Allergy & Immunity

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  1. Where are H1 Histamine receptors present?
    • Smooth muscle
    • Vascular endothelium
    • Brain
  2. Where are H2 Histamine receptors present?
    • Gastric parietal cells
    • cardiac muscle
    • mast cells
    • brain
  3. H1 receptors cause _____ in the lungs, resulting in _____.
    • bronchoconstriction
    • asthma
  4. H1 receptors cause _____ in the vascular smooth muscle, resulting in _____.
    • post capillary venule dilation
    • erythema
  5. H1 receptors cause _____ in the vascular endothelium, resulting in _____.
    • cellular contraction
    • edema
  6. H1 receptors cause _____ in the peripheral nerves, resulting in _____.
    • sensitization
    • itching, pain
  7. H2 receptors cause _____ in the heart.
    minor increase in HR & contractility
  8. H2 receptors cause _____ in the stomach, resulting in _____.
    • gastric acid secretion
    • PUD, GERD
  9. What kind of drug is an H1-antihistamine?
    inverse agonist (stabilizes inactive H1 rc conformation)
  10. When is Cmax (max plasma concentration) reached with H1-antihistamines?
    within 2-3 hours
  11. How are H1-antihistamines metabolized?
    hepatically CYP450
  12. ________ can inhibit arachidonic acid production.
    Steroids (glucocorticoids)
  13. Second gen antihistamine drug names
    • Loratadine
    • Desloratidine
    • Cetirizine
    • Levocetirizine
    • Fexofenadine
  14. Two characteristics of second generation H1 antihistamines.
    • Lipophilic
    • Neutral at physiologic pH
    • **Can cross BBB**
  15. First gen antihistamine drugs.
    • Diphenhydramine
    • Hydroxyzine
    • Chlorpheniramine
    • Promethazine
    • Doxepin
  16. Two characteristics of second generation H1 antihistamines.
    • Albumin binding
    • Ionized at physiologic pH
    • **Do not cross BBB**
  17. Antihistamines are effective in treating?
    • Rhinitis, conjunctivitis,
    • urticaria, pruritis
    • Motion sickness, chemotherapy-related n/v
    • Insomnia
  18. H1 antihistamines are not effective for ______ or ________.
    • systemic anaphylaxis 
    • asthma
  19. Give ______ for anaphylaxis.
    epi
  20. H1-antihistamines given for motion sickness & chemotherapy-related n/v.
    • Diphenhydramine
    • dimenhydrinate
    • meclizine
    • promethazine
  21. H1-antihistamines for insomnia.
    • diphenhydramine
    • doxylamine (indicated for sleep)
  22. AE of H1 antihistamines.
    • CNS toxicity
    • Sedative effects
    • Cardiac toxicity: QT interval prolongation,
    • Withdrawal of terfinadine and astemizole
    • Anticholinergic effects
  23. When sympathetic NS is stimulated, result in lungs is _____ by agonism of _____ receptors.
    • bronchodilation
    • B2
  24. When parasympathetic NS is stimulated, result in lungs is _____ by agonism of _____ receptors.
    • bronchoconstriction
    • muscarinic (ACh)
  25. Three classes of bronchodilators used to tx asthma.
    • β-agonists
    • Anticholinergics
    • Methylxanthines
  26. Epinephrine agonizes what receptors? What are the resulting actions of each?
    • B2 (resulting in airway sm muscle relaxation)
    • B1 (can cause tachy, palpitations, arrhythmias)
    • α (peripheral vasoconstriction)
  27. Is Epi used for asthma? Why or why not?
    NO! Not selective for B2
  28. Nonselective beta agonists that are not used for asthma.
    • Epinephrine (β2, β1, α)
    • Isoproterenol (β2, β1)
    • Metoproterenol (β2, β1)
  29. β-agonists used to tx asthma
    • Terbutaline, albuterol, pirbuterol, bitolterol - β2
    • Levalbuterol (isolated stereoisomer) - β2
  30. Long-acting β-agonists (LABA).
    • Salmeterol
    • Formoterol
  31. Why isn't atropine used for asthma?
    • Rapidly absorbed across respiratory epithelium 
    • Many AEs:
    •     tachycardia,
    •      nausea, dry mouth, GI upset
  32. Two anticholinergics used for asthma (and COPD). Which one is longer acting?
    • Ipratropium bromide (bid)
    • Tiotropium (longer acting), (q day)
  33. Which receptor is most important with anticholinergics? Why?
    • M3
    • Mediates smooth muscle bronchodilation and mucus gland secretion in the airway
  34. Two methylxanthines.
    • Theophylline
    • Aminophylline
  35. MOA of methylxanthines.
    • Inhibition of PDE
    • Airway smooth muscle - bronchodilation
    • Inflammatory cells - anti-inflammatory
  36. Methylxanthines antagonize which receptors? What effects result?
    • adenosine receptors
    • Increased ventilation during hypoxia
    • Increased endurance of diaphragmatic muscles
    • Decreased mast cell release
  37. How are Methylxanthines metabolized? Why is this important?
    • CYP450 1A2
    • Narrow TI so potential for DIs
  38. What induces CYP 1A2?
    Cigarette smoking
  39. AE of methylxanthines.
    • n/v/d, ha, irritability, insomnia;
    • seizures, brain damage,
    • hyperglycemia, hypokalemia, hypotension,
    • cardiac arrhythmias, death
  40. Methylxanthines work in conjunction with _________.
    B-agonists
  41. Anticholinergics are competitive antagonists at _______________ receptors
    muscarinic ACh
  42. ___________ increase the production of cAMP --> bronchodilation.
    B2 agonists
  43. __________ inhibits breakdown of cAMP by inhibiting PDE.
    Theophyline
  44. Anti-inflammatory Agents used to tx asthma & COPD.
    • Corticosteroids
    • Cromolyns
    • Leukotriene
    • Inhibitors
    • Anti-IgE Antibodies
  45. Corticosteroids upregulate ________ and _________.
    • B2 receptors
    • anti-inflammatory proteins
  46. Corticosteroids decrease ________.
    pro-inflammatory proteins
  47. Corticosteroids induce ________ in _______.
    apoptosis in inflammatory cells
  48. AE of corticosteroids.
    • osteopenia/osteoporosis 
    • delayed growth in children 
    • oropharyngeal candidiasis, hoarseness hyperglycemia
  49. Inhaled corticosteroids
    • Beclomethasone
    • Triamcinolone
    • Fluticasone (available in combination with salmeterol)
    • Budesonide (available in combination with formoterol)
    • Flunisolide
    • Mometasone
    • Ciclesonide
  50. Cromolyns stabilize _________ and inhibit the release of ________.
    • mast cells
    • inflammatory mediators
  51. Indication for cromolyns.
    prophylactic therapy for allergic response
  52. What is  nedocromil?
    A cromolyn
  53. Leukotriene Inhibitors.
    • Zileuton (beginning of pathway)
    • Montelukast (inhibits binding)
    • Zafirlukast (inhibits binding)
  54. What is Omalizumab?
    • Anti-IgE Antibody
    • (Humanized mouse monoclonal antibody)
  55. How does Omalizumab work?
    • Binds to IgE
    • prevents IgE from binding to mast cells (causing degranulation of mast cells)
  56. How is Omalizumab administered?
    subQ q 2-4 weeks
  57. Drugs for tx of Gout.
    • Probenecid
    • Allopurinol
    • Colchicine
    • Prednisone
    • NSAIDs
  58. How does Allopurinol work?
    inhibits Xanthine oxidase, preventing formation of Uric Acid
  59. How does Probenecid work?
    facilitates excretion of uric acid
  60. Indication for colchicine.
    • tx of acute gout attack
    • prophylactic tx of gout
  61. How does colchicine affect uric acid levels?
    It doesn't!
  62. AE of colchicine.
    • abdominal pain
    • n/v/d
  63. Indications for Probenecid.
    prophylactic for gout progression
  64. Decreases urate reabsorption in the proximal tubules
    Probenecid
  65. Why does probenecid lead to a variety of DIs?
    • Non-selective blockade of active renal transport of organic acids
    • Includes secretion and reabsorption
  66. Two specific drugs that interact with Probenecid.
    • PCN
    • Naproxen
  67. When should Probenecid NOT be initiated?
    during an acute attack
  68. Increase in frequency, duration, and severity of gout attacks may occur during first 6-12 months tx with this drug.
    Probenecid
  69. How can you minimize urate kidney stones with Probenecid?
    • Maintain high fluid intake (2 L/day minimum)
    • Alkalinize the urine (NaHCO3)
  70. How does allopurinol work?
    inhibits production of uric acid
  71. _________ is a prodrug converted by xanthine oxidase.
    Allopurinol
  72. What gout med can you give with Colchicine?
    Allopurinol
  73. Drugs to treat acute gout.
    • NSAIDS
    • Colchicine
    • Glucocorticoids
  74. Drugs to treat chronic gout.
    • Allopurinal
    • Probenecid
    • Sulfinpyrazone

Card Set Information

Author:
MeganM
ID:
315725
Filename:
Allergy & Immunity
Updated:
2016-02-20 12:14:42
Tags:
GU Pharm
Folders:
GU,Pharm
Description:
Exam 2
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