Pulmonary

Question 1

Beta 2 agonists

Answer 1

Albuterol- relaxes bronchial smooth mm (via Beta 2 receptors). Use during ACUTE asthma exacerbation.

Salmeterol, formoterol- long-acting agents for asthma PROPHYLAXIS. Adverse effects: tremor & arrhythmia

Question 2

Methylxanthines

Asthma Tx

Answer 2

Theophylline- likely causes bronchodilation by inhibiting phosphodiesterase, thereby decreasing cAMP hydrolysis. Usage is limited b/c of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by P-450. Blocks action of adenosine.

Question 3

Muscarinic antagonists

Asthma Tx

Answer 3

Ipratropium- competitive block of muscarinic receptors, preventing bronchoconstriction. Also used for COPD, as is tiotropium, a long-acting muscarinic antagonist.

Question 4

Corticosteroids

Asthma Tx

Answer 4

Beclomethasone, fluticasone- inhibit the synthesis of virtually all cytokines. Inactivate NF- kappa B, the transcription factor that induces the production of TNF- alpha, among other inflamm agents. 1st-line therapy for chronic asthma.

Question 5

Antileukotrienes

Asthma Tx

Answer 5

Montelukast, zafirlukast- block leukotriene receptors. Esp good for aspirin-induced asthma.

Zileuton- 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.

Question 6

Omalizumab

Asthma Tx

Answer 6

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE. Doesn’t work on IgE already on mast cell surface. Used in allergic asthma resistant to inhaled steroids & long-acting Beta2- agonists.

Question 7

Guaifenesin

Answer 7

Expectorant- thins respiratory secretions; does not suppress cough reflex.

Question 8

N-acetylcysteine

Answer 8

Mucolytic- can loosen mucous plugs in CF pts. Also used as an antidote for acetaminophen overdose.

Question 9

Bosentan

Answer 9

Used to Tx pulmonary HTN. Competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance.

Question 10

Dextromethorphan

Answer 10

Antitussive (antagonizes NMDA glutamate receptors). Synthetic codeine analog. Has mild opioid effect when used in excess. Naloxone can be given for overdose. Mild abuse potential.

Question 11

Pseudoephedrine, phenylephrine

Answer 11

MoA: Sypathomimetic alpha-agonistic nonprescription nasal decongestants

Use: reduce hyperemia, edema, & nasal congestion; open obstructed eustachian tubes. Pseudoephedrine also used as a stimulant

Toxicity: HTN. Can also cause CNS stimulation/ anxiety (pseudoephedrine)

Question 12

Metacholine

Answer 12

Muscarinic receptor agonist. Used in asthma challenge testing.