Etp Respiratory Pharm

Front 1

What is asthma?

Back 1

Chronic disease of the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus often in response to one or more triggers. Asthma is a reversible condition.

Front 2

What is chronic obstructive pulmonary disease (COPD)?

Back 2

Disease characterized by the presence of progressive airflow obstruction. COPD is non-reversible.

Front 3

What are the two main categories of medications for treating respiratory conditions?

Back 3

1) Bronchodilators
2) Anti-inflammatory agents

Front 4

What are bronchodilators used for?

Back 4

Acute response

Front 5

What is the MOA for bronchodilators?

Back 5

Act on beta 2 receptors in the lungs to increase cAMP concentration within bronchial smooth muscle. The result is relaxation of airway smooth muscle (bronchodilation).

Front 6

What are anti-inflammatory agents used for?

Back 6

Preventative and maintenance use

Front 7

What is the MOA for anti-inflammatory agents?

Back 7

Decrease production and release of inflammatory mediators

Front 8

What are the different bronchodilator drugs?

Back 8

1) Beta2-adrenergic receptor agonists
2) Methylxanthines
3) Anticholinergic agents

Front 9

What are the different anti-inflammatory agents?

Back 9

1) Corticosteroids
2) Mast cell stabilizers
3) Leukotriene modifiers

Front 10

How do Beta 2-adrenergic receptor agonists affect the lungs?

Back 10

Receptor: Beta 2
Physiologic response: Relaxation of smooth muscle

Front 11

How do Beta 2-adrenergic receptor agonists affect the heart?

Back 11

Receptor: Beta 1 and Beta 2
Physiologic Response: Increase heart rate

Front 12

What are the four important Beta 2-adrenergic receptor agonists?

Back 12

1) Epinephrine (Adrenalin, Primatene)
2) Albuterol (Proventil, Ventolin)
3) Levalbuterol (Xopenex)
4) Salmeterol (Serevent)

Front 13

What is the therapeutic effect of Beta 2-adrenergic receptor agonists?

Back 13

Relaxation of airway smooth muscle --> bronchodilation

Front 14

What is the onset and duration of short-acting beta 2-adrenergic receptor agonists?

Back 14

Onset: 5 minutes
Duration: 3 to 8 hours

Front 15

What is an example of a short-acting beta 2-adrenergic receptor agonist?

Back 15

Albuterol

Front 16

What is the onset and duration of action for long acting beta 2-adrenergic receptor agonists?

Back 16

Onset: 20 minutes
Duration: 12 hours

Front 17

What is an example of a long acting beta 2-adrenergic receptor agonist?

Back 17

Salmeterol

Front 18

What are short acting beta 2-adrenergic receptor agonists used for?

Back 18

Acute symptoms when relief is needed immediately

Front 19

What are long acting beta 2-adrenergic receptor agonists used for?

Back 19

Maintenance of symptoms

Front 20

What is the difference between non-selective and selective beta 2-adrenergic receptor agonists?

Back 20

Non-selective agents act on both beta 1 and beta 2 receptors. Selective agents act only on beta 2 receptors.

Front 21

What is an example of a non-selective beta 2-adrenergic receptor agonist?

Back 21

Epinephrine

Front 22

What is the risk of using epinephrine?

Back 22

Epinephrine has an increased level of side effects because it can act on the heart to increase heart rate.

Front 23

What are some examples of selective beta 2-adrenergic receptor agonists?

Back 23

1) Albuterol
2) Salmeterol

Front 24

What happens when a dose of albuterol or salmeterol is too high?

Back 24

The drug becomes non-selective (i.e., it acts on both beta 1 and beta 2 receptors)

Front 25

What is the key advantage of using beta 2 selective receptor agonists?

Back 25

Minimize side effects

Front 26

What are the different inhaled forms of beta 2-adrenergic receptor agonists?

Back 26

1) Nebulizer
2) Metered Dose Inhaler (MDI)
3) Dry powder

Front 27

What is the benefit of inhaled beta 2-adrenergic receptor agonists?

Back 27

Allows for direct administration at the site of action

Front 28

How much of an inhaled drug is absorbed from the lung into circulation?

Back 28

Approximately 10%

Front 29

How would one use a MDI?

Back 29

1) Shake well before each use
2) Breathe out fully through the mouth
3) While breathing in deeply and slowly through the mouth, fully depress the top of the metal canister
4) Hold breath as long as possible (10 seconds)
5) Wait 1 minute before any additional puffs

Front 30

When would a spacer be used in the use of an MDI?

Back 30

For patients who lack coordination, such as children.

Front 31

What is an example of a MDI?

Back 31

Albuterol

Front 32

How do you use a dry powder inhaler?

Back 32

1) Open DISKUS
2) Activate dose: slide the lever away from you as far as it will go until it clicks
3) Exhale fully while holding the DISKUS level and away from your mouth
4) Breathe in quickly and deeply through the DISKUS through the mouth
5) Hold breath for 10 seconds, or for as long as is comfortable
6) Exhale slowly
7) The dose indicator on the top of the DISKUS tells you how many doses are left

Front 33

What is an example of a dry powder inhaler?

Back 33

Salmeterol

Front 34

What is the result of oral and subQ administration of beta 2-adrenergic receptor agonists?

Back 34

Increased risk of adverse effects

Front 35

Why does the oral form of albuterol have increased risk of adverse effects?

Back 35

The oral drug works systemically thereby making the drug non-selective.

Front 36

What are some adverse effects of beta 2-adrenergic receptor agonists?

Back 36

1) Tachycardia
*more often via oral route
2) Decreased serum K+ levels --> risk of arrythmias
3) Tremor
4) Tolerance
*To counter tolerance, withdraw or add on other meds

Front 37

What are some significant drug interactions with beta 2-adrenergic receptor agonists?

Back 37

1) Adrenergic medications
*For example, caffeine. Additive effect leads to increased heart rate
2) Beta 2-blockers

Front 38

What is some patient teaching for beta 2-adrenergic agonist receptors?

Back 38

1) Advise patient to use the minimal amount needed
2) Teach patients to use drugs for exercise-induced asthma before exercise

Front 39

What are the methylxanthine drugs?

Back 39

1) Aminophylline (Truphylline)
2) Theophylline (Slo-Bid, Theo-Dur)

Aminophylline used less than theophylline

Front 40

What is the MOA for methylxanthines?

Back 40

Inhibits phosphodiesterase --> increases cAMP

Front 41

What is the therapeutic effect of methylxanthines?

Back 41

Relaxation of airway smooth muscle --> bronchodilation

Front 42

How is theophylline administered?

Back 42

Oral preparations
*Oral dosage forms are NOT interchangeable on a mg to mg basis.

Front 43

What is important to note with respect to theophylline?

Back 43

Small therapeutic index

Front 44

How is aminophylline administered?

Back 44

Intravenously

Front 45

Where are methylxanthines metabolized?

Back 45

90% metabolized by the liver

Front 46

How should the maintenance dose of a methylxanthine be adjusted in the setting of a CYP inducer?

Back 46

Increase maintenance dose

Examples of CYP inducers: smoking, antiepileptics

Front 47

How should the maintenance dose of a methylxanthine be adjusted in the settig of a CYP inhibitor?

Back 47

Decrease maintenance dose

Examples of CYP inhibitors:some antimicrobials and antifungals

Front 48

What are some adverse effects of methylxanthines?

Back 48

Mostly observed when serum concentrations >20 mcg/ml
1) Nausea
2) Vomiting
3) Tremor
4) Headache
5) Arrythmias
6) Seizures

Front 49

How should you adminster methylxanthines?

Back 49

Administer oral drug with food or milk

Front 50

What should you monitor the patient for before administering a methylxanthine?

Back 50

Respirations and adventitious sounds

Front 51

What is the MOA for anticholinergic agents?

Back 51

Competes with ACh at the muscarinic receptor site causing decreased vagal tone to the airway --> bronchodilation

Front 52

What is the therapeutic effect of anticholinergic agents?

Back 52

Inhibition of bronchospasm mediated by the parasympathetic nervous system

Front 53

What are the two anticholinergic agents?

Back 53

1) Ipratropium (Atrovent)
2) Tiotropium (Spiriva)

Front 54

How are anticholinergic agents administered?

Back 54

Administered via inhalation only

Front 55

How long does ipratropium (Atrovent) act?

Back 55

Short acting
Duration: 3 to 4 hours

Front 56

How long does tiotropium (Spiriva) act?

Back 56

Long acting
Duration: 24 hours

Front 57

What are some adverse effects of anticholinergic agents?

Back 57

1) Blurred vision (mydriasis)
*can add to cataracts in the elderly
2) With high doses may see headache, flushed skin, tachycardia, urinary retention

Front 58

What should you do when administering anticholinergic agents?

Back 58

1) Ensure adequate hydration and provide environmental controls
2) Provide small, frequent meals and sugarless lozenges

Front 59

What are the different routes of administration for corticosteroids? What is the difference in their use?

Back 59

1) Inhalation
*used for maintenance
2) Systemic (oral or parenteral)
*used for acute reactions

Front 60

What drugs are inhaled corticosteroids?

Back 60

1) Budesonide (Pumicort)
2) Fluticasone (Flovent)

Front 61

What drugs are systemic corticosteroids?

Back 61

1) Hydrocortisone (Solu-Cortef)
2) Methylprednisolone (Solu-Medrol)
3) Prednisone (Deltasone)
4) Dexamethasone (Decadron)

Front 62

What is the MOA of corticosteroids?

Back 62

Primary MOA:
Inhibit the production or release of inflammatory mediators

Additive MOAs:
1) Improves beta 2 receptor agonists sensitivity to the beta 2 receptor in acute setting
2) Preventing or reversing airway remodeling

Front 63

What is the therapeutic effect of corticosteroids?

Back 63

Reduce inflammation

Front 64

How is dosing of corticosteroids decided?

Back 64

Dependent on severity of disease

Front 65

Which patients are given systemic corticosteroids?

Back 65

Systemic administration is reserved for patients with acute exacerbations or severe disease refractory to other treatments

Front 66

Are corticosteroids short-term agents or long-term agents?

Back 66

Best as short-term agents

Front 67

What are some adverse effects of corticosteroids?

Back 67

Inhaled route
1) Fungal infections in mouth

Systemic route
1) Osteoporosis
2) Hypertension
3) Hyperglycemia
4) Thinning of the skin
5) Myopathy (muscle weakness)
6) CNS effects (euphoria, depression)
7) Impaired wound healing

Front 68

What are some considerations for administering corticosteroids?

Back 68

1) Do not administer to treat acute asthmatic attack
2) Taper steroids carefully
3) Rinse mouth after using the inhaler

Front 69

What are mast cells?

Back 69

Cells that contain histamines, prostanglandins, and leukotrienes, which are released in allergic reactions

Front 70

What is the MOA for mast cell stabilizers?

Back 70

Inhibit the breakdown of mast cells

Front 71

What is the therapeutic effect of mast cell stabilizers?

Back 71

Prevention of bronchospasm
*most effective when administered 30 minutes before expsoure to allergen or exercise (not used for acute relief)

Front 72

What is the name of a mast cell stabilizer?

Back 72

Cromolyn (Intal, Nasalcrom)

Front 73

How is a mast cell stabilizer administered?

Back 73

Nebulizer or dry powder inhaler

Front 74

What are some adverse effects of mast cell stabilizers?

Back 74

1) Tracheal irritation
2) Cough
3) Taste disturbances: aluminum taste

Front 75

What are some patient education considerations for mast cell stabilizers?

Back 75

1) Caution the patient not to discontinue abruptly
2) Caution the patient to continue taking the drug even during symptom-free periods

Front 76

What do leukotrienes do?

Back 76

Cause bronchoconstriction

Front 77

What are the two types of leukotriene modifiers?

Back 77

1) Receptor antagonists
2) Inhibitor of 5-lipoxygenase

Front 78

What is the MOA for receptor antagonists?

Back 78

Block the leukotriene receptor site

Front 79

What is the MOA for inhibitors of 5-lipoxygenase?

Back 79

Prevent formation of leukotrirene

Front 80

What are the names of two receptor antagonists?

Back 80

1) Montelukast (Singulair)
2) Zafirlukast (Accolate)

Front 81

What is the name of the inhibitor of 5-lipoxygenase?

Back 81

Zileuton (Zyflo)

Front 82

What are the therapeutic effects of leukotrienes?

Back 82

Reduce inflammation (often used as an alternative of corticosteroids)

*NOT used for the acute relief of bronchoconstriction

Front 83

Which leukotriene modifier has the least amount of drug interactions? Why?

Back 83

Montekulast, because it does not inhibit liver enzymes

Front 84

What are some adverse effects of leukotriene modifiers?

Back 84

1) Hepatotoxicity
--> monitor liver enzymes every 6 months
2) Headache
3) GI upset

Front 85

What are some considerations for implementation of leukotriene modifiers?

Back 85

1) Administer drug on an empty stomach
2) Caution the patient to take the drug continuously