Pharmacology

Question 0

How does theophylline work for asthma (2 ways)

Answer 0

1) inhibits phosphodiesterase hydrolysis of cAMP –> increased cAMP –> bronchodilation
2) blocks actions of adenosine, a vasoconstrictor

Question 1

What are the general treatment strategies for asthma?

Answer 1

Omalizumab is an anti-IgE, Steroids inhibit cytokine release and inflammation, antileukotrienes inhibit inflammation, b-agonists theophylline and muscarinic antagonists are used to block bronchoconstriction

Question 2

What are the toxic effects of theophylline?

Answer 2

Narrow therapeutic index. Cardiotoxicity (arrythmias), neurotoxicity (seizures), abdominal pain. Metabolized by p450

Question 3

What are some b2 agonists used for asthma treatment?

Answer 3

Albuterol (used in acute exacerbation)

Salmeterol, formoterol: prophylaxis. Toxicity = tremor, arrythmia

Question 4

Ipatropium

Answer 4

Muscarinic antagonist, prevents bronchoconstriction. Can be used for COPD.

Question 5

What steroids are used for asthma tx?

Answer 5

Beclomethasone, fluticasone

Question 6

Beclomethasone, fluticasone

Answer 6

Corticosteroids. Inactivate NF-kB, reducing TNF-a and other cytokines/inflammatory agents. Also reduce mucus production.

Question 7

Most common side effect for inhaled steroids

Answer 7

Oropharyngial candida infection

Question 8

Antileukotrienes

Answer 8

Montelukast, zafirlukast: block leukotriene receptors
Sileuton: 5-lipoxygenase inhibitor, blocks conversion of arachadonic acid to leukotrienes.
Prevent inflammation and bronchoconstriction

Question 9

Omalizumab

Answer 9

Monoclonal anti-IgE. Used for allergic asthma resistant to steroids and b2 agonists.

Question 10

Provocation test for asthma

Answer 10

Methacoline (muscarinic agonist) test

Question 11

Bosentan

Answer 11

Endothelin-1 (vasoconstrictor) antagonist –> tx for pulmonary hypertension

Question 12

Mast cell stabilizers

Answer 12

Cromolyn, nedocromil

Question 13

First generation antihistamines: examples, uses, toxicity

Answer 13

Diphenhydramine, dmenhydrinate, chlorpheniramine
Allergy, motion sickness, sleep.
Crosses BBB –> sedation, antimuscarinic, anti-a-adrenergic

Question 14

Second generation antihistamines: examples, uses, toxicity

Answer 14

Loratadine, fexofenadine, desloratadine, certirizine (-adine)
Allergy
Far less sedating than first generation. Mild anticholinergic effects

Question 15

Guaifenesin

Answer 15

Thins respiratory secretions –> decreases mucus viscosity.

Question 16

N-acetyl cysteine

Answer 16

Mucolytic agent, often used in CF.

Also antidote for acetominophen OD

Question 17

Dextromethorphan

Answer 17

Decreases sensitivity of cough receptors, antagonizes NMDA glutamate receptors. Mild opioid effect.

Question 18

Pseudoephedrine, phenlephrine

Answer 18

Nasal decongestants. Sympathomimetic a-agonist. Vasoconstriction – > less congestion

Can cause hypertension and CNS stimulation/anxiety