Pharmacology Midterm Study Guide and Review

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All drugs have generic and trade names. Know the generic/trade names and dosages for medications we have covered.
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Terms in this set (98)
Which of the following organs is considered the primary site of drug excretion/metabolism?Liver1. Approximately what percentage of an inhaled aerosol reaches each part of the respiratory tract with current delivery devices?Particles greater than 10 µm. Useful to treat the nasopharyngeal and oropharyngeal regions. An example is a nasal spray for perennial rhinitis, such as a corticosteroid. Particles 5 to 10 µm. Particles 5 to 10 µm may shift deposition to the more central airways. An example is a nasal spray, but there is no one standard device that creates this specific particle size. Particles 2 to 5 µm. As particle size decreases to less than 5 µm, deposition shifts from the oropharynx and large airways to the overall lower respiratory tract (large airways to periphery). Particles 0.8 to 3.0 µm. Increased delivery of an aerosol to the lung parenchyma, including the terminal airways and alveolar region, can be achieved with particles less than 3 µm.L/T Ratio30% reaches the lung, 70% goes to the stomachParticle size rangesNose > 10 microns ​ mouth > 15 microns ​ 5-10 microns (first 6 generations) ​ 1-5 microns (last 5-6 generations)SynergismDrug interaction that occurs from combined drug effects that are greater than if the drugs were given alone.ToleranceDecreasing intensity of response to a drug over time.Limitation of DPI/ how we would instruct a patient how to use a DPI.Inability to maintain inspiratory flow of 30-90 l/m.The physical mechanisms usually considered for aerosol particle deposition in the human lung include which of the following?Inertial impaction, gravitation settling, and diffusion.Dose Schedule for drug dosing mL/kg calculationDrug amount divided by the wight (kg) and cross multiply with x over the weight of the patient.Continuous albuterol calculationStep 1. Find out how many mg of medication is needed for total time of administration Step 2. Find out how many vials are needed Step 3. Find out how much normal saline is already in the vials Step 4. Find out how much ml is needed to add to the LVN or it to run for the time administeredAdrenergic effect on the heart.Increased heart rate and contractilityParasympathetic and sympathetic response. Parasympathetic = rest and digestSympathetic = fight or flightMimetic means? Lytic means?Mimetic means to mimic or copy Lytic means to blockEfferent signalsSignals from CNS to neuroeffector siteNeuroeffector Epinephrine stimulates what type of receptor sites?SympatheticKnow different receptor sites and what they each do.Alpha 1 = vasocontstriction Alpha 2 = tremors Beta 1 = heart Beta 2 = lungs M1, M2 (heart), M3 (lungs)Adrenergic effect on smooth muscleRelaxation of smooth muscleAnticholinergic effect on smooth muscleConstrictionWhen to use a LABA versus SABA. What disease benefits from a LABA? What are SABA medications? What are LABA medications?SABA is used for rescue agents and LABA's are for controllers. COPD benefits from a LABA. SABA = Albuterol, Levalbuterol, Metaproterol LABA = Salmoterol, Formoterol, Afromoterol, Indacaterol, Olodaterol.Side effects of Albuterol? Side effects of Atrovent?Albuterol increases the hear rate, respiratory rate, and can cause tremors Atrovent can cause a headache, dry mouth, cough.What is Levalbuterol? When would we use it? What isomer is Levalbuterol?Levalbuterol is the R-isomer of Albuterol. We would use it in leu of Albuterol if patients are having an increase of 20% heart rate after taking Albuterol.What diseases benefit from anticholinergic administration?COPDAgonistChemical or drug that binds to a receptor and creates an effect on the body.HFA stands for? What type of inhaler?Hydrofluoroalkane, a propellant in an MDI.Advantages/ disadvantage of MDIAdvantages: consistency, reliable, direct, flexible Disadvantages: coordination, efficiencyHow to use MDI, DPI, SVN.DPI: Place the device in your mouth and breathe in forcefully and as deeply as you can to fill your lungs. Hold your breath for 10 seconds. Take the DPI away from your mouth and exhale slowly. If more than one dose is prescribed, repeat steps 1 through 5 for each dose. MDI: Shake the puffer well before use (three or four shakes) Remove the cap. Breathe out, away from your puffer. Bring the puffer to your mouth. ... Start to breathe in slowly. ... Remove the puffer from your mouth, and hold your breath for about 10 seconds, then breathe out. SVN: Place the mouthpiece in your mouth. Some small children use a mask over the mouth and nose rather than a mouthpiece. Take slow, deep, even breaths through the mouth.Racemic Epinephrine? Dose? Used for? Receptor site?Racemic Epinephrine is an ultra-short-acting adrenergic bronchodilator that promotes vasoconstriction. Used for croup, epiglottitis, post extubation airway swelling and stridor. 11.25 mg, alpha-1 receptor.Xanthines- special considerations when giving these, what patient population can use these benefits?.Asthmatic patients when is albuterol is not working and also for neonatal/premature born patients for stimulation. Xanthines have harsh side effects and must be monitored closely when administration.Corticosteroids- why do we administer them?To create antiinflammation of the airways.Mucolytic- three most common mucolytics? What patients do we give mucolytics to?N-Acetylcysteine (NAC) = mucomist Dornase Alfa = polmazine Hypertonic Saline We give mucolytics to patients struggling with CBABE diseases to reduce accumulation of airway secretions, improve pulmonary function and gas exchange, prevent repeated infection and airway damage Diseases: Cystic fibrosis Chronic bronchitis Pneumonia Primary ciliary dyskinesia Asthma BronchiectasisParasympathomimeticcopying or producing the same effects as those of the parasympathetic nerves; "to mimic" the parasympathetic nerves *Cholingergic*Parasympatholytic*Anticholinergic* blocks Ach an agent that blocks or inhibits the effects of the parasympathetic nervous systemSympathomimeticagent that mimics the effects of the sympathetic nervous system *Adrenergic*Sympatholyticdrugs that inhibit the postganglionic functioning of the sympathetic nervous system *Antiadrenergic*Parasympathetic System sends acetylcholine to what organs?Skeletal muscle Glands Heart Bronchi EyesThe two autonomic nervous systems that we value are the?Sympathetic and parasympathetic nervous systems.Why is Albuterol given?To reverse smooth airway obstruction and to relax smooth muscle in the airway.What is levalbuterol?R isomer of Albuterol (very expensive)Where are most Beta-2 receptors found in the body?The lungsAlbuterol is known as?An agonistCholinisterase breaks down what?AcetylcholineWhat nervous system is under voluntary control?Peripheral nervous systemWhat nervous system is under involuntary control?Autonomic nervous systemWhat is the neurotransmitter for the SNS?NorepinephrineWhat happens to the heart rate when stimulated (SNS)?IncreasesWhat happens to the airways when stimulated?DilateWith the PNS, what is the neurotransmitter?AcetlycholineWhat happens to the parasympathetic system when over stimulated?SLUDWhat does SLUD stand for?Salivation Lacrimation Urination DefecationWhat happens to our HR, BP, and RR when the parasympathetic system is stimulated?Decreases and causes airways to constrictTrade name for Tiotropim Bromide?SpirivaDose for Tiotropim Bromide? (Spiriva)18 mcg DPI *Daily maintenance for COPD*Albuterol Trade NamesProventil HFA Ventolin HFA ProAir HFA ProAir Respiclick AccuNeb VoSpire ERAlbuterol DoseSVN: 2.5mg/3ml (unit dose) or 2.5 mg/0.5 ml (concentrate) MDI 90 MCG/puff,Racemic Epinephrine Dose11.25 mg Promotes Vasoconstriction Only helps upper airwayIpratropium Bromide Trade Name?Atrovent, Atrovent HFAIpratropum Bromide Dose? (Atrovent)0.5 mg Primarily for COPD patients Can be used as a maintenance drug by itself or in an emergency situation in combination with Albuterol.DuoNeb, Combivent DoseDuoneb: 2.5mg/0.5ml or 3ml *Mixutre of Albuteraol and Atrovent* Duoneb= nebulized solution of Albuterol and Atrovent with a SVN Combivent= inhaler version of the mixture of Albuterol and AtroventLevalbuterol Trade NamesXopenex, Xopenex HFALevalbuterol DoseSVN: 1.25mg/3ml 0.31mg/3ml 0.63 mg/3ml MDI: 45 MCG/puffUltra-Short-Acting Adrenergic Bronchodilator Agent?Racemic Epinephrine (Asthmanefrin) 1-3 hours durationShort-Acting Adrenergic Bronchodilator AgentsDuration: 4-6 hours Metaproterol Albuterol LevaluterolLong Acting Adrenergic Bronchodilator agentsDuration: 12-24 hours Salmeterol Formoterol Arformoterol Indacaterol OlodaterolCatecholaminesA chemical that mimics epinephrine and norepinephrineFormoterol Trade NamesPERFORMIST, FORADILARFORMOTEROL Trade NameBROVANAIndacaterol trade nameArcapta NeohalerOlodaterol Trade NameSTRIVERDI RESPIMATSalmeterol Trade NameSEREVENT DISKUSWhen would you stop administering Albuterol?When the Hr increase by 20% or moreCBABE: Obstructive diseasesCystic fibrosis Bronchitis Asthma Bronchiectasis EmphysemaMucarinic receptor M1Parasympathetic ganglia Facilitate neurotransmission and bronchoconstricion Cause secretion and rhinitis n the nose -(GUT)Mucarinic receptor M2Inhibit continued use of cetylcholine Blockade may enhance acetylcholine release, counteracting bronchodilation (tiotropium is selective for M1 and M3)Mucarinic receptor M3Smooth airway muscle and submucosal glands Cause bronhoconstriction Cause secretion and rhinitisAppropriate dose for TheophyllineTherapueutic serum levels of 10 to 20 mcg/mLWhat does caffeine do for the neonatal population?Makes them breatheSerum Levels of Theophylline<5 micrograms / mL: no effects seen 10 to 20 micrograms/mL: Therapeutic range >20 micrograms/mL: Nausea >30 micrograms / mL: Cardiac arrythmias 40 to 45 micrograms/ mL: Seizures Asthma 5 to 15 micrograms/mL COPD 5 to 10 micrograms/ mLAlkaloids in plant speciesTheophylline= Tea leaves Theobromine= Cocoa seeds or beans Caffeine= Coffee beans and kola nuts, Cocoa seeds or beans, and Tea leavesXanthines are used to treat?Neonates COPD Apnea of prematurity AsthmaMOA of xanthinesHAVE A BRONCHODILATING EFFECT, SITMULATE VENTILATORY DRIVE, AND STRENGTHEN THE DIAPHRAGM THEIR EXACt MOA IS UNCLEAR.Diurnal or Circadian steroid cycleProduction of body's own glucocorticoids Follows rhythmic cycle; termed diurnal or circadian rhythmCorticosteroids help with what?Inflammation4 categories of inflammatory response?Increased vascular permeability An exudate is formed in surrounding tissues Leukocytic infiltration White blood cells (WBC) emigrate through capillary walls (diapedesis) in response to attractant chemicals (chemotaxis) Phagocytosis White cells and macrophages (in lungs) ingest and process foreign material such as bacteria Mediator cascade Histamine and chemoattractant factors are released at the injury site. Various inflammatory mediators, such as complement and arachidonic acid products, are generated.What are the major cells responsible for an inflammatory response in asthma?Mast cells and EosinophilsMOA of Corticosteroids?Induce gene expression for anti-inflammatory proteins and receptors To suppress gene expression for proinflammatory proteinsHazards and Side Effects of Corticosteroids?Psychiatric reactions Dysphonia Suppression of the HPA axis CoughWhat do we tell our patients to do in order to reduce Oral Thrush?Use spacer Rinse mouth after useWhat is Oral thrush?Oropharyngeal candidiasis (oral thrush)