Smooth Muscle Drugs

Front 1

Which drug is used in PFT's to test bronchial hyperreativity, bronchoconstriction, and GI upset?

Back 1

Histamine

Front 2

Are first generation antihistamines more sedating than 2nd gen? if so, why?

Back 2

yes,
greater lipophilicity

Front 3

Name 9 first gen antihistamines.

Back 3

Ethanolamines
Dimenhydrinate (dramamine)
Ethylaminediamine
Hydroxyzine(Atarax)
Cyclizine
Meclizine
Brompheniramine
Promethazine
Cyproheptadine

Front 4

Name 3 2nd gen antihistamines.
(longer acting and less sedating - QD dosing)

Back 4

fexofenadine (allegra)
loratadine (claritin)
cetirizine (zyrtec)

Front 5

H2 receptor antagonists...drug interactions.

Back 5

May affect absorption of drugs dependent on lower pH, such as ketoconazole, itraconazole, iron

Front 6

What drug class activates serotonin receptors on presynaptic trigeminal nnerve endings to inhibit the release of vasodilating peptides.

Back 6

Serotonin agonists

"triptans"
used for migrane HA's

Front 7

What are CI for serotonin agonists?

Back 7

CAD
angina
Naratriptan and eletriptan - hepatic/renal, or PVD
Frovatriptin - PVD
Zolmatriptin - WPW

Front 8

Which serotonin agonist has a 1/2 life of 27 hrs?

Back 8

Frovatriptin

Front 9

Which serotonin agonist can be given SQ, PO, and nasal?

Back 9

Sumatriptan

Front 10

What drug class blocks serotonin in 2 ways - periph. antagonism of GI receptors and central antagonism of recptors in medulla?

Back 10

Serotonin antagonists

"setrons"

Front 11

Which ergot alkaloid is used in hyperporlactinemia, acromegaly, and parkinson's?

Back 11

Bromocriptine

Front 12

Which ergot alkaloid is used for pervention and treatment of post partum and post abortion hemorrhage?

Back 12

Ergonovine

Front 13

Which drug class tx HTN,decreases mobidity and mortality in heart failure, delays diabetic neuropathy, decreases systemic vascular resistance without inc. HR and promotes natriuresis?

Back 13

ACE inhibitors.

Front 14

What do kinins do?

Back 14

incite vasodilation and increase permeability and blood flow.

Front 15

What effects does vasopressin have on the kidney?

Back 15

Increases the perm. of the collecting duct to water and thus allows water reabsorption and excretion of small volume of conc. urine, anti-diuresis

Front 16

What effects does vasopressin have on the CV system?

Back 16

Increase periph. vessel resist. -- inc. arterial BP
Becomes an impt compensatory mech for restoring blood pressure in hypovolemic shock

Front 17

What drug decreases systemic arterial pressure and PCWP. Must be given IV gtt.
Can cause fatal renal dmg?

Back 17

Nesiritide (Natrecor)

Front 18

What does ETa do?
(Endothelin)

Back 18

Vasoconstriction and retention of Na

Front 19

What does ETb do?
(Endothelin)

Back 19

Release of NO

Front 20

What drug is an oral agent used for tx of pulmonary HTN to improve exercise capacity and decrease the rate of deterioration?

Back 20

Bosentan

(blocks endothelin receptors - both a and b - more affinity for a)

Front 21

Name 7 thing protaglandins do

Back 21

1 - constr/dilation sm. muscle
2 - aggr/disaggr. of platelets
3 - sensitize spinal neurons to pain
4 - constrict smooth muscle?
5 - regular inflammatory mediation
6 - regulate Ca++ movement
7 - control cell growth

Front 22

What is prostacyclin?

Back 22

effective vasodilator
prevents plt from forming and clumping

Front 23

What is thromboxane?

Back 23

Vasoconstrictor
facilitates plt. aggregation

Front 24

What do leukotrienes do?
(5)

Back 24

1 - airflow obstr.
2 - inc. secretion of mucus
3 - mucosal accumulation
4 - bronchoconstriction
5 - infiltration of inflammatory cells in the airway wall

Front 25

Tx guidelines for mild intermittent asthma.
step 1

Back 25

no long term meds
Quick relief:
inhaled B2 agonist
(>2x wk --- eval)

Front 26

Tx guidelines for mild persistent asthma.
step 2

Back 26

preferred - inhaled steriod (low dose)
Alt - cromolyn/nedocromil lekotriene modifier or theophylline.
Quick relief:
inhaled B2 agonist (daily use or increased use -- eval)

Front 27

Tx guidelines for moderate persistent asthma.
step 3

Back 27

preferred: Inhaled ster. (low to med dose) + long-act. B2 agonist
ALT: inhaled steroid (med) OR inhaled ster. (low-med) leukotriene mod. or theo.
Quick relief:
inhaled B2 agonist
(daily or inc use = eval)

Front 28

Tx guidelines for severe persistent asthma.
step 4

Back 28

Preferred: Inhaled ster. (high dose) AND long acting B2 agonist AND if needed coricosteroid tab/syrup
Quick relief:
Inhaled B2 agonist (daily use or inc use = eval)

Front 29

How do corticosteroids work in the tx of asthma?

Back 29

decrease the number and activity of macrophages, eos, and T-lymphs

Front 30

How do adrenergic agonists work in the tx of asthma?

Back 30

relax smooth muscle by action on B2 receptors in the lung.

Front 31

How do mast cell stablizers work in the tx of asthma?

Back 31

Leukotriene receptor antagonist

Front 32

How do anticholinergics work in the tx of asthma?

Back 32

Block vagally mediated contraction of the airway smooth muscle and mucus secretion.

Front 33

How do methylxanthines work in the tx of asthma?

(theophylline)

Back 33

Bronchodilator that relieves airflow obstr. in chronic asthma.

Front 34

What are adverse effects of steriod inhalers?

(beclomethasone, trimcinolone, flunisolide, fluticason, mometasone)

Back 34

MDI - oral candida; hoarseness; may slow bone growth in kids
Systemic - cushing's synd, growth retard, osteoporosis, glu intolerance, skin thinning, myopathy, euporia, depression.

Front 35

Is immediate benefit seen with steroid inhalers?

Back 35

No
use scheduled not PRN

Front 36

Are mast cell stablizers quick relief?

(Nedcromil, cromolyn)

Back 36

No - not rapid relief, slow

Front 37

Whar are SE of anticholinergic tx for asthma?

(Ipratropium)

Back 37

Headache
flushed skin
blurred vision
tachycardia
palpitations

Front 38

What is asthma drug of choice for COPD?

Back 38

anticholinergics

Front 39

What is drug of choice for acute bronchospasm?

Back 39

B2 Agonists (short acting)
albuterol, pirbuterol, levalbuterol

Front 40

Name 2 long acting B2 agonists.

Back 40

Salmeterol
Formoterol

Front 41

Are long acting B2 agonists for acute symptoms?

Back 41

NO
slow onset of action (30 Min)

Front 42

What are SE of theophylline?

Back 42

N/V
GERD
nervousness
tremors
insomnia
HA
arrhythmia
seizures

Front 43

What is target goal of theophylline?

Back 43

5-15 mcg/ml

Front 44

Which drugs cause increased conc of theophylline?

Back 44

Cipro
clarithro
erythro
isoniazid

Front 45

Which drugs cause decreased conc of theophylline?

Back 45

Barbiturates
carbamazepine
phenytoin
rifampin
Cigs
charcoal-broiled food

Front 46

What SE does zafirlukast cause?

(accolate)

Back 46

Hepatotoxicity
monitor LFT's first 3 months

Front 47

What are drugs that interact with zafirlukast?

Back 47

warfarin
erythro
theophylline

Front 48

What drug interacts with montelukast (singulair)?

Back 48

Phenobarbital
and
for >2yrs old.