Pharm6 - respiratory

  1. define chronotropic
    changes HR
  2. define iontropic
    changes myocardial contractility
  3. drug family that inhibits break down of cAMP?
    effect of having more cAMP?

    name of enzyme inhibited?
    • methylxanthanies
    • more cAMP = bronchodilation

    enzyme: phosphodiesterase
  4. how does methylxanthines' therapeutic window influence their current use?
    narrow ther. window --> dangerous

    not used much except in severe asthma
  5. "... phylline" drugs are what class of drug?
    name the drugs.
    class: methylxanthine

    • theophylline
    • aminophylline
    • oxtriphylline
  6. caffeine is what class of drug r/t respiratory disorders?
  7. drug used as IV drip in neonates to prevent neonatal apnea
  8. how does smoking (tobacco or weed) interact with methylxanthines?
    increases drug elimination, decreases serum concentration
  9. methylxanthine SFX
    • GI
    • CNS: restlessness, irritability, anxiety, insomnia, HA
    • CV: tachycardia, palpitations, hypotension
    • hyperglycemia
    • mild diuresis
  10. do methylxanthines cross breast milk?
    yes --> baby can have tachycardia or vomit
  11. 4 ways that methylxanthines help tx resp disorders
    • 1. decrease airway reactivity (bronchodilation)
    • 2. inhibit mast cell degeneration (stops release of histamine, leukotrienes)
    • 3. stimulate ciliary apparatus (gets rid of secretions)
    • 4. in COPD pts - increases sensitivity of resp center to CO2
  12. best respiratory drug used to tx acute attacks
    beta agonists - albuterol [Proventil, Ventolin, VoSpire]

    *anticholinergics are a possible alternative/addition, but they are much less potent bronchodilators
  13. drug family that promotes production of cAMP?
    effect of having more cAMP?

    name of enzyme activated
    • beta agonists
    • increased caMP = bronchodilation

    activate adenylate cyclase
  14. resp drug family that is sympathomimetic
    beta agonists

    (mimic FX of SNS: vasoconstriction, ^HR, etc.)
  15. non-selective beta agonist FX on beta 1 receptors? on beta 2? on alpha?
    • beta1: positive chronotropic, positive ionotropic
    • beta2: bronchodilation
    • alpha: vasoconstriction (in bronchiole vessels, decreasing mucosal edema)
  16. SFX of beta agonists stemming from beta 1 agonism? beta 2? alpha?

    SFX unique to Severent?
    • beta 1: arrhythmias, tachycardia, palpitations, HA, insomnia
    • beta 2: nervousness, restless, tremors
    • alpha: insomnia, restlessness, anorexia, tremors, HA, cardiac stimulations

    Severent: URI (upper resp infection), angioedema
  17. mast cell inhibitors' (aka mast cell stabilizers) mechanism of action
    stabilize cell membranes, preventing release of bronchoconstrictors, like histamine
  18. names of 2 true mast cell inhibitors
    • cromolyn [Intal]
    • nedocromil [Tilade]
  19. med that is an IgG Ab that binds to IgE receptors sites, stabilizing mast cell cell mebranes; like a mast cell inhibitors, but with different mechanism of action
    omalizumab [Xolair]
  20. can mast cell inhibitors/stabilizers be used for acute bronchospasm?
    NO! only beta agonists (and possibly anticholinergics) can tx acute bronchospasm

    used for prophylaxis only
  21. SFX of mast cell inhibitors
    • -cough, sore throat, rhinitis
    • -taste changes
    • -dizziness and HA
    • -pss bronchospasm
  22. "mast cell inhibitor" that is given SC? SFX?
    omalizumab [Xolair]

    • SFX:
    • local injection site irritation
    • resp infection
    • HA
    • arthralgia
    • fatigue
  23. name the 2 anticholinergics used to tx asthma
    • ipratropium [Atrovent]
    • tiotropium [Spiriva]
  24. drug class that may be combined with beta agonists to provide acute bronchodilation
  25. anticholinergic mechanism of action on resp system
    causes local bronchodilation by blocking cholinergic receptors in bronchial smooth muscle, leading to decreased concentration of cGMP

    blocks PSNS
  26. SFX of anticholinergics
    ipratropium [Atrovent], tiotropium [Spiriva]
    • dry mouth
    • GI
    • HA
    • cough
    • anxiety
  27. drug interactions of most respiratory drugs

    b/c resp drugs usually absorbed in the lungs (site of action), so limited systemic absorption
  28. why pts are switched from systemic to inhaled corticosteroids asap
    • long-term corticosteroid use leads to decreased bone growth
    • -osteoporosis in adults
    • -stunted bone growth & height in kids
  29. 3 corticosteroids
    • beclomethasone [Qvar, Beclovent, Vanceril]
    • flunisolide [AeroBid]
    • triamcinolone [Azmacort]
  30. SFX of inhaled corticosteroids and how to decrease their occurrence
    oral fungal infection, sore throat, cough, dry mouth

    rinse mouth after using inhaler
  31. interaction of corticosteroids with beta agonists
    sensitize bronchial smooth muscl eto be more response to beta agonist stimulation --> corticosteroids aren't brochodilators, but they interact with beta agonists to cause more bronchodilation than beta agonists alone
  32. name 3 leukotriene antagonists and frequency
    • zafirlukast [Accolate] - BID
    • zileuton [Zyflo] - QID
    • monteleukast [Singulair] - qday
  33. what are leukotrienes?
    what kinds of cells produce them?
    mediators of immune and inflammtory responses; products of arachidonic acid breakdown

    • produced by:
    • mast cells
    • basophils
    • neutrophils
    • eosinophils
    • macrophages
    • monocytes
  34. administration route of leukotriene antagonists?
    how should it be taken in relation to meal times?

    take on empty stomach b/c food decreases bioavailability of drug
  35. are leukotrienes used for treating acute asthma attacks?
    no! prophylaxis only
  36. how do leukotrienes antagonists indirectly cause bronchodilation?
    inhibiting leukotriene's normal FX (via receptor antagonism): promotion of inflammation, edema, and hypersecretion of mucus
  37. zafirlukast [Accolate] drug interactions
    • coumadin: increases PT (anticoagulates)
    • erythromycin: decreases Accolate
    • ASA: ^ Accolate
    • also interacts with phenytoin and CBBs, increasing their concentrations
  38. SFX of zafirlukast [Accolate]
    • HA
    • resp infections, esp. in elderly
    • nausea
    • Churg-Strauss syndrome: pulmonary infiltrates, eosinophilia, cardiomyopathy
  39. monteleukast [Singulair]
    • leukotriene receptor antagonist
    • approved for kids 1 y/o+
  40. serious SE of zileuton [Zyflo] and drug contraindications
    potential liver damage (increases liver enzymes, need to do baseline labs)

    contraindicated in pts with liver disease
  41. which of the 3 leukotriene antagonists inhibits leukotriene synthesis by inhibiting enzyme? (other 2 block leukotriene receptors)
    zileuton [Zyflo]
  42. drug used to tx genetic emphysema?
    mechanism of action?
    alpha 1 proteinase inhibitor: antitrypsin, [Prolastin].

    prevents destruction of elastase, enabling lungs to continue expanding and contracting, and keeping alveoli open
  43. name 3 expectorants used to facilitate movement of mucus
    • -guafenesin [Robitussin] - first choice expectorant to tx dry, hacking cough
    • -iodides (more toxic)
    • -terpin hydrate (has lots of ETOH)
  44. what type of tx should follow the administration of a mucolytic?
    chest PT, to get rid of the mucus
  45. name of only mucolytic, also used to tx acetaminophen OD. cons to using the med?
    acetylcysteine [Mucomyst]

    • oodles of drug interactions
    • rotten egg odor, causing nausea
    • stomatitis
    • n/v
    • rhinorrhea
    • bronchospasm, esp. in asthmatic pts
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Pharm6 - respiratory