Pharm Blocks 3/4

Front 1

What category of drugs do you use to deal with airway inflammation of asthma?

Back 1

Glucocorticoids

Front 2

For bronchoconstriction in asthma, what would be the preferred category of drugs to you?

Back 2

Beta-2 agonists

Front 3

With increased mucus production due to astham, what would be the category of drugs preferred to use?

Back 3

Anti-muscarininc drugs (M3 blockers) such as Ipratropium (atropine-like) which have drying effects.

Front 4

To manage mild, intermittent asthma, what category of drugs is preferred to use?

Back 4

Short-acting B2 agonists

If it was mild, persistent, better to use Corticosteroids or LT blockers

Front 5

To manage mild, persistent asthma, what category of drugs is preferred to use?

Back 5

Inhaled Corticosteroids or LT blockers.

If it was mild, intermittent, better to use B2-agonists.

Front 6

To manage moderate, persistent asthma, what category of drugs is preferred to use?

Back 6

low-medium inhaled Corticosteroids with/or long-acting B2 agonists.

Front 7

To manage severe asthma for patients 12yrs or older, what category of drugs is preferred to use?

Back 7

Omalizumab (IgE antagonist)

Front 8

To manage mild, acute exacerbations of asthma, what category of drugs is preferred to use?

Back 8

You can use inhaled B2 agonists, or "burst" of systemic Corticosteroids.

Front 9

For Status Asthmaticus, what combination of category of drugs is preferred to use?

Back 9

Combination of systemic CS, B2 agonists, and oxygen.

Front 10

You avoid non-selective B2 agonists in patients with what kind of pre-disposed problems?

Back 10

Contraindicated in patients with pre-disposed cardiovascular problems.

Non-selective stimulate Alpha-1 (hypertension) and Beta-1 (tachycardia)

Front 11

If a patient has an anaphylactic asthma emergency, what kind of beta-2 agonist would you want to give them?

Back 11

Epinephrine - a non-selective B2 agonist which is used for emergency bronchodilation for anaphylaxis (e.g. Epipen)

Front 12

What are the two toxicities of Epinephrine?

Back 12

Hypertension via Alpha-1

Tachycardia via Beta-1

Front 13

1. What receptors does Isoproterenol stimulate?

2. What is its toxicity?

Back 13

Isoproterenol (non-selective) stimulates B1 and B2 for asthma but causes Tachycardia due to B1.

Front 14

1. What are the three selective B2 agonists (ATM)?

2. What is it mostly used for?

Back 14

1. Albuterol, Terbulatine, Metaproterenol

2. Short acting selective B2 agonists inhaled for fast onset "rescue"

Front 15

1. Which selective B2 agonist can also be used to stop uterine contractions and suppress labor?

Back 15

Terbulatine

Front 16

What are the 5 toxicities mostly associated with high oral/IV dose of selective B2 agonists?

Back 16

1. Muscle stimulation

2. Tachycardia

3. Hypokalemia

4. Restlessness

5. Down-regulation of receptors (tolerance)

Front 17

1. What are the names of two long-acting selective B2 agonists?

2. What are they mainly used for?

Back 17

Mainly used for asthma management.

Not used for "rescue" unlike short-acting selective B2 agonists.

Front 18

What are the three mechanisms of Methylxanthines and their respective effects?

Back 18

They block:

1. Adenosine receptors --> bronchodilation

2. Phosphodiesterase (PDE) --> increases cAMP causing increase of heart beats.

3. Reduces cytokine release --> antiinflammatory

Front 19

1. What are the two names of Methylxanthines?

2. What are their 5 main toxicities?

3. What is the effect of overdose?

4. How do you treat overdose?

Back 19

1. Theophylline (oral), and Aminophylline (IV)

2. Caffeine-like side effects: Alertness, Chronotropic (change in HR), Inotropic (muscle contraction), gastric acidity, diuretic.

3. Convulsions/seizures with overdose.

4. Treat overdose with Beta blocker.

Front 20

In what kind of patients are Methylxanthines contraindicated?

Back 20

You avoid it in patients with liver diseases or that are currently taking CYP-inhibitor drugs as clearance may vary.

Front 21

What is the category of drugs considered the most potent anti-inflammatory?

What is the most commonly used route of dose?

Back 21

Corticosteroids most commonly given as inhaled to prevent absorption.

Front 22

What is the category of drugs considered first line therapy for chronic asthma?

Back 22

Corticosteroids

Front 23

What is the mechanism of Corticosteroids?

Back 23

CS stimulates the synthesis of lipocortin which is an inhibitor of Phospholipase A2--a precursor to Prostaglandin/Leukotrienes.

Front 24

What are Corticosteroids required for in relation to asthma?

Back 24

They are required for emergency relief of bronchospasms and also suppression of advanced (chronic) disease.

Front 25

What kind of systemic toxicity could you see if you use Corticosteroids less than two weeks?

Back 25

Possibly acute peptic ulcer, rarely acute pancreatitis. Otherwise, no serious toxicity.

Front 26

What kind of systemic toxicity could you see if you use Corticosteroids more than two weeks?

Back 26

Cushing's syndrome = exposure to high levels of cortisol --> weight gain, thin skin, poor healing, bruise easily, stretch marks all over body.

Front 27

What are the names of the 5 Corticosteroids with their respective route and use?

Back 27

1. B-methasone --> inhaled to suppress inflammation

2. Triamcinolone, Fluticasone, Prednisone --> orally for long term control of severe inflammation.

3. Methylprednisolone --> IV used for emergency relief of severe acute disease.

Front 28

What are the names of the two muscarinic blockers, and their two actions?

Back 28

1. Ipratropium

2. Tiotropium (longer-lasting)

3. Bronchodilation and reduce parasympathetic-mediated mucus --> promotes dryness

Front 29

What is the name of the Leukotriene inhibitor which blocks 5-lipoxygenase?

What is the main use of this drug?

What is the two toxicities associated with this drug?

Back 29

1. Zileuton

2. Used in the prohylaxis and treatment for those over 12 years old.

3. Increasis hepatic enzymes, and inhibits CYP 3A4

Front 30

What is the mechanism and three benefits of Montelukast and Zafirlukast?

Back 30

C4 and D4 receptor blockers.

1. Blocks early and late bronchoconstriction

2. Improves quality of life by decreasing the need for B2 agonists (good for acute)

3. Good in pediatrics.

Front 31

What are 3 toxicities associated with Montelukast/Zafirlukast?

Back 31

1. Hypersensitivity

2. Liver injury

3. Churg-Strauss syndrome --> immune diseases increasing eosinophils when used with a CS.

Front 32

What are the names of two Mast Cell stabilizers and their overall use?

Back 32

1, Cromolyn/N-cromol = not effect to stop an acute attack. Better used to prevent an anticipated one (traveling to friend's house with pets).

2. Omalizumab = IgE antagonist with same use as above.

Front 33

What are the names of two 5-HT2A antagonists that serve as H1 blockers, without stimulating alpha-1 receptors, unlike H1 1st generation blockers?

Back 33

Cyproheptadine and Phenoxybenzamine

Front 34

For COPD, what is the 1st line drug?

Back 34

You want to use Ipratropium bromide--used to maximum effect before introducing Beta-2 agonists.

Front 35

What benefit does Xanthines have in COPD?

Back 35

Xanthines have been shown to strengthen skeletal muscle contraction and improved ventilatory performance in COPD due to increased diaphragm strength and resistance to fatigue.

Front 36

1. What are two drug names useful for Pulmonary Hypertension that serve as endothelin-1 receptor antagonists?

2. What two toxicities do these two drugs possess?

Back 36

1. Bosentan and Abrisentan which are vasodilators.

2. Edema and teratogen.

Front 37

1. What is the drug name useful for Pulmonary Hypertension who's MOA is Prostacyclin I2?

2. What two actions does it possess unlike other drugs for PH?

3. What is its respective two toxicities?

Back 37

1. Epoprostenol

2. Vasodilation and exclusively inhibits platelet aggregation in the lung.

3. Bleeding and hypotension.

Front 38

1. What is the drug name useful for Pulmonary Hypertension who's MOA is PDE-5 inhibitor?

2. What is the toxicity involved?

Back 38

1. Sildenafil - vasodilator

2. Hypotension, especially with donors of NO.