul Ehrlich 20th century

Question 62

Monoclonal antibodies bind to ___ receptors on mast cell and eosinophils preventing release of mediators to the allergic response

Answer 62

IgE

Question 63

Clinical uses for Monoclonal antibodies ?

Answer 63

Moderate to persistent asthma especially in those patients reactive to perennial allergens and in whom asthma symptoms are not controlled by ICS

Question 64

Example of Monoclonal antibodies ?

Answer 64

Omalizumab (Xolair) modulator

Question 65

BBW of Monoclonal antibodies ?

Answer 65

Anaphylaxis - 6% risk of reaction when infused with the medicine can occur right away or after many dosages

Question 66

Combination products use ___

Answer 66

ICS

Question 67

Examples of Combination products?

Answer 67

Advair - salmeterol/fluticasone | Combivent - Albuterol/ipratropium

Question 68

There are differences in _______ when using combination products

Answer 68

potency

Question 69

________ is a highly reactive nonmetal and oxidizing agent that readily forms oxides with most elements as well as other compounds

Answer 69

oxygen

Question 70

Oxygen is used to treat emphysema , PNA, CHF and some disorders that cause increased pulmonary artery pressure and any disease that _______ the bodies ability to take up and use _______ oxygen

Answer 70

impairs | gaseous

Question 71

Medical devices for delivery of oxygen:

Answer 71

``` tanks regulators PPD ventilators tents masks nasal canulas oxygen generators (90-95%) ```

Question 72

02 delivery percentages ________ from nasal cannula to nonrebreathers

Answer 72

increases nasal cannula, simple mask, venturi's mask, partial rebreather, nonrebreather 28% ro 60-90%

Question 73

On the venturi mask you can adjust the _______ ______ and you can change the oxygen delivery amount

Answer 73

venturi barrel venturi is a way to start to lean people off oxygen therapy ``` blue 24% white 28% orange 31% yellow 35% red 40& green 60% ```

Question 74

Nebulizer machines are for delivery of ________ they are not delivery machines they are just compressors

Answer 74

aerosols

Question 75

Examples of Durble medical good (DMG)?

Answer 75

nebulizers canes hospital bed

Question 76

CPAP - continuous positive airway pressure is a therapy common treatment for obstructive _____ _____

Answer 76

sleep apnea make sure you used distilled clean water for humidification

Question 77

Helix is what combo?

Answer 77

oxygen and helium

Question 78

what is the benefit of using helix?

Answer 78

this mixture of helium and oxygen generates less resistance than atmospheric air when passing through the airways of the lungs, and thus requires less effort by a patient to breathe in and out of the lungs

Question 79

what is the mixture amount of helix?

Answer 79

O2 - 21% | Helium - 79%

Question 80

what type of oxygenation administration rose is used in critical care and ICU units and used in ARDS?

Answer 80

HeliO2 blender