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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?

A

1A2
3A4
2C9

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
Q

Which medications can be given to patients 12 months and older to treat asthma?

A

montelukast

26
Q

Which 2 medications also treats allergic rhinitis in addition to asthma?

A
  1. Montelukast
  2. Omalizumab
27
Q

Montelukast is excreted exclusively through what?

A

bile

must monitor liver function

28
Q

Which asthma medication has a black-box warning for suicidal thoughts as a side effect?

A

Montelukast

29
Q

In addition to suicidal thoughts as a side effect, montelukast may also cause which side effects?

A
  1. upper respiratory infections
  2. churg-strauss
30
Q

Which medication is a CysLT1 receptor antagonist?

A

monteleukast

31
Q

Which medication is a selective and competitive antagonist of the leukotriene D4 and E4?

A

zafirlukast

32
Q

Why is it particularly dangerous to combine Zafirlukast with warfarin (2)?

A
  1. Zafirlukast is metabolized by CYP2C9, which is inhibited by warfarin
  2. zafirlukast is almost 100% bound by plasma proteins
33
Q

Vasculitic rash, eosinophilia and neuropsychiatric effects are side effects of which respiratory medication?

A

Zafirlukast

34
Q

Which 4 medications are used as asthma prophylaxis?

A
  1. cromolyn
  2. zileuton
  3. zafirlukast
  4. monteluekast

(the first 3 are also used as maintenance therapy)

35
Q

Cromolyn indication

A

asthma prophylaxis

36
Q

Cromolyn mechanism of action

A

mast cell stabilizer by Ca2+ blockade

this inhibits immediate and non-immediate bronchoconstriction

37
Q

Which antitussive (cough suppressant) inhibits mu receptors? which inhibits sigma?

both are opioid receptors in the medullary cough center

A
  • codeine inhibits mu
  • dextromehtorphan inhibits sigma
38
Q

Which antitussive is a local anesthetic

respiratory use: lungs, pleura and respiratory passages

A

benzoate

39
Q

Visual hallucinations is a side effects of which antitussive (cough suppressant)?

A

benzoate

40
Q

Which 2 neuromodulators can be used as an antitussive?

for chronic idiopathic cough

A
  1. gabapentin
  2. pregabalin
41
Q

somnolence and dizziness are side effects of which 2 antitussives?

A
  1. pregabalin
  2. gabapentin
42
Q

Morphine and methadone are indicated for which condition?

A

intractable cough in bronchial carinoma

targets cough receptors in proximal airways

43
Q

caution w/codeine

A

enzymatic polymorphisms: high levels of CYP 2D6 –> higher levels of morphine

44
Q

dextromethorphan is a derivitive of which drug?

A

levorphanol

(codein analog)

45
Q

codeine analog

A

dextromethorphan

46
Q

In addition to activating sigma opioid receptors in cough center, dextromethorphan also acts as ______(2).

A
  1. NMDA antagonist
  2. oneirogen (pschadelic)
47
Q

Adverse effects of dextromethorphan

A
  1. toxic psychosis
  2. serotonin syndrome
  3. dystonia
  4. blurred vision
  5. change in muscle reflexes

Pulmonology - OMS 2 (28 decks)

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