Pulmonary Pharmacology

Question 1

Pathogenesis of asthma vs. COPD

Answer 1

Asthma : eosinophils
COPD: neutrophils

(corticosteroids to tx asthma)

asthma = reversible

Question 2

SABA are used to treat _______ (asthma/COPD); LAMA are used to treat __________ (asthma/COPD).

Answer 2

• asthma
• COPD

Question 3

List 3 general categories of brochodilators

(tx asthma & COPD)

Answer 3

1. Beta agonists
2. Muscarinic antagonists
3. Theophylline

beta agonists & muscarinic antagonists have long and short - acting

Question 4

Methylxanthines block ______; whereas iberiotoxins block ______.

both are beta 2 agonists

Answer 4

• PDE
• K+ channels

Question 5

Chemically, albuterol is a racemic mixture of

Answer 5

active R- and inactive S- isomers

Question 6

What is the chemical difference of levalbuterol?

Answer 6

it is R-albuterol

Question 7

List the 2 short-acting B-2 agonists

Answer 7

levalbuterol
albuterol

Question 8

Which bronchodilator reduces sympathetic neurotransmission, decreases vascular leakage, increases mucous secretion and increases cAMP?

Answer 8

albuterol

Question 9

Restlessness, tachycardia, hypotension, chest pain and tremors are adverse effects of which bronchodilator?

Answer 9

albuterol

(B receptor agonists block K+ efflux?)

Question 10

Which 2 B2 agonists can not be used with MOA-I or TCAs?

Answer 10

1. fomoterol
2. albuterol

Question 11

Tachycardia (200 bpm), tremor, seizure, and hypokalemia are signs of ____________ (overdose).

Answer 11

albuterol

Question 12

LABAs MUST be used with _____________(medication)

Answer 12

ICS

Question 13

Which Rx is used as maintenance treatment of bronchoconstriction in COPD?

Answer 13

Fomoterol

LABA

Question 14

Which respiratory medications prevent the release of granules from mast cells (3)?

Answer 14

1. fomoterol
2. omalizumab
3. cromolyn

Question 15

Which respiratory Rx prevents mast cell degranulation by indirectly blocking Ca2+ channels on the mast cell?

Answer 15

cromolyn

(ipratropium prevents Ca2+ increase in bronchial smooth muscle cells

Question 16

Which 2 respiratory Rx increase the risk of asthma-related death if used without long-term asthma control Rx?

Answer 16

1. fomoterol
2. salmeterol

Question 17

Rx that teats asthma & COPD

Answer 17

salmeterol

(fomerterol treats COPD only)

Question 18

Terbutaline & Omalizumab route of administration

Answer 18

injection

(Ipratropium & theophylline given IV)

Question 19

which 2 medications treat reversible broncospasm associated w/chronic broncitis or emphysema?

Answer 19

1. tertbutaline
2. theophylline

Question 20

Which B2 agonist that treats asthma is also used for tocolysis?

(tocolysis: prevents labor)

Answer 20

tertbutaline

(do NOT use beyond 48-72 hours)

because it is IV –> systemic effects

Question 21

Which class of bronchodilator blocks bronchoconstriction and also tracheobronchial mucus secretion?

Answer 21

muscarinic antagonists

(don’t forget DUMBBELLS side effects)

Question 22

Which bronchodilator blocks the increase of Ca2+ in bronchial smooth muscles?

Answer 22

Ipratropium

Question 23

Which 3 bronchodilators are used as maintenance for COPD?

Answer 23

1. Ipratropium
2. Tiotropium
3. Salmeterol

Question 24

Which bronchodilator has the shortest half-life? Which has the longest?

Answer 24

• Ipratropium (2 hours)
• Tiotropium (44 hours)

Question 25

Anaphylaxis and parodoxical bronchospasms is a side effect of which bronchodilator Rx?

Answer 25

Ipratropium

(omalizumab may cause anaphylaxis also)

Question 26

Which medication treats COPD & asthma long-term and has a long half life of 44 hours?

Answer 26

Tiotropium

(anicholinergic: M1 to M5 receptors)

Question 27

Which medication prevents histamine release at high concentrations, and inhibits PDE at low concentrations?

Answer 27

Theophylline

(methylxanthine)

Question 28

Ipratropium & theophylline route of administration?

Answer 28

IV

(theophylline + oral; ipratropium + inhalation)

Question 29

The plasma clearance of which medication may be affected by liver disease, smoking or dietary changes?

Answer 29

Theophylline

(metabolized by CYP 1A2, 2E1, 3A3)

Question 30

Theophylline is metabolized by CYP 1A2, 2E1, 3A3. It may increase clearance of which 3 medications?

Answer 30

1. rifampicin
2. barbituates
3. EtOH

Question 31

Theophylline is metabolized by CYP 1A2, 2E1, 3A3. It may decrease clearance of which 7 medications?

Answer 31

1. cimetidine
2. erythromycin
3. ciprofloxacin
4. allopurinol
5. fluvoxamine
6. zileuton
7. zafirlukast

Question 32

At low doses, wich medication causes n/v, headache, GI discomfort and insomnia?

Answer 32

theophylline

Question 33

Which medication is dosed based on serum concentration?

Answer 33

theophylline

(between 20-40 mg/L)

Question 34

Which medication can exacerbate PUD, seizures and arrhythmias?

Answer 34

Theophylline

Question 35

Which bronchodilator is NOT indicated for acute bronchospasm?

(used for COPD)

Answer 35

Roflumilast

(PDE4 inhibitor)

Question 36

Which 2 medications inhibit PDE?

increases cAMP

Answer 36

1. theophylline
2. roflumilast

Question 37

Which bronchodilator is contraindicated in patients with severe liver impairment?

Answer 37

1. roflumilast
2. zileuton

(monteleukast req. liver monitoring)

Question 38

Which medication is metabolized by phase I & phase II reactions (CYP 1A2 & 3A4)?

Answer 38

roflumilast

Question 39

Which novel potential bronchodilator is used for severe acute asthma?

(reduces cytosolic Ca2+ concentrations)

Answer 39

magnesium sulfate

Question 40

How would a K+ channel opener work as a bronchodilator?

Answer 40

opening ATP-dependent K+ channel membrane leads to hyperpolarization & relaxation

(cromakalim or levcromakalim)