Term
| short acting beta 2 agonists |
|
Definition
| SABA, for acute bronchospasm, rescue inhaler, prevent exercise induced asthma. Albuterol (more potent), Levalbuterol, Pirbuterol. last 3-4 hrs |
|
|
Term
| long acting beta agonists |
|
Definition
| Salmeterol (Serevent)(aerosol powder for inhalation), Formoterol (Foradil)(capsule for inhalation or solution through nebulizer), use in combination with inhaled corticosteroids. Black box warning- can inc the rate of asthma related death when used as monotherapy. work in ~2hrs, last ~12 hrs, give 2xday |
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Term
|
Definition
Salmeterol + fluticasone (Advair)
Formoterol + Budesonide (Symbicort)
Formeterol + Mometasone (Asmanex) |
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|
Term
| inhaled corticosteroid MOA |
|
Definition
| direct local inflammatory, reduce hyperresponsiveness, inhibit inflammatory cell migration and activation, most beneficial and effective for long term control of asthma, reduce impairment in lungs and the risk of exacerbation in pts w asthma |
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|
Term
| inhaled corticosteroid drugs |
|
Definition
| beclomethasone (bike in my zone), budesonide (bet on a zone), ciclesonide/desciclesonide (circle solid), flunisolide (fluky solid), fluticasone (flute in zone), mometasone (moment zone), triamcinolone (try my clone) |
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|
Term
| considerations for inhaled corticosteroids |
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Definition
| can cause systemic side effects, might affect growth velocity in pediatric pts, educate pts to rinse mouth w water after use (prevent fungal infection), takes ~1 week before it starts working |
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Term
| anticholinergic indications |
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Definition
| quick relief of mod-severe asthma in combination w short term beta agonist or as an alternative if pt is intolerant. reduces intrinsic vagal tone of airway |
|
|
Term
| anticholinergic asthma drugs |
|
Definition
ipratropium (Atrovent)- metered dose inhaler or as solution to be administered through nebulization
tiotropium (Spiriva)- inhale contents of capsule |
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|
Term
| Blurred vision, xerstomia (dry mouth) and tachycardia are side effects of? |
|
Definition
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|
Term
| pathway where leukotriene inhibitors work and leukotriene inhibitor MOA |
|
Definition
| pts exposed to allergen -> mast cells and eos release inflammatory markers -> initiates inflammatory cascade -> conversion of arachidonic acid by 5-lipoxygenase enzyme to cysteinyl leukotrienes -> leukotrienes act on cystLT1 receptor -> symptoms of asthma (mucus secretion, bronchoconstriction). Zileuton (Zi-Neuton) inhibits the production of leukotrienes (5-lipoxygenase inhibitor). Drugs that block the action of leukotriene on receptors: Montelukast (Singulair)(Mountain cast), Pranlukast (Prank cast), Zafirlukast (Accolate) (Za fire cast) |
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Term
| leukotriene inhibitor agents indicated when |
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Definition
| moderate to severe persistent asthma, recommended to use in combo w high dose corticosteroid and long term beta agonist. usually considered prior to chronic oral corticosteroids. not usually used as monotherapy |
|
|
Term
| common side effect of Montelukast |
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Definition
|
|
Term
| can cause hepatic injury, inc liver enzymes, contraindicated in pts w hepatic impariment |
|
Definition
|
|
Term
|
Definition
| work on inflammatory pathway. Cromolyn (Cromwell). Alternative agent for pts w mild persistent asthma. inferior to inhaled corticosteroids. can be used for exercise-induced bronchospasm. give as metered dose inhaler or nebulizer, can take 2-6 weeks to start working |
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Term
|
Definition
| block PDE enzyme, inc cyclic AMP -> bronchodilation (nonselective phosphodiesterase inhibitor) also anti inflammatory affect -> activation of histone, deacetylase enzyme, decreases the pro-inflammatory gene expression |
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|
Term
|
Definition
| give loading dose bc takes time to reach steady state. check blood lvl 30 min after loading dose bc can cause a lot of side effects and toxicity |
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|
Term
| has side effects of tachycardia, headache, hypertension, nausea, and vomitting and at very high doses can cause hematemesis, hyperglycemia, hyperkalemia, seizures |
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Definition
| methylxanthine (theophylline) (Elixophyllin) |
|
|
Term
| Cimetidine, Macrolides, Quinolones, Systemic Viral Illnesses, Zileutin, and Propanolol affect Methylxanthine clearance how? |
|
Definition
| decrease, CYP3A4 inhibitors |
|
|
Term
| Phenytonin, Rifampin, Carbamazepine, Smoking, Phenobarbital, High protein diet affect Methylxanthine clearance how? |
|
Definition
| increase, CYP3A4 inducers |
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Term
|
Definition
| Omalizumaub (O mail mob) (Xolair)- sub q injection, Mepolizumab (me pale mob) (Nucala- sub q injection), Reslizumab (re sell mob) |
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|
Term
|
Definition
| Monoclonal IgG antibody that inhibits the IgE receptor binding on mast cells and basophils |
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|
Term
|
Definition
| long-term use decreases asthma exacerbations and corticosteroid use, alt agent for pts w sensitivity to allergens and severe persistent asthma. but doesn't have any effect on baseline of FEV1 ratio |
|
|
Term
| has SE of anaphylactic reactions and injection-site reactions |
|
Definition
| Omalizumab, Mepolizumab, Reslizumab (Immunomodulators) |
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Term
|
Definition
| IgG monoclonal Ab that works by inhibiting the binding of interleukins to eosinophil cell surfaces |
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|
Term
|
Definition
| interleukin-5 receptor antagonist |
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|
Term
|
Definition
| add-on for maintenance treatment of severe asthma w an eosinophilic phenotype |
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|
Term
| metered-dose inhaler, pt education |
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Definition
| inhaler w canister surrounded by plastic holder and mouthpiece, medication mixed w propellant. tell pt to shake before use, exhale before inhaling medication, seal mouthpiece w lips, breathe in slowly, hold for 10 sec then breathe out |
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Term
| dry-powder inhaler pt education |
|
Definition
| hold discus in palm, push thumb grip until clicks into place, slide lever away, seal mouth around mouthpiece, breathe deeply and rapidly, hold breath 10 sec, close mouthpiece |
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|
Term
|
Definition
| used for administering dry-powder medications, twist and lift off cap to load dose, exhale, then twist twisthaler horizontally and breathe in rapidly and deeply then hold breath 10 sec, then close cap |
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|
Term
|
Definition
| usually have worsening of symptoms, preferred to use albuterol as a rescue agent and bedesonide as a maintenance agent. avoid long-acting beta-agonists, avoid omalizumab and zileuton |
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|
Term
| glucocorticoids and asthma vs COPD |
|
Definition
| inhibit inflammation in asthma, variable effect in COPD |
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|
Term
| Short acting beta-2 agonists for COPD |
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Definition
|
|
Term
| Long acting beta-2 agonists for COPD |
|
Definition
| arformoterol, formoterol, indacaterol (lasts 24 hrs), oldaterol, salmeterol, vilanterol |
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|
Term
| Anticholinergic agents for COPD |
|
Definition
short term- ipratropium
long-term- aclininium, tiotropium, umeclidinium |
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|
Term
| inhaled corticosteroids for COPD |
|
Definition
| beclomethasone (bike in my zone), Budesonide (bet on a zone), Ciclesonide (circle solid), Fluticasone (flute in zone), Mometasone (moment zone) |
|
|
Term
|
Definition
| Roflumilast (reduces inflammation and breakdown of cyclic AMP), adjunctive therapy for severe COPD pts or pts w prior history of hospitalization for acute exacerbation |
|
|
Term
| has the side effects of sinus tachycardia and hypokalemia |
|
Definition
|
|
Term
| has the side effects of hoarseness of voice, skin bruising, oral candidiasis, pneumonia |
|
Definition
|
|
Term
| has side effects of diarrhea, nausea, weight loss, insomnia, anxiety, depression, suicidal ideation |
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Definition
|
|
Term
| contraindicated in pts w moderate or severe hepatic impairment |
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Definition
|
|
Term
| antibiotic if COPD pt has infection |
|
Definition
| azithromycin or erythromycin |
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|
Term
| has side effects of nasal dryness, blood-tinged mucus, epistaxis |
|
Definition
| intranasal ipratropium bromide |
|
|
Term
|
Definition
dextromethorphan (Delsym)-dec's sensitivity of the cough receptors and depresses the medullary cough centers in the brain
codeine- only works on CNS cough centers in the brain |
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|
Term
| can cause the side effects at high dose of confusion, excitement, irritability, nervousness, serotonin syndrome w monoamine oxidase inhibitors |
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Definition
|
|
Term
| cases side effects at high dose of altered mental status, visual disturbances, respiratory depression, constipation |
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Definition
|
|
Term
| has black box warning that it can cause respiratory depression and death in some children who receive it following tonsillectomy or adenoidectomy |
|
Definition
| Codeine, if child is an ultra-rapid metabolizer (produce morphine when metabolized by CYP enzyme). not recommended to give codeine to children |
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|
Term
| expectorant agent and how it works |
|
Definition
| guaifenesin- increases the effective hydration of the respiratory tract. reduces the mucus viscosity making it easier for pt to cough out. can be found in combo w codeine, dextromethorphan, phenylephrine, pseudoephedrine |
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|
Term
| decongestant agents and how they work |
|
Definition
| pseudoephedrine (Sudafed)(weak stimulant to CNS), phenylephrine (Sudafed PE) (not as strong, less reaches systemic circulation), work by directly stimulating the alpha adrenergic receptors of the respiratory mucosa leading to vasoconstriction and dec blood flow to mucosa layer which helps in relieving congestion and directly stimulate beta adrenergic receptors causing bronchial dilation (only pseudoephedrine does this). both work on alpha-1 receptors but only pseudoephedrine also works on beta-2 receptors |
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|
Term
| how intranasal itrapropium bromide works |
|
Definition
| relieve rhinorrhea and sneezing, reduces volume of nasal discharge but doesn't affect nasal congestion |
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|
Term
| causes side effects of hypertension and bradycardia |
|
Definition
| pseudoephedrine and phenylephrine |
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|
Term
| inhaled or intranasal glucocorticod agents and how they work |
|
Definition
| beneficial for allergic rhinitis but not helpful for cough or cold. beclomethasone and fluticasone. |
|
|
Term
| what is allergic rhinitis |
|
Definition
| allergies, most common chronic disease in pediatrics, inflammatory process that is IgE mediated and usually presents with symptoms such as nasal congestion, rhinorrhea, sneezing, nasal itching, lacrimation. can be seasonal, perennial (year-round), intermittent, persistent , or episodic |
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Term
| allergic rhinitis vs asthma |
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Definition
| allergic rhinitis affects upper respiratory tract, asthma affects lower respiratory tract, can have both together |
|
|
Term
| main therapy for allergic rhinitis |
|
Definition
| oral antihistamines, usually indicated for sneezing and itching. 1st gen- more sedating and more anticholinergic SEs (diphenhydramine/Benadryl), 2nd gen- less sedating (loratadine/Claritin, desloratadine/Clarinex, fexofenadine/Allegra (least sedating), Cetrizene (Zyrtec), Levocetirizene (xyzal) |
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|
Term
| Intranasal antihistamines good for, agents |
|
Definition
| for allergic rhinitis, faster onset, high efficacy for nasal congestion but more expensive than oral antihistamines. olopatadine, azelastine, azelastine + fluticasone, indicated when symptoms affect quality of life |
|
|
Term
| SE of bitter taste, epistaxis, headache |
|
Definition
| intranasal antihistamines, olopatadine, azelastine, azelastine + fluticasone |
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|
Term
| intranasal corticosteroids used for, agents |
|
Definition
| allergic rhinitis. triamcinolone, budesonide, flunisolide, fluticasone, mometasone, ciclesonide |
|
|
Term
| cause side effects of pharyngitis, epistaxis, cough, can affect taste, cause nasal burning or headache |
|
Definition
| intranasal corticosteroids, triamcinolone, budesonide, flunisolide, fluticasone, mometasone, ciclesonide |
|
|
Term
| intranasal decongestant, agent, MOA |
|
Definition
| oxymetazoline (Afrin), for allergic rhinitis, alpha adrenergic agonist -> nasal arteriolar vasoconstriction, most effective when given in combo w intranasal corticosteroids, do not use >3 days (rebound congestion) |
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|
Term
| Treatment for increased lacrimation in allergic rhinitis, pt counselling |
|
Definition
| naphazoline (Clear Eyes)- vasoconstrictor, antihistamine eye drops- Zaditor, NSAID eye drops- Acular, corticosteroid eye drops- Alrex. All OTC. instruct pt to remove contact lenses before using |
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|
Term
| causes SEs of ophthalmic irritation, mydiasis, photophobia |
|
Definition
| ophthalmic agents- naphazoline (Clear Eyes)- vasoconstrictor, antihistamine eye drops- Zaditor, NSAID eye drops- Acular, corticosteroid eye drops- Alrex |
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|
Term
|
Definition
|
|
Term
| directing acting cholinoreceptor-activating drugs table |
|
Definition
[image]
acetylcholine is highly susceptible to breakdown and is non-selective, binds to both muscarinic and nicotinic receptors equally, DOA a few sec so not a practical drug to give. methyl choline a lot less susceptible to cholinesterase DOA prolonged, more muscarinic selective |
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|
Term
|
Definition
| cholinoreceptor-activating, methacholine (met a cool lad and dined), carbachol (carbs and alcohol), bethanechol (bet you won't call), succinylcholine. poorly absorbed in GI tract and CNS (have NH4 component making them charged) |
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|
Term
|
Definition
| cholinoreceptor-activating, pilocarpine (pill car pine), lobeline (lobe line) (have NH3, not charged, will absorb in GI tract and CNS) |
|
|
Term
| mnemonic to remember what happens when you give someone cholinoceptor-activating drugs |
|
Definition
| DUMBBELS- defecation, urination (relaxation of sphincters), Miosis (narrow pupils), bronchospasm, bronchorrea (bronchial smooth muscle contraction, harder to breathe), Bradycardia (lowering heart rate), emesis (vomiting), lacrimation, salivation, secretory (tears and sweats) |
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|
Term
| activating nicotinic receptors |
|
Definition
if activate M subtype N(M)- can either get a disorganized fasciculation of each skeletal muscle motor unit, or have a strong contraction of the entire muscle
if activate N subtype receptor N(N)- nerve, either get excitatory postsynaptic potential activation or inhibitory postsynaptic potential, very unpredictable |
|
|
Term
| Excitatory postsynaptic potentials (EPSPs) |
|
Definition
|
|
Term
| Inhibitory postsynaptic potentials (IPSPs) |
|
Definition
|
|
Term
| cholinesterase-inhibiting drugs |
|
Definition
inhibit acetylcholinesterase, prolong effects of endogenous acetylcholine, 3 classes:
-simple alcohol w NH4 (charged)- edrophonium (ed phone him)
-carbamates- not charged: physostigmine (fight or stick me), carbaryl (carry a barrel), charged: neostigmine (new stick me), pyridostigmine (pie rid or stick me)
-organoposphates- echothiophate (echo my fate)(charged), malathion (marathon)(not charged), sarin (sawr him)(not charged)
-highly liposoluble (rapid CNS penetration) except for echothiphate, not charged except for carbaryl
-used for insecticide and biochemical warfare
-organophosphate binds the strongest, then carbamates and edrophonium |
|
|
Term
| cholinesterase inhibitor with longest duration of action |
|
Definition
| echothiophate (echo my fate) - 100 hrs, strongest binding |
|
|
Term
| cholinesterase inhibitor with shortest duration of action |
|
Definition
| edrophonium (ed phone him) - 5-15 min), bound less strongly |
|
|
Term
| how to reverse carbamate effect |
|
Definition
|
|
Term
| how to reverse organophosphate effect |
|
Definition
| high-dose prolonged atropine, maybe pralidomine/2-PAM (given to EMT responders in the case of a terrorist attack) |
|
|
Term
| cholinesterase-inhibitor drugs affects |
|
Definition
| muscarinic effects same as cholinoreceptor-activating drugs, DUMBBELLS. nicotinic effects of cholinesterase-inhibitor drugs causes prolonged effects of acetylcholine: inc muscle tone, while cholinoreceptor-activating drugs cause dec muscle tone and flaccid paralysis due to rapid depolarization causing muscle twitching then leading to flaccid muscle |
|
|
Term
| acetylcholinesterase-inhibiting drugs cause |
|
Definition
|
|
Term
| Myasthenia gravis treatment and what is it (common usage) |
|
Definition
| (skeletal muscle weakness bc not enough acetylcholine receptors in body) cholinesterase-inhibiting drugs (neostigmine-new stick me and pyridostigmine-pie or stick me (Edrophonium has too short a DOA)(Pysostigmine [not charged, penetrates CNS, not best choice]). acetylcholine-activating drugs wont' work here bc don't have enough functioning cholinergic receptor- Nm) |
|
|
Term
| inducing neuromuscular paralysis drug (common usage) |
|
Definition
| cholinoreceptor-activating drug: succinylcholine- make skeletal muscle vibrate, send mult action potentials to it then goes flaccid. when pt needs to be intubated |
|
|
Term
| Alzheimer's disease treatment (common usage) |
|
Definition
| cholinesterase-inhibiting drugs- donepezil (don a present) and galantamine (galantly mine) |
|
|
Term
| uncommon drug usage treatment for reflux esophagitis and agent we use now |
|
Definition
uncommon- cholinoreceptor-activating drug: inc tone of lower esophageal sphincter and prevent acid from spilling in from the stomach to the esophagus
today- PPIs |
|
|
Term
| uncommon drug usage treatment for glaucoma and agent we use now |
|
Definition
cholinesterase-inhibiting drugs or cholinoreceptor-activating drug- improves disease by increasing intraocular pressure causing lacrimation
today- topical beta blockers and prostate gland and derivatives |
|
|
Term
| uncommon agent for supraventricular tachyarrythmia |
|
Definition
cholinesterase-inhibitor drugs: inc adrenergic, dec acetylcholine activity
agents today: beta blocker and calcium channel blocker |
|
|
Term
| urinary retention uncommon usage drug |
|
Definition
| cholinesterase drugs caused sphincter to relax. now use tamulosin |
|
|
Term
| uncommon indication for antimuscarinic drug intoxication |
|
Definition
| drug enhances acetylcholine effects, replaced by benzodiazepines |
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