Parm Exam 2 part 1.txt

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Parm Exam 2 part 1.txt
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2012-03-10 09:08:00
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Pharm Exam 2 Part 1
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  1. Agent that stimulates sympathetic nervous fibers, which allow relaxation of smooth muscle in the airway. Also known as sympathomimetic bronchodilator or beta 2 agonist.
    Adrenergic bronchodilator
  2. Causes vasoconstriction and vasopressor effect; in the upper airway (nasal passages), this can provide decongestion.
    alpha-receptor stimulation
  3. Refers to the increasing incidence of asthma morbidity, and especially asthma mortality, despite advances in the understanding of asthma and availability of improved drugs to treat asthma.
    Asthma Paradox
  4. Causes increased myocardial conductivity and increased heart rate as well as increased contractile force.
    beta 1-receptor stimulation
  5. Causes relaxation of bronchial smooth muscle, with some inhibition of inflammatory mediator release and stimulation of mucociliary clearance.
    beta 2-receptor stimulation
  6. Narrowing of the bronchial airways, caused by contraction of smooth muscle.
    Bronchospasm
  7. Group of similar compounds having sympathomimetic action; they mimic the actions of epinephrine.
    Catecholamines
  8. Nucleotide produced by �2-receptor stimulation; it affects many cells, but causes relaxation of bronchial smooth muscle.
    Cyclic adenosine 3�, 5�-monophosphate (cAMP)
  9. Nucleotide producing the opposite effect of cAMP; that is, it causes bronchoconstriction.
    Cyclic guanosine monophosphate (cGMP)
  10. Long-term desensitization of � receptors to beta 2 agonists, caused by a reduction in the number of beta receptors.
    Downregulation
  11. Drug that exhibits its pharmacologic activity when it is converted, inside the body, to its active form.
    Prodrug
  12. Producing effects similar to those of the sympathetic nervous system.
    Sympathomimetic
  13. this group is used for the treatment of reversible airway obstruction in diseases such as asthma and COPD. These agents produce bronchodilation by stimulating beta 2 receptors on airway smooth muscle.
    adrenergic bronchodilator
  14. Short-acting beta 2 agonists such as albuterol, levalbuterol, or pirbuterol are indicated for relief of
    acute reversible airflow obstruction in asthma and COPD
  15. Routes of administration for Beta agonists include:
    inhalation, oral, parenteral
  16. Inhalation is the preferred route for administering beta -adrenergic drugs for all of the following reasons:
    onset is rapid, smaller doses, ruduced side effects, direct delivery, painless/safe
  17. The inhalation route targets the
    lung directly
  18. The major difficulties with aerosol administration are:
    Time for nebs, embarassment of MDI, inability to use correctly
  19. The Guidelines for the Diagnosis and Management of Asthma released by NAEPP EPR 3 recommend 2.5 to 5 mg of albuterol by nebulizer every _________ for three doses and 10 to 15 mg/hr by continuous nebulization
    20 mins
  20. Several delivery methods to accomplish continuous nebulization have been tried and reported, including the following:
    measured refilling of small volume neb, volumetric infusion pump w/SVN, and large-reservoir nebulier such as the heart or hope neb.
  21. Continuous nebulization of beta 2 agonists is not standard therapy, and patients receiving this treatment have serious
    airflow obstruction
  22. Potential complications of continula nebs contain:
    cardiac arrhythmias, hypokalemia, and heyperglycemia
  23. Close monitoring of patients receiving continuous � agonists is necessary and includes observation and cardiac and electrolyte monitoring. Selective �2 agonists, such as ______,should be used to reduce side effects.
    albuterol
  24. has the advantages of ease, simplicity, short time required for administration, and exact reproducibility and control of dosage. However, In terms of clinical effects, this is not the preferred route. The time course of oral beta agonists differs from that of inhaled beta agonists. The onset of action begins in about 1.5 hours, with a peak effect reached after 1 to 2 hours and a duration of action between 3 and 6 hours.
    oral route
  25. The mechanism underlying the increase in bronchial hyperresponsiveness with use of beta agonists is
    unclear
  26. Commonly reported side effects of the adrenergic bronchodilators include:
    headache, nervousness, irritability, anxiety, and insomnia
  27. A decrease in arterial oxygen pressure (PaO2) has been noted with isoproterenol administration during?
    asthmatic bronchospasm. Rarely less than 10
  28. can increase blood glucose and insulin levels and decrease serum potassium levels.
    Adrenergic bronchodilators
  29. Hypokalemia has also been reported after parenteral administration of
    albuterol and epinephrine
  30. The use of MDIs powered by CFC (e.g., Freon) can cause
    bronchospasm
  31. is an ideal alternative formulation to an MDI if sensitivity to propellants exists, assuming drug availability and adequate inspiratory flow rate
    DPI (SVN or Oral can be used too)
  32. An increasingly publicized problem for individuals with hyperreactive airways is sensitivity to
    Sulfite preservatives
  33. are examples of what?
    sulfites
  34. When a sulfite is placed in solution, at warm temperature in an acid pH such as saliva, it converts to sulfurous acid and ________?
    Sulfur Dioxide ( causes bronchospasms)
  35. Same as cholinergic�agent that produces the effect of acetylcholine or an agent that mimics acetylcholine.
    Muscarinic
  36. Blocking parasympathetic nervous fibers.
    Parasympatholytic
  37. Producing effects similar to the parasympathetic nervous system.
    Parasympathomimetic
  38. given by inhalation offer a second class of bronchodilating agents.
    anticholinergic agents
  39. are indicated as bronchodilators for maintenance treatment in COPD, including chronic bronchitis and emphysema. Sometimes asthma
    Ipatropium and tiotropium
  40. is indicated for use in patients receiving regular treatment for COPD who require additional bronchodilation for relief of airflow obstruction.
    A combination anticholinergic and � agonist, such as ipratropium and albuterol (Combivent, DuoNeb)
  41. is indicated for symptomatic relief of allergic and nonallergic perennial rhinitis and the common cold.
    Anticholinergic nasal spray
  42. anticholinergic, or antimuscarinic) agents that are given by aerosol include ipratropium, a combination of ipratropium and albuterol, and tiotropium.
    Parasympatholytic
  43. had been administered as a nebulized solution, using either the injectable solution or, preferably, solutions marketed for aerosolization; however, this agent is no longer aerosolized. Duration of bronchodilation and the incidence of side effects are dose dependent. Dosages for children based on dose-response curves had been given as 0.05 mg/kg three or four times daily.
    Atropine sulfate
  44. is a nonselective antagonist of M1, M2, and M3 receptors. is an N-isopropyl derivative of atropine
    Ipratropium bromide (Atrovent)
  45. Ipatropium has what effect on mucociliary clearance or mucus viscosity?
    minimal or none
  46. Because quaternary compounds do not cross the blood-brain barrier, they do not cause?
    CNS effects
  47. One example of Quaternary compound.
    Ipatropium
  48. What are the eye effect of ipatropium?
    none so long as not sprayed driectly. Topical can cause pupil dilation
  49. What are the effects of ipratropium on cardiac?
    minimal effects
  50. What is the effect of ipratropium of gastro and unrinary?
    non or little
  51. Quaternary compounds, such as ipratropium, are fully ionized and less absorbed in body tissues than tertiary compounds, such as atropine sulfate. Consequently, side effects with quaternary compounds are?
    localized to the site of drug exposure
  52. Administration of parasympathomimetic (cholinergic) agents such as methacholine (e.g., in bronchial provocation testing) can intensify the level of bronchial tone to the point of constriction in healthy subjects and more so in
    asthmatic patients
  53. Cholinergic stimulation of muscarinic receptors on airway smooth muscle and submucosal glands causes contraction and release of
    mucus
  54. Anticholinergic agents such as atropine or ipratropium are antimuscarinic; they competitively block the action of acetylcholine at parasympathetic postganglionic effector cell receptors. Because of this action, anticholinergic agents block
    cholinergic-induced bronchoconstriction
  55. An important point to realize with use of a blocking agent, such as an anticholinergic bronchodilator, is that the effect seen depends on the degree of
    tone present that can be blocked
  56. The anticholinergic agents ipratropium and tiotropium are indicated for the treatment of
    airflow obstruction in COPD
  57. Because atropine and its derivatives are competitive inhibitors of acetylcholine at the neuroeffector junction, such antagonists should block
    parasympathetic reflex bronchoconstriction.
  58. has been shown to inhibit exercise-induced asthma and psychogenic bronchospasm and bronchoconstriction caused by beta blockade or cholinergic agents.
    atropine
  59. Lung inflation during a deep breath stimulates the cough receptors, resulting not only in coughing but also increased
    bronchomotor tone
  60. Agent that blocks parasympathetic nervous fibers, which allow relaxation of smooth muscle in the airway.
    Anticholinergic bronchodilator
  61. Same as anticholinergic bronchodilator�agent that blocks the effect of acetylcholine at the cholinergic site.
    Antimuscarinic bronchodilator
  62. Agent that produces the effect of acetylcholine.
    Cholinergic
  63. causes the breakdown of phosphoinositides into inositol triphosphate (IP3) and diacylglycerol (DAG); this ultimately leads to an increase in the cytoplasmic concentration of free calcium and smooth muscle contraction or gland exocytosis.
    PLC
  64. Both ipratropium and tiotropium also block the
    M2 receptor
  65. This receptor inhibits continued release of acetylcholine.
    M2 receptor
  66. tiotropium has selective affinity for M1 and M3 receptors because it dissociates much more rapidly from the M2 receptor and remains bound
    to the M1 and M3 subtypes
  67. The use of agents such as ipratropium for allergic and nonallergic rhinitis is based on the parasympathetic control of submucosal glands in the
    nasal mucosa
  68. are nonspecific blockers of muscarinic receptor subtypes (M1, M2, and M3) in the airway
    anticholinergic bronchodilators
  69. Blockade of the _________ on bronchial smooth muscle prevents activation of the linking Gq protein, its effector system phospholipase C (PLC), and subsequent increase in free calcium with bronchoconstriction or gland exocytosis.
    M3 receptor
  70. Blockade of M1 and M3 receptors in the nasal passages prevents
    gland secretions and rhinitis
  71. The most common side effect seen with antimuscarinic bronchodilator is
    Dry Mouth
  72. The SVN solution of ipratropium has also been associated with additional side effects in a few patients, including
    pharyngitis, dyspnea, flulike symptoms, bronchitis, and upper respiratory infection.
  73. Systemic side effects such as tachycardia, palpitations, urinary hesitancy, constipation, blurred vision, and increased ocular pressure are less likely with quaternary agents such as ipratropium or tiotropium than with tertiary agents such as
    atropium
  74. must be protected from drug exposure with aerosol use resulting from accidental spraying or with nebulizer delivery
    the eye
  75. As the iris dilates outward and the lens remains flattened, drainage of intraocular aqueous humor is reduced. In patients with narrow-angle glaucoma, intraocular pressure can increase. Because many patients with COPD are older, narrow-angle glaucoma may be present more commonly. Subjects using quaternary ammonium antimuscarinic bronchodilators must be informed of this hazard and should use proper
    aerosol inhalation tech.
  76. Because of the greater risk of eye exposure with a nebulizer, especially disposable, constant-output devices, an MDI with ______ is recomended,
    holding chamber
  77. The most common side effects with quaternary ammonium antimuscarinic bronchodilators are
    dry mouth and perhaps a cough caused by the aerosol particles.
  78. Antimuscarinic agents were found to be more potent bronchodilators than __________in bronchitis/emphysema,
    beta-adrenergic agents
  79. Ipratropium has been approved by the FDA specifically for use in the treatment of
    COPD, but is also used for treatment of asthma
  80. Tiotropium, an antimuscarinic bronchodilator, offers a prolonged duration of action of
    24 hours
  81. In contrast to ipratropium, lung function is maintained more consistently at a higher level throughout the day with
    tiotropium
  82. Current guidelines do not dictate the use of any one specific bronchodilator. It is noted, however, that the use of a short-term beta 2 agonist and an anticholinergic, such as ipratropium, improves the FEV1 in patients with
    COPD
  83. Antimuscarinic and �-adrenergic agents have an approximately equal effect on flow rates in many patients. These agents may be especially useful in the following applications when prescribed for asthmatic patients:
    Nocturnal and psychogenic asthmas, asthma PT's w/ glaucoma,as an alternative to theophylline, and acute asthma
  84. adding multiple doses of anticholinergic (antimuscarinic) bronchodilators to beta 2 agonists was safe, improved lung function, and
    avoid hospital admission
  85. Multiple doses should be preferred to single doses of
    antimuscarinic agents
  86. Sustained-release theophylline is indicated as an alternative for maintenance (step 2) therapy of mild, persistent asthma and higher in patients older than
    5 years
  87. is not recommended in the guidelines for children younger than 5 years or for any person with acute exacerbation of asthma.
    Theophilline
  88. Theophylline is considered effective in COPD but, because of potential toxicity, is recommended as an alternative to
    inhaled bronchodilators such as beta 2 agonists or anticholinergic agents
  89. xanthines should not be used in the treatment of
    COPD exacerbations
  90. If pharmacologic therapy is needed to stimulate breathing in apnea of prematurity,________are considered the first-line agents of choice
    methylxanthines
  91. penetrates the cerebrospinal fluid better and has a higher therapeutic index with fewer side effects compared with theophylline.
    Caffiene citrate
  92. is related chemically to the natural metabolite xanthine, which is a precursor of uric acid
    Theophylline
  93. Theophylline and theobromine ar classified as?
    xanthines
  94. Xanthines are found as alkaloids in?
    plants
  95. There are several synthetic modifications to the naturally occurring methylxanthines, including:
    dyphylline, proxyphylline, and enprofylline
  96. Xanthines generally have stimulant properties, exemplified by the xanthine caffeine. Other effects of this class of drug include
    diuresis and smooth muscle relaxation
  97. The xanthine group has the following general physiologic effects in humans:
    CNS stimulation, cardiac muscle stimulation, diuresis, Bronchial, uterine, and vascular smooth muscle relaxation, Peripheral and coronary vasodilation, and Cerebral vasoconstriction
  98. has more CNS-stimulating effect than theophylline, and this includes ventilatory stimulation. In clinical use, theophylline is generally classified as a bronchodilator because of the relaxing effect on bronchial smooth muscle.
    Caffeine
  99. The exact mode of action of xanthines is
    unclear
  100. An increase in cAMP causes relaxation of
    bronchial smooth muscle
  101. is a weak and nonselective inhibitor of cAMP-specific PDE. The pathway by which this inhibition can lead to an increase in intracellular cAMP, with consequent bronchial relaxation or antiinflammatory effects
    Theophylline

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