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89 Cards in this Set

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b agonist used for asthma
albuterol
bitolterol
epinephrine
formoterol
levalbuterol
pirbuterol
salmeterol
terbutaline
short acting b agonist
reserve for trmt of acute exacerbation and prophylazis of EIB
long acting b agonist + inhaled corticosteroids
maintenance trmt of moderate and severe persistent asthma
prophylaxis of EIB
COPD
B agonist therapeutic eff
relieve bronchoconstriction during acute asthma exacerbation
moa b agonist
stimulate b2 rec
activating cyclase ->inc intracellular production of cAMP
inc intracellular cAMP
activation cAMP
dependent protein kinases -> bronchodilation, improve mucociliary clearance and reduced inflam cell mediator release
tremor
gluconeogenesis
insulin secretion
activation of Na,K ATpase
stimulation of b2 rec in skeletal muscle
b1 rec affinity
cardiac eff
inhalation
minimize systemic exposure and adverse rxns
b agonist adv eff
tremor
palpitation
tachy
nervousness
ha
b agonist interaxn
isoproterenol

induce myocardial ischemia, necrosis and arrhy
tachyphylaxis
occur w/ regular use of inhaled or oral b agonist
downregulation
dec in the # of active B rec due to movement of rec fr the cell surface into the cell
paradoxical bronchoconstriction
result in cold freon effect
and use of adjuvants
S isomer of albuterol
potential cause of inc airway hyperresponsiveness
levalbuterol HCL
comprise of the active R enantiomer
b agonist + mao,tca or methyldopa
lead to severe htn
propranolol
bronchospasm
corticosteroids eff
suppress the inflam response and dec airway hyperresponsiveness
corticosteroids moa
bind to glucocorticoid rec on the cytoplasm of cells

activated rec regulates transcription of target genes
corticosteroids reduce inflam via
- inhibition of transcription and release of inflam genes
- inc transcription of anti inflam genes that produce proteins that participate in or suppress the inflam process
corticosteroid clinical eff
-reduced production of inflam mediators
- enhanced b adrenergic rec expression
- dec mucus prodxn
- prevention of endothelial and vascular leakage
systemic corticosteroids
used for rapid response during an exacerbation
characteristics of systemic corticosteroids
- good glucocorticoid activity
- minimal mineralocorticoid activity
- short to intermediate duration of axn
iv corticosteroid
emergency trmt
most frequently used oral corticosteroids
prednisolone
prednisone
inhaled corticosteroids
chronic trmt

ist line therapy for mild to severe persistenet asthma for adults and children
list of inhaled corticosteroids
beclomethasone cfc
beclomethasone hfa
budesonide dpi
flunisolide
fluticasone
triamcinolone
adult trmt of severe exacerbation
prenisone
iv trmt - methylprednisoloone
inpatient trmt of asthma exacerbation in children
prednisone, methylprenisolone
prednisolone
Corticosteroid + hepatic microsomal enzyme inducers (rifampin, barbiturates, hydantoins)
caused enhanced corticosteroid metabolism
reducing efficacy
corticosteroid + estrogens, oral contra, ketoconazole, macrolide abx- ery,clari
decrease corticosteroid clearance
cyclosporine
inc plasma conc of corticosteroids
K depleting diuretics- thiazides, furosemide or K depleting drugs - amphotericin
causes enhanced hypokalemia
dec serum conc of isoniazid and salicylates
corticosteroids
leukotriene modifiers
antiinflamm prop for use for asthma
cellular effects of leukotrienes
- enhanced migration of eosinophils and neutrophils
- inc adhesion of leukocytes
- inc monocyte and neutrophil aggregation
inc capillary permeability and cause smooth muscle contraction
leukotriene
leukotriene rec antagonist
montelukast
zafirlukast
eff of leu rec antagonist
antiinflam
bronchodilator
allow reduction in corticosteroid doses
moa of leu rec antagonist
selective cysteinyl leokotriene 1 (CysLT1)rec antagonist -> prevent leukotrienes from interacting with their rec
zafirlukast admin
children over 12 yrs
Churg-Strauss syndrome
form of eosinophilic vasculitis
assoc with zafirlukast, montelukast and pranlukast
aspirin
inc zafirlukast levels
erythromycin, theo and terfenadine
dec zafirlukast con
inc anticoagulant effect of warfarin and levels of dofetilide
zafirlukast
hepatic enzyme inducers
rifampin
phenobarbital
chewable montelukast
contain aspartame and shld be avoided in pt's with phenylketonuria
zileuton
only lipoxygenase inhibitor
eff of zileuton
antiinflam
bronchodilator
moa of zileuton
prevent the formation of leukotriene

blks 5-lipoxygenase
5 lipoxygenase
enzyme resp for leukotriene formation
zileuton adv eff
HA
abd pain
asthenia
nausea
dyspepsia
myalgia
zileuton + propranolol, terfendadine ,theo
inc conc of zileuton
zileuton + warfarin
anticoagulant eff of warfarin inc
ALT- hepatic enz
elevalted in zileuton therapy
symptoms of liver dysfuntion
right upper quadrant abd pain
flu like sx
fatigue
nausea
lethargy
itching
jaundice
nonsteroidal drugs with anti inflam prop
cromolyn
nedocromil
cromolyn
nedocromil eff
suppress nonspecific airway reactivity
c/n moa
act locally by stabilizing mast cells and thereby inhibiting mast cell degranulation
inflammatory cells
macrophages
eosinophils
neutrophils
monocytes
platelets
not effective during an acute asthma exacerbation
c/n
theophylline
methylxanthine
theo indication
alternative to long acting b agonist in trmt of asthma
theo eff
produce bronchodilation to a lesser extent than b agonist
nonbronchodilator eff
- reduced mucus secretion
- enhanced mucociliary transport
- improved diaphradmatic contractility
- reduced fatigability
theo-induced phosphodiesterase inhibition
results in increased levels of cAMP
theo moa
- alteration of intracellular calcium
- increased binding og cAMP to its binding protein
- adenosine antagonism
- inc circulating catecholamine
- inhibition of production of contractile prostaglandins (PGE2 AND PGF2alpha)
theo max recom dose in children under age of 1
0.2 x (age in weeks) +5= mg/kg/day given in divided doses
theo max recom dose in children 1 and older
16mg/kg/day in divided doses
methylxanthine compds
oxtriphylline
dyphylline
maintenance infusion rate of theo
0.4mg/kg/hr
factors that inc theo clearance (dec levels)
age 1-9 yrs
cbz
pheno
phenytoin
rifampin
fever
food
high protein diet
smoking (mj /tobacco
factors that dec theo clearance
(inc levels)
elderly
premature neonate
term infants < 6 mos
cor pulmonale
chf decompensated
fever/ viral illness
fatty foods
high carbohydrate diet
liver dysfxn
drugs that inc theo levels
allopurinol
nonselective B blkers
ccb
cimetidine
clindamycin
fluroquinolones
influenza virus vac
macrolides
oral contra
ticlid
zafirlukast
fluroquinolones
cipro
grepafloxacin
norfloxacin
prulifloxacin
macrolide
clarithromycin
erythromycin
fatty foods
increase rate of absorption of some prodts
liver dysfxn
cirrhosis
anticholinergics
blk postganglionic muscarinic rec in the airway -> bronchodilation
COPD
response to anticholinergics is most pronounced
Ipratropium br
quarternary amm compd
ipr br indication
combine with b agonist for trmt of severe, acute asthma exacerbation
glycopyrrolate
quarternary amm compd used with b agonist for trmt of sever, acute asthma exacerbations
antihistamines
for coexisting allergic rhinitis
mgso4
iv admin
modest ability to cause bronchodilation
immunotherapy
improve asthma control
mucus
contribute to airway obstruction in asthma
mucolytics
precipitate bronchospasm and shld not be used for trmt of asthma