Test 2 Pharm Flashcards
(29 cards)
List of SABAs, indication, ADE, warnings
Albuterol, levalbuterol (Xopenex), pirbuterol (Maxair), Terbutaline, Metaproterenol (ALP TM)
Asthma, COPD, bronchoconstriction, hyperkalemia
ADE: tachy, tremor, n/v, h/a, hypokalemia, insomnia, palpitations, PARADOXICAL bronchospasm, arrhythmias, angioedema, ^LFTs
Warning: hepatic metabolism, kidney elimination; preg/lactation: MAY USE DURING PREGNANCY & LACTATION (may cause agitation in child)
LABA names, Indication, ADE, Warnings (BBW)
Sameterol, Formoterol, Indacaterol, Olodaterol, Vilanerol
Asthma, COPD
*Should not be used for quick relief
ADE: same as SABA, but also METABOLIC ACIDOSIS (even though can cause hypokalemia)
Warning: BBW: MUST BE COMBINED w/ICS in ASTHMA, small but sig increase in asthma related death
Cholinergic/Muscarinic antagonist (anticholinergic)
Action, indication, ADE, warnings
Can it be used in preg/lac?
Ipratropium (atrovent) = short acting
tiotropium (Spiriva) = long acting (daily dose inc adherence)
Act on post ganglionic receptors in ANS > blocking this receptor promotes bronchodilation
Uses: Asthma (limited use), COPD (FIRST LINE)
- generally less effective than B2 agonists
- less effective in the elderly
ADE: think SNS activation (dizzy, h/a, palpitations, paradoxical bronchospasm, tachycardia); think suppression of parasympathetic (dry mouth, urinary retention, constipation, worsening narrow-angle glaucoma)
Others: URI s/s, cough, fatigue, anaphylaxis, urticarial rash
Caution in Myasthenia gravis, glaucoma, BPH, bladder neck obstruction
CAN BE USED IN PREGNANCY & LACTATION
Methylxanthine drug class List of drugs, MOA, ADE, warnings
Theophylline, theobromine, caffeine
Exact MOA unknown - ^cAMP, antagonizes adenosine receptors causing bronchodilation & suppression of airway response to stimuli
Was mainstay for asthma, but not really anymore
ADE: seizures, fatal arrhythmias, SIADH, hypotension, hematemesis
*serum monitoring levels needed d/t narrow therapeutic index
Caution: in PUD, gastritis, MI, seizures, liver disease
Preg & lactation: caution advised, no known teratogenicity
Corticosteroids Indications - drug of choice for? ADE Warnings How to use meter dose vs dry powder?
Indications: drug of choice in pts with any degree of persistent asthma
No other medications are as effective as ICS in the long
term control of asthma in children & adults
*must be taken continuously to be effective
*can take days to weeks/months for it to be effective
ADE: dysphonia (hoarseness), oropharyngeal candidiasis, cough, bronchospasm, rhinitis, adrenal suppression, growth suppression in kids, immunosuppression, osteoporosis, fractures, glaucoma/cataracts, bruising, electrolyte imbalances, acne, personality changes, psychosis
*RINSE & SPIT AFTER USING
Meter dose: SLOW AND DEEP
Dry powder: QUICK AND DEEP
Leukotriene Antagonists
List, MOA, indications, ADE, warnings
Zileuton (Zyflo), Zafirlukast (Accolate), Montelukast (Singulair)
Antagonizes the action of leukotriene receptors on airway smooth muscle and vascular endothelium
*NOT a rescue medication
Indications: moderate to severe allergic asthma, EIB (exercise induced bronchospasm), allergic rhinitis
ADE: URI s/s, h/a, cough, otitis, rash, anxiety, tremor, rhinitis, GI s/s in peds, agitation, anxiety, suicidality
Singular: can be used in 1 yr and older; caution advised in pregnancy (no known teratogenicity), can use while breast feeding
Mast Cell Stabilizers
Name, indications, ADE, extra
Cromolyn sodium (Nasalcrom) nasal spray
symptomatic prevention & tx of allergic rhinitis
ADE: sneezing, nasal burning, epistaxis, bad taste, bronchospasm
approved for 2yrs+; can use in pregnancy
Antihistamines (H1 receptor blockers)
Names, MOA, indications, ADE, CAUTIONS
1st gen: benadryl, doxylamine, dramamine
2nd gen: claritin, zyrtec, allegra
Anticholinergic effect: inhibits nasal, salivary & lacrimal gland hypersecretion
Antagonizes ^ capillary permeability, urticarial formation, & pruritis
*when pseudoephedrine is added avoid in 1st trimester
Indications: allergic & seasonal rhinitis, tx & prevention of allergic reactions; 1st generation has antiemetic & motion sickness prevention effects
ADE: drowsiness, dry mouth, difficulty voiding, constipation, n/v
1st gen: nonselective lipid soluble and cross BBB
2nd gen: peripherally selective and have little to no CNS or autonomic nervous system effects
- CAUTION: w/2nd generation AVOID juices (grapefruit, apple, or orange) may decrease bioavailability
- can use antihistamines during pregnancy
Decongestants
Drug names, MOA, indications, ADE, warnings
Pseudoephedrine, phenylephrine
vasoconstriction - can reduce tissue edema & promote drainage of secretions; can decrease eustachian tube congestion relieving pressure
combination of caffeine and pseudoephedrine IS NOT SAFE
ADE: burning, stinging, sneezing, dryness of nasal mucosa, arrhythmia, angina, severe HTN, tachycardia, palpitations, h/a, dizziness, anxiety, tremor
Topical agents have little or no systemic absorption and a rapid onset (nasal spray) AVOID in HTN pts
Pregnancy: avoid in 1st trimester then caution
Can be used during lactation
Antitussives
Suppresses cough centrally or peripherally
Opiate MOA: acts on opioid receptors in medullary cough center
Opiate derivatives most commonly used: codeine & dextromethorphan
Indicated for cough
ADE: can cause retaining/pooling of secretions in lungs, and increased r/f infection
Pregnancy: risk vs benefit; lactation: not recommended
Codeine vs dextromethorphan
codeine = narcotic anti-tussive
-gold standard for cough suppression
-decreases activity of CNS cough centers in medulla
-may have add’l action on cough receptors in prox airways
-decrease mucosal secretion
-therapeutic effect at doses lower than analgesic dose
-often combined w/guaifenesin
-possibly teratogenic
-no lactation
BBW: cough suppressant or pain reliever < 12 yrs
-ultra-rapid CYP2D6 metabolizers = respiratory depression & death
-limit use in children 12-18 & breastfeeding mothers
dextromethorphan:
non-narcotic anti-tussive
-suppresses central cough receptors
-questionable efficacy
-no analgesic effect, but there is abuse potential
-lg doses: euphoria, hallucinations, seizure, death
-can cause histamine release - caution in atopic children
-ADE: less than codeine, sedation, dizziness, nausea, abd pain, rash
-may use in pregnancy and lactation: no indication of harm
expectorants
Guaifenesin: only ingredient recognized as effective by FDA •Lack of evidence for efficacy... •Decreases adhesiveness & surface tension of mucous - thinning secretions for improved clearance w/ cough, also promotes ciliary action • Doses: 100mg/5ml syrups (Robitussin) to 600mg sustained release (Mucinex) capsules
major classes of immunosuppressive drugs
glucocorticoids, calcineurin inhibitors, anti-proliferative/anti-metabolic agents, biologicals (antibodies)
glucocorticoids
prednisone
decreases inflammation via suppression of the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It also suppresses the immune system by reducing the activity and the volume of the immune system
- take w/food to reduce GI upset
- take in AM
- take consistently - relative to food and antacids = helps to reduce variability in blood levels
immunosuppressive calcineurin inhibitors
cyclosporine
- avoid grapefruit juice
- avoid St. John’s wart and never take herbal’s w/o approval
- increased tox w/statins
- caution w/NSAIDs (kidney issues)
- interacts w/antifungals -azoles
Cyclosporine – Adverse Effects •CNS: •HA, tremors, tingling, confusion •Renal: •Renal insufficiency, hypomagnesemia •increased uric acid levels → gout •GI / Oral: •N & V, diarrhea, anorexia, gingival hyperplasia •CV: •HTN, HLD, flushing •Endocrine / Liver: •hyperglycemia, hirsutism / ↑LFTs •Skin: •acne
tacrolimus - used to tx atopic dermatitis, eczema; can also be used in transplant
Anti-proliferative & anti-metabolic
Anti-Proliferative &Anti-metabolic Drugs
•Sirolimus(rapamycin; RAPAMUNE)
•
produced by Streptomyces hygroscopicus.
•Mechanism of Action
•Sirolimus inhibits T-lymphocyte activation, IL-2
and other T-cell growth factor receptors
•Inhibits transplant rejection, graft-versus-host
disease, and other auto-immune diseases
•Effect lasts several months after discontinuing Tx
Sirolimus
•
Sometimes used to avoid the nephrotoxicity associated
with calcineurin inhibitors
•
Extensively metabolized in liver
•7 major metabolites – majority of excretion in feces
•Oral administration- rapidly absorbed
•
Reaches peak blood concentration within 1 hour
•
High-fat meal ↓peak blood concentration by 34%;
•Should be taken consistently- w/ or w/o food
•cyclosporine and sirolimus interact-
•
Separate administration by time
Sirolimus: Clinical Uses
•Prophylaxis of organ rejection - usually in combination
w/ reduced dose of calcineurin inhibitor and
glucocorticoids
•Dosing regimens can be complex
•Dose reduced by about 1/3 in hepatic impairment
•Sirolimus also incorporated into stents to inhibit local
cell proliferation and blood vessel occlusion
Sirolimus: ADE
•
Adverse effects:
•
anemia, leukopenia, thrombocytopenia, mouth ulcer,
hypokalemia, proteinuria, GI effects, delayed wound healing
•
↑risk of neoplasms, especially lymphomas, and infections
•
Not recommended in liver and lung transplants
•
due to the risk of hepatic artery thrombosis and bronchial anastomotic dehiscence
•
Toxicity:use in renal transplant pts associated w/ dose-dependent
increase in serum cholesterol and triglycerides that may require
treatmentSirolimus: ADE
•
Adverse effects:
•
anemia, leukopenia, thrombocytopenia, mouth ulcer,
hypokalemia, proteinuria, GI effects, delayed wound healing
•
↑risk of neoplasms, especially lymphomas, and infections
•
Not recommended in liver and lung transplants
•
due to the risk of hepatic artery thrombosis and bronchial anastomotic dehiscence
•
Toxicity:use in renal transplant pts associated w/ dose-dependent
increase in serum cholesterol and triglycerides that may require
conventional DMARD - anti-neoplastic
Methotrexate
•Folic Acid antagonist – Anti-inflammatory and
immunosuppressive properties
•ASA and NSAIDS slow rate of excretion and increase risk of
severe marrow depression and GI toxicity
•Immunosuppression – monitor for infection
•Adverse Effects:
•hair loss, nausea, oral ulcers, bone marrow suppression,
hepatotoxicity, lung disease
•Contraindicated with renal disease
•Teratogenic: embryo toxicity, abortion, fertility
impairment
chemotherapy agent that causes cardiotoxicity
doxorubicin
chemo drug that causes pulmonary fibrosis
bleomycin
how to use metered dose inhaler
slow and deep, use a spacer
dry power inhaler use how?
quick and deep
treatment for mild intermittent asthma; also use for ALL types of asthma when needed
SABA
first line for persistent asthma (any degree)
for need of even better control use what?
ICS
LABA for better control, but MUST COMBINE w/ICS (symbicort - budesonide/formoterol)
COPD group: Gold 1/a severity and what medication?
MILD
low symptom severity, low exacerbation risk
*use bronchodilator (LABA, SABA)
