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CVPR Pulmonary > Pulmonary Drugs > Flashcards

Pulmonary Drugs Flashcards

1
Q

How do we treat pulmonary arterial hypertension (3)

A

We try to dilate the vasculature by acting on 3 pathways

  • Endothelin - block this vasoconstrictor
  • NO - vasodilator working with cGMP, phosphodiesterase inhibitor increased cGMP to keep NO affects going
  • Prostacyclin - vasodilator working with cAMP, give synthetic forms
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2
Q

How do we treat WHO group 2 pulmonary hypertension

A

Use diuretics to lower load on heart. Use systematic vasodilators.

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3
Q

What are acute vasodilator responders

A

People who when inhaling NO or given IV prostacyclin get a 10Torr decrease in MAP, overall it drops below 40Torr, and doesn’t mess up heart too much. If this is case these people will respond very well to Ca2+ channel blockers (which is weird because these are mostly systemic vasodilators as opposed to pulmonary)

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4
Q

Why do you have to make clear differentiation in patient with pulmonary hypertension between PAH and PVH as it relates to treatment

A

Because if you have PVH then the post capillary obstruction will cause HUGE problems if you give PAH vasodilators. You will get severe pulmonary edema.

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5
Q

What are positive parameters for Bronchodilator test

A

12% increase and overall 200cc increase in FEV and or FVC

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6
Q

What are positive parameters for Methacholine challenge

A

20% decrease in flow from less than 8 mg/ml of drug

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7
Q

Beta-agonists

A

Increase cAMP to relax smooth muscle and bronchodilate
Short acting - albuterol
Long acting - salmeterol, formoterol

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8
Q

Albuterol

A

Short acting Beta agonist

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9
Q

Salmoterol, Formoterol

A

Long acting beta agonist, needs to be paired with ICS

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10
Q

Anti-cholinergics

A

Blocks ACh activity on muscarinic receptors to stop vasoconstriction action (parasympathetic)
Ipratropium
Atropine
Tiotropium

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11
Q

Ipratropium, Tiotropium, Atropine

A

Anti-cholinergics used in COPD, Tiotropium is long acting

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12
Q

Leukotriene inhibitors

A

Blocks inflammatory effects of leukotrienes that are released by mast cells, stop bronchoconstriction
Montelukast (blocks receptor)
Zafirlukast (blocks receptor)
Zileuton (blocks production)

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13
Q

Montelukast
Zafirlukast
Zileuton

A

Leukotriene inhibitors

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14
Q

Comtrast Zafirlukast with Zileuton

A

Zafirlukast blocks receptor of leukotriene, while Zileuton blocks production from arachadonic acid

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15
Q

Mast Cell inhibitors

A

Stops release of inflammatory signals and molecules from mast cells, this includes leukotriene release
Cromolyn

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16
Q

Cromolyn

A

Mast cell inhibitor preventing leukotriene release

17
Q

Contrast Ipratropim with Tiotropium

A

Tioropium is longer lasting (T is later in alphabet)

18
Q

Phosphodiesterase inhibitors (airway) (methylxanthines)

A

Blocks PDE action which stops cAMP destruction thus raising its levels and giving smooth muscle relaxation
Theophylline

19
Q

Theophylline

A

PDE inhibitor for bronchodilation

20
Q

Anti-IgE

A

Helps with allergic asthma stopping IgE from activating basophils and mast cells
Omalizumab

21
Q

Omalizumab

A

Anti-IgE to stop basophil and mast cell activation

22
Q

Describe steps of asthma therapy

A

Step 1 Short acting β agonist (SABA) - as needed
Step 2 Low dose inhaled-corticosteroid (ICS)
Step 3 Low dose ICS + LABA (long acting)
Step 4 Medium dose ICS + LABA
Step 5 High dose ICS + LABA
Step 6 High dose ICS + LABA + oral corticosteroid

23
Q

Describe steps of COPD therapy

A

A Short acting anti-cholinergic (SAMA) or as needed
Short acting β agonist (SABA) as needed
B Short acting anti-cholinergic (SAMA) or dosed
Short acting β agonist (SABA) dosed
C Short acting anti-cholinergic (SAMA) or dosed
Inhaled corticosteroid (ICS) + LABA dosed
D Inhaled corticosteroid (ICS) + LABA + LAMA

24
Q

What bugs cause Community acquired pneumonia (3)

A

Strep pneumo
Haemophilus flu
Moraxella

25
Q

What bugs cause Hospital acquired pneumonia (6)

A 
Actinobacter
Citrobacter
Enterobacter (e coli)
Pseudo
Staph aureus
Serraita
26
Q

How do you treat outpatient CAP in <60yo

A

-Macrolide or Doxycyline

27
Q

How do you treat outpatient CAP in >60yo (3)

A
  • Doxycycline or macrolide
  • Beta lactam AND macrolide (also for inpatient)
  • Fluroquinolone
28
Q

What three types of drugs do you need to treat HCAP

A

Antipseudo
Drug resistance anti pseudo
Anti MRSA

29
Q

How do you treat HCAP

A 
Cephalosporin OR Carbapenem (ceph-carb)
\+
Fluroquinolone OR Aminoglycoside (fluro-amino)
\+
Linezolid OR Vancomycin (lin-vanc)
30
Q

What are medications you can use for AMS or HACE

A

Dexamethasone
Acetazolamide
Ibuprofen

31
Q

Dexamethasone

A

For AMS or HACE

Steroid that decreases mediators that cause the cerebral edema, however gives side effects of depression

32
Q

Acetazolamide

A

For AMS or HACE
Stops reuptake of HCO3- causing acidosis that constantly stimulates the patient to increase breathing, however gives side effect of messing up taste

33
Q

What can you use for treatment of HAPE

A 
Nifedipine - during
Prevention
Salmeterol
Dexamethasone
NOT acetazolamide or diuretics
34
Q

Nifedipine

A

Used in HAPE as Ca2+ channel blocker that vasodilates to decrease pulmonary pressure

CVPR Pulmonary (2 decks)

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