pharm pulmonary condensed

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pharm pulmonary condensed
2010-10-14 22:06:25
pharm pulmonary

pharm pulmonary condensed
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  1. Systemic Toxicity of po or iv corticosteroids for use less than 2 wks
    Possibly acute peptic ulcer, rarely acute pancreatitis.
  2. Systemic Toxicity of po or iv corticosteroids for use more than 2 wks
    Adrenal suppression. Iatrogenic Cushing’s Syndrome. Face: round, puffy “moon” face. fat redistribution to trunk and back of neck; increased hair growth on face and body; acne; insomnia; increased appetite; muscle wasting; thinning of skin; hyperglycemia; osteoporosis; diabetes; aseptic necrosis of hip; impaired wound healing
  3. short acting glucocorticords
    hydrocortisone (cortisol), cortisone, prednisone, prednisolone, methylprednisolone
  4. corticosteroids that are oral only
    fludcortisone (mineralcorticoid), cortisone and prednisone are short acting
  5. corticosteroids that can be injected
    hydrocortisone, prednisolone, and methylprednisolone are short acting. triamcinolone is intermediate acting. betamethasone and dexamethasone are long acting
  6. intermediate acting corticosteroids
  7. long acting corticosteroids
    betamethasone and dexamethasone
  8. toxicity of inhaled corticosteroids
    hoarsness and oropharyngeal candidiasis. Very long-term use may cause cataracts and osteoporosis
  9. inhaled corticosteroids
    Beclomethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone
  10. topical corticosteroids
    hydrocortisone (short acting), as well as intermediate and long acting corticosteroids (triamcinolone, betamethasone and dexamethasone)
  11. not absorbed. Stabilize Mast Cells against antigen IgE-sensitized release of Histamine
    Cromolyn sodium & Nedocromil
  12. H1 blocker, anticholinergic
    dimenhydrinate (dramamine) and diphenhydramine (benadryl)
  13. H1 blocker, anticholinergic, alpha-1 block
  14. toxicity of promethazine
    drowsiness, strong sedation, orthastatic hypotension, blurred vision, urinary retention
  15. H1 block, anticholinergic, blocks 5-HT2
  16. usefulness of cyproheptadine
    antiemetic, antimotion, allergy, dermitis, hay fever
  17. toxicity of cyproheptadine
    drowsiness, strong sedation, blurred vision, urinary retention
  18. competitive H1 blockers, no anticholinergic actions
    Fexofenadine (Allegra), Loratadine (Claritin), Citrizine (zyrtec)
  19. serotonin-improving indirect agonists
    Tricyclic Antidepressants (TCA), Imipramine NE, 5-HT, Amitriptyline NE, 5-HT
  20. Phenelzine
    irreversible, inhibits MAO-A, MAO-B. indirect serotonin agonist
  21. Tranylcypromine
    reversibly inhibits MAO-A, -B. indirect serotonin agonist.
  22. sumatriptan MOA
    Partial Agonist at 5-HT-1 receptors. Objective is to overcome vasodilation which causes throbbing pain. Migraine and cluster headaches.
  23. carcinoid tumor
    neoplasm of enterochromaffin cells releases serotonin
  24. symptoms of carcinoid tumor
    Flushing of the head and neck. Abdominal cramps and diarrhea are common. Asthmatic wheezing
  25. Alpha-1 antagonist (also blocks 5-HT2)
  26. DA-2 antagonist (also blocks H1, M3, 5-HT2, Alpha-1)
  27. used for nausea, vomiting or GI hyperactivity
    5-HT3 Antagonists
  28. 5-HT3 Antagonists
    Ondansetron, Palonosetron, Alosetron is toxic
  29. blocks 5-HT3 receptor, stops activation of vomiting center in medulla. Prevents nausea and vomiting during cancer chemotherapy
  30. new, potent 5-HT3 antigonist, can be used during nausea/vomiting to reverse the problem
  31. toxic 5-HT3 antigonist, can cause ischemic colitis, but was returned to market to treat severe diarrhea, irritable bowel syndrome in women. FDA warning is attached
  32. PGs from COX-1 pathway are...
    cellular protective. regulates angiogenesis and reduces acid & pepsin level in stomach (protective)
  33. PGs from COX-2 pathway are
  34. Acetaminophen action
    COX-2 selective blocker
  35. Thromboxane A2 (TXA2) actions
    vasoconstriction, bronchoconstriction
  36. actions of prostacyclin (PGI2)
    Vasodilator. Bronchodilator. Stabilizes platelets, disaggregates platelets
  37. Epoprostenol
    PGI2 agonist – Reversal of pulmonary hypertension
  38. actions of prostaglandin E1 (PGE1)
    Vasodilator. Bronchodilator. Cytoprotective in GI tract (decreases acid and pepsin). Regulates renal blood flow, probably is a local vascular autoregulator of flow. Contracts uterine smooth muscle, active in labor and delivery
  39. Dinoprostone
    PGE1 second trimester abortion
  40. actions of prostaglandin F2alpha
    Vasoconstrictor. Bronchoconstrictor. Pathogenic in asthma
  41. Latanoprost
    PGF2alpha agonist topical for glaucoma
  42. actions of Alprostadil
    PGE1 agonist. vasodilator in peripheral vascular disease. Maintains an open (Patent) Ductus Arteriosus
  43. GI protective drug
    Misoprostol (PGE1)
  44. COX2 inhibitors (tylenol) lead to...
    COX1 pathway activation ---> platelet aggregation via more thromboxane being produced
  45. blocks lipoxygenase, inhibits leukotriene synthesis
  46. a leukotriene receptor antagonist. Toxicity is Churg Strauss Syndrome, systemic eosinophilic vasculitis when steroid dose is decreased
  47. leukotriene receptor antagonist. Side effects are GI distress, bleeding and hypersensitivity
    Montelukast (Singulair)
  48. Epi actions
    B1, B2, alpha1
  49. isoproterenol
    B1, B2. used in EM
  50. mast cell stabilizers
    cromolyn sodium and nedocromil
  51. ipratropium
  52. IgE antibody
  53. Low dose, non-prescription inhaler. Emergency bronchodilation, sc, im. Acts in 15 min, lasts 60-90 min, sold OTC as Primatene Mist and Bronkaid inhalers, a “Rescue” medication
  54. Orally available, 4-6 hrs, like EPI
  55. Inhaled for onset in 1-5 minutes, Duration of action is 2-6 hr
    Rapidly acting, used as “Rescue” medications, can be used approx. 15 min before exercise
    Metaproterenol, Albuterol, Terbutaline
  56. Both are inhaled for prophylactic decrease of histamine release. Short and long – term.
    Effective when administered before exercise, allergens, cold air, etc
    Less than 1% is absorbed into systemic circulation à very safe, absence of side effects
    Very high Therapeutic Index (200-500)
    cromolyn sodium and nedocromil. stabilize mast cells
  57. iv, is used in high dose in emergency relief of severe acute asthma
  58. Less potent than Beta-2 Agonists, but are often used in combination.
    po 6-12 hrs, iv during acute episodes, sustained release preps for overnight coverage
    Therapeutic is 10-15 mg/L blood. Toxicity is significant at 20 mg/L or higher, fatality at 25 mg/L. TI=1.3
    aminophylline and theophylline
  59. Ipratropium has low or high TI?
    high. safe, not much absorbed
  60. LKT4 Receptor Antagonists
    • Zafirlukast: po 12 hr
    • Montelukast: po 24 hr
  61. Alternative to CS or Cromolyn
    LKT4 receptor antagonist and 5-lipooxygenase blocker
  62. 5-lipooxygenase blocker
    Zileuton. po 6 hr