Pulmonary Drugs

Question 0

Beclomethasone*

Asthma/COPD

Answer 0

Inhaled glucocorticoid; inhibits synthesis of virtually all cytokines;
1st-line therapy for chronic asthma (except mild asthma)

–> inactivate NF-kB (transcription factor that induces production of TNF-alpha, among other inflammatory agents)

Question 1

Prednisone*

Asthma/COPD

Answer 1

Oral glucocorticoid
Inhibits synthesis of virtually all cytokines;
1st-line therapy for chronic asthma (except mild asthma)

–> inactivate NF-kB (transcription factor that induces production of TNF-alpha, among other inflammatory agents)

Question 2

Nicotine*

Tobacco Cessation

Answer 2

Patch, lozenge, gum, inhaler, spray

Question 3

Varenicline (Chantix)*

Tobacco Cessation

Answer 3

Partial nicotine receptor agonist, blocks effect of real nicotine, 3-fold increase in quitting rate but headache, nausea, insomnia, psychiatric side effects

Question 4

Bupropion (Zyban)

Tobacco Cessation

Answer 4

Antidepressant, mxn of action not well understood

Question 5

Diltiazem

Pulmonary Arterial Hypertension

Answer 5

Calcium channel blockers (test vasoreactivity first)

Question 6

Verapamil

Pulmonary Arterial Hypertension

Answer 6

Calcium channel blockers (test vasoreactivity first)

Question 7

Epoprostenol

Pulmonary Arterial Hypertension

Answer 7

Prostacyclin analogue

Question 8

Sildenafil

Pulmonary Arterial Hypertension

Answer 8

PDE5 (Phosphodiesterase 5) inhibitor
Oral
Drug

Question 9

Bosentan

Pulmonary Arterial Hypertension

Answer 9

Endothelin receptor competitive antagonists (endothelin is protein that constricts blood vessels and raises blood pressure)
–> Result: decreased pulmonary vascular resistance

generally kept in balance
PO?

Question 10

Omalizumab*

Asthma

Answer 10

Anti-IgE therapy; binds to circulating IgE regardless of specificity (IN CIRCULATION); does not activate complement; forms small, biologically inert omalizumab:IgE complexes
Result: interrupts allergic cascade

Question 11

Budesonide

Asthma

Answer 11

Glucocorticoid

Question 12

Omalizumab*

Asthma

Answer 12

Anti-IgE therapy; binds to circulating IgE regardless of specificity; does not activate complement; forms small, biologically inert omalizumab:IgE complexes
Result: interrupts allergic cascade

Question 13

Albuterol*
Short-Acting Beta2 Agonist (SABA)
Asthma/COPD

Answer 13

“A” for “Acute” asthma attack; relaxes bronchial smooth muscle (beta2)
Use: symptom relief (acute exacerbation)
intermediate duration

aerosols
also affect airway edema and airway inflammation

Question 14

Salmeterol*
Long-Acting Beta2 Agonists (LABA)
Asthma (longer term)/COPD

Answer 14

Use: controller, prophylaxis
long-acting agent for prophylaxis = prolonged management

adverse effects: tremor and arrhythmia
aerosol
also affect airway edema and airway inflammation

Question 15

Ipratropium
Short-acting Anti-cholinergic
Asthma/COPD

Answer 15

competitive block of muscarinic receptors –> preventing bronchoconstriction (modest effect)
Use: symptom relief of asthma
used with COPD if there is reversible bronchoconstriction

Question 16

Tiotropium
Long-Acting Anticholinergic
Asthma/COPD

Answer 16

Use: controller

Question 17

Budesonide
Glucocorticoids
Asthma

Answer 17

Use: controller

Question 18

Fluticasone
Glucocorticoids
Asthma

Answer 18

Use: controller

Question 19

Terbutaline
Short-acting Beta2 Agonist (SABA)
Asthma/COPD

Answer 19

Use: symptom relief
aerosols
also affect airway edema and airway inflammation
intermediate acting!

Question 20

Montelukast

Asthma

Answer 20

Leukotriene D4 Receptor Antagonist (LTD4) (block leukotriene receptors);
–> especially good for aspirin-induced asthma

Question 21

Zafirlukast

Asthma

Answer 21

Leukotriene D4 Receptor Antagonist (LTD4) (block leukotriene receptors);
–> especially good for aspirin-induced asthma

Question 22

Chromolyn Sodium

Asthma

Answer 22

Mast cell stabilizer
prevents release of mediators from mast cells; effective ONLY for *prophylaxis against asthma*
NOT EFFECTIVE DURING ACUTE ASTHMA ATTACK
--> block airway inflammation
Toxicities: rare

Question 23

Zileuton

Asthma

Answer 23

5-lipoxygenase pathway inhibitor;
blocks conversion of arachadonic acid to leukotrienes
–> may be good in children to avoid giving them glucocorticoids; also to patients with ASPIRIN SENSITIVITY or whose asthma is exacerbated by other NSAIDS