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Pulm > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

epinephrine

A

B > alpha agonist

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2
Q

ephedrine

A

indirect adrenergic agonist, release stored catecholamines (stimulate B for lung effects)

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3
Q

isoproterenol

A

B1 and B2 agonist

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4
Q

albuterol

A

B2 agonist

short acting

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5
Q

terbutaline

A

B2 agonist

short acting

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6
Q

salmeterol

A

B2 agonist
long acting
used with steroids

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7
Q

formeterol

A

B2 agonist
long acting
used with steroids

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8
Q

atropine

A

M antagonist

Tx: asthma/COPD

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9
Q

ipratropium

A

M antagonist
poorly absorbed with no significant systemic effects
Tx: COPD

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10
Q

tiotropium

A

M antagonist
long acting
poorly absorbed with no significant systemic effects
Tx: COPD

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11
Q

Umeclidinium

A

M3 antagonist

Tx: COPD

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12
Q

theophylline

A

methylxanthine

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13
Q

aminophylline

A

methylxanthine

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14
Q

cromolyn sodium

A

Mast cell stabilizer: inhibits mast cell degranulation
alter chloride channel activity, inhibit eosinophilic inflammatory response, inhibit cough, reduces bronchial hyperactivity
AE: (no systemic toxicity) tracheal irritation (cough, bronchospasm), bad taste
RARE: chest pain, restlessness, hypotension, arrhythmia, N/V, CNS depression, seizure, anorexia
PROPHYLAXIS: asthma/COPD

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15
Q

methylxanthines

A

related to CAFFEINE
PDE inhibition (decrease cAMP degradation)
adenosine antagonist (strengthens diaphragm, inhibits bronchoconstriction)
decrease release of histamine
AE:
5-10 ug/mL serum: N/V, nervous, headache, insomnia
>20 ug/mL: vomit, HYPOKALEMIA, hyperglycemia, tachycardia, arrhythmia, tremor, neuromuscular irritability, seizures
Tx: asthma/COPD
CI: caffeine, CV

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16
Q

B agonist

A

bronchodilator: increase cAMP
inhibitory effect on release of mediators from mast cell, inhibit microvascular permeability, stimulate mucociliary clearance
Tx: asthma/COPD
AE: N/V, headache
decrease BP, increase HR and cardiac arrhythmias, HYPOKALEMIA-QT prolongation, PaO2 decrease, CNS toxic effects (agitation, convulsions, coma, respiratory and vasomotor collapse), HYPERGLYCEMIA

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17
Q

M antagonist

A

reduces bronchoconstriction, decreases mucus, enhances B2 bronchodilation
AE: pupillary dilation, cycloplegia

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18
Q

budesonide

A

corticosteroid

give with FORMOTEROL

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19
Q

fluticasone

A

corticosteroid

give with SALMETEROL

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20
Q

mometasone

A

corticosteroid

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21
Q

beclomethasone

A

corticosteroid

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22
Q

ciclesonide

A

corticosteroid
oral inhalation
prodrug of des-ciclesonide

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23
Q

prednisone

A

corticosteroid

oral

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24
Q

prednisolone

A

corticosteroid

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25
Q

methyprednisolone

A

corticosteroid

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26
Q

dexamathasone

A

corticosteroid

oral or IV

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27
Q

corticosteroids

A

anti-inflammatory
MoA: decrease inflammatory cytokines (NFkB, HDAC2), reduce mucus secretion, reduces bronchial hyperactivity, enhance B2 agonist effect), reduce GATA into nucleus (suppress TH2 cell activity), inhibits PLA2
inhaled AE: oral candidiasis, hoarse, dry mouth, decrease growth (children), decrease bone density (premenopausal women)
oral AE: glucose intolerence, HTN, weight gain, bone demineralization, cataracts, immunosuppression, retarded growth (children), cushingoid syndrome
AE: HYPERGLYCEMIA
Tx: ASTHMA, wegners granulomatosis
not as much COPD

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28
Q

leukotriene receptor blocker

A

block LTD4: decrease bronchial reactivity and bronchoconstriction, decrease mucosal hyper secretion and mucosal edema, decrease inflammation
AE: GI
PROPHYLAXIS: asthma/COPD

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29
Q

monteleukast

A

leukotriene receptor blocker
AE: laryngitis, pharyngitis, nausea, otitis, sinusitis, viral infections
CI: possible suicide ideation

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30
Q

zafirlukast

A

leukotriene receptor blocker

AE: headache, elevated liver enzymes

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31
Q

zileuton

A

leukotriene synthesis inhibitor (LTB4, LTC4, LTD4, LTE4): decrease sm. muscle contraction and vessel permeability, reduce leukocyte migration
AE: elevated hepatic enzymes
CI: CYP1A2 (interacts with theophylline)
PROPHYLAXIS: asthma/COPD

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32
Q

omalizumab

A

anti-IgE Ab (use with steroid)
AE: allergic rxn, injection reaction, sore throat/cold sym.
CI: cardiac complications, avoid concurrent agents
Tx: asthma/COPD

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33
Q

B2 receptor

A

Gs

stimulate AC - cAMP - PKA - increase EPAC and decrease MLCK

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34
Q

first generation antihistamines

A

short lived
SEDATION
anticholinergic side effects: DON’T give to asthmatics (thickening/drying of mucosa)
mild effect of GI peristalsis
AE: serotonergic: increase appetite
adrenergic: hypotension, tachycardia
antimuscarinic: dry mouth, urinary retention, tachycardia, constipation, blurred vision
minor not clinically important: QT prolongation, ventricular arrhythmia
other AE: resp. distress, potentiation of nasal congestion
Tx: allergy, nausea, insomnia, allergic rhinitis
CI: MAOI, COPD, asthma, peptic ulcer, BPH

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35
Q

second generation antihistamines

A

longer action
no sedation or anticholinergic SE
Tx: urticaria, seasonal allergic rhinitis

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36
Q

diphenhydramine

A

1st gen: H1 antagonist
suppresses cough reflex by acting directly on cough center
Tx: cough, anaphylaxis, parkinsonism (not sure if just this one or all H1 antagonists)
HIGHLY sedating

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37
Q

dimenhydrinate

A

1st gen: H1 antagonist
Tx: anaphylaxis
HIGHLY sedating

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38
Q

clemastine

A

1st gen: H1 antagonist

HIGHLY sedating

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39
Q

chlorpheniramine

A

1st gen: H1 antagonist

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40
Q

brompheniramine

A

1st gen: H1 antagonist

Tx: urticaria

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41
Q

triprolidine

A

1st gen: H1 antagonist

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42
Q

promethazine

A

1st gen: H1 antagonist
AE: IV use gangrene, breathing problems in children
HIGHLY sedating

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43
Q

cyclizine

A

1st gen: H1 antagonist

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44
Q

meclizine

A

1st gen: H1 antagonist

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45
Q

hydroxyzine

A

1st gen: H1 antagonist

Tx: N/V, pruritis

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46
Q

tripelennamine

A

1st gen: H1 antagonist

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47
Q

loratadine

A

2nd gen: H1 antagonist

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48
Q

terfenadine

A

2nd gen: H1 antagonist

ANTIFUNGALS: fatal arrhythmia

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49
Q

astemizole

A

2nd gen: H1 antagonist ANTIFUNGALS: fatal arrhythmia

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50
Q

acrivastine

A

2nd gen: H1 antagonist

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51
Q

cetirizine

A

2nd gen: H1 antagonist

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52
Q

telemastine

A

2nd gen: H1 antagonist

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53
Q

3rd generation antihistamines

A

greater binding to H1
early gen drugs modified
non sedating, fewer antimuscarinic effects
Tx: allergic conjunctivitis, saesonal allergic rhinits

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54
Q

desloratadine

A

2nd gen H1 antagonist

long half life

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55
Q

olopatadine

A

3rd gen: H1 antagonist
inhibits histamine, PGD2, and tryptase release from mast cell
Tx: OCULAR rhinitis

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56
Q

levocabastine

A

3rd gen: H1 antagonist

most potent and specific

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57
Q

azelastine

A

3rd gen: H1 antagonist
inhibits histamine and leukotriene receptors
blocks Ca mobilization and 5-lipoxygenase pathway
inhibits PAF receptor

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58
Q

emedastine

A

3rd gen: H1 antagonist

asthmatic use

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59
Q

mizolastine

A

3rd gen: H1 antagonist

anti PAF and LTD4

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60
Q

ebastine

A

3rd gen: H1 antagonist

anti leukotriene and antibradykinin

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61
Q

indacaterol

A

long acting bronchodilator

Tx: COPD

62
Q

vilanterol/fluticasone

A

B2 agonist: long acting

Tx: COPD

63
Q

doxopram

A

ICU only: narrow margin of safety
respiratory stimulant: activates PERIPHERAL carotid receptors
AE: HTN, tachycardia, arrhythmias, seizures
Tx: respiratory depression; acute hypercapnia in COPD

64
Q

Drugs CI in respiratory disease

A

sedatives
B blockers
COX inhibitors
ACE inhibitors

65
Q

ambrisentan

A

endothelin-1 antagonist

AE: peripheral edema

66
Q

sildenafil

A

PDE-5 inhibitor
AE: epistaxis, flush, insomnia, dizziness with sudden hearing loss
CYP2C9

67
Q

tadalafil

A

PDE-5 inhibitor

AE: back pain, change in color vision (NAION)

68
Q

diltiazem

A

Ca Channel Blocker

AE: bradycardia, HA

69
Q

nifedipine

A

Ca Channel Blocker

AE: flushing, heartburn

70
Q

amlodipine

A

Ca Channel Blocker

AE: fatigue

71
Q

bosentan

A

endothelin-1 antagonist
AE: liver enzymes, anemia, nasopharyngitis
interaction: cyclosporine, glyburide

72
Q

ivacaftor

A 
improves Cl transport through mutated channels
CFTR G551D mutation
metab: CYP3A4/5, inhibits CYP3A4, P-gp
AE: URTI symptoms, GI, rash
Tx: CF
EXPENSIVE
73
Q

lumacaftor

A 
protein conformation stabilizer: improves delivery of more fully functional portent apical surface of cell
CFTR G551D mutation
induces CYP3A4
AE: URTI symptoms, GI, rash
Tx: CF
EXPENSIVE
with IVACAFTOR
74
Q

poractant alfa

A

surfactant

Tx: preterm immature lungs

75
Q

calfactant

A

surfactant

Tx: preterm immature lungs

76
Q

beractant

A

surfactant

Tx: preterm immature lungs

77
Q

methotrexate

A

DHFR inhibitor, inhibits AICAR (adenosine accumulation leading to immunosuppression)
AE: myelosuppression, hepatic, PULMONARY FIBROSIS, derm., TERATOGEN, malignant lymphoma, nephrotoxic
Tx: sarcoidosis, SCLC

78
Q

rituximab

A

mAb to CD20
AE: HTN, asthenia, pruritis, urticaria, rhinitis, arthralgia
Tx: wegners granulomatosis

79
Q

azathioprine

A

prodrug for 6- mercaptopurine: decrease de novo purine synthesis
activated by HGPRT
AE: myelosuppression
Tx: wegners granulomatosis
CI: ALLOPURINOL or febuxostat (metabolized by xanthine oxidase)

80
Q

cyclophosphamide

A

alkylating agent
Tx: wegners granulomatosis, SCLC (off label)
AE: HEMORRHAGIC CYSTITIS (give MESNA), myelosuppression, infertility, malignancies, pulm. fibrosis, renal

81
Q

epoprostenol

A 
prostanoid
portable infusion pump
AE: catheter infection
Tx: PAH (IMPROVE SURVIVAL)
SE: jaw pain, diarrhea, arthralgia
pump: infection, thrombosis, pump malfunction
82
Q

iloprost

A

prostanoid

AE: cough, tongue/back pain, hemoptysis

83
Q

teprostinil

A

prostanoid
AE: jaw pain, vasodilation, N/D, injection reaction
CI: CYP2C8 drugs (gemfibrozil decreases clearance, rifampin increases it)

84
Q

platinum drugs

A

intrastrand crosslinks
Tx: SCLC (off label)
AE: allergic rxn

85
Q

taxanes

A

binds B-tubulin and prevents depolymerization
Tx: NSCLC
AE: peripheral neruopathy

86
Q

vinca alkaloids

A

binds B-tubulin and prevents polymerization

87
Q

folic acid analogs

A

DHFR inhibitors

88
Q

EGFR TKI

A

oral: CYP interactions
ATP binding site
inhibits phosphorylation of dimerized TK receptors and leads to apoptosis
Tx: lung adenocarcinoma with EGFR phenotype
AE: SEVERE bradyarrhythmia, QT prolongation, STEVEN JOHNSON SYNDROME, GI PERFORATION, hepatic, interstitial lung disease, PE, corneal perforation, corneal keratitis
CI: PREGNANCY, breastfeeding
res: KRAS, BRAF mutation, MET phosphorylation of tyrosine
AE: RASH
chromosome: 19 or 21 mutation

89
Q

ALK TKI

A

oral: CYP interactions
ATP binding site
inhibits ALK TK: EML4-ALK fusion gene produces oncogene that activates MEK/ERK pathway and cell proliferation
Tx: lung adenocarcinoma with EML4-ALK phenotype
AE: SEVERE bradyarrhythmia, QT prolongation, STEVEN JOHNSON SYNDROME, GI PERFORATION, hepatic, interstitial lung disease, PE, corneal perforation, corneal keratitis
CI: PREGNANCY

90
Q

cisplatin

A

platinum durg
Tx: NSCLC
AE: nephrotoxic, ototoxic

91
Q

docetaxel

A

taxane

AE: edema (use steroids), neutropenia

92
Q

paclitaxel

A

taxane

AE: myelosuppresion,

93
Q

gemcitabine

A

pyrimidine analog: DNA pol inhibitor
Tx: NSCLC
AE: myelosuppresion, PERIPHERAL NEUROPATHY, drowsy/fatigue, arthralgia

94
Q

pemetrexed

A

DHFR inhibitor
Tx: NSCLC
AE: hepatic, myelosuppression, GI

95
Q

vinorelbine

A

vinca alkaloid
Tx: NSCLC
AE: myelosuppression, neutorpenia
CI: intrathecal injection

96
Q

irinotecan

A

DNA topo 1 complex stabilizer
Tx: NSCLC, SCLC (off label)
AE: asthenia

97
Q

doxorubicin

A
  1. intercalator
  2. free radical generator
  3. topo II inhibitor
    Tx: SCLC
    AE: CARDIOTOXICITY, hepatic, other malignancies, EXTRAVASIONAL NECROSIS
98
Q

etoposide (VP-16)

A

topo II inhibitor: complex stabilizer
Tx: SCLC
AE: HEMATOLOGIC

99
Q

topotecan

A

DNA Topo I complex stabilizer
Tx: SCLC
AE: hyperbilirubinemia

100
Q

carboplatin

A

platinum drug

AE: myelosuppression, blood dyscrasia, hepatic

101
Q

ifosfamide

A

alkylating agentz: intra and inter
Tx: SCLC
AE: blood dycrasias, neurotoxic, hematuria renal failure

102
Q

vincristine

A

vinca alkaloid
Tx: SCLC
AE: peripheral neuropathy

103
Q

afatinib

A

EGFR TKI

AE: diarrhea, loss of appetite

104
Q

erlotinib

A

EGFR TKI

AE: CV, edema, loss of appetite, elevated hepatic enzymes, ophthalmic toxicity, neurotoxic

105
Q

getfitinib

A

EGFR TKI

AE: N/V/D, elevated hepatic enzymes, ophthalmic, neuro, renal

106
Q

ceritinib

A

ALK TKI

AE: constipation, NVD, fatigue, loss of appetite, elevated hepatic enzymes, hematologic, hyperglycemia

107
Q

bevacizumab

A

VEGF inhibitor (false VEGF receptor)
Tx: non-squamous NSCLC with phenotype
AE: wound healing, life treathening HEMORRHAGE, HAND-FOOT syndrome, endocrine, near, proteinuria, TE FISTULA, PE/DVT, PAH, fatigue
CI: SQUAMOUS lung cancer (cavitation predisposes)
works well with CARBOPLATIN

108
Q

nivolumab

A

immune checkpoint inhibitor
PD1 inhibitor:
PD1 down regulates T cell activity during immune response
Tx: NSCLC (adenocarcinoma) after failure of platinum based Tx
AE: rash, HYPERkalemia/HYPOnatremia, constipation, decreased appetite, NV, elevated hepatic enzymes, musculoskeletal pain, cough, resp, infection, fatigue
CI: PREGNANCY

109
Q

dextromethorphan

A

acts directly on cough center in medulla
CYP2D6 into active metabolite
AE: hallucinations, dizzy, drowsy, insomnia, irritable/excitable
Tx: cough
CI: MAOI, resp. insuffiency, hepatic, allergy to product

110
Q

codeine

A

mu receptor: acts directly on cough center
10% to morphine by CYP2D6
Tx: cough
AE: constipation, sedation, histamine release, orthostatic hypotension, dizzy, resp. distress
CI: hypersensitivity, premature labor, pregnancy, BPH, sedatives, ARDS, asthma, COPD, recent tonsil/adenoid surgery, CONSTIPATION

111
Q

camphor

A

topical Tx of cough

do NOT use in nostrils, under nose or by mouth

112
Q

menthol

A

topical Tx of cough

do NOT use in nostrils, under nose or by mouth

113
Q

guaifenesin

A

expectorant: stimulates bronchial gland secretion: loosens and thins
AE: dizzy, dry mouth, rash, uric acid NEPHROLITHIASIS, stomach pain
CI: hypersensitivity

114
Q

alpha 1 agonist

A

increases smooth muscle contraction, mydriasis, increase sphincter contraction
Tx: decongestant
AE: HTN, bradycardia, REBOUND CONGESTION
CI: heart block, hypothyroidism, bradycardia, HTN

115
Q

pseudoephedrine

A

alpha 1 agonist and release NE
AE: tachycardia, arrhythmia, CNS (restless, insomnia, anxiety, tremor, etc.),
CI: ventricular tachycardia, elderly, children
metab: MOA, COMT, N-demethylation

116
Q

oxymetazoline

A

alpha 1 agonist

117
Q

phenylephrine

A

alpha 1 agonist

118
Q

levamfetamine

A

inhaled decongestant

119
Q

benzadrex

A

inhaled decongestant

120
Q

iodides-iodinated glycerol

A

SSKI: saturated solution of potassium iodide
expectorant: increase serous fluid

121
Q

bromohexine

A

expectorant: secrolytic

122
Q

acetyl cysteine

A

expectorant: mucolytic: free sulfhydryl group opens mucus disulfide bonds
AE: bronchospasm
Tx: Tylenol overdose, chest congestion
CI: asthma (unless used with bronchodilator), antibiotics

123
Q

dornase alfa

A

DNase: breaks extracellular DNA molecules of bronchial secretions into smaller fragments
Tx: CF, bronchiectasis, chronic bronchitis
AE: voice alteration, pharyngitis/laryngitis, rash, chest pain, conjunctivitis
AE: hypersensitivity to Chinese Hamster Ovary cells

124
Q

amiloride

A

diuretic: blocks Na channel: prevents dehydration of mucus
Tx: CF, bronchial asthma

125
Q

denufosol tetrasodium

A

binds P2Y2 receptor: inhibits ENaC transport and activates Cl secretion: enhances mucosal hydration and mucus clearance
Tx: CF

126
Q

prostanoids

A

PG’s: vasodilation and reduce inflammation
Tx: PAH
AE: hypotension, muscle pain/cramp, flushing, HA
CI: anti-thrombolytics

127
Q

endothelin-1 antagonists

A 
blocks pulmonary artery vasoconstriction and smooth muscle cell proliferation
AE: TERATOGEN, HA
CYP, OATP, PGP substrates
Tx: PAH
interaction: cyclosporin, glyburide
128
Q

PDE-5 inhibitors

A

prevent breakdown of cGMP: vasodilation and reduced cellular proliferation
Tx: PAH
AE: HA, indigestion
CI: organic nitrates, CYP interactions (3A4)

129
Q

Ca channel blocker

A

block Ca into smooth muscle: vasodilation
AE: edema, hypotension
CYP 3A4 substrate
must pass vasodilator challenge: decrease PAP without decrease in CO
Tx: PAH

130
Q

crizotinib

A

ALK TKI

AE: CV, edema, constipation, NVD, ophthalmic toxicity

131
Q

bupropion

A

unclear: NE/DA reuptake inhibitor
smoking cessation: better than nicotine replacement
AE: insomnia, dry mouth, nausea, suicidal ideation

132
Q

varenicline

A

nicotinic acetylcholine receptor partial agonist; release of dopamine
smoking cessation: BEST
AE: nausea, depression, suicidal ideation, emotional lability

133
Q

clonidine

A 
smoking cessation (off label): anti-HTN drug: blocks cravings, anxiety, restlessness, tensioning hunger
AE: sedation, dry mouth, dizziness
134
Q

mecamylamine

A 
smoking cessation (off label): ganglionic blocker (nicotinic receptor antagonist)
AE: orthostatic hypotension, fatigue, sedation, constipation, dry mouth, N/V
CI: coronary or renal insufficiency, glaucoma, uremia
135
Q

naltrexone

A

smoking cessation (off label): opiate receptor antagonist

136
Q

nicotine replacement therapy

A

smoking cessation: central nicotinic agonist

137
Q

nicotine replacement therapy PATCH

A

12 week step down
AE: applicationsite, HA, flu like symptoms
CI: CVD, DM, hepatic impairment, peptic ulcers, pheochromocytoma, hyperthyroidism, smoking (increase CV risk)

138
Q

nicotine replacement therapy GUM

A

12 week course
AE: jaw pain, orodental probs, HA, indigestion, nausea
CI: exceeding 24 pieces in a day can cause ADDICTION

139
Q

nicotine replacement therapy INHALER

A

12 week course: prescription needed

AE: irritation in mouth, HA, nausea, heartburn, hiccups

140
Q

nicotine replacement therapy NASAL SPRAY

A

12 week course min.

AE: nostril irritation, HA, Nausea, heartburn, hiccups

141
Q

nicotine replacement therapy ORAL LOZENGE

A

nicotinic agonist

142
Q

riocigat

A

stimulate guanylate cyclase: incrase cGMP

Tx: PAH

143
Q

macitentan

A

endothelin-1 antagonist

144
Q

warfarin

A

anticoagulant of choice for PAH

may IMPROVE SURVIVAL

145
Q

Small cell lung cancer tx

A

Etiposide (iranotecan) and a platinum drug

146
Q

Squamous cell lung carcinoma Tx

A

Platinum drug with one of these three (topo drug or a taxol or vinca)

147
Q

EGFR adenocarcinoma tx

A

Gefitnib
Erlotinib
Afatinib

148
Q

ALK adenocarcinoma

A

Certizinib

After failure try other c-nib

149
Q

Adenocarcinoma Tx

A

Platinum drugs and (topo or vinca or taxanes)

150
Q

Large cell carcinoma Tx

A

Platinum drug and (topo or vinca or taxane)

Pulm (11 decks)

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