Chung Pharmacology Lecture 3 Test 1

Front 1

➢Widely used to treat allergic rhinitis
➢MOA: compete with histamine for binding to H1 receptors after histamine released due to allergen stimuli
➢Most beneficial when given early before the release of histamine (prophylaxis)

located in the Respiratory system and the CNS

Back 1

Antihistamines (H1 Antagonists)

Front 2

1._______

➢Prototype: Diphenhydramine (___2___)
➢MOA: acting centrally and peripherally
➢Cross blood brain barrier
➢More significant central adverse effects such as drowsiness and sedation
➢Tolerance develops after a few doses
➢Excessive anticholinergic adverse effects such as dry mouth and urine hesitancy

Back 2

1. 1st generation H1 antagonists

2. Benadryl

(*diphenhydramine (Benadryl) can also help when you have a sleep problem)

Front 3

1._______

➢Prototype: Loratidine (__2___), Cetirizine (___3___), Fexofenadine (___4___)
➢MOA: acting peripherally to bind to Histamine 1 receptors
➢Not cross blood brain barrier
➢Less significant central adverse effects
➢Less anticholinergic side effects

Back 3

1. 2nd generation of H1 Antagonists

2. Claritin

3. Zyrtec

4. Allegra

Front 4

Parkinson’s disease (central and anticholinergic effects,______

Back 4

1st generation

Front 5

_______OTC sleep aids, 1st generation but tolerance, less than 2 weeks)

Back 5

Insomnia

Front 6

__________and other skin rashes (1st and 2nd generation, oral and tropical creams)

Back 6

Urticaria

Front 7

STUDY CARD FYI!!!!!!!!Vertigo and motion sickness (Promethazine (Phenergan) discussed in GI drugs)

Back 7

FYI STUDY CARD !!!!

Front 8

➢Prototype: Pseudoephedrine (Sudafed)
➢MOA
➢Activate alpha1 adrenergic receptors which causes (vasoconstriction) in nasal mucosa
➢Stimulate beta2 adrenergic receptors of respiratory tract, which may result in some

(bronchodilation)
➢Oral or Intranasal Spray

Back 8

Decongestants

Front 9

➢Headache
➢Nervousness and tremors
➢Tachycardia, palpitations, hypertension
➢Rebound effects
➢Often occur after taken too long
➢Worsen symptoms when drug discontinued
➢A result of a tissue dependence

OTC drugs

Back 9

Adverse effect of decongestants

Front 10

What are the rebound effects for decongestants

Back 10

➢Use no longer than 3-5 days
➢Patients with dependence need a gradual switch to intranasal corticosteroids
➢Oral drugs eliminate rebound effects but slower onset and less effective

Front 11

1._________

➢Used to suppress cough reflex
➢Two types
➢Opioids vs Nonopioids
➢Opioid (__2____)
➢Suppress cough reflex center in medulla
➢Non-opioid (3)

➢Inhibit cough reflex in the throat, trachea, or lungs

Back 11

1. Antitussives

2. Codeine

3. Dextromethorphan

Front 12

what are the adverse effects,interactions, and the precautions for anti-tussives

Back 12

***Adverse effects
➢Dizziness
➢Sedation
➢Abuse causing CNS toxicity (limit use < a week)
***Interaction
➢Alcohol
➢Other CNS drugs
***Precaution
➢Fever and productive cough
➢Pre-existing pulmonary disease

Front 13

1.______

➢Prototype: Guaifenesin (Robitussin, ___2___)
➢MOA: reduce thickness or viscosity of bronchial secretions
➢Commonly used OTC drug
➢No smoking or 2nd hand smoke

NOT and ANTI-TUSSIVE

Lose sputum not direct act of cough reflux

Back 13

1. Expectorants

2. Mucinex

Front 14

Lower Respiratory Tract

Autonomic Control

_________ ,Beta 2 adrenergic receptors, Bronchodilation,& needs agonist

Back 14

Sympathetic system

Front 15

Lower respiratory tract

Autonomic Control

_______, Muscarinic receptor, Bronchoconstriction, and needs antagonists

Back 15

➢Parasymphathetic system

Front 16

_____is a common indication of pharmacotherapy

Back 16

Bronchoconstriction

Front 17

1._______

-Bronchospasm

Sudden contraction bronchus causing acute __2____
Bronchodilators
-Chronic inflammation
Thick, viscous secretions
Block __3___
Antibiotics or mucolytics
-Edema
Engorgement of pulmonary blood vessels
____4___

Back 17

1. Brochoconstriction

2. dyspnea

3.airways

4. Diuretics

Front 18

What are the 3 types of bronchodilators?

Back 18

➢Beta2 adrenergic agonists
➢Methylxanthines
➢Anticholinergics

Front 19

what is the indication for bronchodilators

Back 19

➢Chronic Obstructive Pulmonary Disease (COPD)
➢Emphysema
➢Chronic bronchitis
➢Asthma

Front 20

1.______

➢Prototype: ___2____ (Proventil)
➢MOA
➢Activate selective beta2 adrenergic agonists in bronchus resulting in bronchodilation
➢Inhalation – short acting as rescuer
➢Oral – long acting
➢Adverse effects – tachycardia, angina, tremors
➢Levalbuterol (__xopenex_____) – expensive but less cardiac adverse effects

Back 20

1. Beta 2 Adrenergic Agonists

2. albuterol

Front 21

➢Prototype: theophylline (Theolair)
MOA :Increase cyclic adenoside monophosphate (cAMP) to dilate bronchial smooth muscle
➢Suppress airway responsiveness to stimuli that promote bronchospasm
➢Not available for inhalation – long term management
➢Risk of toxicity (drug level monitor)

Back 21

Methylxanthines

Front 22

➢Increased cAMP
➢Cerebral stimulation (restlessness, insomnia, dizziness)
➢Skeletal muscle stimulation (restlessness)
➢Bronchodilation
➢Pulmonary vasodilation
➢Cardiac stimulation (Palpitation, tachycardia)
➢Diuretics (Urinary frequency)
➢Multiple drug-drug interactions and contraindications

Back 22

Adverse effects of methylxanthines

Front 23

1.__________

➢Prototype: Ipratropium (____2___)
➢MOA
➢Block cholinergic receptors in bronchial smooth muscle
➢Intranasal administration reduces nasal hypersecretion
➢Available for inhalation and nasal spray
➢Indication
➢Bronchospasm associated with COPD
➢Used for allergen- or exercise-induced asthma

Back 23

1. Anticholinergic drugs

2. Atrovent

Front 24

What are the nursing concerns for anticholinergic drugs?

Back 24

➢Complete respiratory history
➢Respiratory signs assessment including dyspnea, orthopnea, cyanosis, nasal flaring, wheezing
➢Vital signs
➢Pulse Oximetry
➢Peak Flow (usually >=6yr)
➢Arterial blood gas
➢Pulmonary Function Test (PFT)

Front 25

________________ - a test in which a device that clips on the finger measures the saturation of hemoglobin in the blood

Back 25

Pulse Oximetry

Front 26

______ the maximum speed that air is exhaled from the lungs; used to determine the effectiveness of asthma medications

Back 26

Peak flow measurements

(* Green is ok/Yellow needs rescue treatment/Red urgent go to the ER or call 911it means you don't have enough air exchange in the lungs )

Front 27

Inhaled Corticosteroids as controller

Anti inflammatory drugs

__1___-cost effectiveness, most prescribed

__2___- expensive with nebulizer

Beclomethasone (Qvar)

Back 27

1.Fluticasone (Flovent)

2. Budesonide (Pulmicort)

Front 28

STUDY CARD FYI

Anti inflammatory drugs

➢Mast Cell Stabilizers
➢Cromolyn (Intal)
➢Leukotriene Modifiers as controller
➢Montelukast (Singulair)

Back 28

STUDY CARD FYI

Front 29

Reduces inflammation and immune response thus reducing frequency of asthma attacks

Back 29

➢Inhaled Corticosteroids

Front 30

Stabilizes mast cells thus preventing inflammatory response

Back 30

➢Mast Cell Stabilizers

Front 31

Blocks leukotriene receptors in airways thereby preventing airway edema and inflammation

Back 31

➢Leukotriene Modifiers

Front 32

➢Infectious disease caused by Mycobacterium _____
➢System/organ affected
➢Lungs/pulmonary ___
➢Extrapulmonary ______
➢Community disease with incidence of 10 to 15 million people in US
➢Might be asymptomatic and activate when immune system compromised (HIV-AIDS, transplant, steroid users, chemotherapy)

Back 32

Tuberculosis (TB)

Front 33

_________________the presence of T memory cells but can not determine active or latent (48 to 72 hr)

Back 33

Tuberculin skin test (Mantoux/purified protein derivative (PPD)

Front 34

True /False 15% of TB infected people develop active TB

Back 34

False: ➢Only 10% of TB infected people develop active TB

Front 35

True/False: People with healthy immune system fight off the infection and TB dormant (inactive) in lungs

Back 35

True

Front 36

what are thee other tools used to diagnose TB

Back 36

➢Sputum culture/acid fast bacilli (several weeks)
➢Chest radiology (not specific but helpful with PPD+)
➢Amplified DNA/RNA tests (expensive)

Front 37

what are the signs and symptoms of TB

Back 37

➢Coughing
➢Chest pain with breathing and cough
➢Cough with sputum or blood
➢Weight loss
➢Fatigue
➢Malaise
➢Fever
➢Night sweats

Front 38

1.____

➢Kill or inhibit mycobacterial organism
➢Often given in combination
➢Decrease drug resistance (mutation)
➢Increase adverse effects
➢Long and complex
➢6 months to 2 years
➢Directly observed therapy (____2___)
➢Health care provider directly observe patient swallowing pills everywhere all the time and provide education

Back 38

1. Anti-TB agents

2. DOT

Front 39

1.______

➢Prototype: Isonizid (___2__)
➢MOAs
➢Inhibits synthesis of mycolic acid on cell wall
➢Bacteriocidal for rapidly dividing organisms
➢Bacteriostatic for dormant mycobacteria
➢Most effective and safest (1st line ___1___drugs)
➢Prophylaxis and active treatment
➢Monitor therapeutic effectiveness in first 2-3 weeks. Chest x-ray and sputum culture

Back 39

1. Anti-TB drugs

2. INH

Front 40

➢Bacteriocidal by inhibiting RNA synthesis
➢Flulike hypersensitivity, potent CYP450 inducer

Back 40

Rifampin (other anti-tb drug)

*1st line tb drug

Front 41

➢Inhibiting synthesis of mycolic acid
➢Old drug, easily to develop resistance when used alone, gout or arthralgia

Back 41

➢Pyrazinamide (PZA) (other anti-tb drug)

1st line

Front 42

➢Unclear but bacteriostatic by inhibiting cell wall and RNA synthesis
➢Active against TB resistance, short half life (1 to 4 hr), optic neuritis to affect visual acuity for distinguishing red and green

Back 42

➢Ethambutol (Myambutol)

other anti-tb drug

Front 43

The nurse teaches the client that which type of over-the-counter cough preparations is not effective with coughs associated with the common cold and allergic rhinitis?
1.Dextromethorphan
2.Diphenhydramine
3.Mucolytics
4.Pseudoephedrine

Back 43

4. Pseudoephedrine

Front 44

The nurse knows that sympathomimetic decongestants should be avoided by people with which conditions or situations?
1.Hypertension and coronary artery disease
2.Wide-angle glaucoma
3.Breast-feeding women
4.Elderly clients

Back 44

1. Hypertension and coronary artery disease

Front 45

A client is prescribed beclomethasone (Beclovent), a glucocorticoid inhaler. Education by the nurse will include:
1.“Check your heart rate because this may cause tachycardia.”
2.“Limit your coffee intake while on this drug.”
3.“Rinse your mouth out well after each use.”
4.“You may feel shaky and nervous after using this drug.”

Back 45

3 Rinse your mouth out well after each use

Front 46

A client with asthma asks which of the prescribed medications should be used in the event of an acute episode of bronchospasm. The nurse will instruct the client to use:
1.Albuterol, a beta agonist bronchodilator, by inhalation.
2.Beclomethasone, a glucocorticoid anti-inflammatory drug, by inhalation.
3.Ipratropium, an anticholinergic bronchodilator, by inhalation.
4.Zafirlukast, a leukotriene modifier, by mouth.

Back 46

1. Albuterol, a beta agonist bronchodilator, by inhalation.

Front 47

The nurse should inform the client who is prescribed a nebulizer treatment with a bronchodilator agent that a common adverse effect is:
1.An increased heart rate with palpitations.
2.Predisposition to infection.
3.Sedation.
4.Temporary dyspnea.

Back 47

1.An increased heart rate with palpitations.

Front 48

Question 6
A 4-year-old child with respiratory distress secondary to asthma has an order for a nebulizer treatment. The type of medication most likely to be given for asthma management is a:
1.Beta agonist.
2.Beta antagonist.
3.Corticosteroid.
4.Leukotriene modifier.

Back 48

1.Beta agonist.

Front 49

A client who is receiving antituberculosis therapy is complaining of tingling and numbness of the fingers and toes. The nurse knows that these symptoms are most likely due to the drug’s ability to:
1.Increase the sensitivity of nerve endings.
2.Decrease the activity of pyridoxine (vitamin B6).
3.Accelerate the excretion of neurotransmitters.
4.Enhance skin receptors to ascorbic acid (vitamin C).

Back 49

2.Decrease the activity of pyridoxine (vitamin B6).

Front 50

A client’s family asks the nurse to explain the most common cause for treatment failure in pulmonary tuberculosis. The nurse knows that treatment failure is most often caused by the client’s:
1.Inability to pay for the medication.
2.Poor nutritional intake of complex proteins.
3.Inability or unwillingness to adhere to the therapeutic regimen.
4.Inability to restrict intake of calcium-enriched foods.

Back 50

3.Inability or unwillingness to adhere to the therapeutic regimen.

Front 51

Which of the following clients receiving isoniazid (INH) is most likely to experience hepatotoxicity?
1.A 42-year-old housewife
2.A 22-year-old postpartum female
3.An 82-year-old farmer
4.A 42-year-old marketing executive

Back 51

3.An 82-year-old farmer