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54 Cards in this Set
- Front
- Back
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Name 2 ORAL decongestants
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Pseudoephedrine, phenylephrine
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Name 2 TOPICAL decongestants
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Phenylephrine (Neo-synephrine nasal spray)
Oxymetazoline (Afrin nasal spray) |
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What are the dosage differences b/w phenylephrine and Afrin nasal sprays?
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Phenylephrine is Q4hrs
oxymetazoline is BID |
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What drug interaction must be avoided with decongestants?How long b/w use?
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MAO-Is
2 weeks |
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What disease states are decongestants less safe?
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heart disease, high blood pressure, thyroid disease, diabetes, enlarged prostate
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What drug class are the following generics: Brompheniramine, astemizole, ceftirizine, chlorpheniramine, loratadine?
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Oral antihistamines
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What diesease states are anti-histamines less safe?
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emphysema, chronic bronchitis, glaucoma, enlarged prostate
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Name 3 drug classes for allergic rhinitis?
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topical anti-histamines
topical anti-cholinergics topical mast cell stabilizers topical corticosteroids |
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Name a topical mast cell stabilizer amd usual dose
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Nasalcrom (cromolyn sodium)
1 spray/nostril 3-6x day |
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Name 3 topical corticosteroids
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beclomethasone
budesonide fluticasone mometasone |
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Which are more efficacious in allergic rhinitis: antihistamines or intrnasal steroids? WHY?
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Intranasal steroids:
greater relief overall no sig diff on eye sx relief within 12-24hrs good safety profile |
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Is asthma large airway or small airway disease?
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Both- large airway iniflammation leads to small airway constriction
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Name three properties of asthma attack
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spasm, edema, mucus
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There are 7 drug classes to treat asthma- name them
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beta agonists
corticosteroids leuokotriene modifiers mast cell stabilizers anticholinergics theophylline monoclonal antibodies |
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How do beta agonists treat asthma?
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preferential activity at beta 2 receps-stimulates adenyl cyclase-incr conversion of ATP to cyclic AMP-smooth muscle relaxation
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List some side effects of beta agonists
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tachycardia, palpitations, tremor, hypokalemia
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List 3 beta-agonists (generic/trade)
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1- albuterol (proventil, ventolin)
2- Salmetrol (serevent) 3- levalbuterol (Xopenex) |
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Which beta-agonist is long-acting?
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salmetrol (serevent)
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Which asthma tx drug class is recc to avoid 1st line use?
Why? |
long-acting beta-agonists
chronic use may incr risk of severe asthma episodes |
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Which class of corticosteroid has electrolyte-regulating activity?
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Mineralocorticoid
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Which class of corticosteroid has metabolic activity?
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Glucocorticoid
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List 6 ACUTE side effects of corticosteroids
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hyperglycemia, electrolyte, HTN, wt gain, fluid retention, GI irritation/ulceration, CNS
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List 6 CHRONIC side effects of corticosteroids
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immunosuppression, adrenal suppression, growth suppression, osteoporosis, prox muscle weakness, ocular toxicities
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What is beclomethasone, budesonide, triamcinolone?
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inhaled corticosteroids for asthma
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What inhaled corticosteroid has highest potency, receptor T1/2, elimination T1/2?
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Fluticasone (Flovent)
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Which inhaled corticosteroid has lowest potency, receptor and elimination T 1/2?
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triamcinolone (Azmacort)
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Leukotrienes are produced by which enzyme in the arachidonic acid pathway?
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Lipooxygenase
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Leukotrienes are bad- WHY?
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mediate bronchospasm, mucus secretion, edema, esosinophil recruitment, smooth muscle proliferation
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How do Leukotriene modifiers work? 2 mechanisms
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1) 5-Lipooxygenase inhibitors- block synthesis of leukotrienes
2) selective leukotriene receptor blockers |
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Aileuton, zafirlukast, and montelukast are which type of drug?
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Leukotriene modifiers
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Which leukotriene antagonist has fewest drug interactions? WHY?
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Montelukast (Singulair)
little interaction with P450 enzyme system |
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Which side effect do leukotriene antagonists have in common?
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hepatoxicity
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Which leukotriene antagonists interact with theophylline
and warfarin? WHY? |
Zileuton and zafirlukast
inhibits CYP450 isoenzymes |
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Name two antihistamines for asthma TX- what is their role?
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cromolyn sodium (Intal), nedocromil sodium (Tilade)
block release from mast cells for maintenance only |
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How does ipratropium bromide work?
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bloskc acetycholine at muscarinic receptors- prevents intracellular increase in cyclic-GMP = bronchodilation
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Accumulation of what enzyme causes bronchoconstriction?
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cGMP
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MOA for aminophylline and theophylline?
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smooth muscle relaxation
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Side effects of aminophylline and theophylline?
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GI irritation,
CNS (agitation, seizures) cardiac (tachycardia, arrhythmias) |
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Which settings can increase blood levels of aminophylline and theophylline?
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Age, heart failure, liver disease, drug interactions
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Which drugs can increase blood levels of aminophylline and theophylline?
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cimetidine, erythromycin,ciprofloxacin
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Therapeutic blood level of aminophylline and theophylline?
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10-20 mcg/ml
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Which settings can DECREASE blood levels of aminophylline and theophylline?
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Age, smoking, drug interactions
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3 drugs which can decrease blood levels of aminophylline and theophylline?
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Phenobarbital, phenytoin, rifampin
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What is MOA and use for Omalizumab (Xolair)?
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monoclonal antibody to IgE
role in allergic asthma, allergic rhinitis, other allergies? |
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Side effects of Omalizumab?
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headache, injection site, rash (urticarial)
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COPD is _______ leading cause of death in US?
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4th
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How many COPD deaths worldwide in 2000?
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2.74 million
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What is difference between asthma and COPD?
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CD-8 lymphocytes, macrophages, neutrophils-
completely irreversible |
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What are 4 main management goals for COPD?
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assess & monitor disease
reduce risk factors (smoking, vaccinate) maintain stable disease manage exacerbations |
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name 5 classes of bronchodilators for COPD?
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Beta agonists
Anticholinergic Theophylline Combinations Inhaled corticosteroids? |
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What is Tiotropium (Spiriva), treats what?
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Inhaler for COPD
Blcoks achetycholine at muscarinic receptors-prevents intracellular release of cyclicGMP = bronchodilation |
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When are inhaled corticosteroids indicated for COPD?
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- if some reversibility demonstrated, if low FEV1 and repeated exacerbations requiring other drug therapy
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What is STEP 1 treatment for adult asthma (ie intermittent sx, 2 days week)
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short-acting beta agonist as needed
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What is STEP 4/5 treatment for severe asthma (ie 7x week sx, peak flow <60%)?
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ICS (med-high dose)
plus long-acting beta agonist |
