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What does half life mean on a prescription?
Length of time when 1/2 the dosage is still active in the body
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What does additive effect mean?
The effect of 2 chemicals acting simultaneously is the sum of the effects that they would have if it were acting alone
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What does tachyphylaxis mean?
Rapidly developing tolerance to a drug
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What are the 5 prescription requirements?
- PTs name
- Drug name
- Dose
- Frequency (times a day)
- Route of administration (po, pr etc)
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What are some normal routes of administration? (6)
- IV (intravenous)
- Inhaled (aerosol to lung)
- IM (intramuscular)
- Sub Q (subcataneous injection)
- Oral
- Topical (ointment)
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What are the 3 most common devices used to administer inhaled aerosols?
- MDI (metered dose inhaler)
- SVN (small volume nebulizer)
- DPI (dry powder inhaler)
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What are some advantages of inhaled aerosols? (4)
- Can use smaller doses as compared to the systemic route
- Onset of drug is rapid
- Delivery is to the specific organ needing Tx
- Less systemic side effects
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What is the pharmacokinetic phase?
The time course and disposition of a drug in the body based on its absorption, distribution, metabolism and elimination
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What is the pharmacodynamic phase?
Describes the mechanisms of drug action by which a drug molecule causes its effects in the body
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Which 2 receptors are in the lungs?
- Sympathetic adrenergic
- Parasympathetic cholinergic
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What neurotransmitter is in the sympathetic system? What does it do?
- Norepinephrine (epinephrine) AKA adrenaline
- Fight or flight
- Dilates pupils
- Dilates bronchioles
- Increased HR
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What neurotransmitter is in the parasympathetic system? What does it do?
- Acetylcholine
- Constricts pupils
- Constricts bronchioles
- Decreased HR
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What are antagonists?
block neuroreceptors
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What are agonist?
stimulates receptors
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What are the 3 receptor preferences and define each
- Alpha - located in peripheral blood vessels; causes vasoconstriction and vasopressor effect
- Beta 1 - located in the heart; causes increased HR and heart contractility
- Beta 2 - located in bronchial smooth muscles; stimulates mucocilliary action
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What is an adrenergic drug?
Drug that stimulates a receptor responding to norepinephrine or epinephrine
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What is an antiadrenergic drug?
Drug that blocks a receptor for epinephrine or norepinephrine
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What is a cholinergic drug?
Drug that stimulates a receptor for acetylcholine
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What is a anticholinergic drug?
Drug that blocks a receptor for acetylcholine
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What is a muscarinic drug?
Drug that stimulates acetylcholine receptors specifically at parasympathetic nerve-ending sites
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What are the 3 Adrenergic bronchodilators?
- Short acting agents -For relief of acute reversible airflow obstruction. Albuterol
- Long acting agents - For maintenance bronchodilation in PTs with obstructive lung disease. Salmeterol
- Racemic epinephrine - Reduces the airway swelling after extubation or with acute upper airway inflammation from croup. Micronefrin
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What are some adverse effects of andrenergic bronchodilators?
- Isoproterenol commonly caused tachycardia, palpitations and nervouseness
- Newer B2 selective agents are safe with tremor as the primary side effect
- Tolerance to the drug may occur
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What are the 2 anticholinergic bronchodilators?
Ipratropium bromide and Tiotropium bromide
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What is the mode of action for anticholinergic bronchodilators?
These agents act as competitive antagonsits for acetylcholine on airway smooth muscle
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What are the adverse effects for anticholinergic bronchodilators?
Ipatropium and tiotropium bormide have few systemic side effects since they are both fully ionized and not absorbed
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What are the 3 mucoactive contorlling agents?
- Acetylcysteine 10%
- Acetylcysteine 20%
- Dornase alfa
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What is Acetylcysteine or mucomyst used for PTs with?
bronchitis
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What is dornase alfa or pulmozyme used for PTs with?
Cystic fibrosis
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What is a common side effect with Acetylcysteine or mucomyst?
Bronchospasm so give albuterol first
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What is the mode of action for Acetylcysteine or mucosil?
- Breaks down disulfide groups, smells like sulphur
- Given to reduce accumulation of airway mucus
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What is the mode of action for dornase alfa or pulmozyne?
breaks down DNA
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What kind of PTs should you NOT use mucoactive agents on?
Neuromuscular PTs. they do not have the Vt cough, they dont have a problem with mucus
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What are the 3 different inhaled corticosteroids?
- Fluticasone propionate - Flovent
- Budesonide - Pulmicort turbuhaler
- Fluticasone propionate/salmeterol - Advair
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What is an inhaled corticosteroid?
Maintenance drugs, antiinflamatory
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What is the mode of action for corticosteroids?
- Lipid soluble drugs that act on interacellular receptors
- Full antiinflammatory effects require hours to days
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Why must PTs rinse their mouth out after usuing steroidal drugs?
Thrush can develop
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What are the 3 Nonsteroidal antiasthma drugs?
- Comolyn - like agents (cromolyn, nedocromil sodium)
- Antileukotrines (zafirlukast, zileuton)
- Monoclonial antibodies or anti-IgE agents (omalizumab)
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What are the 4 antiinfective inhaled agents?
- Pentamidine isethionate - Nebupent
- Ribavirin - Virazole
- Tobramycin - TOBI
- Zanamivir - Relenza
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Which 2 antiinfective agents have antiviral modes of action?
- Ribavirin
- Inhaled Zanamivir
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Which 3 antiinfective agents have antibiotic modes of action?
- Tobramyacin
- Colistimethate sodium
- Amphotericin B
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Which antiinfective agent has an antiprotozol mode of action?
Pentamadine Isethionate
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What are the 2 most dangerous aerosolized medications?
- Pentamidine Isethionate
- Ribavirin
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What are the 2 inhaled pulmonary vasodilators and Tx's?
- Nitric Oxide (INOmax) - Tx of neonates <34 wks with hypoxic resp. failure and pulmonary hypertension
- Iloprost - Tx of pulmonary hypertension
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What are the 2 antidiabetic agents?
- Exubera - inhaled insulin used to control hyperglycemia in diabetics
- Xanthines - inhibits phosphodiesterase which maintains cyclic 3,5 amp used with asthmatics and COPD PTs
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What are the 2 different Xanthines?
- Theophylline
- Aminophylline
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