(Respiratory) Respiratory Pharmacology

Front 1

Review your treatment algorithm concept map

Go ahead, the cards will be here waiting

Back 1

Good job

Front 2

Which class of drugs inhibits cellular activation in a number of cells by altering the function of delayed chloride channels

Back 2

Cromolyn and Nedocromil

Front 3

How does cromolyn affect smooth muscle tone? What is the clinical implication of this?

Back 3

Does nothing to smooth muscle tone - which means it will do nothing to stop an acute attack

Front 4

Describe the clinical use of cromolyn and nedocromil:

Back 4

Useful when taken prophylactically, as in before exercise or unavoidable exposure to an allergen.

Can be used chronically to reduce the severity and need of bronchodilators (although not as potent as inhaled steroids)

Front 5

Cromolyn and nedocromil can be used in therapy for chronic asthma. What's the major downside to using them?

Back 5

Requires up to four times a day dosing

Front 6

Relatively speaking, is cromolyn and Nedocromil relatively safe? What are the side effects?

Back 6

Yes they are very safe (for that reason, used a lot in children)

They can cause irritation, chough, mouth dryness, and can taste bitter

Front 7

Cromolyn and Nedocromil work on which two types of inflammatory cells

Back 7

Mast cells and Eosinophils

Front 8

Besides asthma, what other conditions can cromolyn treat?

Back 8

Allergic rhinitis (nasal spray)

Conjunctivitis (eye drops)

Front 9

In which beverages do you naturally find these compounds?

Theophylline
Theobromine

Back 9

Theophylline = Tea
Theobromine = Cocoa

Front 10

Although the mechanism of action for theophylline is not firmly established, what is the leading hypothesis?

Back 10

Inhibits cell surface receptors for adenosine

Inhibits phosphodiesterase leading to an increase cAMP (dilation)

May possible have anti-inflammatory properties as well

Front 11

Theophylline is most selective for ______ _____, while caffeine is more selective for ____

Back 11

Theophylline is most selective for SMOOTH MUSCLE, while caffeine is more selective for CNS.

Front 12

CNS effects of methylxanthines (Theophylline)

Back 12

Similar to caffeine (Mild cortical arousal and deferral of fatigue, nervousness, insomnia)

High doses = medullary stimulation and seizures

Front 13

CV effects of theophylline:

Back 13

Direct positive chronotropic and inotropic effects.

Sensitive folks may get cardiac arrhythmias

Front 14

Effect of theophylline on skeletal muscle:

Back 14

Potent effects in improving the contractility and reversing fatigue of the diaphragm (especially in COPD)

Front 15

Where is theophylline metabolized? What is the clinical significance?

Back 15

Metabolized by the liver which means that there are several drug interactions

For instance, smoking speeds up the induction by cigarette smoking

Front 16

Is the therapeutic index for theophylline wide or narrow?

Back 16

narrow

Front 17

(T/F) Tolerance to theophylline is a problem

Back 17

False - No tolerance is seen

Front 18

(T/F) There is a wide variance in the amount of theophyline that shows up in people's blood.

Back 18

True

Front 19

What is the bottom line when it comes to theophylline?

Back 19

It improves long term control of asthma. It's cheap and can be effective when added to inhaled corticosteroids. However, blood monitoring and side effects limit its use

Front 20

Which class of asthma medications causes skeletal muscle tremor?

Back 20

Beta agonists

Front 21

Beta-2 agonists like albuterol and salmeterol don't reach their maximum effect until 30 minutes after inhalation. What is the clinical significance of this?

Back 21

When used as a rescue inhaler, patients need to be told of this delay so they don't overdose thinking the meds aren't working

Front 22

(T/F) If administered correctly, metered dose inhalers are as effective as nebulizers.

Back 22

True*

*Although psychologically, nebulizers are more comforting

Front 23

Are adverse effects caused by beta-2 agonists worse with the pill form or the inhaled form?

Back 23

Pill form

Front 24

What are some common side effects when using beta-2 agonists

Back 24

Muscle tremor, nervousness, occasional weakness, bad taste, insomnia, headache, nausea, palpitations

Also since there's no such thing as a 100% selective agonist, they could also cause Beta-1 cardiac side effects

Front 25

What needs to be present in order for antimuscarnic antagonists to work?

Back 25

Established cholinergic tone

Front 26

When you think of herbal medicine, especially leaves from Datura Stramonium, which class of asthma medications are you thinking?

Back 26

Antimuscarinic antagonists

Front 27

Ipratropium bromide is a drug in which class

Back 27

Antimuscarinics

Front 28

This class of asthma drugs causes dry mouth when inhaled; systemic absorption can lead to urinary retention, tachycardia, and loss of visual accommodation

Back 28

Antimuscarinics

Front 29

There is only one mechanism of action for this class of drugs, and that's anti-inflammatory:

Back 29

Corticosteroids

Front 30

Which form of corticosteroids is best used for patients who are having acute exacerbation of asthma despite maximal maintenance therapy?

Back 30

Oral corticosteroids

Front 31

Can you use corticosteroids as rescue meds?

Back 31

No, but you can use them for prolonged exacerbations

Front 32

Zarfirlukast and motelukast block this receptor?

Back 32

LTD4

Front 33

(T/F) Leukotriene inhibitors are as effective at reducing the frequency of exacerbations as corticosteroids, although they are less effective on improving the symptoms of asthma, as well as airway caliber, bronchial reactivity, and airway inflammation

Back 33

True

Front 34

Phenylephrine, naphazoline, oxymetazoline, and zylometazoline are dugs in which class?

Back 34

Decongestants

Front 35

Name two short acting decongestants (4 hours)

Back 35

Phenylephrine and naphazloline

Front 36

Name two long acting decongestants:

Back 36

Oxymetazoline and xylometazoline

Front 37

How do decongestants work?

Back 37

They are alpha adrenergic smooth muscle stimulators that lead to vasoconstriction

This leads to decreased blood flow and therefore decreased congestion

Front 38

What is rhinitis medicamentosa?

Back 38

Effect of long term use of topical decongestant nasal sprays - After using for 3-5 days they don't last as long

Front 39

(T/F) Although decongestants can cause hypertension, it's only at extremely high doses, so patients shouldn't worry about it too much.

Back 39

False false false false

Front 40

Are diphenhydramine, brompheniramine (Dynatap) and chlorpheniramine first generation or second generation antihistamines?

Back 40

First generation

Front 41

What is the difference between first generation and second generation antihistamines?

Back 41

First generation ones are dirtier and carry more anticholinergic effects

Front 42

What is the most common use for second generation antihistamines like fexofenadine, loratidine, and certizine?

Back 42

Rhinits

Front 43

(T/F) Even if a person doesn't feel sedated when using a first generation antihistamine, they should still be careful when operating machinery.

Back 43

True

Front 44

Why might first generation antihistamines be beneficial for treating colds compared to second generation antihistamines?

Back 44

Because of the anticholinergic side effects - which may be more beneficial in reducing the symptoms of cold than the antihistamine action.

Front 45

How does Dr. Binder feel about using antihistamines for treating colds?

Back 45

He isn't too keen on them…

First generation meds sedate you too much, and second generations don't help as much with colds

Front 46

The mechanism of this drug is to hydrate mucus, which increases the volume and lowers the viscosity of respiratory tract secretions

It helps you to FINALLY hack up that phlegm

Back 46

Guiafenesin

Front 47

What is the mechanism of action of guiafenesin?

Back 47

Trick question! Unknown MOA

Front 48

The antitussive medications, dextromethorphan and codeine are also drugs in which class?

Back 48

Opiods

Front 49

What is the mechanism of benzonatate?

Back 49

It anesthetizes respiratory passages, although Dr. Binder questions this since it's a pill

Front 50

The side effects of this drug is minimal nausea and vomiting. Also, although it's technically an opioid derivative, it's essentially free of analgesic and addictive properties.

Back 50

Dextromethorphan

Front 51

What are some side effects of benzonatate (antitussive)

Back 51

Rare bronchospasm and laryngospasm

More commonly, sedation, headache, and dizziness.

Front 52

Codeine is often mixed with phenergan (an antihistamine with strong anti-emetic effects).

What do you get when you combine these two together?

Back 52

A good night's sleep