Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
55 Cards in this Set
- Front
- Back
Advantage of inhaled asthma treatment
|
Fewer side effects
More rapid relief |
|
B2 agonists MOA
|
Activates adenylate cyclase, which increases cAMP production
cAMP relaxes bronchial smooth muscle |
|
B2 agonists (4)
|
Albuterol (Ventolin, Proventil, Accuneb)
Levabuterol (Xopenex) Fluticasone/salmeterol (Advair) Formoterol Fumarate (Foradil) |
|
Prototype of B2 agonists
-Effects on B1 receptors |
Albuterol
Not much effect, pretty selective for B2 in airway; so few cardiac side effects |
|
A long acting B2 agonist
-Advantages |
Salmeterol
Able to use less frequently; less likely to develop tolerance |
|
Advantage of Levabuterol
|
An isolated isomer that produces specific effects at receptors, thereby reducing side effects
However, more expensive |
|
Serious adverse effects of albuterol
|
Urticaria
Arrythmia QT prolongation Angina Hypokalemia Paradoxical bronchospasm |
|
Common adverse effects of albuterol
|
Nervousness
Tremor Tachycardia Bad taste Throat irritation |
|
Vagal stimulation on airways
|
Causes bronchoconstriction and mucus secretion
|
|
Anticholinergics (2)
|
Ipratroprium bromide (Atrovent)
Tiotroprium bromide (Spiriva Handihaler) |
|
Anticholinergics MOA
|
Blocks ganglionic vagal pathways; vagal stimulation produces bronchoconstriction.
|
|
Ipratroprium bromide
-Advantage |
It's a quaternary amine, so it isn't absorbed well systemically - so can't have as many side effects
|
|
Tiotroprium advantage
|
Has long half life, so can be used just once daily
|
|
Anticholinergic metabolism and excretion
|
Little metabolism of either, excreted unchanged in urine and feces
|
|
Corticosteroids MOA
|
Prevents neutrophils and eosinophils from coming to airway. Prevents production of inflammatory chemicals. Thereby reduces mucus production and swelling.
|
|
Corticosteroids also
|
Increases the number and sensitivity of B2 receptors.
|
|
Corticosteroids (4)
|
Beclomethasone (Beclovent® Vanceril® QVAR80® )
Budesonide (Pulmicort®) Fluticasone / salmeterol (Advair®) Triamcinolone acetonide (Azmacort®) |
|
Corticosteroids elimination
|
Both renal and fecal
|
|
Serious adverse effects of corticosteroids
|
Adrenal suppression
Osteoporosis Growth suppression Bronchospasm Peptic ulcer |
|
Common adverse effects of corticosteroids
|
Oral candidiasis
Sinusitis Rhinitis Hoarseness |
|
Leukotrines made from
|
Lipoxygenase converting arachidonic acid to leukotrines
|
|
Leukotrine receptor antagonists MOA
|
Prevents leukotrines from participating in inflammatory response
|
|
Leukotrine antagonist (1)
|
Montelukast (Singulair)
|
|
Why might compliance be better with leukotrine antagonists
|
B/c administered orally, so especially easier for children to take
|
|
Serious adverse effects of leukotrine modifiers
|
Angioedema
Anaphylaxis Churg Strauss syndrome |
|
Common adverse effects of leukotrine modifiers
|
Flu like symptoms
|
|
Leukotrine modifiers metabolism
|
CYP 450 enzymes
|
|
Monoclonal antibodies MOA
|
Inhibits IgE binding to receptors on mast cells and basophils, preventing degranulation (release of allergic response mediators).
|
|
Problem with monoclonal antibodies
Intended recipient |
Expensive and injectable only
People who do not respond to inhaled corticosteroids |
|
Monoclonal antibodies (1)
|
Omalizumab (Xolair)
|
|
Decongestants MOA
|
A1 stimulation, producing vasoconstriction - restricted blood flow so less edema and mucus production.
|
|
Topical decongestants (3)
|
Oxymetazoline (Afrin®, Allerest®)
Phenylephrine (Neo-synephrine®) Topical spray Xylometazoline (Otrivin ®) |
|
Systemic degongestant (1)
|
Pseudoephedrine (Sudafed®)
Systemic extended release tablets |
|
Serious adverse effects of decongestants
|
Cardiovascular collapse
Arrythmia Tachycardia |
|
Common adverse effects of decongestants
|
Sneezing
Burning Irritation HTN Insomnia Agitation, tremor |
|
Topical decongestants should not be used longer than
|
3 days
|
|
Antihistamines MOA
|
Block H1 receptors, preventing inflammation and mucus production
|
|
Effects of histamine (3)
|
Stimulates nerve endings to cause pain and itchy
Dilates arterioles so BP goes down and reflex tachycardia is initiated Causes increased permeability of capillaries so causes edema and hives |
|
Do antihistamines have any effect on histamine release?
|
No
|
|
1st generation antihistamines (3)
|
Dimenhydrinate (Dramamine)
Diphenhydramine HCl (Benadryl) Chlorpheniramine (Chlor-Trimeton) |
|
2nd generation antihistamines (4)
|
Cetirizine (Zyrtec)
loratidine (Claritin) des-loratidine (Clarinex) fexofenadine (Allegra®, Allegra D) |
|
Two notes about first generation antihistamines
|
More sedative
More distribution in the CNS |
|
Note about second generation antihistamines
|
Have longer half-lives
|
|
Other useful effects of antihistamines
|
Sedation
Antiemetic Anticholinergic for rhinitis |
|
Corticosteroids for treatment of the cold MOA
|
Antinflammatory effects in the nose spray; limited absorption so doesn't affect rest of the body
|
|
Intranasal inflammatory sprays (4)
|
Corticosteroids - Rx
Triamcinolone acetonide (Nasacort) Budesonide (Rhinocort) Fluticasone (Flonase) |
|
Intranasal spray MOA
|
Decrease inflammatory effect in nose
|
|
Cough produced by
|
Cough center in the medulla
|
|
Antitussives
-2 general actions |
Inhibit cough through
1. Action with trachea 2. Action with medulla |
|
Expectorants MOA
|
Make respiratory mucus thin so it can be removed
|
|
The only safe expectorant
|
Guaifenesin (Robitussin, Mucinex)
|
|
Other cough medicines
|
Opioids like codeine - used at lower levels than pain control
|
|
Antitussives with Dextromethorphan (an isomer of opioid): MOA
|
Dextromethorphan (Robitussin-DM, Mucinex-DM, Delsym)
Acts at medulla to depress cough |
|
Antitussives with codeine (1)
|
Tussionex, Tussi-organidin
|
|
Non-codeine antitussives (1) and MOA
|
Benzonatate (Tessalon Perles)
Numbs trachea, so can't send cough signal to medulla |