Pulmonary Drugs Flashcards
How do we treat pulmonary arterial hypertension (3)
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
How do we treat WHO group 2 pulmonary hypertension
Use diuretics to lower load on heart. Use systematic vasodilators.
What are acute vasodilator responders
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)
Why do you have to make clear differentiation in patient with pulmonary hypertension between PAH and PVH as it relates to treatment
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.
What are positive parameters for Bronchodilator test
12% increase and overall 200cc increase in FEV and or FVC
What are positive parameters for Methacholine challenge
20% decrease in flow from less than 8 mg/ml of drug
Beta-agonists
Increase cAMP to relax smooth muscle and bronchodilate
Short acting - albuterol
Long acting - salmeterol, formoterol
Albuterol
Short acting Beta agonist
Salmoterol, Formoterol
Long acting beta agonist, needs to be paired with ICS
Anti-cholinergics
Blocks ACh activity on muscarinic receptors to stop vasoconstriction action (parasympathetic)
Ipratropium
Atropine
Tiotropium
Ipratropium, Tiotropium, Atropine
Anti-cholinergics used in COPD, Tiotropium is long acting
Leukotriene inhibitors
Blocks inflammatory effects of leukotrienes that are released by mast cells, stop bronchoconstriction
Montelukast (blocks receptor)
Zafirlukast (blocks receptor)
Zileuton (blocks production)
Montelukast
Zafirlukast
Zileuton
Leukotriene inhibitors
Comtrast Zafirlukast with Zileuton
Zafirlukast blocks receptor of leukotriene, while Zileuton blocks production from arachadonic acid
Mast Cell inhibitors
Stops release of inflammatory signals and molecules from mast cells, this includes leukotriene release
Cromolyn
Cromolyn
Mast cell inhibitor preventing leukotriene release
Contrast Ipratropim with Tiotropium
Tioropium is longer lasting (T is later in alphabet)
Phosphodiesterase inhibitors (airway) (methylxanthines)
Blocks PDE action which stops cAMP destruction thus raising its levels and giving smooth muscle relaxation
Theophylline
Theophylline
PDE inhibitor for bronchodilation
Anti-IgE
Helps with allergic asthma stopping IgE from activating basophils and mast cells
Omalizumab
Omalizumab
Anti-IgE to stop basophil and mast cell activation
Describe steps of asthma therapy
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
Describe steps of COPD therapy
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
What bugs cause Community acquired pneumonia (3)
Strep pneumo
Haemophilus flu
Moraxella
