Wk 1 Obstructive Airway Pharmacology Flashcards
(155 cards)
1
Q
Three subcategories of bronchodilators
A
Beta2 Agonists
Anticholinergics
Xanthine derivatives
2
Q
Three subcategories of anti-inflammatories
A
Leukotriene receptor antagonist (LTRAs)
Inhaled glucocorticoids
Mast cell stabilizers
3
Q
Bronchodilators are used to treat __ respiratory diseases
A
ALL
4
Q
Bronchodilators MOA
A
Relaxes bronchial smooth muscle which causes dilation of bronchi and bronchial airways
5
Q
Beta-adrenergic agonists can be __-__ or __-__.
A
short acting or long acting
6
Q
What is the suffix for beta2-adrenergic agonists (usually)?
A
-erol
7
Q
What type of beta2-adrenergic agonist should be used in an asthma attack?
A
short-acting only
8
Q
What are the short-acting beta2-adrenergic agonist drugs? (2)
A
albuterol and levalbuterol
9
Q
What is the brand name of albuterol?
A
Proventil
10
Q
What is the brand name of levalbuterol?
A
Xopenex
11
Q
Albuterol can be given how?
A
PO or inhalant
12
Q
Levalbuterol can be given how?
A
inhalant
13
Q
All long-acting beta2-adrenergic agonist drugs are __.
A
inhalants
14
Q
What are the two long-acting beta2-adrenergic agonist drugs?
A
salmetrol and formoterol
15
Q
What is the brand name of salmetrol?
A
Servent
16
Q
What is the brand name of formoterol?
A
Foradil
17
Q
Albuterol is inhaled every __ hours.
A
4-6
18
Q
Salmetrol is inhaled every __ hours.
A
12
19
Q
Short-acting beta2-adrenergic agonist drugs are __ drugs.
A
RESCUE
20
Q
Long-acting beta2-adrenergic agonist drugs are __ drugs.
A
preventer
21
Q
Long-acting beta2-adrenergic agonist drugs are give how frequently?
A
12-24 hrs
22
Q
What is the MOA of beta2-adrenergic agonist drugs?
A
Mimics the action of the SNS, fight or flight. Relaxes bronchial smooth muscle which causes dilation of bronchi and bronchial airways by stimulating beta 2 receptors throughout the lungs
23
Q
What do non-specific adrenergic drugs stimulate?
A
beta1, beta2, AND alpha receptors
24
Q
What is an example of a non-specific adrenergic drug?
A
epinephrine
25
What do non-selective beta-adrenergic drugs stimulate?
beta1 and beta2 receptors
26
What is an example of a non-specific adrenergic drug?
metaproterenol
27
Non-selective adrenergic drugs stimulate alpha receptors with =
vasoconstriction
28
Non-selective adrenergic drugs (ex: epinephrine) decrease what?
Edema/swelling in mucous membranes and limits the amount of secretions
29
Non-selective adrenergic drugs (ex: epinephrine) also stimulate which receptor?
beta1 and beta2
30
beta1 and beta2 receptors =
cardiovascular effects
31
What vital sign changes would you see with epinephrine adminstration?
Increased BP and increased HR
32
Epinephrine also decreases __
bronchoconstriction
33
If you give epinephrine for bronchodilation, what do you need to be aware of?
You will see other systemic effects such as increased BP and increased HR
34
Non-selective adrenergic drugs (ex: epinephrine) also stimulates what system?
CNS
35
If you stimulate the CNS, what symptoms might you see?
nervouness/tremors
36
What are beta2-adrenergic agonist drugs indicated for?
prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions
37
What are contraindications for beta2-adrenergic agonist drugs?
uncontrolled hypertension, cardiac dysrhythmias, or a patient at high risk for stroke
38
Beta2-adrenergic agonist drugs can be taken with __ __, but this may diminish effects
beta blockers
39
Avoid use of beta2-adrenergic agonist drugs with what two types of drugs?
MAOIs and sympathomimetics
40
Why should use of beta2-adrenergic agonist drugs be avoided with MAOIs and sympathomimetics?
Because they can cause hypertension
41
Why would diabetics need higher doses of their meds if on Beta2-adrenergic agonist drugs?
beta2-adrenergic agonist drugs can cause a raise in blood sugar
42
Non-selective adrenergic drugs have the most __ __ of adrenergic agonist drugs.
side effects
43
Beta2-adrenergic agonist drugs can cause __ OR __
hypertension or hypotension
44
What can you reverse effects of beta2-adrenergic agonist drugs with?
beta blockers but watch for bronchospasm
45
Most beta2-adrenergic agonist drugs have a very short __ __
half life
46
What are the side effects of beta2-adrenergic drugs?
Insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache
47
Why are beta2-adrenergic drugs almost always given inhaled?
It minimizes the systemic effects
48
What type of inhaler is a MDI?
Metered dose inhaler
49
What type of inhaler is a DPI?
Dry powder inhaler
50
Selective beta2-adrenergic agonist drugs are mostly used in __.
Asthma
51
Selective beta2-adrenergic agonist drugs are given through __ or __
MDI or nebulizer
52
What is the first line of treatment for an acute asthma attack?
beta2-adrenergic agonist drugs through MDI or nebulizer
53
Use of more than 1 cannula of albuterol per month indicates what?
Poor control of asthma and need for initiating anti-inflammatory therapy
54
How many actuations (puffs) per canister of albuterol?
200
55
What is not recommended for use of albuterol?
Regular scheduled daily use
56
Albuterol is often used to prevent __ __ __
Exercise induced asthma
57
__ is not for acute treatments, it's a maintenance drug
Salmeterol
58
How often is salmeterol usually given?
BID inhalation
59
With salmeterol, what is more common in african americans?
Asthma related deaths
60
What are the indications for salmeterol?
Worsening of COPD or severe asthma
61
What is notable about salmeterol?
It's always given with an inhaled corticosteroid, never given alone
62
Anticholinergics work on what type of receptors?
acetylcholine
63
Giving anticholinergics works by...
turning off the cholinergic response (PNS) and turning on the SNS
64
When the SNS is turned on, what happens?
It opens airways, bronchodilation
65
What type of drug is ipratroprium?
Anticholinergic
66
What is the brand name for ipratroprium?
Atrovent
67
What is the indication for ipratroprium?
Prophylaxis and maintenance therapy
68
Ipratroprium is often given in conjunction with __.
albuterol
69
What drug is a combination of ipratroprium and albuterol?
combivent
70
What are the anticholinergic adverse effects?
```
urinary retention
dry throat/mouth
constipation
feeling hot, decreased sweating
tachycardia
blurry vision, dry eyes
sedation, dizziness, confusion, hallucinations
```
71
What is the saying for the adverse anticholinergic effects?
dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter
72
What type of drug is theophylline?
xanthine derivative
73
What type of drug is aminophylline?
xanthine derivative
74
Why are xanthine derivatives used as second line treatment?
Because of the high risk of toxicity and drug-drug interactions
75
What does taking xanthine derivatives feel like?
A caffeine high
76
What are the contraindications for xanthine derivatives?
cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers
77
What can increase side effects for xanthine derivatives?
Caffeine
78
What can decrease absorption for xanthine derivatives?
Smoking
79
Xanthine derivatives have a narrow __ __
therapeutic index
80
What needs to be monitored for a patient taking xanthine derivatives?
serum levels and watch for toxicity
81
How can toxicity be reversed for xanthine derivatives?
Activated charcoal
82
What are some drug interactions with xanthine derivatives?
macrolide antibiotics, allopurinol, cimeidine, quinolones, flu vaccine, oral contraceptives
83
What are leukotrienes?
Inflammatory mediators that cause inflammation, bronchoconstriction, and mucus production
84
What is the MOA of leukotriene receptor antagonists?
LTRAs prevent leukotrienes from attaching to receptors located on immune cells and within the lungs
85
What type of drug is montelukast?
Leukotriene receptor antagonist (LTRA)
86
What type of drug is zafirlukast?
Leukotriene receptor antagonist (LTRA)
87
What is the brand name of montelukast?
Singulair
88
What is the brand name of zafirlukast?
Accolade
89
What type of cell releases leukotrienes during the inflammatory response?
mast cells
90
What route are leukotriene receptor antagonists given?
PO
91
Which leukotriene receptor antagonist (LTRA) can be given to kids over 12 months?
montelukast (Singulair)
92
Which leukotriene receptor antagonist (LTRA) can only be given to children over the age of 5?
zafirlukast (Accolade)
93
Both montelukast and zafirlukast can be __ __ or __.
chewable tablets or granules
94
How long does it take to see improvement in asthmatic conditions after taking a leukotriene receptor antagonist?
about a week
95
What is the indications for leukotriene receptor antagonist (LTRAs) drugs?
Oral prophylaxis, and chronic treatment of asthma in adults and children
96
What else can leukotriene receptor antagonist drugs be given for?
Allergies
97
What are the adverse effects of leukotriene receptor antagonist drugs?
headache, nausea, dizziness, insomnia, diarrhea
98
Montelukast has __ drug-drug interactions
few
99
Zafirlukast has __ drug-drug interactions
several
100
what type of drug is beclomethasone diproprionate?
inhaled corticosteroid
101
What is the brand name for beclomethasone diproprionate?
Beclovent
102
What type of drug is budesonide?
inhaled corticosteroid
103
What is the brand name for budesonide?
Pulmicort Turbuhaler
104
What type of drug is fluticasone?
inhaled corticosteroid
105
What is the brand name for fluticasone?
Flovent
106
What is an example of a PO corticosteroid?
prednisone
107
When would you take a PO corticosteroid?
When having a COPD exacerbation, or asthma
108
When would a patient be put on an inhaled corticosteroid?
Not during an exacerbation, if they are chronically needing the corticosteroid
109
What is the advantage of inhaled corticosteroids versus PO corticosteroids?
You limit the systemic effects and limit the effects primarily to the respiratory system
110
Inhaled corticosteroids can be given via __ or __
Nebulizer or MDI
111
What is the MOA of inhaled corticosteroids?
Reduce inflammation and enhance activity of beta agonists
112
Inhaled corticosteroids are often used in conjunction with __ __.
beta agonists
113
How long does it take to see effects of inhaled corticosteroids with continuous therapy?
Can take several weeks
114
What are inhaled corticosteroids given for?
Prevention of persistent asthma attacks and long-term maintenance of severe COPD
115
For patients with asthma, should they take their inhaled corticosteroid as needed or on a schedule?
Schedule
116
In what order should patients with asthma take their inhaled corticosteroids?
Take bronchodilator first to allow more thorough absorption of the steroids
117
If a patient is on a beta agonist and an inhaled corticosteroid which one should they take first?
beta agonist to bronchodilate
118
What are the adverse effects of inhaled corticosteroids?
Pharyngeal irritation, coughing, dry mouth, oral/fungal infections
119
What is important to teach patients who are on inhaled corticosteroids?
Rinse mouth after use!
120
What two medications can be combined to treat moderate to severe asthma?
Inhaled glucocorticoid and bronchodilators
121
What type of drug is the combination of budesonide and formoterol?
Inhaled glucocorticoid and bronchodilators
122
What is the brand name of the combination drug of budesonide and formoterol?
Symbicort
123
What is another drug that is an inhaled glucocorticoid and bronchodilator combination?
fluticasone and salmeterol
124
What is the brand name for the combo drug of fluticasone and salmeterol?
Advair
125
What is the key teaching for inhaled glucocorticoid and brochodilator combo meds?
These are never for acute asthma attacks
126
What medication should be used for an acute asthma attack?
albuterol
127
How fast does symbicort work?
within minutes
128
How fast does budesonide and formoterol combo take to work?
within minutes
129
How fast does Advair work?
a little longer than Symbicort
130
How fast does fluticason and salmeterol combo take to work?
a little longer than the budesonide and formoterol combo drug
131
What drug is a mast cell stabilizer?
cromolyn
132
What is the brand name for cromolyn?
Intal
133
What is the MOA for mast cell stabilizers?
Stabilizes membranes of mast cells and prevents release of bronchoconstrictive inflammatory substances
134
What are mast cell stabilizers used for?
Prevention of acute asthma attacks
135
When should cromolyn be used?
15-20 minutes before contact with known triggers
136
What are mast cell stabilizers not used for?
Rescue drugs!
137
What type of drug is omalizumab?
Monoclonal antibody anti-asthmatic
138
What is the MOA for monoclonal antibody anti-asthmatics?
Monoclonal antibody which selectively binds to immunoglobulin IgE
139
What is the end effect of monoclonal antibody anti-asthmatics?
Limits release of mediators of allergic response
140
How is omalizumab given
Injection
141
What generation is omalizumab?
The newest generation
142
Omalizumab is an add-on medication. What does this mean?
It's never given by itself
143
What is a big risk for omalizumab?
Anaphylaxis
144
Which drug is specifically for asthma only?
omalizumab
145
What is the brand name for omalizumab?
Xolair
146
What type of drug is roflumilast?
Selective PDE-4 inhibitor
147
What is the MOA of selective PDE-4 inhibitor drugs?
Selectively inhibitors PDE-4 enzyme in the lung cells and has potent anti-inflammatory effects within the lungs
148
What is roflumilast indicated for?
Prevention of COPD exacerbations
149
What does PDE-4 do?
Associated with inflammation
150
PDE-4 inhibitor drugs do not work...
acutely/immediately
151
How is roflumilast given?
PO
152
What do PDE-4 inhibitor drugs work best for?
Chronic bronchitis with a history of exacerbations
153
What are the side effects of roflumilast?
N/V/D, headache, muscle spasms, decreased appetite, tremors
154
What are the long-term control medications that are PREVENTERS for the treatment of asthma (6)
1) Anticholinergics
2) Xanthine derivatives
3) Inhaled corticosteroids
4) Leukotriene modifiers
5) Mast cell stabilizers
6) Long-acting beta agonists
155
What are quick relief medications or rescue medications for the treatment as asthma? (2)
1) Short acting beta agonist
| 2) Albuterol/Proventil
