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resp pharm exam

QuestionAnswer
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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Created by: soleil6296