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Pulmonology - OMS 2 > Pulmonary Pharmacology: Anti-inflammatory Rx > Flashcards

Pulmonary Pharmacology: Anti-inflammatory Rx Flashcards

1
Q

What are the 4 general categories of anti-inflammatory drugs?

A
  1. ICS (1st & 2nd gen)
  2. Oral & IV corticosteroid
  3. Leukotriene pathway inhibitor
  4. Monoclonal antibodies
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2
Q

Why are there no drug interactions for monoclonal antibody drugs?

A

metabolized by antibodies

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3
Q

Hoarse voice and oropharyngeal candidiasis are common side effects of which class of drugs?

A

corticosteroids

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4
Q

What is the genomic vs. non-genomic mechanism of action for anti-inflammatory Rx?

A

genomic: decreases TH2 cytokines
non-genomic: inhibits arachidonic acid production

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5
Q

If a patient has perennial aeroallergen that is not well controlled w/inhaled corticosteroids, what would you recommend?

A

omalizumab

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6
Q

Which bronchodilator is used to treat nasal polyps that are not responding to nasal corticosteroids?

A

omalizumab

(costs up to $2,706 for one month’s supply)

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7
Q

Which bronchodilator blocks binding of IgE to FcERI on mast cells and basophils?

A

omalizumab

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8
Q

How does omalizumab provide extra protection after viral illness?

A

enhances type 1 IFN, reducing FCeRI

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9
Q

How is omalizumab dosed?

A

measure IgE + patient’s body weight

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10
Q

bronchospasm, hypotension, syncope, uticaria, angioedema of throat are symptoms of which condition?

A

anaphylaxis

(omalizumab, ipratropium & tiotropium may cause this)

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11
Q

Hoarse voice and oropharyngeal candidiasis are common side effects of which class of drugs?

A

corticosteroids

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12
Q

Dupilumab v. omalizumab: both decrease prevent the effects of IgE. How are they different?

A

Dupilumab: IL-4 Receptor blocker (prevents IgE synthesis)
Omalizumab: IgE binding

(decreasing production ineffective, MUST bind receptor)

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13
Q

When would you use omalizumab or Dupliumab?

A

severe asthma

symptoms inadequately controlled w/ICS

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14
Q

What is the main difference in the function of IL-4 and IL-5 as it pertains to respiratory inflammation?

A

IL-4 enhances IgE synthesis
IL-5 keeps eosinophils alive

“5 keeps eosinophils alive”

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15
Q

Which 2 drugs target IL-5 antibodies?

(prevents eosinophil survival)

A
  1. mepolizumab
  2. reslizumab
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16
Q

Which drug targets IL-5 receptor?

(prevents eosinophil survival)

A

Benralizumab

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17
Q

IL-5 inhibitors benefit the patient by decreasing the need for which therapies?

A

maintenance dose of ICS

(reduces exacerbations by 50%)

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18
Q

Which general class of medicine is indicated for severe asmtha, but NOT reducing COPD exacerbations?

A

IL-5 inhibitors

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19
Q

Which drug can treat severe asthma, atopic dermatitis and rhinosinusitis?

A

Dupilumab: IL-4 inhibitor

20
Q

What is the treatment for aspirin-sensitivity asthma?

A

leukotriene pathway inhibitors

when COX-2 is inhibited, no arachidonic acid –> more leukotrienes

21
Q

Which 3 medications are used for prophylaxis and maintenance therapy for asthma?

A
  1. zileuton
  2. zafirlukast
  3. monteleukast

(cromolyn = also prophylactic)

22
Q

Which 3 respiratory medications are contraindicated for patients with liver disease?

A
  1. zileuton
  2. roflumilast
  3. theophylline
23
Q

Zileuton is metabolized by which CYP enzymes?

24
Q

Why does zileuton increase levels of theophylline, warfarin and propranolol when co-administered?

A

it has a high level-of plasma protein binding and so do the other drugs

25
Which medications can be given to patients **12 months** and older to treat asthma?
montelukast
26
Which 2 medications also treats allergic rhinitis in addition to asthma?
1. Montelukast 1. Omalizumab
27
Montelukast is excreted exclusively through what?
bile | must monitor liver function
28
Which asthma medication has a black-box warning for suicidal thoughts as a side effect?
Montelukast
29
In addition to suicidal thoughts as a side effect, montelukast may also cause which side effects?
1. upper respiratory infections 1. churg-strauss
30
Which medication is a CysLT1 receptor antagonist?
monteleukast
31
Which medication is a selective and competitive antagonist of the leukotriene D4 and E4?
zafirlukast
32
Why is it particularly dangerous to combine Zafirlukast with warfarin (2)?
1. Zafirlukast is metabolized by CYP2C9, which is inhibited by warfarin 1. zafirlukast is almost 100% bound by plasma proteins
33
Vasculitic rash, eosinophilia and neuropsychiatric effects are side effects of which respiratory medication?
Zafirlukast
34
Which 4 medications are used as asthma prophylaxis?
1. cromolyn 1. zileuton 1. zafirlukast 1. monteluekast | (the first 3 are also used as maintenance therapy)
35
Cromolyn indication
asthma prophylaxis
36
Cromolyn mechanism of action
mast cell stabilizer by Ca2+ blockade | this inhibits immediate and non-immediate bronchoconstriction
37
Which antitussive (cough suppressant) inhibits mu receptors? which inhibits sigma? | both are opioid receptors in the medullary cough center
* codeine inhibits mu * dextromehtorphan inhibits sigma
38
Which antitussive is a local anesthetic | respiratory use: lungs, pleura and respiratory passages
benzoate
39
Visual hallucinations is a side effects of which antitussive (cough suppressant)?
benzoate
40
Which 2 neuromodulators can be used as an antitussive? | for chronic idiopathic cough
1. gabapentin 1. pregabalin
41
somnolence and dizziness are side effects of which 2 antitussives?
1. pregabalin 1. gabapentin
42
Morphine and methadone are indicated for which condition?
intractable cough in bronchial carinoma | targets cough receptors in proximal airways
43
caution w/codeine
enzymatic polymorphisms: high levels of CYP 2D6 --> higher levels of morphine
44
dextromethorphan is a derivitive of which drug?
levorphanol | (codein analog)
45
codeine analog
dextromethorphan
46
In addition to activating sigma opioid receptors in cough center, dextromethorphan also acts as ______(2).
1. NMDA antagonist 1. oneirogen (pschadelic)
47
Adverse effects of dextromethorphan
1. toxic psychosis 1. serotonin syndrome 1. dystonia 1. blurred vision 1. change in muscle reflexes

Pulmonology - OMS 2 (28 decks)

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