pharm resp info

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tallone4830
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261155
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pharm resp info
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2014-02-09 22:29:58
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pharm resp info
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  1. beta agonists indications
    asthma (especially exercised-induced), COPD, anaphylaxis, aspiration
  2. beta agonists kinetics
    onset 5 minutes (SABA/formoterol) - 20 minutes (salmeterol). systemic uptake limits maximum dose
  3. beta agonists black box
    LABA should not be given as monotherapy due to increased risk of asthma-related death (LABAs do not relieve sudden wheezing)
  4. beta agonists bonus info
    regular use (>1 canister/month) is associated with diminished control of asthma. administer prior to other inhalers (dilates lungs)
  5. beta agonists side effects
    tachycardia, tremor, nervousness (beta 1 spillover). also hypOkalemia and hypERglycemia
  6. beta agonists MOA
    cause relaxation of bronchial smooth muscles by agonizing beta 2 receptors in the lungs
  7. anticholinergic kinetics
    ipratropium onset 15-30 min, duration 5 hours. tiotropium onset <30 min, duration 24 hrs.
  8. anticholinergics MOA
    reverse vagally mediated bronchospasm (but not allergen- or exercise-induced bronchospasm) -- PREVENTS bronchoconstriction
  9. anticholinergics indications
    acute asthma (not first line), bronchospasm prophylaxis, COPD, rhinorrhea (ipratropium)
  10. anticholinergics side effects
    dry mouth, throat irritation / dysphagia. rarely increased intraocular pressure, urinary retention
  11. corticosteroids indications
    bronchospasm prophylaxis, rhinitis, asthma, COPD
  12. corticosteroids MOA
    inhibit the activity of a variety of cell types and mediators involved in allergic and irritant inflammation
  13. corticosteroids side effects
    *THRUSH*/dysphona/sore throat, osteoporosis, psychosis, growth retardation (children). also hypOkalemia and hypERglycemia
  14. mast cell stabilizer MOA
    work at the mast cell to inhibit its degranulation, preventing the release of histamine and other mediators of allergic reactions
  15. leukotriene modifier indications
    asthma/bronchospasm PROPHYLAXIS, allergic rhinitis
  16. leukotriene modifier MOA
    either antagonize the leudotriene receptor or inhibit leukotriene synthesis, preventing bronchoconstriction/mucous hypersecretion
  17. leukotriene modifier side effects
    HA, N/V, diarrhea, elevated LFTs. rare Churg-Strauss syndrome
  18. methylxanthines indications
    asthma (alternative to ICS), COPD (4th line)
  19. methylxanthines bonus
    theophylline has a narrow therapeutic index (5-15mcg/mL). IV aminophylline is 80% theophylline dose
  20. methylxanthines MOA
    not fully understood. theophylinne may inhibit phosphodiesterase (PDE) eventually resulting in antiinflammatory effects
  21. methylxanthines kinetics
    CYP 1A2 substrate (metabolism enhanced by smoking). ER tablets peak concentration 4-7h, dosed q12h
  22. methylxanthines contraindications
    active or symptomatic coronary heart disease
  23. methylxanthines side effects
    simpathomimetic (insomnia, tremor, seizures, restlessness)
  24. anti-IgE indications
    asthma
  25. anti-IgE MOA
    blocks the binding of IgE to high-affinity IgE receptors on mast cells, preventing their activation by allergens
  26. PDE-4 inhibitors indication
    severe COPD associated with bronchitis and hx of exacerbations
  27. PDE-4 inhibitors MOA
    selectively inhibit PDE-4, decreasing the migration/action of pro-inflammatory cells
  28. PDE-4 contraindications
    moderate-severe hepatic impairment
  29. PAH + positive vasoreactivity test = ?
    treat with calcium channel blockers (dihydropyridines like nifedipine or amlodipine)
  30. calcium channel blocers MOA
    antagonize L-type calcium channels, causing vasodilation of arterial smooth muscle
  31. endothelin receptor antagonist MOA
    antagonize endothelin receptors resulting in vasodilation/decreased proliferation
  32. endothelin receptor antagonist contraindications
    *PREGNANCY CATEGORY X*, liver issues
  33. endothelin receptor antagonist black box
    only available through restricted programs due to risk of birth defects and/or hepatotoxicity
  34. PDE-5 inhibitors MOA
    result in increased intracellular cGMP, resulting in vasodilation in the pulmonary vessels
  35. PDE-5 inhibitors side effects
    HA, flushing. inhibitors/inducers of CYP 3A4.
  36. PDE-5 inhibitors contraindications
    do not co-administer with nitrates due to life-threatening hypotension (Isordil, Imdur, Minitran, others)
  37. vascular prostaglandins MOA
    mimic prostacyclin, a potent vasodilator that posesses antithrombotic and antiproliferative properties (increases cAMP)
  38. bupropion side effects
    dry mouth, nausea, insomnia. rarely SEIZURES
  39. bupropion contraindications
    lowers seizure threshold (hx seizures, drug/EtOH withdrawal, bulimia/anorexia)
  40. varenicline MOA
    partial agonist at alpha4-beta2 neuronal nicotinic acetylcholine receptors
  41. clonidine side effects
    sedation/drowsiness/dizziness, hypotension
  42. nortriptyline side effects
    sedation, anticholinergic effects, tremor
  43. first-line treatments for nicotine dependence
    nicotine replacement, bupropion, varnicline
  44. second-line treatments for nicotine dependence
    clonidine, nortriptyline
  45. varenicline black box
    serious neuropsychotic events, particularly in people with depression/suicidal thoughts
  46. varenicline side effects
    insomnia/abnormal dreams, HA, nausea

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