1What are H1 antihistamines used for?
allergic reactions and mast cell mediated disorders
2Which generation of H1 antihistamines have a central and sedative effect?
first generation
3Which generation of H1 antihistamines have less of a central effect and primarly used as anti-allergic drugs?
second generation
4What effect does H1 antihistamines have on capillaries?
it increases dilation and permeability of capilaries causing hypotension and edema
5What effect does H1 antihistamines have on bronchilar smooth muscle? What does it do this through? What does it cause?
increases bronchiolar smooth muscle contraction via IP3 and DAG release causing bronchoconstriction
6What effect does H1 antihistamines have on peripheral nociceptive recptors and what does this cause?
increased activation of peripheral nociceptive receptors which causes increased pain and pruritus
7What are the 2 other effects H1 antihistamines have on the body?
increases nasal and bronchiol mucus production
decreases conduction though the AV node
8Most H1 and H2 antihistamines are contraindicated for?
pregnancy
children
9When are both first and second generation H1 antihistamines contraindicated?
angle closure glaucoma and pyloric stenosis
10What are the three first generation H1 antihistamines?
diphenhydramine
meclizine
dimenhydrate
11What are the three second generation H1 antihistamines?
loratadine
desloratadine
cetirizine
12Aside from closed angle glaucoma and pyloric stenosis when are second generations also contraindicated?
BPH
13Which H1 antihistamines have the biggest antiallergic effect?
cetirizine
loratadine
fexofenadine
14Which H1 antihistamines have the most muscarinic effect and most sedation effect?
diphenhydramine
promethazine
15Which H1 antihistamines have the most anti-motion sickness effect?
diphenhydramine
meclizine
16Oxymetazoline and pseudoephedrine are?
adrenergic agonist/decongestants
17What is oxymetazoline used for?
eye redness
epistaxis
nasal congestion
rosacea-associated erythema
18How does pseudophedrine work?
constricts blood vessels in the nose and thereby reduces edema,hyperemia and congestion
19MOA for oxymetazoline
selective alpha 1 adrenergic agonist and alpha 2 adrenergic receptor partial agonist
20Is psuedophedrine act more as an alpha 1 or alpha 2 agonist?
alpha 1
21Compared to COPD asthma is
reversible
22What exposure in childhood increases the risk of developing asthma?
second hand smoke
23When diagnosing asthma vs COPD what rules out COPD?
complete reversibility of bronchial obstruction after bronchodilator administration
24What is the key to long term asthma management?
continuous cycle of clinical assessment and treatment adjustment
27alformoterol, formoterol, indacaterol and saleterol are
LABA
28What medication is a SAMA?
ipratropium
29What are the LAMA meds?
aclidinium
tiotropium
umeclidinium
30SABA/SAMA?
albuterol/ipratropium
31LABA/LAMA?
formoterol/aclidinium
vilanterolmeclidinium
32Theophylline and aminophylline are?
methylxanthines
33Which drugs are LABA/ICS?
formoterol and beclomethasone
formoterol and budesonide
formoterol and mometsone
salmeterol and fluticasone
vilanterol and fluticasone
34LABA/LAMA/ICS?
fluticasonemedclidinium/vilanterol
35Which medication is the PDE-4?
roflumilast
36What is the MOA for LABA?
dilation of bronchial smooth muscles
37What receptors do LABA work on?
beta 2 agonists
38What are the interactions with LABA?
beta blockers
adrenergic drugs
increase digoxin serum levels
39When are LABAs CI?
hypersensitivity
hyperthyroidism
glaucoma
diabetes
40What are the adverse effects of LABAs?
arrhythmias
tachy
tremor
hyperglycemia
hypokalemia
41What might young children with asthma require?
nebulizers since inhalers can be more difficult to use
42What are the two SABA medications
inhaled: albuterol
oral: terbutaline
43What are the three inhaled corticosteroids?
budesonide
fluticasone
mometasone
44What is the MOA for inhaled corticosteroids?
inhibit transcription factors which decrease expression of proinflammatory genes
45When are inhaled corticosteroids CI?
hypersensitivity
status asthmaticus
46What is the DDI with inhaled corticosteroids?
CYP3A4 inhibitors decreases clearance of corticosteroids
47What are the AE of inhaled corticosteroids?
increase BP, insulin resistance, gluconeogenesis and appetite
decrease fibroblast activity, bone formation and immune response
48What do you worry about with inhale corticosteroids and what should you tell the patient to do after inhaling the medication?
canida albicans infections
must rinse and spit after admin
49What are the oral corticosteroids?
methylprednisolone
prednisone
50What is an ICS-LABA?
budesonide-formoterol
51how does an ICS-LABA work?
it inhibits transcription factors which decreases expression of proinflammatory genes and bronchodilation
52What are the leukotriene receptor antagonists?
montelukast
zafirlukast
53What is the MOA of montelukast?
prevent leukotrienes from binding to their receptors (cysLT1) which decreass bronchoconstriction and inflammation
54What is the MOA of zafirlukast?
competitively inhibits LTD4/LTE4 receptors
55What is a CI with leukotriene receptor antagonists?
hypersensitivity
56What are some AE of leukotriene receptor antagonists?
upper respiratory infections
pharyngitis
h/a
fever
cough
57What are leukotriene receptor antagonists used for?
exercise induced asthma
aspirin induced astha
long term maintanence
58What are long acting muscarinic antagonists?
tiotropium bromide
59What is the MOA of LAMA?
competatively inhibits postganglionic muscarini receptors (M3) in bronchial smooth muscles causing bronchodilation
60What is a DDI with tiotropium bromide?
anticholinergic drugs
61What are some AE or tiotropium bromide?
dry mouth
bitter taste
alter taste
62What is the short acting muscarinic antagonists?
Ipratropium bromide
63What are SAMAs used for?
severe and life threatening asthma exacerbations
64What are leukotriene pathway modifiers?
zileuton
65What is zileuton used for?
exercised induced asthma and aspirin induced asthma
66What is the MOA for zileuton?
inhibit 5 lipoxygenase which decreases production of leukotriens and decreases bronchoconstriction and inflammation
67What are the adverse affects with leukotriene pathway modifiers?
hepatotoxicity
excessive fatigue
68What are the CIs with zileuton
hypersensitivity
liver disease
69Which drug does zileuton interact with and increases its concentration?
propranolol
70What are the mast cell stabilizers/chromones used for?
preventative treatment prior to exercise
71What is the MOA of chromones/mast cell stabilizers?
prevent release of inflammatory mediators from mast cells
no intrinsic anti-inflammatory, antihistamine or vasoconstrictive effects
72What are the AE of chromones?
throat irritation
cough
sneezing
nasal congestion
73Which methylxanthine is used out patient/long term?
theophylline
74Which methylxanthine is used for inpatient/short term IV?
aminophylline
75What is the MOA of methylxanthines?
inhibit PDE which increases cAMP levels causing an anti-inflammatory and mild bronchodilatory effect
76What are the AE or methylxanthines?
n/v
h/a
insomnia
toxicity
77what are the s/s of theophylline toxicity?
persistent vomitting
arrhythmias
intractable seizures
78What are the DDI for methylxanthines?
adenosine receptor blocker
alcohol
nonselective bb
phenytoin
lithium
79What causes increased clearance of theophylline?
enzyme induction
smoking
barbecued meat
80What causes decreased clearance of theophylline?
CYP inhibition
congestive HF
liver disease
81What is COPD?
perisistent respiratory symptoms and airflow limitation
82What defines chronic bronchitis?
productive cough for atleast 3 months each year for 2 consecutive years
83What defines emphysema?
permanent dilation of pulmonary air spaces distal to the terminal bronchioles which causes destruction of the alveolar walls and pulmonary capillaries required for gas exchange
84What is mild COPD?
equal to or greater than 80% FEV1%
85What is moderate COPD?
between 50% and 79% FEV1
86What is severe COPD?
between 30% and 49% FEV1
87Which type of COPD patient is usually over weight?
chronic bronchitis
88PACO2 is increased early in which type of COPD?
chronic bronchitis
89What is roflumilast?
PDE4 inhibitor
90What is roflumilast used for?
improved lung function and prevent exacerbations in patients with severe cases of COPD
91What are some AE of PDE4 inhibitors?
gi upset
weight loss
sleep disturbances
anxiety/depression
92What is the MOA for theoplylline?
adenosine receptor blockate and nonspecific PDE inhibition
93When is theophylline indicated for COPD?
severe and refractory COPD
94When do you use atbx for COPD exacerbation?
2 or more are present:
increased dyspnea
increased sputum proction
increased sputum purulence
on mechanical vent
95What are the 2 smoking cessation drugs?
bupropion SR
varenicline
96What do you worry about with bupropion SR?
lowers seizure thresholds and can cause/worsen neuropsychiatric disorders