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αναπνευστικο f > farmaka > Flashcards

farmaka Flashcards

1
Q

Are H1 blockers reversible or irreversible inhibitors?

A

Reversible

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2
Q

What are three first-generation H1 blockers?

A

Diphenhydramine, dimenhydrinate, and chlorpheniramine

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3
Q

Name four second-generation H1 blockers.

A

Loratadine, fexofenadine, cetirizine, and desloratadine

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4
Q

First-generation H1blockers usually end in ____, whereas second-generation H1blockers usually end in ____.

A

-en/-ine or -en/-ate, -adine

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5
Q

A patient has motion sickness on a flight and would like to fall asleep. What class of medication would be useful for this patient?

A

H1 blockers (e.g., diphenhydramine), which are useful for allergies, motion sickness, and as sleep aids

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6
Q

A patient takes chlorpheniramine for allergies. What side effects would you counsel the patient on?

A

Sedation, antimuscarinic symptoms, anti-α-adrenergic symptoms

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7
Q

What is the clinical use of second-generation H1 blockers?

A

Allergies

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8
Q

A truck driver has bad allergies. You want to prescribe a histamine blocker. Would diphenhydramine work for him?

A

No (although it treats allergies, it makes him too sleepy [second-generation H1-blockers are less sedating due to lower CNS activity])

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9
Q

How does guaifenesin help a patient with a severe cough productive of sputum?

A

It thins respiratory secretions, but it does not reduce the cough reflex

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10
Q

N-acetylcysteine is an expectorant. How does it work?

A

Dissolves mucous plugs by disrupting disulfide bonds (it is a mucolytic)

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11
Q

A patient with cystic fibrosis is prescribed a medication that would loosen mucous plugs. What is the mechanism of action of this drug?

A

Disrupts disulfide bonds (N-acetylcysteine is a mucolytic)

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12
Q

Which mucolytic is also used as an antidote for acetaminophen overdose?

A

N-acetylcysteine

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13
Q

By what mechanism does dextromethorphan suppress cough?

A

It antagonizes NMDA glutamate receptors

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14
Q

Dextromethorphan is a synthetic analog of what drug?

A

Codeine

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15
Q

Excess use of dextromethorphan can produce what side effect?

A

Mild opioid effect

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16
Q

A patient with a cough overdoses on an NMDA glutamate receptor antagonist. What drug can be used to treat the overdose?

A

Naloxone (dextromethorphan can cause opioid-like effects)

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17
Q

Why does dextromethorphan have mild abuse potential?

A

If used in excess, it has a mild opioid effect

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18
Q

A patient with depression takes a medication to suppress cough. She quickly becomes tachycardic & sweaty, & her fingers tremble. Diagnosis?

A

This is serotonin syndrome, seen when dextromethorphan is combined with another serotonergic agent such as certain antidepressants

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19
Q

What is the main clinical function of pseudoephedrine and phenylephrine? By what mechanism?

A

Nasal decongestants via α-adrenergic agonism

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20
Q

What are the clinical indications for pseudoephedrine and phenylephrine?

A

Reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes; and act as stimulant (pseudoephedrine only, used to make meth)

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21
Q

A patient takes α-adrenergic agonists for nasal congestion. What side effects can be expected?

A

Can cause hypertension and central nervous system stimulation/anxiety

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22
Q

Name the three types of drugs that are used for pulmonary hypertension.

A

Endothelin receptor antagonists, prostacyclin analogs, and PDE5 inhibitors

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23
Q

Name a competitive endothelin receptor antagonist that is used to decrease pulmonary vascular resistance for pulmonary hypertension.

A

Bosentan

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24
Q

A patient with COPD has a pulmonary artery pressure of 26 mmHg. He is prescribed an endothelin receptor antagonist. What must you monitor?

A

Monitor LFTs for hepatotoxic side effects (this patient has pulmonary hypertension from COPD, and the medication described is bosentan)

25
Q

What is the mechanism of action of sildenafil?

A

Inhibits cGMP PDE5 and prolongs nitric oxide vasodilatory effects

26
Q

A man with pulmonary hypertension and erectile dysfunction would benefit from which medication?

A

Sildenafil

27
Q

Name two prostacyclin analog medications that directly vasodilate pulmonary and systemic vascular beds for pulmonary hypertension.

A

Epoprostenol and iloprost

28
Q

A man with elevated pulmonary artery pressure is given a PGI2 analog that also works to inhibit platelet aggregation. Side effects?

A

Flushing and jaw pain (he has pulmonary artery hypertension, and the medication described is epoprostenol or iloprost)

29
Q

Bronchoconstriction is mediated by which two processes?

A

Inflammation and parasympathetic tone (these are targets for therapy)

30
Q

What is the mechanism of action of albuterol?

A

Albuterol relaxes bronchial smooth muscle through its agonism of β2-adrenergic receptors

31
Q

A typical patient with asthma takes a combination of drugs that targets which two pathways mediating bronchoconstriction?

A

Inflammation and parasympathetic tone

32
Q

Is albuterol used as a controller medication or for relief of symptoms during exacerbations?

A

Relief in acute asthma exacerbations

33
Q

Salmeterol and formoterol are ____ (short/intermediate/long)-acting agents. What class of drugs are they?

A

Long; β2-agonist

34
Q

List two adverse effects that a patient may experience while taking salmeterol.

A

Tremor and arrhythmias

35
Q

Name two inhaled corticosteroids commonly used to treat asthma.

A

Fluticasone and budesonide

36
Q

What mechanism of inhaled corticosteroids makes them useful to treat asthma?

A

They inhibit the synthesis of virtually all cytokines

37
Q

Inhaled corticosteroids are useful in treating asthma by inactivating what transcription factor?

A

Nuclear factor κB

38
Q

Nuclear factor κB induces the production of inflammatory agents including ____.

A

Tumor necrosis factor-α

39
Q

A patient has chronic asthma. What class of drugs is considered first-line therapy for this patient?

A

Inhaled corticosteroids

40
Q

Ipratropium is an example of what class of drugs?

A

Muscarinic antagonists

41
Q

Does ipratropium cause a competitive or a noncompetitive receptor blockade? Mechanism?

A

Competitive; prevents endogenous acetylcholine from inducing bronchoconstriction

42
Q

Ipratropium is used to treat chronic obstructive pulmonary disease, as is what other long-acting muscarinic antagonist?

A

Tiotropium

43
Q

Name two clinical indications for the use of ipratropium.

A

Asthma and chronic obstructive pulmonary disease

44
Q

A patient has both asthma and COPD. What is the mechanism of action of the drug that would be useful against both of his conditions?

A

Ipratropium is used against both, as it blocks muscarinic receptors competitively

45
Q

Name three examples of antileukotriene drugs.

A

Zileuton, zafirlukast, and montelukast

46
Q

Zileuton is an inhibitor of what pathway? Toxicity?

A

The 5-lipoxygenase pathway that produces leukotrienes from arachidonic acid; it is hepatotoxic

47
Q

What medication is used for allergic asthma resistant to inhaled corticosteroids and β2-agonists? Its mechanism of action?

A

Omalizumab, a monoclonal anti-immunoglobulin E antibody that binds unbound immunoglobulin E and blocks FcεRI binding

48
Q

Theophylline likely causes ____ by inhibiting phosphodiesterase and increasing what molecule?

A

Bronchodilation; cAMP

49
Q

What is the effect on bronchial smooth muscle of increased cAMP concentration?

A

Decreased bronchial tone (i.e., it causes bronchodilation)

50
Q

The use of what asthma drug is limited because of its narrow therapeutic index?

A

Theophylline, a methylxanthine

51
Q

A patient wants to try theophylline but is worried about side effects. What two side effects do you counsel the patient on?

A

Cardiotoxicity and neurotoxicity

52
Q

In addition to inhibiting phosphodiesterase, theophylline also blocks endogenous ____ from inducing bronchoconstriction.

A

Adenosine

53
Q

In the pathogenesis of asthma, the binding of antigens to immunoglobulin E on mast cells results in what?

A

The release of mediators such as leukotrienes and histamine from mast cells

54
Q

In the pathogenesis of asthma, the release of mediators from mast cells results in what two responses?

A

Bronchoconstriction (early) and inflammation (late)

55
Q

In asthma, the early response to the release of mediators is ____, whereas the late response to the release of mediators is ____.

A

Bronchoconstriction; inflammation

56
Q

In the treatment of asthma, what drug type prevents released mast cell mediators from inducing the late response of airway inflammation?

A

Steroids

57
Q

What is the primary function of methacholine? By what mechanism does it work?

A

Bronchoconstriction via muscarinic (M3) receptor agonism

58
Q

A physician cannot tell if a patient has asthma. What drug could be used in an asthma challenge test for this patient?

A

Methacholine

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