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Pharm Exam 4
Respiratory
115
Criminology
Professional
03/29/2011

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Cards

Term
What is Asthma?
Definition
Reversible narrowing of bronchial airways

Characterized by inflammation

Feature of bronchial hyperactivity
Term
Symptoms Associated with Asthma:
Definition
Wheezing, Bouts of Coughing
Tightness in Chest
Shortness of Breath, Reduced FEV1
Mucous Plugs
Mild: episodic, less severe symptoms
More Severe: Frequent attacks, chronic airway narrowing
Exposure to allergens and irritants; infection - particularly viral respiratory infections
Term
Pathogenesis of Asthma:
Increased _____ to inhaled stimuli: allergens and non-allergens leading to _____

____ & _____ infiltration which lead to _____

Pathologic ______ of the bronchial mucosa
Definition
reactivity
bronchospasm

Lymphocytic and eosinophilic
bronchospasm

remodeling
Term
Allergens and irritants -> Directly cause release of _____ mediators (_____ & ______). May activate neural pathways, such as the _____ (_____) pathway
Definition
inflammatory
preformed and induced
cholinergic (PNS)
Term
Enormous variety of mediators are released. Thus, blocker of a single mediator, e.g., antihistamine, is unlikely to be effective in alleviating the symptoms or the progression of asthma. _______, which are capable of blocking many key steps in the inflammatory process, come closest to this ideal therapy.
Definition
Corticosteroids
Term
binding of allergen to specific ____ antibody causes ______ and release of ______
Definition
Ige
degranulation
mediators
Term
Early phase: Allergen-IgE mediated release of preformed mediators causes ____ and infiltration of more ____.
Definition
bronchospasm
mast cells
Term
Late phase: hours later, eosinophils, neutrophils, and other inflammatory cells can cause .... (4)
Definition
reactive hyperemia
edema
cellular inflammation
bronchospasm
Term
Repeated exposure: heightened ___ reactivity to specific and nonspecific stimuli.
Definition
bronchial
Term
In the early reaction, FEV1 decreases _____ and in the late reaction, it decreases _____
Definition
rapidly
slowly
Term
Neural Regulators of Bronchiolar Smooth Muscle and Vessel Tone:
Sympathetic Nervous System (NE, Epi)
b2 receptors: .......
a1 receptors: .......
Definition
b2 receptors: bcauses increase cAMP -> causes relax smooth muscle, decrease in airway resistance, & dilation of blood vessels

a1 receptors: constriction of blood vessels
Term
Neural Regulators of Bronchiolar Smooth Muscle and Vessel Tone:
Parasympathetic Nervous System (ACh)
Muscarinic receptors: .....
Definition
causes contraction of bronchiolar smooth muscle
Term
NO: Powerful ____ _____ _____
Definition
smooth muscle relaxant
Term
___ as a marker for asthma -> it is ____
Definition
NO
increased
Term
NO is ____ after corticosteroid treatment
Definition
reduced
Term
cGMP: Activated by ____ & ____. Also causes ____ ____ ____ in bronchioles
Definition
nitric oxide and natriuretic peptides
smooth muscle relaxation
Term
Goals of Asthma Treatment: Directly relax bronchiolar smooth muscle via ... (3)
Definition
b adrenergic agonists
muscarinic antagonists
theophylline
Term
Goals of Treatment
Reduce inflammation by inhibiting formation/release/action of inflammatory mediators via... (3)
Definition
Corticosteroids
cromolyn (mast cell degranulation)
montelukast (leukotriene inhibitor)
Term
B agonists have a ___ therapeutic window than theoplylline
Definition
safer
Term
Drugs used to treat asthma (2-agonists and corticosteroids) have potentially serious adverse side effects when administered ____ . So, ___ application is used to produce high local concentrations of drug in lungs and limit ___ absorption.
Definition
systemically
aerosol
systemic
Term
Aerosol Delivery of Drugs (3 types)
Definition
Metered Dose Inhalers (MDI)-> spacer device is very helpful for some patients

Dry powder inhalers

Nebulizers
Term
____ size of aerosol is important.
Also Rate of breathing and breath holding is important.
Definition
Particle
Term
Even under ideal conditions, __% of inhaled aerosol drug is swallowed. Therefore, ideally the best drugs also have poor absorption from the ___ and/or ___ metabolism in the liver.
Definition
90
GI tract
first-pass
Term
Why is a spacer useful?
Definition
with a spacer, larger particles are deposited in chamber before pt inhales = inhaled aerosol is enriched w/ smaller particles which more readily travel to the small airways.
Term
Drug of choice for rapid relief of bronchospasm?
Definition
B-Adrenergic Agonists
Term
B-Adrenergic Agonists: Highly effective and safe for _____, _____ treatment of asthma.
Definition
intermittent, prophylactic

"but Primarily used as a rescue method. May use it prophylactically in situatios where you know you will be exposed to an allergen. Ex. take it before going to a house where you know there is a cat"
Term
Current Emphasis for B-Adrenergic Agonists:
Short Acting b2 stimulants: Intermittent use on an as-needed basis for relief of ____, _____ bronchospasm.
Definition
acute, severe
Term
B-Adrenergic Agonists Overuse:
_____ intensify with overuse, but a greater danger is the tendency to continue to self-medicate during periods when symptoms are escalating.
To avoid a medical emergency, patients should be encouraged to seek medical attention as soon as possible after they detect a decline in the efficacy of their usual therapeutic regimen.
Definition
Side effects
Term
B-Adrenergic Agonists Mechanism of Action:
Stimulate ____ receptor on surface of bronchiolar smooth muscle cells -> This receptor couples to __ protein and activates ____ enzyme leading to increased cellular levels of _____ -> which stimulates phosphorylation cascade that leads to decreased intracellular ____ and smooth muscle ____. They Also inhibit ___ release from ___ cells.
Definition
B2-adrenergic
Gs
adenylyl cyclase
cyclic AMP
calcium
relaxation
mediator
mast
Term
B-adrenergic agonists are _____, and thus, higher affinity/potency at ___-adrenergic receptors than at __-adrenergic receptors.
Definition
selective
b2
b1
Term
Selectivity of the b-adrenergic agonists helps limit side effects mediated by activation of __-receptors
Definition
b1
Term
Since b-adrenergic agonists are b2 selective, we get vasodilation and that results in ______
Definition
reflex tachycardia
Term
Albuterol is what type of drug?
Definition
Rapid Acting-Short Duration B2-Adrenergic Agonists
Term
Levalbuterol is what type of drug?
Definition
Rapid Acting-Short Duration B2-Adrenergic Agonists
Term
Terbutaline is what type of drug?
Definition
Rapid Acting-Short Duration B2-Adrenergic Agonists
Term
Pirbuterol is what type of drug?
Definition
Rapid Acting-Short Duration B2-Adrenergic Agonists
Term
Rapid Acting-Short Duration B2-Adrenergic Agonists (Pirbuterol, Terbutaline, Levalbuterol, Albuterol)
onset< ___ min duration: ___-___ hr
Definition
15
2-4
Term
Salmeterol is what type of drug?
Definition
Long Acting B2-Selective Agonists
Term
Formoterol is what type of drug?
Definition
Long Acting B2-Selective Agonists
Term
Salmeterol:
___ onset
duration > ___ hours of useful broncholdilation
useful to control ____ asthma symptoms
not suitable for treatment of ___ ___ ____
Definition
slower
12
nighttime
acute bronchospastic attacks
Term
Formoterol
Similar to ____
Not for ___ ___
Definition
salmeterol
acute attacks
Term
Long Acting B2-Selective Agonists don't have much _____ action so are Typically used in combination with inhaled _____
Definition
anti-inflammatory
corticosteroid
Term
Epinephrine is what type of drug?
Definition
Less Selective or Nonselective B -Adrenergic Agonists
Term
Isoproterenol is what type of drug?
Definition
Less Selective or Nonselective B -Adrenergic Agonists
Term
Oral administration of B-Adrenergic Agonists increases incidence of adverse side effects: (4)
Definition
muscle tremor
cramps
cardiac tachyarhythmias
metabolic disturbances
Term
Appropriate situations for oral b-adrenergic agonist therapy:
therapy in ___ with upper respiratory tract infections who cannot manipulate inhaler
in ___ asthma exacerbations where inhaler cannot be used or when aerosol is ____
Definition
children
severe
irritating
Term
____ & _____ are b-adrenergic agonists available in oral form
Definition
albuterol and terbutaline
Term
Patients with ___ or ____ are at higher risk of adverse effects of B-Adrenergic Agonists
Definition
cardiovascular disease
diabetes
Term
Adverse Side Effects of B-Adrenergic Agonists:
Definition
Skeletal muscle tremor
CNS: restlessness, apprehension, anxiety, tremors
CVS: tachycardia, dysrhythmias, hyper- or hypotension
hypokalemia
worsen hyperglycemia in diabetics
drug interactions with thyroid, digitalis, methylxanthines
Term
_____ is the drug of choice for treatment of anaphylactic reactions.
Definition
Epinephrine
Term
Epinephrine: Give SQ (or IM or IV with ___)
Definition
dextrose
Term
Epinephrine causes (3)
Definition
Bronchodilation
Vasoconstriction -> maintain BP & decrease edema
Inhibition of mediator release
Term
Additional Anaphylaxis Treatments (other than Epi)
_____ via nebulizer
IV ______
_________
Secondary therapy:
H1 antagonist - ____
Corticosteroid - ______, ______
______(salt/IV form of theophylline)
Definition
Albuterol
fluids
Oxygen

diphenhydramine
hydrocortisone, methylprednisolone
Aminophylline
Term
Ipratropium bromide is what type of drug?
Definition
A quaternary muscarinic receptor antagonist
Term
Ipratropium bromide: If given parenterally, effects are like ____ b/c they have a similar structure. However, it is only given as ________!
Definition
atropine -> (Ach antagonist - anticholinergic drug)
inhaled aerosol
Term
Ipratropium bromide is only given as inhaled aerosol and has few side effects, even when swallowed because is ___ absorbed from ___ and does not cross _____ b/c it is a _____ amine = poor diffusion across membranes
Definition
poorly
GI
blood brain barrier
quaternary
Term
________ mediated bronchospasm is a significant component of airway resistance in some asthmatics and COPD patients, especially psychogenic exacerbations
Definition
Parasympathetic

I belive Ipratropium bromide affects the parasympathetic response b/c it is a muscarinic receptor antagonist? see slide 30
Term
with Ipratropium bromide, Bronchodilation develops more ___ and is usually less ____ than that produced by B-agonists
Definition
slowly
intense
Term
with Ipratropium bromide, bronchodilation lasts up to __ hours.
Definition
6
Term
Ipratropium bromide causes ______
Definition
bronchodilation
Term
Principal use of ipratropium bromide is in ______
Definition
COPD
Term
Ipratropium bromide is Combined with albuterol = ___
Definition
COMBIVENT
Term
Ipratropium bromide Also used intranasally to reduce secretions in the upper and lower respiratory tract in ____ and chronic ____ syndrome.
Definition
allergic rhinitis
postnasal drip
Term
Tiotropium (Spiriva): newer long-acting agent used for maintenance therapy in _____ & _____; dry powder inhaler device
Definition
chronic bronchitis and emphysema
Term
Tiotropium is what type of drug?
Definition
a form of Ipratropium bromide
A quaternary muscarinic receptor antagonist
Term
Theophylline is what type of drug?
Definition
Methylxanthine Bronchodilators
Term
caffeine is what type of drug?
Definition
Methylxanthine Bronchodilators
Term
theobromine is what type of drug?
Definition
Methylxanthine Bronchodilators
Term
Methylxanthine Bronchodilators: (3)
Definition
theophylline, caffeine, theobromine
Term
Methylxanthines are found in (5)
Definition
coffee, tea, chocolate, cocoa, colas
Term
Methylxanthines diverse cellular actions: (4)
Definition
*block cyclic AMP (cGMP) degradation- phosphodiesterase inhibition*
adenosine receptor antagonists
lower intracellular calcium concentrations
hyperpolarize cell membranes

the last two = increase smooth muscle contractions
Term
Main action of Theophylline is ________.
Other effects: (4)
Definition
bronchodilation

CNS stimulation
modest peripheral vasodilation
improved skeletal muscle contractility
and a thiazide-like diuresis
Term
Theophylline Therapeutic Use:
Formerly a ___ agent for treatment of asthma
Now has a far less prominent role because:
benefits are modest
___therapeutic window- N&V, HA, anxiety -> seizures, arrhythmias
considerable ___ in absorption and elimination between different patients
monitoring of ___ concentrations is often required
Definition
first-line
narrow
variation
plasma
Term
Nocturnal asthma can be improved with slow-release ____ but inhaled ____ and ___ are probably more effective. Also not used b/c it can cause insomnia. Why?
Definition
theophylline
corticosteroids
salmeterol

B/c it is a stimulant
Term
corticosteroids cause....
Definition
reduced inflammation - anti-inflammatory effects
Term
Corticosteroid MOA:
corticosteroids are ___ receptor ___ that bind to intracellular receptors that translocate to the cell nucleus and positively or negatively regulate gene transcription. This takes ____.
corticosteroids inhibit the production and release of cytokines, vasoactive and chemoattractive factors, lipolytic and proteolytic enzymes, decrease mobilization of leukocytes to areas of injury, and decrease fibrosis.
Enhance actions of _____
Definition
steroid
agonists
time
b adrenergic agonists
Term
Corticosteroids have potentially important adverse side effects. However, ____ delivery of the steroid has significantly improved the safety of treatment for moderate to severe asthma. Asthmatics who require inhaled B-adrenergic agonist therapy (resuce inhaler) __-__ or more times weekly are candidates for inhaled steroid therapy.
Definition
Aerosol
3 - 4
Term
Beclomethasone dipropionate (Beclovent) is what type of drug?
Definition
inhaled corticosteroid
Term
Budesonide dipropionate (Pulmicort) is what type of drug?
Definition
inhaled corticosteroid
Term
Fluticasone (Flovent) is what type of drug?
Definition
inhaled corticosteroid
Term
what corticosteroid is combined with salmeterol to make (Advair Diskus)?
Definition
Fluticasone (Flovent)
Term
Asthmatic patients maintained on ____ show improvement of symptoms and lower requirements for “rescue” with a bronchodilator.
Definition
inhaled corticosteroids
Term
Inhaled Corticosteroids: Available preparations have equivalent efficacy and potential side effects, but differ in the amount of drug aerosolized per inhaler activation, i.e., high-dose and low-dose.
Therefore, the dose of inhaled steroid must be empirically determined for each patient.
Definition
Term
Prednisone is what type of drug?
Definition
Systemic Corticosteroids - oral
Term
Prednisolone is what type of drug?
Definition
Systemic Corticosteroids - Oral, Injectable
Term
Methylprednisolone is what type of drug?
Definition
Systemic Corticosteroids - Oral, Injectable
Term
Corticosteroids Systemic Therapy:
Systemic (i.v. or oral) steroid therapy is used in severe asthmatic attacks requiring _____.
For severe asthma, ____ or ____ is given i.v., followed by oral doses and gradual tapering of the dose.
For acute exacerbations, oral is ____ administered for 1 -2 weeks.
Longer treatments require tapering of the dose to account for hypothalamic-pituitary-adrenal suppression.
Definition
hospitalization
prednisone or methylprednisolone
prednisone
Term
What is given IV in the ER for severe asthma attacks?
What about actue exacerbation?
Definition
Prednisolone- Injectable
Methylprednisolone- Injectable

Prednisone- Oral for exacerbation
Term
Inhaled Corticosteroids: Potential Side Effects: (8)
Definition
Candidiasis - use spacer device and rinse mouth
Hoarseness - usually resolves
HPA suppression - low risks until high doses
Bone resorption - modest risks
Carbohydrate and lipid - minor risks
Cataracts and skin thinning - dose-related
Purpura - dose-related
Growth retardation – may of concern in children
Term
Cromolyn sodium (Intal) is what type of drug?
Definition
Cromolyn Compounds (anti-inflammatory agent)
Term
Nedocromil (Tilade) is what type of drug?
Definition
Cromolyn Compounds (anti-inflammatory agent)
Term
Cromolyn compounds are ____ agents that indirectly inhibit antigen-induced ____ and directly inhibit the release of ____ and other autocoids from sensitized mast cells.
May suppress the activating effects of ____ peptides on eosinophils, neutorphils, and monocytes.
Definition
anti-inflammatory
bronchospasm
histamine
chemoattractant
Term
Cromolyn compounds do not ____ relax smooth muscle, therefore they are not useful for control of ___ bronchospasm. So would never use this on someone who needs a rescue inhaler. Cromolyn compounds are primarily ____. When inhaled several times daily, they inhibit both the immediate and late asthmatic responses to antigenic challenge or exercise.
Definition
directly
acute
prophylactic
Term
Nedocromil is a newer compound, somewhat more ___ than cromolyn sodium.
Definition
potent
Term
Nedocromil is approved for use is asthmatic patients > ___ years old; cromolyn is approved for ____.
Definition
12
all ages.
Term
Cromolyn compounds Adverse effects:
are ___ and generally ___.
Definition
infrequent
mild
Term
Cromolyn compounds are Used mostly in ___ to ____ asthma as an added therapy or as a prophylactic alternative to inhaled ___ or oral ___.
Definition
mild to moderate
steroids
methylxanthines
Term
Leukotrienes- formed through the action of ___ on arachidonic acid. Synthesized by a variety of ___ cells in the airways: mast cells, eosinophils, macrophages, and basophils
Definition
5-lipoxygenase
inflammatory
Term
Zileuton is what type of drug?
Definition
Leukotriene Inhibitors -> Inhibit 5-lipoxygenase enzyme
Term
Montelukast is what type of drug?
Definition
Leukotriene Inhibitors -> Leukotriene (LTD4) receptor antagonist
Term
Leukotriene Inhibitors Improve asthma control but are Not as effective as corticosteroids on bronchiole reactivity and airway inflammation, but nearly = in reducing asthma exacerbations (oral use). Why not as effective on inflammation?
Definition
b/c they only inhibit one type of inflammatory mediator
Term
Leukotriene Inhibitors Approved for children as young as __
Definition
6
Term
Leukotriene Inhibitors are Generally well tolerated, but FDA is now investigating ___/___ link
Definition
mood swings/suicide
Term
Omalizumab is what type of drug?
Definition
Monoclonal Antibodies - Antibody against region of IgE that binds to mast cell
Term
Omalizumab Does not activate IgE already bound to _____. But Possible inhibition of IgE _____
Definition
mast cells
synthesis
Term
Omalizumab Lessens asthma ___ and reduces ___, decreasing need for corticosteroids and hospitalizations
Definition
severity
exacerbations
Term
With Omalizumab, ______ reported in ~ 0.2% of patients, so is restricted to most severe asthmatics, who have documented ____
Definition
Anaphylaxis
allergies
Term
Other Considerations:

Allergy Testing
-Desensitization

Control of Environment
- Removal/reduction of allergens
- Removal/reduction of irritants
- Air purifiers
Definition
Term
FEV 1 ____ as you progress from intermittent to severe
Definition
declines

*this is all she said we need to know of slide 50
Term
___ dose ICS treats the inflammation the best
Definition
Low

*from notes
Term
Chronic Obstructive Pulmonary Disease (COPD) (2)
Definition
Emphysema and chronic bronchitis
Term
irreversible component of COPD?
reversible components?
Definition
Alveolar destruction is the main pathophysiological component (irreversible component)

Some patients have inflammation and bronchospasm (reversible components)
Term
Drug therapy is applicable to the ____ component of COPD
Definition
reversible
Term
COPD treatment?
Inhaled _____ -> especially useful in patients with a vagally-mediated psychogenic component. (anxiety provoked)
Inhaled _____ -> As with asthma, continuous (overuse) of bronchodilators may be associated with worsening of symptoms.
Definition
ipratropium bromide
B2-adrenergic agonists
Term
A subgroup of COPD patients may benefit from ____ therapy, but generally mixed results and not often used.
Definition
corticosteroid
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