Pharmacology Mostly Resp Meds

Front 1

-olol

What is it and what is it used for?

How does it work?

Back 1

beta blocker.

Blocks beta 1 receptors.

HTN, arrhythmias, migraines, glaucoma, angina.

Front 2

Pred-

What is it and what is it used for?

How does it work?

Back 2

steroid.Asthma and COPD.Reduces inflammation in bronchioles

Front 3

-olone

What is it and what is it used for?

How does it work?

Back 3

steroid.

Asthma and COPD.

Reduces inflammation in bronchioles

Front 4

Thiazide

What is it and what is it used for?

How does it work?

Back 4

diuretic

DM

Principal cell in distal tubule

Front 5

-meline

What is it and what is it used for?

How does it work?

Back 5

cholinergic agonist

Tx dry mouth

stimulates salivation

Front 6

-pezil

What is it and what is it used for?

Back 6

Acetylcholinesterase inhibitors used in the treatment of Alzheimer's disease

Front 7

-meline

What is it and what is it used for?

Back 7

Cholinergic agonists (arecoline derivatives used in treatment of Alzheimer's disease)

Front 8

-stigmine

What is it and what is it used for?

Back 8

Cholinesterase inhibitors .

Myasthenia gravis tx.

drug OD of anticholinergic agents.

Front 9

asthma and COPD rescue meds

Back 9

bronchodilators.

epinephrine for asthma only.

anticholinergics.

theophyline.

Front 10

Asthma anti inflammatory meds

Back 10

GLUCOCORTICOSTEROIDS.

mAST CELL STABILIZERS

leukotriene inhibitors.

Omalizumab

Front 11

COPD anti inflammatory meds

Back 11

inhaled glucocorticosteroid

systemic glucocorticosteroid

roflumilast which is a PDE 4 inhibitors

Front 12

what are cholinergics good for?

Back 12

better for COPD and emphysema.

Less effective for asthma.

Front 13

what is theophylline used for?

Back 13

long term basis to prevent bronchoconstriction in asthma and emphysema.

Front 14

how long to wait between MDI use?

Back 14

5-10 minutes

Front 15

Do you need to be able to inhale a lot of air to make MDI med administration work?

Back 15

no

Front 16

how to use MDI with aerochamber

Back 16

get med into chamber and breath normally.

Rinse chamber w/soapy water. Let dry with soap.

Front 17

DPI work how?

Back 17

capsule punctured and misted but the patient must have a good inspiratory volume to work well.

Front 18

when to use racemic epi?

Back 18

trying to overcome spasm like in croup cough.

Front 19

what is isoproterenol and pirbuterol?

Back 19

beta agonist bronchodilator. It has some effect on beta 1 receptors.

Front 20

what is the difference between beta agonist and beta 2 selective agonist?

Back 20

beta 2 selective have less cardiac stimulation.

Front 21

what is tertbutaline and what is it good and bad for?

Back 21

good for allergic asthma. It is IV only. Good for patient who can't breath well enough to get inhaled medication in lungs.

Front 22

what is salmeterol, Formoterol and Arformoterol used for?

Back 22

beta selective agonist that is long acting SALA asthma and COPD. given BID .

Front 23

ADR's for all beta agonist?

Back 23

Local:dry irritated throat, cough, bad taste.

Systemic:CNS stimulation (insomnia, excitability, tremor), cardiac stimulation, hypotension(depending on degree of beta 2 stimulation in vasculature) Hyperglycemia and hypokalemia also occur secondary to beta 2 agonist activity.

Front 24

what are anticholinergic drugs for?

Back 24

everyday use for asthma, rhinitis and COPD.

Front 25

what is ipratropium?

Back 25

an anticholinergic drug for COPD, asthma and rhinitis.

COPD it is used PRN.

Front 26

are ipratropium and albuterol ever combined?

Back 26

in combivent and duoneb.

Front 27

ADR's of anticholinergic drugs

Back 27

CNS, palpitations, bitter taste and cough.

Front 28

what is tiotropium?

Back 28

long acting anticholinergic. need good inspiratory ability to take. Might need bronchodilator before taking.

Front 29

tiotropium versus ipratropium.

Back 29

tiotropium only needs once daily where ipratropium is taken 4 times daily.

But ipratropium is much cheaper.

Tiotropium has no pediatric use.

Front 30

xanthine derivatives are for what?

Back 30

Asthma dn refractory COPD

Front 31

how do xanthine derivatives work?

Back 31

Phosphodiesterase Inhibitor causing bronchodilation and some anti-inflammatory effects

Front 32

cautions with xanthine derivatives?

DDI's?

Back 32

:Produces high amount of CVS and CNS stimulation and diuresis.

narrow therapeutic index

Substrate of CYP1A2, many DDI

Front 33

ADR's with xanthine derivatives

Back 33

N, V, D, epigastric px.

insomnia, agitation, dizziness, seizures.

tachycardia, PVC's.

Front 34

xanthine derivatives examples?

Back 34

Theophylline PO

Aminophylline IV

Front 35

Glucocorticosteroids for asthma and COPD works how?

Back 35

reduces inflammation in the bronchioles.

Front 36

When do yo use Glucocorticosteroids in COPD?

Back 36

stage 3 and stage 4

Front 37

why to use Glucocorticosteroids in asthma and COPD?

Back 37

Used on long term basis for asthma and COPD treatment; inhaled form NOT for acute attacks.

Maximal Response requires 8 weeks to develop .

Reduce# and severity of Sx and decrease need for rescue inhalers (short-acting B2 agonists).

Front 38

oral steroids for respiratory vs inhaled steroids for respiratory symptoms

Back 38

oral use for 3-5 days for exacerbations and inhaled for long term use.

Front 39

will I get some immunosuppression with oral versus inhaled steroids?

Back 39

no. Inhaled steroids are better about not immunosuppression because little is getting to the blood unless patient ins't swishing and spitting after each inhalation.

Front 40

Beclomethasone is what kind of drug and whats it for?

Back 40

inhaled glucocorticoid for asthma and COPD

Front 41

budesonide is what kind of drug and whats it for?

Back 41

inhaled glucocorticoid for asthma and COPD

Front 42

flunisolide is what kind of drug and whats it for?

Back 42

inhaled glucocorticoid for asthma and COPD

Front 43

Fluticasone is what kind of drug and whats it for?

Back 43

inhaled glucocorticoid for asthma and COPD

Front 44

mometasone is what kind of drug and whats it for?

Back 44

inhaled glucocorticoid for asthma and COPD

Front 45

triamcinolone is what kind of drug and whats it for?

Back 45

inhaled glucocorticoid for asthma and COPD

Front 46

ciclesonide is what kind of drug and whats it for?

Back 46

inhaled glucocorticoid for asthma and COPD

Front 47

if a patient is taking multiple inhalers what order should they take them in?

Back 47

1st SABA then anticholinergic 2nd and rinse after.

Front 48

systemic glucocorticosteroids used for what for how long?

Back 48

Used for short course “burst” therapy and for asthma or COPD exacerbations for 3- days.

Front 49

Prednisone when taken systemically is what and what is it used for?

Back 49

Systemic Glucocorticosteroids taken for asthma or COPD exacerbations

Front 50

Methylprednisolone when taken systemically is what and what is it used for?

Back 50

Systemic glucocorticosteroids taken for asthma or COPD exacerbations

Front 51

prednisolone when taken systemically is what and what is it used for?

Back 51

Systemic glucocorticosteroids taken for asthma or COPD exacerbations

Front 52

hydrocortisone when taken systemically is what and what is it used for?

Back 52

Systemic glucocorticosteroids taken for asthma or COPD exacerbations

Front 53

dexamethasone when taken systemically is what and what is it used for?

Back 53

Systemic glucocorticosteroids taken for asthma or COPD exacerbations

Front 54

Mast cell stabilizers are used for what?

Back 54

Asthma- Not used for acute attacks, MUST use prophylactically (maintenance therapy);

NOT FoR COPD. NOT FOR COPD

Front 55

ADR's for Mast cell stabilizers?

Back 55

–local irritation, bad taste, cough & bronchospasm

Front 56

what do Mast cell stabilizers do?

Back 56

Stabilizes plasma membrane of mast cells and eosinophils.

that leads to preventing degranulation and release of histamine, leukotrienes and other mediators.

That leads to reduction in inflammation

Front 57

what is Cromolyn?

Back 57

mast cell stabilizer

Front 58

what is nedocromil?

Back 58

mast cell stabilizer

Front 59

what are Leukotrienes and why does that make Leukotriene inhibitors good for?

Back 59

Leukotrienes an arachidonic acid metabolite, inflammatory mediator. Leukotriene Receptors mediate: Airway Inflammation, Edema, Bronchoconstriction, Secretion Of thick, viscous mucus.

Can be used to treat mild-moderate persistent asthma. Also used to treat seasonal and allergic rhinitis. Not for COPD. NOT FOR COPD.

Front 60

Leukotriene inhibitors subdivided into two categories. What are they?

Back 60

Leukotriene Receptor blockers Lipoxygenase inhibitors

Front 61

things to remember about using Leukotriene inhibitors? how long does it take for them to work?

Back 61

May take weeks to see benefit – improved pulm fxn, control of Sx,reduction in attacks, reduction in airway inflammation.

NOT for acute Treatment; often used in conjunction w/ b2 adrenergic agonists

Front 62

Zafirlukast is what? whats it for?

Back 62

Leukotriene inhibitor? asthma. Lots of DDI's like CYP450 enzyme inhibitor - increased levels of ASA, warfarin and theophylline.

Less commonly used.

Front 63

Montelukast Is what for what?

Back 63

leukotriene inhibitor.

asthma tx.

Front 64

ADR's with Zafirlukast?

Back 64

fever,malaise, peripheral neuropathy (28%), rash, GI disturbances

Front 65

ADR's with montelukast?

Back 65

HA

Front 66

Zileuton Is what?

how does it work?

Back 66

Leukotriene Inhibitor.

nMOA- inhibits 5-lipoxygenase enzyme which results in decreased production of leukotrienes

Front 67

what is a contraindication of Zileuton ?

Back 67

active liver disease.

its a Leukotrieine inhibitor

Front 68

ADR's of Zileuton ?

Back 68

Leukotriene inhibitor

CNS effects (headache in up to 25% of pts); flu like Sx, dyspepsia and ­ LFTs

Front 69

DDI's of Zileuton ?

Back 69

CYP450 enzyme inhibitor - increased levels Beta Blockers, theophylline and warfarin levels.

Leukotriene inhibitor

Front 70

what leukotrienes inhibitors can be used can be used with peds over 5 years old

Back 70

Zafirlukast

Front 71

what leukotrienes inhibitors can be used can be used with peds over 12 months

Back 71

Montelukast

Front 72

what leukotrienes inhibitors can be used can be used with peds over 12 year olds

Back 72

Zileuton

Front 73

Omalizumab is wht and how does it work?

Back 73

Asthma medication. NOT COPD. NOT COPD.

MOA:IgG monoclonal antibody. Inhibits IgE binding to the IgE receptor on mast cells and basophils, this leads to decreased activation and release of inflammatory mediators.

Front 74

Omalizumab cautions and ADR's

Back 74

:Anaphylactic reactions can occur.

ADRs:Anaphylaxis, CNS effects (headache, dizziness), arthralgias, local injection site reactions .

IgE binding inhibitor.

Front 75

Roflumilast is what and how does it work?

Back 75

MOA: selectively blocks PDE4, a major cAMP metabolizing enzyme found in inflammatory cells, which is involved in promoting the pathogenesis of COPD.

Front 76

when is Roflumilast used?

Back 76

Add-on therapy to bronchodilators to decrease the risk of exacerbations in pts with severe COPD. Not for asthma

Front 77

Roflumilast precautions and ADR's?

Back 77

Moderate-severe liver dysfunction.

Precautions: neuropsychiatric ADRs, weight loss.

ADR's. nGI(nausea, diarrhea, ab. pain, decreased appetite, wt. loss), dizziness, headache, insomnia, back pain DDIs: CYP3A4 and 1A2 substrate.

Front 78

Intermittent vs persistent asthma

Back 78

intermittent asthma is controlled by a short acting beta 2 agonist.

Persistent asthma needs long acting medications for control.

Front 79

intermittent vs mild vs moderate vs severe

Back 79

intermittent= less than or equal to 2 times per week having symptoms needing beta 2 agonist. less than or equal to 2 night time awakenings per month.

mild= >2 per week needing SABA. 3-4 awakenings times per month.

Moderate= daily SABA use. once weekly awakenings, but not nightly.

Severe= daily need for SABA. daily awakenings.

Front 80

Steps of asthma control medications

Back 80

step 1 = SABA

Step 2= low dose ICS

step 3= low dose ics + LABA or medium dose ics

step 4= medium dose ics +laba

step 5= high dose ics +laba and consider omalizumab for pts with allergies

step 6= high dose ics + LABA + oral corticosteroid and consider omalizumab for pts with allergies

Front 81

COPD managment in stage 1-4

Back 81

stage 1- SABA

stage 2- LABA with SABA prn

stage 3- LABA with SABA prn + inh glucocorticoids

stage 4- LABA with SABA prn + inh glucocorticoids + O2

Front 82

MDI versus DPI

Back 82

MDI must be shaken. must prime. med delivered by propellant.

DPI - no need to shake. no prime needed. no propellants.

Front 83

MDI instructions

Back 83

Start breathing in slowly through mouth, THEN press down on the inhaler.

Front 84

DPI instructions

Back 84

For DPI – put mouthpiece to lips and breathe in QUICKLY. Hold your breath and count to 10 slowly (if you can)

If using 2 puffs – wait one minute between puffs nIf using a different inhaled drug, wait 5 minutes between drugs nUse bronchodilators first and steroids last Rinse and spit after steroid use

Front 85

nPDE-4 inhibitors do what? what are they for?

Back 85

Decrease Inflammation and promote smooth muscle relaxation.

cilomilast under investigation for the management of both asthma and COPD .Roflumilast Recently approved for COPD

Front 86

what is an Antiprotease used for?

Back 86

for alpha-1 antitrypsin deficiency in emphysema. still Under investigation.

Front 87

PulmonaryHypertension characterisitics?

Back 87

Characterized by elevated pulmonaryarterial pressure and secondary right ventricular failure

Front 88

causes of PHTN?

Back 88

idoopathic.

congenital heart disease.

genetic.

drugs-- fenfluramine, dexfenfluramine and PPA.

SSRI's, amphetamines, chemo drugs and cocaine.

connective tissue diseases.

HIV.

Portal HTN.

Front 89

PHTN classification group 1 is caused by what?

Back 89

pulmonary arterial HTN

Front 90

PHTN classification group 2 is caused by what?

Back 90

P HTN w/left heart disease (PVH)

Front 91

PHTN classification group 3 is caused by what?

Back 91

PHassociated w/ lung disease and/or hypoxemia )

Front 92

PHTN classification group 4 is caused by what?

Back 92

PHdue to chronic thrombotic and/or embolic disease

Front 93

PHTN classification group 5 is caused by what?

Back 93

Miscellaneous

Front 94

what treatments should all classifications groups of COPD get?

Back 94

diuretics.

O2.

Warfarin.

Digoxin.

exercise.

Front 95

with oral PDE inhibitros what drugs should you not use?

Back 95

nitrates and alpha-1 blockers.

Front 96

Oral PDE ADR's?

Back 96

HA and facial flushing.

Front 97

Oral endothelin receptor blockers used for what?

Back 97

preferred therapy for group 1 PAH.

Front 98

ADR's from oral endothelin receptor blockers

Back 98

heptotoxicity, yeretgenic, HA, flushing and edema.

Front 99

bosentan (& )ambrisentan do what?

Back 99

targetd tx for PHTN.