Pharmacology Test 5 (Ch. 11, 12, 13, And 14)

Front 1

Are also known as cromolyn-like agents used as prophylactic to treat the inflammatory response in asthma?

Back 1

Mast cell stabilizers

Front 2

Alternatives to low-dose corticosteroids in Step 2 asthma include?

Back 2

cromolyn-like drugs and antileukotrienes

Front 3

Systemic corticosteroids are controllers or relievers?

Back 3

Relievers

Front 4

Leukotriene Modifers are controllers or relievers?

Back 4

Controller

Front 5

Cromolyn sodium and Nedocromil sodium are controllers or relievers?

Back 5

Controllers

Front 6

SABA is controllers or relievers?

Back 6

Relievers

Front 7

LABA is a controller or reliever?

Back 7

Controller

Front 8

TMP-SMZ (Bacterim) (1st line) is considered as 1st line therapy to treat Pneumocystis carinii pneumonia (PCP) or (Pneumocystis jiroveci)? True or False

Back 8

True

Front 9

What is 2nd line prophylactic therapy in HIV or AIDS patients to prevent Pneumocystis carinii pneumonia (PCP) or (Pneumocystis jiroveci)?

Back 9

Pentamidine (NebuPent); given through inhalation and IV; give with SABA like Albuterol

Front 10

Which drugs are Antileukotrienes (anti-LTs)? Know which agents is appropriate per specific

Back 10

a. Zileuton (Zyflo, Zyflo (R): Zyflo 600 mg QID and Zyflo ER 1200 mg BID

b. Zafirlukast (Accolate): 10 mg bid children 5-11 years old. 20 mg bid 12 years old and older.

c. Montelukast (singulair): 10 mg tabs, 4 mg- 5mg chewable tabs, 4 mg granules QD for >6 months of age

Front 11

Ribavirin is FDA approved for use in infants? True or False

Back 11

True

Front 12

Ribavirin treats TB?

Back 12

False

Front 13

When giving an aersolized antibiotic, can you mix them with other drugs or use the same nebulizer?

Back 13

No

Front 14

Know which steroids are available for inhalation and the purpose of their use with asthmatic and COPD patients?

Back 14

1. QVAR; Beclomethasone dipropionate

2. Pulmicort; Budesonide

3. Alvesco; ciclesonide

4. Aerospan; Flunisolide

5. Flovent; Fluticasone propionate

6. Asmanex; mometasone furoate

7. Advair; Fluticasone propionate + Salmeterol

8. Symbicort; Budesonide + Formoterol

9. Dulera; mometasone furoate + Formoterol

10. Breo Ellipta; Fluticasone furoate + vilanterol

Front 15

Know the time frame for early phase and late phase of an asthmatic reaction?

Back 15

Early phase: 50 min to an hour

Late phase: can be up to12 hours. 8 to 10 hours

Front 16

All of the following represent modes of action of cromolyn sodium except?

Back 16

Remember is NOT a bronchial smooth muscle relaxer

Front 17

Name the antileukotriene modifier that is approved for children less than 5 years of age is?

Back 17

Singulair

Front 18

Per NAEPP guidelines which drugs should be the first line maintenance therapy in asthma patients?

Back 18

Inhaled corticosteroid agents

Front 19

What is the difference between endogenous and exogenous?

Back 19

Endogenous is our body produces it and external (outside) ( produced outside of patients body)

Front 20

Body cannot distinguish between endogenous and exogenous? True or False

Back 20

True

Front 21

Corticotropin, or adrenocorticotropic (ACTH), produced in the hypothalamus, stimulates the adrenal cortex to secrete glucocorticoids, such as cortisol. True or False

Back 21

True

Front 22

Which antibiotic is commonly used in CF population to treat Pseudomonas aeruginosa?

Back 22

Tobi or Tobromyosin

Front 23

Body can distinguish between endogenous and exogenous?

True or False

Back 23

True

Front 24

Side effects with inhaled steroids can be minimized by use of reservoir device, rinsing of mouth after treatments, and use of minimal doses. True or False

Back 24

True; rinse after treatments so don’t get fungal infection in the mouth (oral thrush)

Front 25

Side effects associated with systemically administered steroids.

Back 25

Fluid retention, osteoporosis, hyperglycemia

Front 26

Patients with adrenal or HPA suppression can be abruptly withdrawn from oral steroids and placed on an aerosol dosage. True or False

Back 26

False

Front 27

Know side effects associated with aerosol corticosteroids.

Back 27

Oral thrush (fugal infection - oropharyngeal candidiasis), dysphonia (difficulty in speaking), minimal HPA suppression, voice alteration

Front 28

Symbicort is combination of what two drugs?

Back 28

Budesonide and Formoterol

Front 29

Symbicort is combination of what two drugs?

Back 29

Budesonide and Formoterol

Front 30

Omalizumab (xoliar) is monoclonal antibody against human IgE, it inhibits the binding of IgE to receptors on mast cells and basophils. Given subcutaneous 150/1.2 mL every 2 to 4 weeks. True or False

Back 30

True

Front 31

Nonsteroidal antiasthmatic drugs are Relievers and can be used in acute asthma exacerbation. True or False

Back 31

False

Front 32

What is the most common aerosol generator used to aerosolize Ribavirin?

Back 32

SPAG (Small Particle Aerosol Generator)

Front 33

What is the most common aerosol generator used to aerosolize Ribavirin?

Back 33

SPAG (Small Particle Aerosol Generator)

Front 34

Oral candidiasis is a common side effect of inhaled corticosteroids. True or False

Back 34

True

Front 35

Before choosing an antimicrobial agent, it is important to identify the organism responsible for the infection. True or False

Back 35

True

Front 36

It is acceptable to treat an unknown microorganisms with a broad-spectrum antibiotic?

Back 36

Yes

Front 37

Name two groups of nonsteroidal anti asthma agents

Back 37

Cromolyn-like drugs and leukotrienes inhibitors (antileukotrienes)

Front 38

Name two groups of nonsteroidal anti asthma agents

Back 38

Cromolyn-like drugs and leukotrienes inhibitors (antileukotrienes)

Front 39

Name two cromolyn-like drugs?

Back 39

1. Cromolyn sodium, intal (brand name, generic still available).

For cromolyn sodium: SVN 20 mg/amp

2. Nedocromil sodium, Tilade (off market)

Front 40

Why to use cromolyn- like drugs ?

Back 40

-Used to prevent degranulation of the mast cell and subsequent release of Histamine, PGs, LTs, proteases, cytokines

- NOT USED AS A BRONCHODILATOR

- thought to help prevent or reduce LATE-PHASE response in asthma

- Used as ACE inhibitor cough pts., a reduction in Sickling in sickle cell pts..

Front 41

List the leukotriene inhibitors?

Back 41

1. Zafirlukast - Accolate

2. Montelukast- Singulair

3. Zileuton-Zyflo

Front 42

What is the dosage for Zafirlukast-Accolate?

Back 42

Tablet: 10 mg, age 5-11 y/o

Tablet: 20 mg, age> 11y/o

Front 43

Dosage for Zileuton-Zyflo?

Back 43

Tablets: 600 mg & Zyflo ER 1200 mg (complications include liver decreasing effective use of the drug, Also may interact with Theophylline and Warfarin

Front 44

What is the dosage for Montelukast- Singulair ?

Back 44

Tablets: 10 mg, 4 mg and 5 mg chewable. 4 mg packet of granules can be given children over 6 months

Front 45

What is the roles of antileukotriene drugs in asthma management?

Back 45

1. Exercise induced asthma

2. Aspirin induced asthma

3. Allergen induced asthma

4. Used to block or stop formation of leukotrienes at receptor site

5. Can cause Churg- Strauss Syndrome, which is a vasculitis of unknown etiology, usually occurs in adults between 20 and 40 y/o

Note: corticosteroid are still better anti-inflammatory agent for treatment of asthma

6. In clinical use for asthma it is ONLY to be used prophylactically for the control of mild persistent step 2 asthma

Front 46

In acute and moderate ER asthmatic attacks what SABA would be a good choice?

Back 46

Albuterol would be a good choice. Salmeterol would not be good cause it’s slow acting.

Front 47

What is the first line drug for PCP-PJP, PCP means Pneumocystis carinii pneumonia and PJP means Pneumocystis jiroveci pneumonia?

Back 47

Bactrim (TMP- SMX)

Front 48

What are inhaled corticosteroids used for?

Back 48

1. Maintenance control therapy of chronic asthma

2. COPD

3. Intranasal aerosol agents

Front 49

What are inhaled corticosteroids used for?

Back 49

1. Maintenance control therapy of chronic asthma

2. COPD

3. Intranasal aerosol agents

Front 50

Another name for Beclomethasone dipropionate ?

Back 50

QVAR (40 mcg, 80 mcg)

Front 51

What are inhaled corticosteroids used for?

Back 51

1. Maintenance control therapy of chronic asthma

2. COPD

3. Intranasal aerosol agents

Front 52

Another name for Beclomethasone dipropionate ?

Back 52

QVAR (40 mcg, 80 mcg)

Front 53

Another name for Flunisolide hemihydrate ?

Back 53

Aerospan (80 mcg)

Front 54

Other names for Fluticasone propionate?

Back 54

Flovent( 44, 110, 220 mcg)

Flovent Diskus ( 50, 100, 250 mcg)

Front 55

Another name for Fluticasone furoate?

Back 55

Arnuity Ellipta ( 100 & 200 mcg dosages)

Front 56

Another name for Budesonide?

Back 56

Pulmicort Flexhaler, Pulmicort Respules

Front 57

Another name for Budesonide?

Back 57

Pulmicort Flexhaler, Pulmicort Respules

Front 58

Other names for mometasone furoate?

Back 58

Asmanex Twisthaler, Asmanex

Front 59

Another name for Budesonide?

Back 59

Pulmicort Flexhaler, Pulmicort Respules

Front 60

Other names for mometasone furoate?

Back 60

Asmanex Twisthaler, Asmanex

Front 61

Another name for Alvesco?

Back 61

Ciclesonide

Front 62

What two drugs do Symbicort have?

Back 62

Budesonide and Formoterol

Front 63

What two drugs does Dulera have?

Back 63

Mometasone furoate, Formoterol

Front 64

What two drugs does Advair have?

Back 64

Salmeterol, Fluticasone propionate

Front 65

What two drugs are in Breo Ellipta ?

Back 65

Fluticasone furoate, vilanterol

Front 66

What two drugs are in Advair?

Back 66

Fluticasone propionate, Salmeterol

Front 67

What do glucocorticoids do?

Back 67

Regulate the metabolism of carbohydrates, fats, and protein to increase levels of glucose for body energy

Front 68

What do mineralocorticoids do?

Back 68

Regulate water, e.g.. aldosterone

Front 69

What do mineralocorticoids do?

Back 69

Regulate water, e.g.. aldosterone

Front 70

What do sex hormones do?

Back 70

Androgens and estrogens

Front 71

Name 3 adrenal cortical hormones?

Back 71

Glucocorticoids, mineralocorticoids, sex hormones

Front 72

What is the (HPA) Axis or the Hypothalamic-Pituitary- Adrenal- Axis?

Back 72

Pathway for release and control of endogenous (made in the body) corticosteroids.

Stimulation of the hypothalamus causes impulses to be sent to median eminence, where corticotropin- releasing factor (CRF) is released.

Front 73

What does the HPA suppression do?

Back 73

Inhibits hypothalamus and pituitary glands.

Ex: Thermostat regulates production of heat by monitoring temperature levels.

Front 74

What is Diurnal steroid cycle?

Back 74

Production of body’s own glucocorticoids follows rhythmic cycle; termed diurnal or circadian rhythm.

Front 75

What is Diurnal steroid cycle?

Back 75

Production of body’s own glucocorticoids follows rhythmic cycle; termed diurnal or circadian rhythm.

Front 76

When are cortisol levels the highest?

Back 76

At 8:00 am in the morning

Front 77

Give examples of interference with the diurnal or circadian rhythm?

Back 77

Jet lag, and Night shift work

Front 78

What is one of the primary reasons for aerosolized steroids ?

Back 78

To minimize adrenal or HPA suppression by minimizing dosage and localizing the site of treatment

Front 79

What is the triple response for inflammation?

Back 79

Redness( local dilation of blood vessels, occurring in seconds),

Flare ( Reddish color several centimeters from the site, occurring 15 to 30 seconds after injury),

Wheal ( local swelling, occurring in minutes)

Front 80

Name four categories for the inflammatory response?

Back 80

1. Increased vascular permeability- an exudate is formed in surrounding tissues

2. Leukocytic infiltration- white blood cells emigrate

3. Phagocytosis- white cells and macrophages ingest bacteria

4. Mediator cascade: histamine release

Front 81

Name the two most common inflammatory diseases?

Back 81

Chronic bronchitis, and asthma

Front 82

What is the number 1 cause of chronic bronchitis?

Back 82

Smoking tobacco

Front 83

Name the major effector cells of inflammatory response?

Back 83

Mast cells and esinophils

Front 84

The early asthmatic response is caused by what?

Back 84

Immunoglobulin E (IgE)

- Activates mast cells that releases histamines (bronchospasm)

- Response peaks at 15 min

- Declines over 1 hour

Front 85

Mast cell mediators and release of cytokines recruit other inflammatory cells to cause what?

Back 85

Late-phase reaction

- Recruit esinophils, basophils, monocytes/macrophages and lymphocytes

- response occurs after 6 to 8 hours

- can last up to 24 hours

Front 86

What happens in the airway inflammatory response?

Back 86

- smooth muscle spasm, mucus secretions, shedding of airway, goblet cell hyperplasia

Front 87

What do steroids do?

Back 87

Reduce number of mast cells within the airway and help restore responsiveness to beta- adrenergic stimulation

Front 88

Side effects of oral corticosteroids?

Back 88

Suppression of the HPA axis, immunosuppression, slowing of growth in children, osteoporosis, peptic ulcer, fluid retention, hypertension, increased WBC count, hyperglycemia

Front 89

Name the most common side effects with aerosol administration?

Back 89

Fungal infection - Oropharyngeal candidiasis (oral thrush), Dysphonia (difficultly in speaking), voice alteration, cough, incorrect use of MDI

Front 90

What to do cause of the side effects with the aerosol administration?

Back 90

Use minimal dose, use reservoir, rinse mouth after use

Front 91

Inhaled corticosteroids are considered to be the most effective long-term therapy for ?

Back 91

Mild, moderate or severe persistent asthma. In addition to beta agonist therapy