Pulmonary Drugs

Question 1

What class of drug is Triamcinolone?

Answer 1

Glucocorticoid

Question 2

What is the mechanism of action of Triamcinolone?

Answer 2

Inhibits inflammation: 1. Increases lipocortin synthesis blocking PLA2 & release of AA. 2. Decreases synthesis of COX-2. 3. Blocks IFN- γ, IL-1, IL-2 production

Question 3

What is the physiological effect of Triamcinolone?

Answer 3

1. Prevents synthesis of leukotrienes & prostaglandins. 2. Further inhibits production of prostaglandins. 3. Prevents leukocyte and lymphocyte chemotaxis & activation

Question 4

What are the indications of Triamcinolone?

Answer 4

Allergic rhinitis (nasal inhalation); asthma (oral inhalation)

Question 5

What are the adverse effects of Triamcinolone?

Answer 5

Headache, pharyngitis, hoarseness, GI upset, xerostomia, facial edema

Question 6

What class of drug and the mechanism of action of Nedocromil?

Answer 6

Mast cell stabilizer
Antagonizes the antigen-induced degranulation of mast cells & eosinophils preventing the release of histamine, leukotrienes & slow- reacting inflammatory mediators

Question 7

What are the physiological effects of Nedocromil?

Answer 7

Inhibits the early & late bronchoconstriction responses to inhaled antigen and secondary to non-antigenic stimuli; also decreases the activation of airway nerves

Question 8

What are the indications and adverse effects of Nedocromil?

Answer 8

Prophylaxis of asthmatic episodes (before exercise), long-term Tx of mild to moderate asthma (daily use)

Nausea, vomiting, dysgeusia, cough

Question 9

What is the class of drug and mechanism of action of Omalizumab?

Answer 9

Monoclonal antibody to IgG

Binds to high affinity Fc receptor on IgE preventing binding to mast cells and lowers serum [IgE]

Question 10

What is the physiological effect of Omalizumab?

Answer 10

Reduces mast cell degranulation limiting release of early & late phase allergic mediators

Question 11

What are the indications and adverse effects of Omalizumab?

Answer 11

Moderate to severe allergic asthma; given SubQ every 2- 4 weeks

Headache, URTI, sinusitis, pharyngitis, arthralgia

Question 12

What is the class and mechanism of action of Montelukast?

Answer 12

Leukotriene receptor antagonists

Selectively inhibits the binding of leukotrienes to their receptors

Question 13

What is the physiological effect of Montelukast?

Answer 13

Reduces airway inflammation that causes edema, bronchoconstriction, & mucus secretion

Question 14

What are the indications and adverse effects of Montelukast?

Answer 14

Prophylaxis & Tx of chronic asthma, allergic rhinitis

Headache, gastritis, URTI (flu-like); Zafirlukast inhibits CYP450 system causing several drug-drug interactions

Question 15

What is the class and mechanism of action of Zafirlukast?

Answer 15

Leukotriene receptor antagonists

Selectively inhibits the binding of leukotrienes to their receptors

Question 16

What is the physiological effect of Zafirlukast?

Answer 16

Reduces airway inflammation that causes edema, bronchoconstriction, & mucus secretion

Question 17

What are the indications and adverse effects of Zafirlukast?

Answer 17

Prophylaxis & Tx of chronic asthma

Headache, gastritis, URTI (flu-like); Zafirlukast inhibits CYP450 system causing several drug-drug interactions

Question 18

What is the class and mechanism of action of albuterol?

Answer 18

β-2 receptor agonist

Relaxes SM by activating adenylate cyclase which increases intracellular [cAMP]

Question 19

What is the physiological effect of albuterol?

Answer 19

Bronchodilation persisting for 3-4 hrs with maximal effect at 30 min

Question 20

What are the indications and adverse effects of albuterol?

Answer 20

Inhaler: acute asthma attacks, prophylaxis & Tx of COPD/asthma induced bronchospasm; oral: asthma prophylaxis

Most related to activation of sympathetic system: tremor, tachycardia, palpitations, anxiety, excitability, hypokalemia

Question 21

What is the class and mechanism of action of Ipratropium?

Answer 21

Muscarinic receptor antagonists (anticholinergic agents)

Block the effects of vagus nerve stimulation on the airway by antagonizing the action of Ach at parasympathetic sites in bronchial SM

Question 22

What is the physiological effect of Ipratropium?

Answer 22

Bronchodilation; inhibits serous & seromucous gland secretions in the nasal mucosa

Question 23

What are the indications and adverse effects of Ipratropium?

Answer 23

COPD, occasionally asthma by oral inhalation

Airway irritation, GI upset, xerostomia, urinary retention, increased ocular pressure, anticholinergic effects

Question 24

What is the class and mechanism of action of Tiotropium?

Answer 24

Muscarinic receptor antagonists (anticholinergic agents)

Block the effects of vagus nerve stimulation on the airway by antagonizing the action of Ach at parasympathetic sites in bronchial SM

Question 25

What is the physiological effect of Tiotropium?

Answer 25

Bronchodilation; inhibits serous & seromucous gland secretions in the nasal mucosa

Question 26

What are the indications and adverse effects of Tiotropium?

Answer 26

COPD (oral inhalation)

Airway irritation, GI upset, xerostomia, urinary retention, increased ocular pressure, anticholinergic effects