Asthma & COPD & NSAIDs & Gout & RA

Question 1

Bosentan

Answer 1

• Competetively inhibited endothelin-1 receptors.
• Use: pulmonary arterial HTN
• decreased pulmonary vascular resistance.

Question 2

Celecoxib

Answer 2

• Selective COX2 inhibitor
• Use: Analgesia, antipyretic, and anti-inflammatory
• No GI ditress or platelet depression (b/c both of these are COX1 mediated).
• Tox: pro-thrombotic, nephrotoxic.

Question 3

Methotrexate

Answer 3

• dihydrofolate reductase inhibitor. suppresses bone marrow, less lymphocytes = less rheumatoid factor.
• Use: anti-cancer, Rheumatoid arthritis
• Tox: teratogen, mucosal ulcers, nausea, hepatotox.

Question 4

Colchicine

Answer 4

• inihibits MT assembly (inhibits leukocyte migration/degranulation): anti-inflammatory
• Use: Gout, cancer
• Tox: Diarrhea/GI distress

Question 5

Probenecid

Answer 5

• inhibits renal resorption of uric acid in PCT
• also inhibits secretion of PCN in PCT.
• Use: Chronic gout
• Tox: sulfa drug, exacerbation of acute gout, inhibits renal secretion of weak acids (like PCN, methotrexate).

Question 6

Allopurinol

Answer 6

• irreversibly inhibits xanthine oxidase and lowers production of uricacid.
• Use: Chronic gout
• Tox: stevens-johnsons, hypersensitivity, bone marrow suppresion.

Question 7

Salmeterol, formoterol, indacaterol

Answer 7

• beta-2 agonists, potentiation of corticosteroid action
• Use: asthma prophylaxis. They are long acting.
• PK: inhaled aerosol
• Tox: tremor, tachy, CV events

Question 8

isoproterenol

Answer 8

• beta agonist
• Use: asthma (obsolete)
• Tox: excessive sympathetic effect

Question 9

Ephedrine

Answer 9

• releases stores catecholamines
• Use: asthma (obsolete)
• Tox: insomnia, anorexia, tremor, arrythmias

Question 10

Theophylline

Answer 10

• PDE inhibition, adenosine receptor antagonist
• Use: Asthma, esp. prophylaxis against noctural attacks
• Tox: Insomnia, tremor, anorexia, seizures, arrhythmias
• caffeine is similar but w/more CNS effects

Question 11

Ipratropium, tiotropium

Answer 11

-M3 blocker
-Use: Asthma and chronic obstructive pulmonary disease
(stops bronchoconstriction + mucus prod).
-Tox: dry mouth, cough

Question 12

Cromolyn, nedocromil

Answer 12

• prevents degranulation of mast cells
• Use: Asthma prophylaxis (rare), ophthalmic, nasopharyngeal, and gastrointestinal allergy
• Tox: Cough

Question 13

Montelukast, zafirlukast

Answer 13

• leukotriene antagonist (LTD4 receptor)
• Use: Prophylaxis of asthma
• Tox: minimal

Question 14

Zileuton

Answer 14

• Inhibitor of lipoxygenase • reduces synthesis of leukotrienes
• Use: Prophylaxis of asthma
• Tox: elevation of liver enzymes

Question 15

Inhaled Beclomethasone

Answer 15

-Inhibition of phospholipase A2, reduces expression of
COX
-Use: DOC for asthma prophylaxis
-Tox: Pharyngeal candidiasis, minimal systemic steroid
toxicity (eg, adrenal suppression)

Question 16

Systemic Prednisone

Answer 16

• inhibits phospholipase A2
• Use: severe refractory chronic asthma
• given orally
• Tox: cortisol effects

Question 17

Omalizumab

Answer 17

-Binds IgE antibodies on mast cells; reduces reaction to
inhaled antigen.
-Use: Prophylaxis of severe, refractory asthma not
responsive to all other drugs.
-parenteral, very expensive.