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resp pharm exam
| Question | Answer |
|---|---|
| What are the 3 categories of nonsteriodal antiastmatic agents? | cromolyn-like drugs(mast cell stabalizers), antileukotrienes, and monoclonal antibodies |
| What is the indication for clinical use of nonsteroidal antiasthmatics? | prophylactic management (control) of mild persistent asthma (asthma require 2 step care) |
| compare and contrast controllers and relievers in the treatment of asthma. | CONTROLLERS- INHALED CORTICOSTEROIDS, ooral corticosteroids, cromolyn sodium, long-acting inhaled B2 agonist, Leukotriene releivers- short-acting inhaled B2 agonist, systemic corticosteriods IV, inhaled anticholinergic bronchodilator |
| summarize the immune mechanisms involved in allergy and inflammation | activation of T lymphocytes results in production of IgE binds to effector cells such as mast cells mast cells= inflammation histamine, prostaglandins leukotrienes |
| Once initiated, how is the inflammatory response amplified? | chemoattraction, lymphocytes eosinophils, basophils, neutrophile by an increase in mast cells |
| list stimuli that can trigger an asthma attack | extrinsic allergy dependent, exercise induced, sulfer dioxide, dust, cold air, food |
| what cell plays a key role in the allergic inflammatory response | mast cells, IgE |
| Explain the mode of action of cromolyn sodium | prophylactic for inhibition of mast cells, cromolyn inhibit preventing calcium influx for microfilament contraction and doesn't operate through cAMP and doesn't affect a or b receptors |
| describe the side effects of cromolyn sodium | nasal congestion, dermatitis, myositis, and gastroenteritis, nebulized caused nasal congestion, wheezing, sneezing, nasal itching |
| outline the use of cromolyn in the treatment of ACE inhibitor cough and sickle-cell anemia | protection against cough often seen as a side effect with the use of ACE inhibitor,the reduction in sickling due to the blocking of calcium-activated potassium channels play a part in water loss and RBC dehydration |
| explain the 3 point important in the application of cromolyn sodium | 1st drug is the only a prophylactic 2nd withdrawal of oral corticosteroid and substitution of cromolyn in asthmatics can result in inadequate adrenal function 3rd it may take 2 to 4 weeks for improvement |
| explain the mode of action of nedocromil sodium | nedocromil inhibits mast cells release, inhibits eosinophils, can prevent neuronally mediated bronchoconstriction by inhibiting afferent sensory nerve impulses |
| describe the side effects of nedocromil | unpleasant taste, headache, nausea, vomiting, dizziness |
| what is the effect on the airway of leukotrienes | airway constrictor, causes airway edema, mucus secretion ciliary beat inhibition and recuitment of inflammatory cells |
| when are leukotrienes synthesized? | after mechanical, chemical, or physical stimulus, activates phospholipase A2 |
| what cells can synthesize leukotrienes | eosinophils, mast cellsm monocytedm macrophages, basophils, neutrophils, and Blymphocytes...eosinophils, mast cells and macrophages recruited to the lung |
| what is the response if aBLT receptor is stimulated | recruitment neutrophils, and may be involved in ARDS |
| what is the response if a CysLT1 receptor is stimulated? | bronchoconstriction, bronchial hyperresponsiveness |
| what drugs block the the CystLT1 receptor | lukast (Zafirlukast, montelukast, and pranlukast) |
| How does Zyflo block the inflammatory response | interrupting synthesis of this biological active leukotrienes |
| explain how antileukotrienes are useful in controlling exercise-induced, asprin-induced, and allergen-induced asthma | exercise induced- promotes leukotrienes, resulting in bronchoconstriction, antileukorienes develop no tolerance asprin induced- asprin=bronchoconstriction caused by increase leukotriene production allergen- antileukotriene also block the early asthma |
| advantages and disadvantages of antileukotriene drug therapy in asthma management | advantages= oral administration, safe, few side effects, effective in asprin sensitivity disadvantages=limited anti-inflammatory action, not limited to lung, effective in 50-70% |
| compare and contrast the use of sterois with the use of antileukotrienes in asthma | superior efficacy for inhaled steroid withpoor complaince versus superoir complaince of orally administered antileukotrienes with more limited antiinflammatory action, additive effect between antileukotriene and corticosteroids |
| what is the indication for aerosolized Pentamidine | pentamidine is indicated for the prevention of PCP in high-risk HIV- infected patients who have a history of one or episodes of PCP or a peripheral CD4 |
| what is the indication for aerosolized Ribavirin | aerosolized ribavirin is indicated for RSV |
| what is the indication for aerosolized Tobramycin | for the management of chronic Pseudominis aeruginosa infection if CF |
| what is the indication for aerosolized zanamivir | treatment of uncomplicated acute illiness by influenza virus in adults and children and 7 who have been symptomatic for no more than 2 days |
| what is the mode of action of pentamidine | blocks RNA and DNA synthesis, inhibits oxidative phosphorylation, and interferes |
| what viruses are affected by ribavirin | RSV and influenza types A and B |
| what dosage of ribavirin is used for how many hours, for how many days? | 20mg/ml solution, nebulized for 12 to 18 hours for 3 to 7 days |
| explain the SPAG and its function | large volume pneumatically powered nebulizer operating on a jet shearing with baffling of aerosol particles and a drying chamber to further reduce the particle size to 1.3 um |
| what is respigam and what is it used to treat | RSV immune globulin intravenous liquid formulation of immunoglobulin G containing neutralizing antibody to RSV, pooled human plasma containg high titers |
| calculate to dosage of Respigram and what is it used to treat | drug is available in 50 ml vials,containing 2500mg administered monthly IV infusion of 750mg/kg, infused as 1.5ml/kg/hr for 15 min then increased to 3ml/kg/hr for 15min up to 6ml/ kg/hr |
| Explain the mode of action of respigram | the product places antibody to RSV in the bloodstream of the patient, and the patiens achieves a level of immunity to RSV |
| for what is synagis used? | for the prevention anf treatment of RSV in premature infants and those with bronchopulmonary dysplasia |
| explain the mode of action of synagis | humanized monoclonal antibody produced by recombinant DNA technique |
| what are advantages of tobramycin aerosolization | reduced cost potential and ease of use at home |
| what dose of TOBI used, how many hours apart, for how many days? | 300mg twice daily, 12hrs apart but not less than 6 hrs apart for 28 days on and 28 days off |
| explain the mode of action of Tobi | tobi binds irreversibly to the 30s subunit of bacterial ribosomes, the binding blocks protein synthesis in the bacteria |
| what are the side effects associated with aerosolized tobi | parenteral- ototoxicity, nephrotoxicity, neuromuscular clackade, hypomagnesemia, fetal harm inhaled-voice alterations, tinnitus, nonsignificant increase in bacterial resistance |
| what flow rate should be used when nebulizing an antibiotic | 10-12lpm |
| what is the mode of action of zanamivir | binds to the viral enzyme neuraminidase and thus blocking the enzymes action |
| what is the dose of zanamivir commonly used, how many hours apart, for how many days | 10mg taken twice daily approximately 12 hrs apart for 5 days |
| what assessment outcomes would indicate effective application of an aerosolized antiinfective agent | reduce RSV symptoms, fever reduction, less myalagia and headache, reduced coughing |
| describe the use of sympathomimetics with a cold | decongestant effect resulting from vasoconstriction |
| list the effects of histamine | smooth muscle contraction, capillary permeability and dilation,itching and pain |
| outline the triple response | wheal and flare reaction (local redness, welt formation, and a reddish white border) |
| differentiate between the different histamine receptors and what occurs when each is stimulated | H1 receptor-involved in inflammation and allergic reactions producing wheal flare and bronchoconstriction and mucus secretion H2- gastric region=regulate gastric acid secretion and feedback controlls H3 in CNS involved in CNS functioning |
| describe how anti-histamines work and their mechanism of action | antihistamine block the increase vascular permability, pruritus, and bronchial smooth muscle constriction caused by hismine, they dry secretions |
| list example H-1 blockers | claritin, allegra, clarinex, piperdines |
| explain the effects of antihistamines | dry secretions, drowsiness |
| what is the duration of action of old vs new anthistamine | duration for older is generally 4 to 6 hrs, is up to 12 hrs |
| explain the benefits of 2nd generation agents over 1st generation | 2nd generation have little affinity for muscarinic cholinergic receptors and therefore do not cause dry mouth of gastrointestional side effect. lack antiserotinin activity and dont cause appetite stimulation and nonsedating |
| discuss the use of antihistamines with colds and seasonal allergies | dring of upper airways secretions lessen rhinitis and sneezing |
| define expectorant and compare and contrast mucolytic and stimulant expectorants | agent that facilitate the removal of mucus from lower resp tract stimulant-clearance the production of mucus secretions mucolytic-agents that facilitate removal of mucus by a lysing, or mucolytic |
| describe how different expectorants work | iodine products-expectorant in asthma and chronic bronchitis to distrubute to mucous glands, where it is secreted along with increased mucus guaifenesin reduces the adhesiveness and surface tension of mucus |
| describe the use of expectorants with chronic bronchitis | used to improved cough symptoms, chest discomfort, ease in bringing up sputum |
| explain the mechanism of action of expectorant | vagal gastric reflex stimulation, absorption into respiratory glands to directly increase mucus production |
| antitissive | cough suppressant |
| what is the best antitussive and how does it work | diphenhydramine(benadryl) inhibitory effect on the CNS depressing the cough center at the medulla |
| explain how tessalon is an antitussive | anesthetizes stretch receptors in the lung and pleura |
| for what patients is Alpha 1 proteinase inhibitor indicated? | given IV with congenital A1-antitrypsin deficiency and who exhibits panacinar emphysema at premature age |
| describe alpha1 antitrypsin deficiency and explain how it causes emphysema | generic defect can lead to panacinar emphysema has alveolar wall destruction caused by insufficiant production from the protease neutrophil elastase, an enzyme that cleave connective tissue and degrade elestic fibers |
| what are the 3 alpha-1 proteinase inhibitor medications currently available | aralast, prolastin, and zemaira |
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soleil6296
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