Pul 9 - Pulmonary Medication

Question 1

What is the side effect of beta2 agonists?

Answer 1

They are mild beta1 agonists:

1. Jittetriness.
2. Tachycardia.

-Levalbuterol: less beta1-agonist.

Question 2

What are some inhaled corticosteroids for asthma?

Answer 2

1. Fluticasone.
2. Budesonide.
3. Beclomethasone.

Question 3

What do corticosteroids do?

Answer 3

1. Inhibit the synthesis of cytokines.

2. Inhibit TNF-alpha production.

Question 4

When are systemic steroids used in asthma?

Answer 4

1. Severe chronic asthma.

2. Acute asthma exacerbation w/ inhaled beta2 agonists.

Question 5

What does Cromolyn do?

Answer 5

1. Prevents the release of mediators from mast cells.

2. Prevents bronchoconstriction and inflammation.

Question 6

What are some beta2 agonists used in asthma and what do they do?

Answer 6

Albuterol and levalbuterol: smooth muscle relaxation in the bronchi. Used for acute asthma exacerbations.

-Salmeterol: long-acting. Used for asthma prophylaxis.

Question 7

What are some muscarinic antagonists and what do they do in the lungs?

Answer 7

• Tiotropium and ipatropium.
• They are inhaled agents, they decrease the overall vagal or parasympathetuc tone in the lungs, causing smooth muscle relaxation and decrease in mucus production.

Question 8

What are some antileukotrienes and what do they do?

Answer 8

1. Zileuton:
   - 5-lipoxygenase inhibitor; blocks the conversion of arachidonic acid into leukotrienes.
2. Zafirlukast, Montelukast: Prevent chemotactic and bronchospasmic effects of leukotrienes D4.

Question 9

What are some methylxanthines and what do they do?

Answer 9

1. Theophylline: causes bronchodilation by inhibiting phosphodiesterase.
   - Metabolized by cytochrome P450.
   - Blocks the action of adenosine.

Question 10

Why are methylxanthines dangerous?

Answer 10

Has a very narrow therapeutic index:

• Cardiotox: tachycardia and hypotension.
• Neurotoxicity: Seizure.

Question 11

What are some expectorants and what do they do?

Answer 11

1. Guaifenesin.
   - They loosen up sputum.
2. N-acetylcysteine.
   - Usually used as acetaminophen overdose.
   - Has mucolytic protperties: cleaves disulfide bonds within mucous glycoproteins.
   - Can also be used to prevent contrast-induces renal nephropathy.

Question 12

What are some H1 blockers and what do they do?

Answer 12

1. H1 blockers: 1st generation.
   - Diphenhydramine.
   - Dimenhydrinate.
   - Chlorpheniramine.
   - Hydroxyzine.
   - -Used as allergic rhinitis, motion sickness, sleep aids, sedation, antimuscarinic effects.
2. Second generation:
   - Loratadine.
   - Fexofenadine.
   - Desloratadine.
   - Cetirizine.

–far less sedating, but can be if used in high doses like cetirizine.

Question 13

What is cyproheptadine used for?

Answer 13

Appetite stimulant on pediatric patients.

Question 14

What is Promethazine used for?

Answer 14

Nausea, vomiting.

Question 15

What is Chlorpheniramine used for?

Answer 15

OTC allergy/cold.

Question 16

What is hydroxyzine used for?

Answer 16

Sedation, itching.

Question 17

What is Meclizine used for?

Answer 17

Vertigo.

Question 18

What is Dextromethorphan used for?

Answer 18

Synthetic derivative of morphine used as a cough supressant.

-No analgesic affect.

Question 19

What are psedudoephedrine and phenylephrine and what are they used for?

Answer 19

They are alfa-agonists and they are used as nasal decongestants. They constrict dilated arterioles in the nasal mucosa.

Question 20

What medication is used for inhaled treatment of choice for chronic asthma?

Answer 20

Inhaled steroids.

Question 21

What inhaled treatment of choice for acute exacerbations of asthma?

Answer 21

Albuterol or levalbuterol.

Question 22

What medication has narrow therapeutic index, is the drug of last resort in asthma?

Answer 22

Theophylline.

Question 23

What medication blocks conversion of arachidonic acid to leukotriene, used in asthma?

Answer 23

Zileuton.

Question 24

What medication inhibits mast cell release of mediators, used for prophylaxis only in asthma?

Answer 24

Cromolyn.

Question 25

What medication is used as inhaled treatment that blocks muscarinic receptors used in asthma?

Answer 25

Ipratropium and triotropium.

Question 26

What medication is an inhlaed long-acting beta2 agonist used in asthma?

Answer 26

Salmeterol.

Question 27

What medication blocks leukotriene receptors that is used in asthma?

Answer 27

Zafirlukast and montelukast.

Question 28

Which medication, if taken long term, can result in rebound nasal congestion?

Answer 28

Pseudoephedrine and phenylephrine.