lOMoAR cPSD| 65448581
NURS 615 – Exam 4 Study Guide Respiratory, GI, & Renal Pharmacology |
Actual study verified Solutions | A+ Graded | 2026 Updated | 100%
correct
CONTENT
WK 12: Respiratory System 1: Bronchodilators, Inhaled Corticosteroids, Leukotriene Modifiers
WK 13: Respiratory System 2: Allergy, Cough/Cold
WK 14: GI: Laxatives, Antidiarrheals, Antiemetics
WK 15: Renal: Diuretics
WEEK 12 – RESPIRATORY SYSTEM PART 1
Respiratory System 1: Bronchodilators, Inhaled Corticosteroids, Leukotriene Modifiers
BRONCHDILATORS: β2 Receptor Agonists, Inhaled Anticholinergics, Methylxanthines
*****β2 Receptor Agonists
Types: SABA, LABA, ULABA
• Short Acting Beta Agonists (SABA) – 4-6 hrs
Use: Reversible bronchoconstriction d/t asthma, reactive airway disease, COPD*
– Albuterol (selective)– Proair, Ventolin, Proventil
– Levalbuterol - Xopenex
– Pirbuterol - Maxair
– Terbutaline (selective) – Brethine, Brethaire (also stop uterine contractions) –
Metaproterenol (selective)
• Long-Acting Beta Agonists (LABA) – 12 hrs (listed weakest to strongest)
Use: bronchospasm d/t asthma, COPD , allergens, exercise, histamine, methacholine*
– Salmeterol - Serevent
– Formoterol - Foradil
– Arformoterol – Brovana
• Ultra Long-Acting Beta Agonists (ULABA) – 24 hrs
– Indacaterol – Arcapta Neohaler
– Olodaterol – Striverdi Respimat
– Vilanterol – Breo Ellipta (in combination w/ ICS only)
MOA*: bind to β2 smooth muscle cells in the airway
– Stimulates smooth muscle cell relaxation causing bronchodilation via cyclic AMP pathway
– Inhibits release of hypersensitivity mediators – especially from mast cells
All have some β1 receptor activity which causes many of the side effects
Pharmacokinetics: Absorbed from the bronchi /// Metabolized in the liver /// Excreted in the urine
AE: tachycardia, tremors * (Albuterol: because the drug acts on β2 rcpts in heart & skel musc)
, lOMoAR cPSD| 65448581
Precautions: monitor when used in pts w/ arrythmias, CV, hyperthyroidism
*****Inhaled Anticholinergics
Types: SAMA, LAMA
• Short Acting Muscarinic Antagonists (SAMA) – 4 – 6 hrs – Ipratropium bromide –
Atrovent
– Ipratropium bromide/albuterol – Combivent
• Long-Acting Muscarinic Antagonists (LAMA)
– Tiotroprium bromide – Spiriva Handihaler and Spiriva Respimat – 24 hrs
– Aclidinium bromide – Tudorza Pressair – 12 hrs
– Umeclidinium bromide – Incruse Ellipta – 24 hrs
– Revefenacin – Yupelri – 24 hrs + - first long acting nebulized LAMA
– Glycopyrrolates
• MOA : Preferentially bind to M3 receptors which are the 1° muscarinic receptor
involving bronchoconstriction in COPD
• Glycopyrronium bromide
• Seebri Neohaler – 12 hrs
• Breztri (in combination w/ LABA and ICS)
MOA*: Block muscarinic cholinergic receptors by antagonizing acetylcholine
– Decreases formation of cyclic GMP → decreased contractility of smooth muscle of the lungs
Pharmacokinetics: Poorly absorbed from lungs and GI tract /// 90% swallowed and excreted in feces ///
10% is metabolized by hydrolysis
AE: dry mouth, cough, HA (headache)
Precautions: Avoid in pts w/ urinary retention or BPH and closed-angle glaucoma
Should not be used for acute bronchospasm unless in combination w/ albuterol
*****Methylxanthines: Theophylline
MOA: Inhibit phosphodiesterases that lead to an increase in cyclic AMP
– Bronchial smooth muscle relaxation
– Pulmonary vessel relaxation
Pharmacokinetics: Well, fully absorbed orally /// little first pass effect /// Metabolized in liver AE:
headache, irritability, gastric irritation, n/v
Precautions: Multiple drug interactions /// Monitoring w/ serum drug levels to prevent toxicity
INHALED CORTICOSTEROIDS
Types: Highest to Lowest Potency (multiple forms and systems)
– Fluticasone furoate DPI – Arnuity Ellipta
– Mometasone furoate DPI – Asmanex Twisthaler
– Fluticasone propionate DPI – ArmonAir Digihaler and generic diskus formulation
– Beclomethasone dipropionate – QVAR RediHaler
– Ciclesonide MDI – Alvesco Inhalation Aerosol
– Budesonide DPI – Pulmicort Flexhaler
MOA*: Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
– Late-phase allergic reaction Pharmacokinetics:
– Rapidly absorbed from lungs and GI tract
, lOMoAR cPSD| 65448581
• Less than 1/4 of dose is deposited in the lungs
• Swallowed portion undergoes extensive first pass metabolism
• Excreted in urine and feces
AE*: xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis
Precautions*: C/I in status asthmaticus /// HPA suppression /// High-dose in kids may inhibit growth
(Hypothalamic-pituitary-adrenal axis suppression = adrenal fatigue)
LEUKOTRIENE MODIFIERS: Leukotriene Receptor Agonists, 5-Lipoxygenase Pathway Inhibs
Patho: Leukotrienes are inflammatory mediators produced by eosinophils and mast cells that can
lead to bronchospasm, airway hyperresponsiveness and vascular leakage
Types:
*****Leukotriene Receptor Agonists: Montelukast (Singulair)
MOA: Inhibits cysteinyl leukotriene receptor → blocks action of LTD4 – a component of SRS-A
*****5-Lipoxygenase Pathway Inhibitors: Zileuton (Zyflo)
MOA: Inhibits 5-Lipoxygenase – enzyme responsible for formation of leukotrienes from
arachidonic acid Pharmacokinetics:
– Both gps rapidly absorbed from GI and highly protein bound*/// extensively metabolized in
liver /// excreted in the urine
• Montelukast – metabolized by CYP3A4 and CYP2C9
• Zileuton – metabolized by CYP1A2, CYP2C9 and CYP3A4
AE: -- Montelukast – headache, sore throat*
– Zileuton - dyspepsia
Precautions: both groups associated w/ neuropsychiatric events post-marketing including irritability,
agitation, tremors, insomnia, depression and suicidality
– Leukotriene Receptor Agonists
• Should be avoided in pts w/ severe liver disease
• Montelukast chewable tabs contain phenylalanine so C/I w/ PKU*
– 5-Lipoxygenase Pathway Inhibitors
• C/I in pts w/ active liver disease
WEEK 13 – RESPIRATORY SYSTEM PART 2
Respiratory System 2: Allergy, Cough/Cold
ALLERGY MEDICATIONS: Antihistamines, Intranasal Antihistamines, Nasal Corticosteroids
*****Antihistamines
Types:
• First generation
– Diphenhydramine – Benadryl
– Chlorpheniramine – Chlor-Trimeton
– Hydroxyzine – Atarax
NURS 615 – Exam 4 Study Guide Respiratory, GI, & Renal Pharmacology |
Actual study verified Solutions | A+ Graded | 2026 Updated | 100%
correct
CONTENT
WK 12: Respiratory System 1: Bronchodilators, Inhaled Corticosteroids, Leukotriene Modifiers
WK 13: Respiratory System 2: Allergy, Cough/Cold
WK 14: GI: Laxatives, Antidiarrheals, Antiemetics
WK 15: Renal: Diuretics
WEEK 12 – RESPIRATORY SYSTEM PART 1
Respiratory System 1: Bronchodilators, Inhaled Corticosteroids, Leukotriene Modifiers
BRONCHDILATORS: β2 Receptor Agonists, Inhaled Anticholinergics, Methylxanthines
*****β2 Receptor Agonists
Types: SABA, LABA, ULABA
• Short Acting Beta Agonists (SABA) – 4-6 hrs
Use: Reversible bronchoconstriction d/t asthma, reactive airway disease, COPD*
– Albuterol (selective)– Proair, Ventolin, Proventil
– Levalbuterol - Xopenex
– Pirbuterol - Maxair
– Terbutaline (selective) – Brethine, Brethaire (also stop uterine contractions) –
Metaproterenol (selective)
• Long-Acting Beta Agonists (LABA) – 12 hrs (listed weakest to strongest)
Use: bronchospasm d/t asthma, COPD , allergens, exercise, histamine, methacholine*
– Salmeterol - Serevent
– Formoterol - Foradil
– Arformoterol – Brovana
• Ultra Long-Acting Beta Agonists (ULABA) – 24 hrs
– Indacaterol – Arcapta Neohaler
– Olodaterol – Striverdi Respimat
– Vilanterol – Breo Ellipta (in combination w/ ICS only)
MOA*: bind to β2 smooth muscle cells in the airway
– Stimulates smooth muscle cell relaxation causing bronchodilation via cyclic AMP pathway
– Inhibits release of hypersensitivity mediators – especially from mast cells
All have some β1 receptor activity which causes many of the side effects
Pharmacokinetics: Absorbed from the bronchi /// Metabolized in the liver /// Excreted in the urine
AE: tachycardia, tremors * (Albuterol: because the drug acts on β2 rcpts in heart & skel musc)
, lOMoAR cPSD| 65448581
Precautions: monitor when used in pts w/ arrythmias, CV, hyperthyroidism
*****Inhaled Anticholinergics
Types: SAMA, LAMA
• Short Acting Muscarinic Antagonists (SAMA) – 4 – 6 hrs – Ipratropium bromide –
Atrovent
– Ipratropium bromide/albuterol – Combivent
• Long-Acting Muscarinic Antagonists (LAMA)
– Tiotroprium bromide – Spiriva Handihaler and Spiriva Respimat – 24 hrs
– Aclidinium bromide – Tudorza Pressair – 12 hrs
– Umeclidinium bromide – Incruse Ellipta – 24 hrs
– Revefenacin – Yupelri – 24 hrs + - first long acting nebulized LAMA
– Glycopyrrolates
• MOA : Preferentially bind to M3 receptors which are the 1° muscarinic receptor
involving bronchoconstriction in COPD
• Glycopyrronium bromide
• Seebri Neohaler – 12 hrs
• Breztri (in combination w/ LABA and ICS)
MOA*: Block muscarinic cholinergic receptors by antagonizing acetylcholine
– Decreases formation of cyclic GMP → decreased contractility of smooth muscle of the lungs
Pharmacokinetics: Poorly absorbed from lungs and GI tract /// 90% swallowed and excreted in feces ///
10% is metabolized by hydrolysis
AE: dry mouth, cough, HA (headache)
Precautions: Avoid in pts w/ urinary retention or BPH and closed-angle glaucoma
Should not be used for acute bronchospasm unless in combination w/ albuterol
*****Methylxanthines: Theophylline
MOA: Inhibit phosphodiesterases that lead to an increase in cyclic AMP
– Bronchial smooth muscle relaxation
– Pulmonary vessel relaxation
Pharmacokinetics: Well, fully absorbed orally /// little first pass effect /// Metabolized in liver AE:
headache, irritability, gastric irritation, n/v
Precautions: Multiple drug interactions /// Monitoring w/ serum drug levels to prevent toxicity
INHALED CORTICOSTEROIDS
Types: Highest to Lowest Potency (multiple forms and systems)
– Fluticasone furoate DPI – Arnuity Ellipta
– Mometasone furoate DPI – Asmanex Twisthaler
– Fluticasone propionate DPI – ArmonAir Digihaler and generic diskus formulation
– Beclomethasone dipropionate – QVAR RediHaler
– Ciclesonide MDI – Alvesco Inhalation Aerosol
– Budesonide DPI – Pulmicort Flexhaler
MOA*: Inhibit IgE and mast cell mediated migration of inflammatory cells into bronchial mucosa
– Late-phase allergic reaction Pharmacokinetics:
– Rapidly absorbed from lungs and GI tract
, lOMoAR cPSD| 65448581
• Less than 1/4 of dose is deposited in the lungs
• Swallowed portion undergoes extensive first pass metabolism
• Excreted in urine and feces
AE*: xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis
Precautions*: C/I in status asthmaticus /// HPA suppression /// High-dose in kids may inhibit growth
(Hypothalamic-pituitary-adrenal axis suppression = adrenal fatigue)
LEUKOTRIENE MODIFIERS: Leukotriene Receptor Agonists, 5-Lipoxygenase Pathway Inhibs
Patho: Leukotrienes are inflammatory mediators produced by eosinophils and mast cells that can
lead to bronchospasm, airway hyperresponsiveness and vascular leakage
Types:
*****Leukotriene Receptor Agonists: Montelukast (Singulair)
MOA: Inhibits cysteinyl leukotriene receptor → blocks action of LTD4 – a component of SRS-A
*****5-Lipoxygenase Pathway Inhibitors: Zileuton (Zyflo)
MOA: Inhibits 5-Lipoxygenase – enzyme responsible for formation of leukotrienes from
arachidonic acid Pharmacokinetics:
– Both gps rapidly absorbed from GI and highly protein bound*/// extensively metabolized in
liver /// excreted in the urine
• Montelukast – metabolized by CYP3A4 and CYP2C9
• Zileuton – metabolized by CYP1A2, CYP2C9 and CYP3A4
AE: -- Montelukast – headache, sore throat*
– Zileuton - dyspepsia
Precautions: both groups associated w/ neuropsychiatric events post-marketing including irritability,
agitation, tremors, insomnia, depression and suicidality
– Leukotriene Receptor Agonists
• Should be avoided in pts w/ severe liver disease
• Montelukast chewable tabs contain phenylalanine so C/I w/ PKU*
– 5-Lipoxygenase Pathway Inhibitors
• C/I in pts w/ active liver disease
WEEK 13 – RESPIRATORY SYSTEM PART 2
Respiratory System 2: Allergy, Cough/Cold
ALLERGY MEDICATIONS: Antihistamines, Intranasal Antihistamines, Nasal Corticosteroids
*****Antihistamines
Types:
• First generation
– Diphenhydramine – Benadryl
– Chlorpheniramine – Chlor-Trimeton
– Hydroxyzine – Atarax
