Phar 641 Drugs For Respiratory Disorders

Front 1

For treatment of respiratory disorders, what type of drug do you want to use?
a) beta agonist
b) beta antagonist
c) muscarinic agonist
d) muscarinic antagonist

Back 1

a) beta agonist
d) muscarinic antagonist

Front 2

What are the proinflammatory mediators released from inflammatory cells (mainly mast cells)?

Back 2

histamine and leukotrienes

Front 3

What proinflammatory mediators causes Vasoconstriction, increased vascular permeability, itching, cough when released?

Back 3

histamine

Front 4

What proinflammatory mediators causes Bronchoconstriction and leukocyte chemotaxis when released?

Back 4

leukotrienes

Front 5

What are the indicated drug targets for respiratory disorders? Hint: there are 3

Back 5

beta agonist
muscarinic antagonist
anti-inflammatory agents

Front 6

What are the contraindicated drugs for respiratory disorders? Hint: there are 3

Back 6

beta blocker
muscarinic receptor agonist
anticholinesterases

Front 7

What route of administration has more side effects, oral/IV or inhalation?

Back 7

oral/IV

Front 8

What route of administration requires the use of lower doses, oral/IV or inhalation?

Back 8

inhalation

Front 9

True or False: The pathophysiology of asthma indicates respiratory and systemic involvement

Back 9

False: the pathophysiology of asthma indicates only respiratory involvement

Front 10

What is more effective: agents that prefer beta receptor or agents that prefer adrenergic receptors?

Back 10

agents that prefer beta receptors

Front 11

What route of administration is most used to deliver beta agonist?

Back 11

inhalation

Front 12

What type of beta agonist are used to relieve symptoms of respiratory disorders: long-acting or short-acting?

Back 12

short-acting

Front 13

What type of beta agonists are used prophylactically: long-acting or short-acting?

Back 13

long-acting

Front 14

What pathway is activated from the activation of beta receptors?

Back 14

Gs adenylyl cyclase-cAMP pathway

Front 15

True or False: Long-term exposure to beta agonists may desensitize some of these receptor-response pathways (more in inflammatory cells than bronchial cells)

Back 15

True

Front 16

True or False: Stimulation of beta receptors do inhibit inflammatory cells

Back 16

True

Front 17

True or False: activation of the Gs adenylyl cylase-cAMP pathway DECREASES the conductance of large Ca2+-sensitive K+ channels

Back 17

False: activation of Gs adenylyl cylase-cAMP pathway increases the conductance of large Ca2+-sensitive K+ channels

Front 18

Which of the following are short-acting beta agonist?
Albuterol (Proventil, Ventolin)
Levalbuterol (Xenopex)
Salmeterol xinafoate (Serevent)
Metaproterenol (Alupent)
Terbutaline (Brethaire, Bricanyl)
Formoterol (foradil)
Pirbuterol (Maxair)

Back 18

albuterol (Proventil, Ventolin), levalbuterol (Xopenex), metaproterenol (Alupent), terbutaline (Brethair, Bricanyl), pirbuterol (Maxair)

Front 19

Which of the following are long-acting beta agonist?
Albuterol (Proventil, Ventolin)
Levalbuterol (Xenopex)
Salmeterol xinafoate (Serevent)
Metaproterenol (Alupent)
Terbutaline (Brethaire, Bricanyl)
Formoterol (foradil)
Pirbuterol (Maxair)

Back 19

salmeterol xinafoate (Serevent), formoterol (Foradil)

Front 20

When do you usually see side effects of inhaled beta agonist?

Back 20

when using at high doses

Front 21

What are the side effects of using inhaled beta agonists? Hint: there are 3

Back 21

increased HR
cardiac arrythmias
tremor

Front 22

Which of the following are side effects seen in oral dose of beta agonists but not seen in inhaled doses?
a) cardiac arrythmias
b) tremor
c) muscle cramps
d) metabolic disturbances

Back 22

c) muscle cramps
d) metabolic distrubances

Front 23

True or False: adverse effects of beta agonists are seen more in adults that children

Back 23

True

Front 24

Oral dosing of beta agonists are not widely used. When do you use oral dosing? Hint: there are 2

Back 24

1. Used over short-term, primarily in children less than 5 years old
2. Used in patients with severs asthma exacerbations that are sensitive to aerosols

Front 25

This class of drugs bind to nuclear receptors that binds to GRE

Back 25

glucocorticoids

Front 26

True or False: Glucocorticoids directly relax airway smooth muscle

Back 26

False: Glucocorticoids indirectly relax airway smooth muscle

Front 27

True or False: Glucocorticoids have little effect of bronchoconstriction

Back 27

True

Front 28

True or False: Glucocorticoids are not very effective against airway inflammation

Back 28

False: Glucocorticoids are very effective against airway inflammation

Front 29

glucocorticoids have been use for many years to treat what type of asthma? Hint: there are 2

Back 29

chronic and severe acute exacerbation of asthma

Front 30

True or False: The development of aerosol forms increased the safety of glucocorticoids

Back 30

True

Front 31

The development of aerosol forms allows for the use of glucocorticoids to treat what type of asthma?

Back 31

moderate asthma

Front 32

What are the conditions that the patient must meet in order to be considered candidates for inhaled glucocorticoid therapy?

Back 32

Patients require beta agonist 2 to 4 or more times weekly

Front 33

Oral candidiasis, dysphonia, and decrease in mineral density in women are toxicities of what type of glucocorticoid therapy?
a) inhaled therapy
b) brief oral therapy
c) withdrawal of long term therapy
d) overdose during long term therapy

Back 33

a) inhaled

Front 34

Mood disturbances, increased appetite, impaired glucose control in diabetics, and candidiasis are toxicities of what type of glucocorticoid therapy?

a) inhaled therapy
b) brief oral therapy
c) withdrawal of long term therapy
d) overdose during long term therapy

Back 34

b) brief oral therapy

Front 35

Fever, myalgias, arthralgias, malaise, increased intracranial pressure (rare), acute adrenal insufficiency, and flare-up of underlying disease are toxicities of whay type of glucocorticoid therapy?

a) inhaled therapy
b) brief oral therapy
c) withdrawal of long term therapy
d) overdose during long term therapy

Back 35

c) withdrawal of long term therapy

Front 36

Fluid and electrolyte abnormalities, hypertension, hyperglycemia, increased susceptibility to infections, osteoporosis, myopathy, behavioral disturbances, cataracts, growth arrest, fat redistribution, striae, ecchymoses are toxicities of what type of glucocorticoid therapy?

a) inhaled therapy
b) brief oral therapy
c) withdrawal of long term therapy
d) overdose during long term therapy

Back 36

d) overdose during long term therapy

Front 37

Which of the following do LTC4, LTD4, LTE4 not do?
a) bronchodialation
b) increase vascular permeability
c) neutrophil chemoattractants
d) increase bronchial reactivity
e) decrease mucous production

Back 37

a) bronchodialation
e) decrease mucous production

LTC4, LTD4, LTE4 causes bronchoconstriction and increases mucous production too.

Front 38

How much more potent are leukotrienes vs histamine as bronchoconstrictors?

Back 38

leukotrienes are 1000x more potent than histamine

Front 39

What leukotriene receptor is responsible for bronchoconstriction effects?

Back 39

Cys-LT1 receptor

Front 40

Leukotriene inhibitors are used prophylactically to treat what type of asthma?
a) mild
b) severe

Back 40

a) mild

Front 41

What class of drugs have the following MOA: Competitive inhibitor at leukotriene receptor cys-LT1

Back 41

leukotriene receptor blockers
drug: zafirlukast, montelukast

Front 42

What class of drugs have the following MOA: : Blocks the enzyme 5-lipoxygenase

Back 42

leukotriene synthesis inhibitors
drug: zileuton

inhibition of 5-lipoxygenase inhibits leukotriene synthesis

Hint 42

inhibition of 5-lipoxygenase inhibits leukotriene synthesis

Front 43

True or False: Side effects of leukotriene receptor blockers are rare

Back 43

True

Front 44

This class of leukotriene inhibitors have rare side effects that include: systemic eosinophilia and vasculitis

Back 44

leukotriene receptor blockers
drug: montelukast (singulair), zafirlukast (Accolate)

Front 45

This class of leukotriene inhibitors have side effects that include: 4-5% elevation in liver enzymes and decrease clearance of theophiline and warfarin

Back 45

leukotriene synthesis inhibitors
drug: zileuton (Zyflo CR, Zyflo)

Front 46

Which leukotriene inhibitors (drugs) interfere with warfarin therapy?

Back 46

zafirlukast (Accolate) and zileuton (Zyflo CR, Zyflo)

Front 47

This class of drugs have the following MOA: unknown but involves reducing activity of chloride channels that are involved in histamine release

Back 47

chromones

Front 48

What type of asthma are chromones indicated for?

Back 48

mild to moderate asthma

Front 49

What are some adverse reactions of chromones?

Back 49

bad taste
Rare: bronchospasm, cough or wheezing, laryngeal edema, joint swelling and pain, angioedema, headache, rash, nausea

Front 50

What class of drugs have the following MOA: bronchodilation by nonselective inhibitors of cyclic nucleotide phosphodiesterase enzymes (PDEs), which catalyze the hydrolysis of cyclic nucleotides

Back 50

methylxanthine drugs

Front 51

What class of drugs are third line therapy of asthma?

Back 51

methylxamthine

Front 52

What drug have the following MOA: competitive antagonist at adenosine receptors

Back 52

theophylline

Front 53

True or False: theophylline activates histone deacetylase in the nucleus

Back 53

True

Front 54

List some adverse effects of methylxanthines

Back 54

Narrow therapeutic window
CNS stimulation; including seizures – may lower seizure threshold; also insomnia, nervousness
Cardiovascular, including arrhythmia
Diuretic actions
Nausea, vomiting
Death
Rapid infusion of aminophylline can cause death

Front 55

What class of drugs have the following MOA: Competitively inhibit the effect of acetylcholine at muscarinic receptors

Back 55

antimuscarinic agents

Front 56

What class of drugs have the following MOA: Monoclonal antibody against the portion of IgE that binds to receptors on mast cells and other inflammatory cells

Back 56

anti-IgE

Front 57

What are some side effects of anti-IgE therapy?

Back 57

Injection-site reaction – most common
Development of antibodies to the drug
Anaphylaxis
Various malignancies in patients in one study

Front 58

What kind of respiratory disorder is anti-IgE therapy indicated for?

Back 58

Adults and children over 12 for allergies and moderate-to-severe asthma

Front 59

What are some OTC asthma treatments?

Back 59

Primatene and Primatene mist

Front 60

Inflammation of nasopharynx due to allergens caused by an adverse reaction to environmental stimuli is the definition of what?

Back 60

allergic rhinitis

Front 61

What are some symptoms of allergic rhinitis

Back 61

Nasal congestion and/or obstruction, runny nose, sneezing, conjunctivitis, and itching of the nose, eyes, and palate, hoarseness, swollen and watering eyes
Sore throat may occur with postnasal drip
Ear congestion is a complication, as well as sinus headache and discomfort, sinus infection, acute asthma exacerbations

Front 62

What do you use to treat mild allergic rhinitis?

Back 62

Oral antihistamine with or without decongestant
Intranasal cromolyn sodium

Front 63

What do you use to treat moderate to severe allergic rhinitis?

Back 63

Antihistamines, decongestants, intranasal corticosteroids
Oral corticosteroid may be considered (short-term) for severe cases
May need ocular antihistamines and decongestants for allergic conjunctivitis

Front 64

What are some contraindications of decongestants?

Back 64

MAOI therapy, hypersensitivity or adverse reactions to sympathomimetic amines that results in insomnia, dizziness, weakness, tremor, or arrhythmias

Front 65

What are some warnings under decongestants?

Back 65

hypertensive patients, diabetic patients, cardiovascular or ischemic heart disease, prostatic hypertrophy, nursing mothers; risk of rebound congestion, nasal irritation, drug interactions

Front 66

Constriction of blood vessels, which reduces swelling and congestion and decreases nasal airway resistance is the action of what type of drug?

Back 66

sympathomemetics

Front 67

List some decongestants. There are 6.

Back 67

Oxymetazoline (Afrin, Dristan, others)
Xylometazoline (Otrivin)
Tetrahydrozoline (Visine, others)
Naphazoline (Privine)
Phenylephrine (Neo-Synephrine, Sudafed PE, Afrin Children’s Nasal Decongestant Spray, others)
Pseudoephedrine (Children’s Sudafed, Triaminic, others)

Front 68

This type of cough does not produce sputum and serves to clear airway of particulate matter or herald underlying disease

Back 68

non-productive cough

Front 69

This type of cough assists in the removal of mucus or other respiratory secretion

Back 69

productive cough

Front 70

Where does cough expel foreign matter from?

Back 70

tracheobronchial tree

Front 71

Codeine and hydrocodone, diphenhydramine, and dextromethorphan are what kind of agents for cough?

Back 71

antitussive

Front 72

What antitussive agents increases the cough threshold?

Back 72

codeine and hydrocodone
dextromethorphan

Front 73

What antitussive agent is also an antihistamine?

Back 73

diphenhydramine

Front 74

What antitussive agents have analgesic, sedative, and/or respiratory effects?

Back 74

codeine and hydrocodone

Front 75

What drug interacts with dexamethorphan to cause hypotension, hyperpyrexia, nausea, myoclonic leg jerks, and coma?

Back 75

MAOIs

Front 76

What drug interacts with dexamethorphan to cause an increase in the plasma concentration of dexamethorphan?

Back 76

quinidine
terbinafine

Front 77

What non-drug interacts with dexamethorphan to cause in increase plasma concentration of dexamethorphan?

Back 77

grape fruit juice

Front 78

What drug interacts with dexamethorphan to cause potentially fatal seratonin syndrome?

Back 78

sibutramine

Front 79

What adverse drug events happen in adults who overdose on dexamethorphan?

Back 79

altered sensory perception
atexia, slurred speech, dysphoria

Front 80

What advers drug events occur in children who overdose with dexamethorphan?

Back 80

ataxia, respiratory depression, convulsions

Front 81

This agent aid in the removal of mucus from the respiratory tract by reducing adherence, surface tension,a nd viscosity of respiratory secretions

Back 81

expectorants

Front 82

Guaifenesin is what type of agent used for cough?

Back 82

expectorant

Front 83

Acetylcysteine (acetadote) and Dornase alfa (Pulmozyme) is what type of agent use for cough?

Back 83

nucolytic

Front 84

What mucolytic drug reduces disulfide bonds within protein to decrease viscosity of mucus?

Back 84

acetylcysteine (Acetadote)

Front 85

What mucolytic agent is a recombinant human deoxyribonuclease?

Back 85

Dornase alfa (Pulmozyme)

Front 86

What type of mucolytic drug breaks down DNA via decreased polymerization to decrease mucus viscosity?

Back 86

Dornase alfa (Pulmozyme)

Front 87

This herbal treatment is used for asthma, allergies, colds, and weight loss

Back 87

Ephedra (Ma Huang)

Front 88

This herbal treatment has antitussive acitivity and is extracted from Cimicifuga racemosa

Back 88

Black cohosh

Front 89

What is Ginkgo used for?

Back 89

antitussive, expectorant, and antiasthma

Front 90

What is the mechanism of action of H1 receptor antagonist?

Back 90

reversible competitive antagonist of H1 receptors

Front 91

What generation of antihistamine drugs have strong sedative effects?

Back 91

first generation

Front 92

Why do first generation antihistamines have other effects?

Back 92

structuraly similiar to agents that act at other receptors

Front 93

Which histamine receptoe increases contractility of the heart and increase pacemaker rate?

Back 93

H2

Front 94

Which histamine receptor mediates pain and itching?

Back 94

H1

Front 95

Which histamine receptor causes vasodilation at high doses?

Back 95

H2

Front 96

Which histamine receptor causes vasodilation at low doses?

Back 96

H1

Front 97

Which histamine receptor causes contraction of intestinal and uterine smooth muscle?

Back 97

H1

Front 98

Which histamine receptor cause bronchoconstriction?

Back 98

H1

Front 99

Which of the following is not a second generation antihistamine?

a. fexofenadine (allegra)
b. loratadine (claritin)
c. Ceterizine (zyrtec)
d. diphenhydramine (benadryl)

Back 99

d. diphenhydramine (benadryl)

see page 277 of Katzung for complete list