Bronchodilators and Methylxanthines Overview
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Questions and Answers

What is the primary action of Beta-2 adrenergic agonists?

  • Activate Beta-2 receptors in the lungs (correct)
  • Cause bronchoconstriction
  • Increase mucus production in airways
  • Suppress the immune system

What is a common side effect of using Beta-2 adrenergic agonists?

  • Dysrhythmias (correct)
  • Hypoglycemia
  • Hypotension
  • Cough

Which type of bronchodilator is recommended for long-term control in asthma?

  • Short-acting beta agonists (SABAs)
  • Long-acting beta agonists (LABAs) (correct)
  • Intermediate-acting agonists
  • Anticholinergics

How should albuterol be administered for acute asthma attacks?

<p>As needed (PRN) (D)</p> Signup and view all the answers

What is the scheduling recommendation for the use of LABAs for patients with stable COPD?

<p>Every 12 hours (C)</p> Signup and view all the answers

What is a significant risk when using LABAs alone for asthma management?

<p>Increased risk of death (B)</p> Signup and view all the answers

Which of the following medications is a short-acting beta agonist (SABA)?

<p>Levalbuterol (D)</p> Signup and view all the answers

For optimal medication delivery with an inhaler, what practice is recommended?

<p>Breathe out fully before inhaling (C)</p> Signup and view all the answers

Which of the following is a potential systemic side effect of bronchodilators?

<p>Tremor (D)</p> Signup and view all the answers

When are inhaled bronchodilators typically prescribed?

<p>To manage acute asthma attacks or for routine control (C)</p> Signup and view all the answers

What are the common side effects of Acarbose?

<p>Flatulence and abdominal distention. (A)</p> Signup and view all the answers

Which medication primarily minimizes insulin resistance?

<p>Pioglitazone. (B)</p> Signup and view all the answers

What is a significant concern when taking Dipeptidyl Peptidase-4 Inhibitors?

<p>Pancreatitis. (C)</p> Signup and view all the answers

What is the key mechanism of action of statins like Atorvastatin?

<p>Inhibiting HMG-CoA reductase. (D)</p> Signup and view all the answers

Which class of drugs may interact with diuretics and cause postural hypotension?

<p>SGLT-2 Inhibitors. (C)</p> Signup and view all the answers

What action do Incretin mimetics such as Dulaglutide have on gastric emptying?

<p>They slow gastric emptying. (B)</p> Signup and view all the answers

Which of the following is NOT an adverse effect associated with Gemfibrozil?

<p>Increased LDL cholesterol. (B)</p> Signup and view all the answers

Levothyroxine should be taken at what time for optimal absorption?

<p>On an empty stomach. (B)</p> Signup and view all the answers

What is the primary route of excretion for Thiazolidinediones like Pioglitazone?

<p>Fecal excretion. (D)</p> Signup and view all the answers

Which medication would most likely cause hypoglycemia when used with other agents?

<p>Sulfonylureas. (B)</p> Signup and view all the answers

The primary action of bile acid sequestrants is to:

<p>Bind bile acids for excretion. (B)</p> Signup and view all the answers

What should patients on Acarbose monitor due to possible liver dysfunction?

<p>Liver function tests (LFTs). (C)</p> Signup and view all the answers

Which of the following is a characteristic of non-insulin injectable glucagon-like peptide (GLP-1) receptor agonists?

<p>Reduces gastric emptying time. (C)</p> Signup and view all the answers

What is the primary function of Theophylline in asthma management?

<p>It relaxes bronchial smooth muscle. (B)</p> Signup and view all the answers

What is a notable side effect associated with Theophylline?

<p>Insomnia (A)</p> Signup and view all the answers

Which medication is most commonly used to prevent exercise-induced bronchospasm?

<p>Montelukast (C)</p> Signup and view all the answers

What is a contraindication for using pseudoephedrine?

<p>Severe hypertension (D)</p> Signup and view all the answers

What side effect is associated with antihistamines such as Diphenhydramine?

<p>Constipation (A)</p> Signup and view all the answers

Which of the following medications must be taken on an empty stomach for proper absorption?

<p>Alendronate (B)</p> Signup and view all the answers

Which medication is primarily used as a mucolytic agent?

<p>Acetylcysteine (B)</p> Signup and view all the answers

What is a common effect of using Cromolyn in asthma treatment?

<p>Reduction of inflammatory mediators (B)</p> Signup and view all the answers

What is the main action of Ipratropium in respiratory treatment?

<p>Blocks muscarinic receptors (C)</p> Signup and view all the answers

Which of the following is a potential adverse effect of Dextromethorphan?

<p>Drowsiness and dizziness (A)</p> Signup and view all the answers

Which class of medication is known to cause dry mouth as a side effect?

<p>Anticholinergics (B)</p> Signup and view all the answers

Which of the following is the safest option among asthma medications?

<p>Cromolyn (B)</p> Signup and view all the answers

Raloxifene is an example of which type of medication?

<p>Selective Estrogen Receptor Modulator (B)</p> Signup and view all the answers

What is a potential effect of levothyroxine on insulin requirements?

<p>It can increase insulin requirements. (A)</p> Signup and view all the answers

Why should methimazole be avoided during the first trimester of pregnancy?

<p>It may induce hypothyroidism. (B)</p> Signup and view all the answers

What is the primary function of methimazole?

<p>It inhibits thyroid hormone synthesis. (B)</p> Signup and view all the answers

What should be monitored in infants and children taking levothyroxine?

<p>Height and development (B)</p> Signup and view all the answers

What serious side effect should patients taking methimazole be aware of?

<p>Agranulocytosis (A)</p> Signup and view all the answers

How long can it take for methimazole to achieve a euthyroid state?

<p>3-12 weeks (D)</p> Signup and view all the answers

What is a key consideration for pediatric patients on levothyroxine?

<p>Height and development should be regularly monitored. (C)</p> Signup and view all the answers

What is a unique property of propylthiouracil (PTU) compared to methimazole?

<p>It suppresses conversion of T4-T3. (C)</p> Signup and view all the answers

How often should blood work be conducted after changing levothyroxine formulation?

<p>After 6 weeks (A)</p> Signup and view all the answers

Why is propylthiouracil generally not preferred over methimazole?

<p>It has a risk of liver injury. (D)</p> Signup and view all the answers

In what condition is methimazole NOT typically used?

<p>Thyroid storm (D)</p> Signup and view all the answers

What precaution should be taken regarding different brands of levothyroxine?

<p>They may not work the same. (C)</p> Signup and view all the answers

Which statement about levothyroxine administration is accurate?

<p>It should be taken on an empty stomach. (B)</p> Signup and view all the answers

What is the main reason for frequent follow-up and lab monitoring in patients on levothyroxine?

<p>To check for euthyroid status. (D)</p> Signup and view all the answers

Flashcards

What are Beta-2 Adrenergic Agonists?

Beta-2 Adrenergic Agonists are medications that open up the airways in the lungs by activating Beta-2 receptors, making it easier to breathe. They are commonly used to treat asthma and COPD.

What are SABAs?

SABAs are short-acting Beta-2 Adrenergic Agonists. They are used to quickly relieve asthma symptoms and prevent acute attacks.

What are LABAs?

LABAs are long-acting Beta-2 Adrenergic Agonists. They are taken on a regular schedule to prevent asthma symptoms and control COPD.

What is Albuterol?

Albuterol (ProAir) is a common SABA used to quickly relieve asthma symptoms.

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What is Levalbuterol?

Levalbuterol (Xopenex) is another common SABA used to quickly relieve asthma symptoms.

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What is Salmeterol?

Salmeterol (Serevent Diskus) is a common LABA used to prevent asthma symptoms. It is often used in combination with inhaled steroids to control asthma.

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What is Terbutaline?

Terbutaline is a LABA that can be taken orally or inhaled. It is used for both asthma and COPD.

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How should MDIs be used?

When using MDIs (Metered-Dose Inhalers), it's crucial to take 2 breaths with a 1-minute pause between each breath. This improves medication delivery.

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Why should LABAs not be used alone for asthma?

Using LABAs alone for asthma is not recommended as it increases the risk of death. Always use a LABA in combination with an inhaled corticosteroid for effective asthma management.

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What are some side effects of Beta-2 Adrenergic Agonists?

Beta-2 Adrenergic Agonists can cause side effects like tachycardia (rapid heart rate), dysrhythmias (irregular heartbeat), angina (chest pain), tremor (shaking), and seizures.

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Theophylline

A bronchodilator that works by relaxing bronchial smooth muscle, improving airflow in the lungs.

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Theophylline Toxicity

A side effect of Theophylline, often associated with higher doses.

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Anticholinergics (Ipratropium & Tiotropium)

A type of bronchodilator that blocks muscarinic receptors in the bronchi, reducing bronchoconstriction.

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Montelukast (Singulair)

This medication is a leukotriene receptor blocker that blocks the activation of leukotrienes, preventing inflammation.

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Cromolyn

This medication reduces inflammation by stabilizing mast cell membranes, inhibiting the release of histamine and other inflammatory mediators.

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First Generation Antihistimes (Diphenhydramine & Hydroxyzine)

This medication blocks histamine receptors and some also block muscarinic receptors.

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Second Generation Antihistamines (Fexofenadine, Loratadine, and Cetirizine)

This medication blocks histamine receptors, but has low affinity for CNS H1 receptors, meaning it does not cross the blood-brain barrier significantly.

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Pseudoephedrine (Sudafed)

A sympathomimetic medication that activates alpha-1 receptors in the nose, causing vasoconstriction that relieves congestion.

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Dextromethorphan

This medication suppresses cough reflex by acting on the central nervous system.

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Benzonatate (Tessalon)

This medication decreases sensitivity of respiratory stretch receptors, reducing the cough reflex.

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Expectorants (Guaifenesin)

These medications increase the flow of respiratory secretions to allow for easier expulsion.

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Mucolytics (Hypertonic Saline and Acetylcysteine)

These medications help thin mucus, making it easier to cough up.

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Alendronate (Fosamax)

This medication binds to bone and inhibits osteoclast activity, leading to increased bone density.

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Calcitonin-Salmon

This medication inhibits bone reabsorption and increases renal calcium excretion, helping to regulate calcium levels, especially when bone loss is excessive.

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Raloxifene

A selective estrogen receptor modulator that has estrogenic effects on bone, reducing bone resorption and increasing bone density.

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What are sulfonylureas?

Sulfonylureas are medications that stimulate insulin release from the pancreas, helping lower blood sugar levels. They are generally used in conjunction with other diabetes medications.

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How are sulfonylureas metabolized?

Sulfonylureas are primarily metabolized by the liver, breaking them down for excretion.

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How are sulfonylureas excreted?

Sulfonylureas are primarily excreted from the body through bile in the digestive system.

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What is a potential side effect of sulfonylureas?

Sulfonylureas can cause a drop in blood sugar levels, known as hypoglycemia. Patients using these drugs need to be aware of this risk and monitor their blood sugar levels closely.

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When are sulfonylureas usually taken?

Sulfonylureas are typically taken with meals, helping to manage blood sugar levels after eating.

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How does Gemfibrozil interact with sulfonylureas?

Gemfibrozil, a medication used for high cholesterol, can inhibit the metabolism of sulfonylureas, leading to potentially higher levels in the body.

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What do thiazolidinediones do?

Thiazolidinediones (glitazones) improve blood sugar control by making cells more responsive to insulin, effectively lowering blood sugar levels.

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How are thiazolidinediones metabolized?

Thiazolidinediones are primarily metabolized by the liver.

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How are thiazolidinediones excreted?

Thiazolidinediones are excreted primarily through stool (feces), with a smaller amount excreted through urine.

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When are thiazolidinediones taken?

Thiazolidinediones can be taken with or without meals, offering more flexibility to patients.

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What are some potential side effects of thiazolidinediones?

Thiazolidinediones can cause side effects like fluid retention, potential bladder cancer risks, and unintentional pregnancies.

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How do alpha-glucosidase inhibitors work?

Alpha-glucosidase inhibitors work by slowing down the breakdown of complex carbohydrates into simple sugars, delaying their absorption and preventing spikes in blood sugar levels.

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How are alpha-glucosidase inhibitors absorbed and metabolized?

Alpha-glucosidase inhibitors are minimally absorbed in the gut, working directly in the digestive system. They are broken down by bacteria and digestive enzymes.

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What are some common side effects of alpha-glucosidase inhibitors?

Alpha-glucosidase inhibitors can cause digestive side effects such as gas, cramping, bloating, and diarrhea.

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Can alpha-glucosidase inhibitors cause hypoglycemia?

Alpha-glucosidase inhibitors, while not causing hypoglycemia on their own, can increase the risk when used alongside other diabetes medications that can lower blood sugar levels.

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What is Levothyroxine?

Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. It replaces the hormone that the thyroid gland is not producing.

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How does Levothyroxine interact with other medications?

Levothyroxine can increase the requirements of insulin and digoxin.

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How does pregnancy impact Levothyroxine dosage?

The dose of Levothyroxine needs to be increased during pregnancy to meet the increased demands of the developing baby.

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How is Levothyroxine used in children?

Levothyroxine is used to treat hypothyroidism in children. It should be continued until the child is three years old.

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Why is Levothyroxine stopped for four weeks in children?

After stopping Levothyroxine for four weeks in a child, it can be determined if hypothyroidism is permanent or temporary.

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What is monitored in infants and children on Levothyroxine?

It's important to monitor the height and development of infants and children taking Levothyroxine.

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When should Levothyroxine be taken?

Levothyroxine is best taken on an empty stomach to ensure proper absorption.

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What are the important follow-ups and monitoring for Levothyroxine?

Regular follow-ups and blood tests (especially TSH levels) are necessary to monitor the effectiveness of Levothyroxine treatment and adjust the dose as needed.

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What should be considered when changing Levothyroxine brands?

Different brands of Levothyroxine may not be equivalent in strength.

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What is Methimazole?

Methimazole is a first-line drug for hyperthyroidism. It works by inhibiting the synthesis of thyroid hormones.

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How does Methimazole work?

Methimazole does not destroy existing thyroid hormone stores. It prevents the production of new hormones.

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How long does Methimazole take to work?

It can take 3-12 weeks to achieve a euthyroid state (normal thyroid function) with Methimazole.

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Is Methimazole safe in pregnancy?

Methimazole is generally considered safer than PTU in the first trimester of pregnancy.

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How is Methimazole administered?

Methimazole is typically taken by mouth (PO).

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What are the possible side effects of Methimazole?

Methimazole can cause hypothyroidism, requiring a reduction in dose.

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What is the most serious side effect of Methimazole?

The most serious and dangerous toxicity associated with Methimazole is agranulocytosis.

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Study Notes

Bronchodilators

  • Bronchodilators activate beta-2 receptors in the lung, causing bronchodilation.
  • Adrenergic agonists exhibit selective but can have systemic effects like tachycardia, dysrhythmias, angina, tremors, and seizures.
  • SABAs (Short-acting beta agonists):
    • Albuterol (ProAir) and Levalbuterol (Xopenex) are inhaled and have a quick onset of action.
    • Used for preventing or treating acute asthma attacks.
    • Available as metered-dose inhalers (MDI), dry-powder inhalers (DPI), or nebulizers.
    • Usually 2 inhalations with a 1-minute wait.
    • Administer the first one before the next breath.
  • LABAs (Long-acting beta agonists):
    • Salmeterol (Serevent Diskus) and Terbutaline are inhaled or oral and used for long-term control.
    • Administered on a fixed schedule.

Methylxanthines

  • Theophylline relaxes bronchial smooth muscle, crucial in maintaining stable asthma, especially during nocturnal attacks.
  • Toxicity includes nausea, vomiting, diarrhea, restlessness, insomnia, dysrhythmias, and convulsions.
  • Avoid caffeine as it increases toxicity risks.

Anticholinergics

  • Ipratropium (Atrovent) and Tiotropium (Spiriva) block muscarinic receptors in the bronchi, reducing bronchoconstriction.
  • Available in both short and long-acting forms.
  • Potential for anticholinergic effects such as xerostomia (dry mouth).

Anti-Inflammatory Drugs

  • Montelukast (Singulair) blocks leukotriene receptor activation .

Cromolyn

  • Used to prevent exercise-induced bronchospasm (EIB).
  • Taken on a regular schedule to reduce mast cell inflammation, resulting in reduced histamine and other inflammatory mediators, eosinophils and other inflammatory cells.
  • Considered as a third-line therapy as it is less effective compared to glucocorticoids.

Antihistamines

  • Hydroxyzine (Vistaril) and Diphenhydramine (Benadryl, Unisom) block histamine receptors, reducing symptoms like flushing, edema, itching, and mucus production, and some block muscarinic receptors.
  • Lipid soluble, crosses the blood-brain barrier (BBB), and can cause CNS depression/drowsiness at therapeutic doses, and CNS excitation at toxic doses.
  • Use with caution with other anticholinergic drugs due to potential additive effects.

Sympathomimetics

  • Pseudoephedrine (Sudafed) activates alpha-1 receptors, causing vasoconstriction, which can relieve congestion, but rebound congestion may occur.
  • Long-term use or abuse can lead to the creation of methamphetamine.

Antitussives

  • Dextromethorphan suppresses the cough reflex in the central nervous system (CNS).
  • Benzonatate (Tessalon) decreases the sensitivity of respiratory stretch receptors, reducing cough.
  • Use as directed and swallow capsules whole to avoid complications like laryngospasm, bronchospasm, and circulatory collapse.

Expectorants and Mucolytics

  • Expectorants like Guaifenesin (Mucinex) increase the flow of respiratory secretions ,improving easier expulsion.
  • Mucolytics like Hypertonic saline and Acetylcysteine thin the mucus, aiding in easier removal.

Drugs Affecting Calcium and Bone Metabolism

  • Alendronate (Fosamax) binds to bone and inhibits osteoclasts (cells that break down bone).
  • Poorly absorbed within 2 hours of calcium intake.
  • Taken with 6-8 ounces of water on an empty stomach 30 minutes before other foods.
  • Irritating to the stomach lining, so remain upright for 30 minutes after taking.
  • Colesevelam (Welchol) reduces cholesterol absorption and increases cholesterol excretion.
  • Calcitonin (salmon) inhibits bone reabsorption and increases renal calcium excretion; useful in managing hyperparathyroidism, malignancy, and hypercalcemia.

Raloxifene

  • A selective estrogen receptor modulator (SERM) with both estrogenic and anti-estrogenic effects.
  • Regulates bone density, minimizing risks associated with clots and menopausal symptoms.

Teriparatide

  • A form of parathyroid hormone, used to stimulate osteoblast activity and increase bone formation.
  • Increases osteoblastic activity to improve bone density.

Drugs for Diabetes

  • Insulin Lispro (Humalog) and Aspart (NovoLog) are rapid-acting insulins.
  • Insulin Glargine (Lantus) and Detemir (Levemir) are long-acting insulins.
  • Used to regulate blood glucose levels.

Sulfonylureas

  • Glipizide (Glucotrol) and Glyburide (DiaBeta, Micronase) stimulate insulin release, particularly in type II diabetes.
  • Risk of hypoglycemia should be monitored.

Meglitinides

  • Nateglinide (Starlix) also promotes insulin release, but with a faster onset and shorter duration compared to sulfonylureas.

Thiazolidinediones (Glitazones)

  • Pioglitazone (Actos) decreases insulin resistance, crucial in regulating blood glucose.

Alpha-Glucosidase Inhibitors

  • Acarbose (Precose) delays the absorption of carbohydrates, which plays a critical role in managing blood sugar levels.

Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors

  • Dapagliflozin (Farxiga) blocks glucose reabsorption in the kidneys, allowing more glucose to be excreted in the urine.
  • Increases urinary glucose excretion can potentially help lower glucose levels with minimal risk of hypoglycemia.

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

  • Sitagliptin (Januvia) stimulates glucose-dependent insulin release to control blood sugar regulation.

Incretin Mimetics

  • Dulaglutide (Trulicity) is a glucagon-like peptide-1 (GLP-1) receptor agonist that activates GLP-1 receptors to increase insulin release and regulate blood sugar.
  • Improves glucose control in people with Type 2 diabetes.

Drugs Affecting Lipid Levels

  • Atorvastatin (Lipitor) decreases LDL cholesterol, while increasing HDL cholesterol.
  • Also promotes the formation of LDL receptors in the liver.
  • Take at night as most cholesterol production occurs at night.
  • Avoid during pregnancy due to potential for liver enzyme elevation.

Nicotinic Acid (Niacin)

  • Improves HDL levels and decreases triglyceride levels.

Bile Acid Sequestrants

  • Cholestyramine (Questran) binds to bile acids in the intestine, preventing their reabsorption and encouraging the liver to use cholesterol to produce more bile.

Fibric Acid Derivatives (Fibrates)

  • Gemfibrozil (Lopid) reduces triglycerides and raises HDL levels

Ezetimibe (Zetia)

  • Specifically inhibits cholesterol absorption in the gastrointestinal tract.

Drugs Affecting the Thyroid

  • Levothyroxine (Synthroid, Levoxyl) is a synthetic thyroid hormone used to replace or supplement low thyroid hormone levels

Methimazole (Tapazole)

  • First-line medication for hyperthyroidism; inhibits thyroid hormone synthesis.

Propylthiouracil (PTU)

  • Second-line medication for hyperthyroidism; also inhibits thyroid hormone synthesis, considered safer during the first trimester of pregnancy.

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FINAL PHARM EXAM PDF

Description

This quiz covers the mechanisms, types, and applications of bronchodilators, including short-acting and long-acting beta agonists, as well as the role of methylxanthines like theophylline in asthma management. Learn about their uses, side effects, and administration methods to enhance your understanding of respiratory medications.

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