Pulmonology Flashcards
albuterol
SABA used during acute asthma exacerbation. relaxes bronchial smooth muscle by increasing intracellular cAMP
Max effect in 15-30 mins. lasts 3-4 hours
Other SABAs: terbutaline, metaproterenol, pirbuterol
Salmeterol
LABA. Asthma prophylaxis
potent selective B2 agonist.
Lasts >12 hours due to high lipid solubilitiy
Side effects: tremor + arrhythmia
No anti-inflammatory actions - not recommended as monotherapy
Works well with inhaled corticosteroids so often combines (salmeterol-fluticasone)
Formoterol
LABA. Asthma prophylaxis
potent selective B2 agonist.
Lasts >12 hours due to high lipid solubilitiy
Side effects: tremor + arrhythmia
Works well with inhaled corticosteroids so often combines (formoterol-budesonide)
Theophylline
methylxanthine -
Asthma symptomatic relief in someone poorly controlled by anti-inflammatory agents
Relief of skeletal muscle and diaphragm fatigue in COPD
creates bronchodilation by inhibiting PDE which prevents breakdown of cAMP and thus raises its levels
Also blocks the actions of adenosine (which normally promotes bronchoconstriction)
Limited usage due to narrow therapeutic index
Side effects: cardiotoxicity (arrhythmia), neurotoxicity (seizures)
Metabolized by Ccytchrome P-450
Atropine
Short acting muscarinic receptor antagonist (SAMRA)
Low doses cause bronchodilation without increasing HR and persists for 5 hurs
Adverse effects: systemic absorption leading to muscarinic toxicity
Ipratropium
SAMRA - Asthma and COPD. competitively block muscarinic receptors leading to bronchodilation
Very effective if combined with a SABA
Does not readily enter the CNS
Tiotropium
LAMRA - Asthma and COPD. competitively block muscarinic receptors leading to bronchodilation
Very effective if combined with a SABA
Does not readily enter the CNS
Fluticasone
Inhaled corticosteroid
1st line for chronic asthma
inhibits synthesis of almost every cytokine, inactivates NF-Kb (transcription factor that induces TNF-alpha and other inflammatory agent production)
Side effect: oral thrush–>Use a spacer or wash mouth after use to prevent
Other: beclomethasone, flunisolide, mometasone, circlesonide
Budesonide
Inhaled corticosteroid
1st line for chronic asthma
inhibits synthesis of almost every cytokine, inactivates NF-kB (transcription factor that induces TNF-alpha and other inflammatory agent production). Overall, decreases bronchial reactivity
***Potentiates B-agonists
Side effect: oral thrush (oropharyngeal candidiasis)–>Use a spacer or wash mouth after use to prevent, dysphonia (myopathy of vocal cords)
Zileuton
anti-LEUkotrienes
Asthma
5-lypoxygenase pathway inhibitor. blocks conversion of arachidonic acid to leukotrienes
Side effect: hepatotoxicity
Not commonly presecribed because requires 4x daily dosing
Montelukast
LU - antiLEUkotrienes
block leukotriene receptors
Good for aspirin or exercise induced asthma
Zafirlukast
LU - antiLEUkotrienes
block leukotriene receptors
Good for aspirin or exercise induced asthma
Omalizumab
Monoclonal antibody Anti-IgE therapy
Allergic asthma with high IgE and is resistant to inhaled corticosteroids and LABA
Binds to unbound serum IgE and prevents binding to FEeRI. This prevents interaction with mast cells and basophils
Mepolzumab, Reslizumab, Benralizumab
Monoclonal antibody Anti-IL-5 therapy
Eosinophilic Asthma
Effects maturation and differentiation of eosinophils
Dupilizumab
Monoclonal antibody Anti-IL-13R/IL-4R therapy
Eosinophilic Asthma
Cromolyn
prevent bronchospasm by preventing release of inflammatory mediators from mast cells
Nedocromil
prevent bronchospasm by preventing release of inflammatory mediators from mast cells
Diphenhydramine, dimenhydrinate, chloropheniramine
First genertation anti-histamines
Reversible inhibitor of H1 receptor
Use: allergy, motion sickness, sleep aid
Adverse effects: sedation, antimuscarinic, anti-a-adrenergic
Loratidine, fexofenadine, desloratadine, cetirisine
Second generation anti-histamines
Reversible inhibitor of H1 receptor
Use: allergy
Side effects: LESS sedating than 1st generation because decreased CNS entry
Guafenesin
Exoectorant - thins respiratory secretions, does not suppress cough reflex
N-acetylcysteine
Mucolytic - liquifies mucus in chronic bronchopulmonary diseases (COPD, CF), by disrupting disulfide bonds
Antidote for acetaminophen overdose
Dextromorphan
Antitussive - antagonizes NMDA glutamate receptor
synthetic codeine analog. mild opioid effect in excess –> naloxone is the antidote
Side effects: serotonin syndrome possible if combined with other serotonergic agents
Psuedoephedrine, phenylephrine
alpha adrenergic agonist
USE: Nasal decongestant, reduce hyperemia, reduce edema, open onstructed eustachian tube
Adverse Effects: HTN, rebound congestion, CNS stimulation/anxiety (pseudoephedrine)
Bosentan
endothelian 1 receptor antagonist which decreases PVR
Use: pulmonary HTN
Adverse effects: hepatotoxicity (must monitor LFTs)
NOTE: PDE5 inhibitors (sildenafil) and prostacyclin analogs (epoprostenol, iloprost also used for [pulmonary HTN
Terbutaline
SABA
Increases cAMP
Metaproterenol
SABA
Increases cAMP
