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99 Cards in this Set
- Front
- Back
-olol What is it and what is it used for? How does it work? |
beta blocker. Blocks beta 1 receptors. HTN, arrhythmias, migraines, glaucoma, angina. |
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Pred- What is it and what is it used for? How does it work? |
steroid.Asthma and COPD.Reduces inflammation in bronchioles |
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-olone What is it and what is it used for? How does it work? |
steroid. Asthma and COPD. Reduces inflammation in bronchioles |
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Thiazide What is it and what is it used for? How does it work? |
diuretic DM Principal cell in distal tubule |
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-meline What is it and what is it used for? How does it work? |
cholinergic agonist Tx dry mouth stimulates salivation |
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-pezil What is it and what is it used for? |
Acetylcholinesterase inhibitors used in the treatment of Alzheimer's disease |
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-meline What is it and what is it used for? |
Cholinergic agonists (arecoline derivatives used in treatment of Alzheimer's disease) |
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-stigmine What is it and what is it used for? |
Cholinesterase inhibitors . Myasthenia gravis tx. drug OD of anticholinergic agents. |
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asthma and COPD rescue meds |
bronchodilators. epinephrine for asthma only. anticholinergics. theophyline. |
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Asthma anti inflammatory meds |
GLUCOCORTICOSTEROIDS. mAST CELL STABILIZERS leukotriene inhibitors. Omalizumab |
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COPD anti inflammatory meds |
inhaled glucocorticosteroid systemic glucocorticosteroid roflumilast which is a PDE 4 inhibitors |
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what are cholinergics good for? |
better for COPD and emphysema. Less effective for asthma. |
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what is theophylline used for? |
long term basis to prevent bronchoconstriction in asthma and emphysema. |
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how long to wait between MDI use? |
5-10 minutes |
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Do you need to be able to inhale a lot of air to make MDI med administration work? |
no |
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how to use MDI with aerochamber |
get med into chamber and breath normally. Rinse chamber w/soapy water. Let dry with soap. |
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DPI work how? |
capsule punctured and misted but the patient must have a good inspiratory volume to work well. |
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when to use racemic epi? |
trying to overcome spasm like in croup cough. |
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what is isoproterenol and pirbuterol? |
beta agonist bronchodilator. It has some effect on beta 1 receptors. |
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what is the difference between beta agonist and beta 2 selective agonist? |
beta 2 selective have less cardiac stimulation. |
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what is tertbutaline and what is it good and bad for? |
good for allergic asthma. It is IV only. Good for patient who can't breath well enough to get inhaled medication in lungs. |
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what is salmeterol, Formoterol and Arformoterol used for? |
beta selective agonist that is long acting SALA asthma and COPD. given BID . |
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ADR's for all beta agonist? |
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. |
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what are anticholinergic drugs for? |
everyday use for asthma, rhinitis and COPD. |
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what is ipratropium? |
an anticholinergic drug for COPD, asthma and rhinitis. COPD it is used PRN. |
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are ipratropium and albuterol ever combined? |
in combivent and duoneb. |
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ADR's of anticholinergic drugs |
CNS, palpitations, bitter taste and cough. |
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what is tiotropium? |
long acting anticholinergic. need good inspiratory ability to take. Might need bronchodilator before taking. |
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tiotropium versus ipratropium. |
tiotropium only needs once daily where ipratropium is taken 4 times daily. But ipratropium is much cheaper. Tiotropium has no pediatric use. |
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xanthine derivatives are for what? |
Asthma dn refractory COPD |
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how do xanthine derivatives work? |
Phosphodiesterase Inhibitor causing bronchodilation and some anti-inflammatory effects |
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cautions with xanthine derivatives? DDI's? |
:Produces high amount of CVS and CNS stimulation and diuresis. narrow therapeutic index Substrate of CYP1A2, many DDI |
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ADR's with xanthine derivatives |
N, V, D, epigastric px. insomnia, agitation, dizziness, seizures. tachycardia, PVC's. |
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xanthine derivatives examples? |
Theophylline PO Aminophylline IV |
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Glucocorticosteroids for asthma and COPD works how? |
reduces inflammation in the bronchioles. |
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When do yo use Glucocorticosteroids in COPD? |
stage 3 and stage 4 |
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why to use Glucocorticosteroids in asthma and COPD? |
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). |
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oral steroids for respiratory vs inhaled steroids for respiratory symptoms |
oral use for 3-5 days for exacerbations and inhaled for long term use. |
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will I get some immunosuppression with oral versus inhaled steroids? |
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. |
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Beclomethasone is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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budesonide is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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flunisolide is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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Fluticasone is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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mometasone is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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triamcinolone is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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ciclesonide is what kind of drug and whats it for? |
inhaled glucocorticoid for asthma and COPD |
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if a patient is taking multiple inhalers what order should they take them in? |
1st SABA then anticholinergic 2nd and rinse after. |
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systemic glucocorticosteroids used for what for how long? |
Used for short course “burst” therapy and for asthma or COPD exacerbations for 3- days. |
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Prednisone when taken systemically is what and what is it used for? |
Systemic Glucocorticosteroids taken for asthma or COPD exacerbations |
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Methylprednisolone when taken systemically is what and what is it used for? |
Systemic glucocorticosteroids taken for asthma or COPD exacerbations |
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prednisolone when taken systemically is what and what is it used for? |
Systemic glucocorticosteroids taken for asthma or COPD exacerbations |
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hydrocortisone when taken systemically is what and what is it used for? |
Systemic glucocorticosteroids taken for asthma or COPD exacerbations |
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dexamethasone when taken systemically is what and what is it used for? |
Systemic glucocorticosteroids taken for asthma or COPD exacerbations |
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Mast cell stabilizers are used for what? |
Asthma- Not used for acute attacks, MUST use prophylactically (maintenance therapy); NOT FoR COPD. NOT FOR COPD |
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ADR's for Mast cell stabilizers? |
–local irritation, bad taste, cough & bronchospasm |
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what do Mast cell stabilizers do? |
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 |
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what is Cromolyn? |
mast cell stabilizer |
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what is nedocromil? |
mast cell stabilizer |
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what are Leukotrienes and why does that make Leukotriene inhibitors good for? |
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. |
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Leukotriene inhibitors subdivided into two categories. What are they? |
Leukotriene Receptor blockers Lipoxygenase inhibitors |
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things to remember about using Leukotriene inhibitors? how long does it take for them to work? |
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 |
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Zafirlukast is what? whats it for? |
Leukotriene inhibitor? asthma. Lots of DDI's like CYP450 enzyme inhibitor - increased levels of ASA, warfarin and theophylline. Less commonly used. |
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Montelukast Is what for what? |
leukotriene inhibitor. asthma tx. |
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ADR's with Zafirlukast? |
fever,malaise, peripheral neuropathy (28%), rash, GI disturbances |
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ADR's with montelukast? |
HA |
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Zileuton Is what? how does it work? |
Leukotriene Inhibitor. nMOA- inhibits 5-lipoxygenase enzyme which results in decreased production of leukotrienes |
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what is a contraindication of Zileuton ? |
active liver disease. its a Leukotrieine inhibitor |
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ADR's of Zileuton ? |
Leukotriene inhibitor CNS effects (headache in up to 25% of pts); flu like Sx, dyspepsia and LFTs |
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DDI's of Zileuton ? |
CYP450 enzyme inhibitor - increased levels Beta Blockers, theophylline and warfarin levels. Leukotriene inhibitor |
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what leukotrienes inhibitors can be used can be used with peds over 5 years old |
Zafirlukast |
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what leukotrienes inhibitors can be used can be used with peds over 12 months |
Montelukast |
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what leukotrienes inhibitors can be used can be used with peds over 12 year olds |
Zileuton |
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Omalizumab is wht and how does it work? |
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. |
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Omalizumab cautions and ADR's |
:Anaphylactic reactions can occur. ADRs:Anaphylaxis, CNS effects (headache, dizziness), arthralgias, local injection site reactions . IgE binding inhibitor. |
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Roflumilast is what and how does it work? |
MOA: selectively blocks PDE4, a major cAMP metabolizing enzyme found in inflammatory cells, which is involved in promoting the pathogenesis of COPD. |
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when is Roflumilast used? |
Add-on therapy to bronchodilators to decrease the risk of exacerbations in pts with severe COPD. Not for asthma |
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Roflumilast precautions and ADR's? |
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. |
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Intermittent vs persistent asthma |
intermittent asthma is controlled by a short acting beta 2 agonist. Persistent asthma needs long acting medications for control. |
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intermittent vs mild vs moderate vs severe |
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. |
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Steps of asthma control medications |
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 |
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COPD managment in stage 1-4 |
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 |
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MDI versus DPI |
MDI must be shaken. must prime. med delivered by propellant. DPI - no need to shake. no prime needed. no propellants. |
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MDI instructions |
Start breathing in slowly through mouth, THEN press down on the inhaler. |
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DPI instructions |
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 |
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nPDE-4 inhibitors do what? what are they for? |
Decrease Inflammation and promote smooth muscle relaxation. cilomilast under investigation for the management of both asthma and COPD .Roflumilast Recently approved for COPD |
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what is an Antiprotease used for? |
for alpha-1 antitrypsin deficiency in emphysema. still Under investigation. |
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PulmonaryHypertension characterisitics? |
Characterized by elevated pulmonaryarterial pressure and secondary right ventricular failure |
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causes of PHTN? |
idoopathic. congenital heart disease. genetic. drugs-- fenfluramine, dexfenfluramine and PPA. SSRI's, amphetamines, chemo drugs and cocaine. connective tissue diseases. HIV. Portal HTN. |
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PHTN classification group 1 is caused by what? |
pulmonary arterial HTN |
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PHTN classification group 2 is caused by what? |
P HTN w/left heart disease (PVH) |
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PHTN classification group 3 is caused by what? |
PHassociated w/ lung disease and/or hypoxemia ) |
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PHTN classification group 4 is caused by what? |
PHdue to chronic thrombotic and/or embolic disease |
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PHTN classification group 5 is caused by what? |
Miscellaneous |
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what treatments should all classifications groups of COPD get? |
diuretics. O2. Warfarin. Digoxin. exercise. |
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with oral PDE inhibitros what drugs should you not use? |
nitrates and alpha-1 blockers. |
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Oral PDE ADR's? |
HA and facial flushing. |
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Oral endothelin receptor blockers used for what? |
preferred therapy for group 1 PAH. |
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ADR's from oral endothelin receptor blockers |
heptotoxicity, yeretgenic, HA, flushing and edema. |
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bosentan (& )ambrisentan do what? |
targetd tx for PHTN. |