Pharmacology Exam 3, from review

What drugs are Leukotriene Receptor antagonists, what do they do?

Zafirlukast ( Accolate) & Montelukast ( Singulair)

• They block the CysLT receptor

What drugs are Leukotriene Synthesis Inhibitors, what do they do?

Zileuton ( zyflo)

• They stop leukotriene production at the 5- Lipoxygenase (5- Lo) enzyme

What are leukotrienes?

Natural chemicals in the body produced by mast cells that cause bronchoconstriction, airway edema, mucus secretion, and airway obstructions

What kind of medication of antileukotrienes?

Controller/ Prophylactic drugs, NOT rescuers

What does surfactant do?

It lowers the surface tension inside of the alveoli, this keeps the alveoli

What cells make surfactant?

Type II alveolar cells and is STORED in the lamellar bodies

Can surfactant be given to new born babies?

Yes

How soon after can Prophylactic ( prevention) surfactant be given to premature babies?

• 15 minutes after birth

• Beractant ( Survanta)

When should rescue surfactant be given to newborns?

8 hours or sooner after birth

• Beractant ( survanta)

What does Prophylactically mean?

A preventative drug that is meant to control and prevent a disease

What does rescue mean?

Fast acting drug meant to treat flare ups and is taken as needed

What is an exogenous surfactant?

a surfactant that we will GIVE to the patient to lower the alveoli surface tension

Exogenous corticosteroid agents can suppress what?

The HPA axis

• Hypothalamic pituitary adrenal axis

True or False?

Aerosolized steroids are used to control asthma and rhinitis.

True

An initial allergic response is initiated by an interaction between

1. An allergen , antigen

2. IgE antibodies on mast cells

What chemical reaction are you having during an asthma attack?

A biochemical cascade, allergen- IgE- histamines & leukotrienes- mucus, airway constriction, inflammation

True or false

Does giving steroids effect the patient’s vital signs?

No, the vital signs aren’t normally effected

What is the first line therapy for moderate to severe asthma?

A bronchodilator, not a steroid

Multiple Multiple

Which of the following are true regarding an acute asthma attack?

• persistent inflammation

• IgE mediated allergic response

• early phase is 15 minutes, late is 6-8 hours

• bronchoconstriction, edema, mucus production

• corticosteroids help by reducing airway inflammation

which of the following are a natural surfactant?

• Beractant ( Survanata)

• Calfactant ( Infasurf)

• Poractant alfa (Curosurf)

• Beractant ( Survanata)

• Calfactant ( Infasurf)

• Poractant alfa (Curosurf)

Lung mechanics show sustained improvement of only one or two does of an exogenous surfactant because?

Because pulmonary surfactant is recycled and continues to function after the intial administration.

Surfactant is produced by which type of alveolar cell?

Type II alveolar cell, stored in the lamellar bodies

Which of the following surfactants contain a protein found in natural surroundings?

• Beractant ( Survanata) - COW

• Calfactant ( Infasurf) - COW

• Poractant alfa (Curosurf) - PIG

What is the Major therapeutic effect of corticosteroids?

Controller medications that reduce airway inflammation.

Which of the following are side effects of topical application of aerosolized steroids?

• Oral candidiasis ( thrush )

• Dysphonia ( voice changer)

• Pharyngeal irritation/ sore throat

What is the rationale for administering steroids on an alternate day schedule?

To reduce the suppression of the HPA ( Hypothalamic pituitary adrenal axis, give the adrenals a break

What are the hazards to systemically administered steroids include…

• HPA/ adrenal suppression

• Hypothalamus suppression

• Cortisol blocking

• hyper tension

• hyperglycemia

• edema/ fluid retention

• osteoporosis

• cushingoid effects

What helps minimize local side effects?

• inhaled cortico steroids

• smaller doses

• reduce basal airway inflammation

• Increase B2 adrenergic receptor transmission

• help protect against B2 receptor tolerance

Surfactant accomplishes which of the following?

• Reduces surface tension in the alveoli

• keeps alveoli open

• makes alveoli easier to inflate and open

Which of the following are indications for exogenous surfactant therapy?

• Treatment of new born respiratory distress syndrome, RDS

• Prevention (prophylaxis) or RDS in premature/ high risk infants

• Rescue treatment when a baby already has RDS

How is natural surfactant obtained?

Bovine → Cows : Survanta, Infasurf

Porcine → Pigs : Curosurf

When should exogenous glucocorticoids be taken?

8 AM , alternate day schedule as morning is when cortisol levels are highest because of the circadian rhythm

Lack of pulmonary surfactant in the respiratory distress of a newborn typically results in?

• Atelectasis

• Alveolar collapse

• Decreased surface tension

The term used to describe surfactant produced outside of the patient’s body is?

EXOgenous surfactant

What is surfactant primarily composed of?

Phospholipids

What is the major stimulus for surfactant into the alveolus?

Lung inflation

• lungs inflate → type II cells → surfactant releases → surface tension lowers

Multiple multiple

Which of the following are currently used methods for delivering surfactant?

• Instillation through a 5-f catheter through a ETT

• Endotracheal tube

What newborn weight, symptoms, indications and dose would you give for Beractant ( Survanta)

• below 1,250 Grams

• Premature infant at risk of RDS, rescue if RDS is happening

• 4 mL/Kg

What newborn weight, symptoms, indications and dose would you give for Calfactant ( Infasurf) ?

• younger than 29 weeks gestational age for prophylaxis

• High risk for RDS

• Rescue treatment if younger than 72 hours

• 3 mL/Kg

What newborn weight, symptoms, indications and dose would you give for Poractant alfa (Curosurf) ?

• No specific weight, Premature infant

• Rescue treatment for premature infant with RDS

• 2.5 mL/Kg initially

Corticosteroids normally produced by the body are known as?

ENDOgenous corticosteroids

The major cells responsible for an inflammatory response in asthma are what?

• Mast cells

• IgE, eosinophils

Corticosteroids are used with asthmatics for patients with COPD to achieve which effect?

Reduce airway inflammation

Use of oral steroids for long periods of time can cause what?

• HPA suppression

• Peptic ulcers

• slowed growth in children

Corticosteroids are available for use in the United States in which of the following dosage situations?

oral pills, topical creams, liquids, ointments, inhaled aerosols, nasal sprays, injectables

Why would the white blood cell count be effected from corticosteroids?

• Demmargination: depletion of neutrophils reduces their amount in inflammatory sites

• general overall increase in white cell count

Multiple Multiple

Which of the following are the result of an interaction between T cells and antigens?

T cell activation that triggers the adaptive immune response

• T cell interacts with the antigen

• Allergic immune response is initiated

• Mast cells/ eosinophils are attracted

• Inflammatory mediators are released

• Vascular leakage occurs

• Air way edema + mucosal swelling + mucus + broncho + constriction

What does vascular leakage mean?

Blood vessels become more permeable causing fluid to leak resulting in airway tissue swelling

Mediators of asthma cause which of the following to occur in the airway?

• Vascular leakage

• bronchoconstriction

• mucous secretions

• mucous swelling

Cromolyn sodium is useful in the management of asthma because? What properties, what does it do, what’s its mechanism of action?

It’s Mast Cell stabilizing properties

• cromolyn prevents mast cell degranulation, therefore preventing the inflammatory mediator response

• Prophylactic drug, prevents asthma

In the airway , leukotrienes exert what actions?

• inhibit ciliary beating

• broncho constriction

• airway edema

• mucus secretion

• recruit inflammatory cells

Multiple multiple

Advantages of antileukotriene therapy include..

• Prophylactic controller/ preventer of persistent asthma

• Alternative to inhaled corticosteroids ICS

• combined with inhaled corticosteroids to reduce the dose

• Given once daily to making administering easier

• Aspirin sensitive asthma

• exercise induced asthma

• Montelukast can be used in children

What new category of drugs may reduce inhaled corticosteroid use?

• Antileukotriene agents

Which biologic is approved only for patients 18 and older?

Clinqair ( Reslizumab)

Which biologic is approved for Atopic dermatitis/ eczema?

Dupilumad ( Dupixent)

True or False

Biologics are used when a patient is in Status Asthamticus.

False, these medications are controllers NOT rescuse agents

What type of asthma is associated with allergic reactions?

Extrinsic asthma

Which of the following are Antileukotriene agents?

• Zileuton → Zyflo → blocks 5-LO

• Zafirlukast → Accolate → blocks LT receptor

• Montelukast → Singulair → blocks CysLT1 receptor

Most commonly recorded side effect of Cromolyn sodium?

Cough

Type of synthetic surfactant

Surfaxin (Lucinactant)

Exosurf ( Colfosceril palmiate)