Pulmonology

Question 1

albuterol

Answer 1

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

Question 2

Salmeterol

Answer 2

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)

Question 3

Formoterol

Answer 3

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)

Question 4

Theophylline

Answer 4

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

Question 5

Atropine

Answer 5

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

Question 6

Ipratropium

Answer 6

SAMRA - Asthma and COPD. competitively block muscarinic receptors leading to bronchodilation
Very effective if combined with a SABA
Does not readily enter the CNS

Question 7

Tiotropium

Answer 7

LAMRA - Asthma and COPD. competitively block muscarinic receptors leading to bronchodilation
Very effective if combined with a SABA
Does not readily enter the CNS

Question 8

Fluticasone

Answer 8

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

Question 9

Budesonide

Answer 9

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)

Question 10

Zileuton

Answer 10

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

Question 11

Montelukast

Answer 11

LU - antiLEUkotrienes
block leukotriene receptors
Good for aspirin or exercise induced asthma

Question 12

Zafirlukast

Answer 12

LU - antiLEUkotrienes
block leukotriene receptors
Good for aspirin or exercise induced asthma

Question 13

Omalizumab

Answer 13

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

Question 14

Mepolzumab, Reslizumab, Benralizumab

Answer 14

Monoclonal antibody Anti-IL-5 therapy
Eosinophilic Asthma
Effects maturation and differentiation of eosinophils

Question 15

Dupilizumab

Answer 15

Monoclonal antibody Anti-IL-13R/IL-4R therapy

Eosinophilic Asthma

Question 16

Cromolyn

Answer 16

prevent bronchospasm by preventing release of inflammatory mediators from mast cells

Question 17

Nedocromil

Answer 17

prevent bronchospasm by preventing release of inflammatory mediators from mast cells

Question 18

Diphenhydramine, dimenhydrinate, chloropheniramine

Answer 18

First genertation anti-histamines
Reversible inhibitor of H1 receptor
Use: allergy, motion sickness, sleep aid
Adverse effects: sedation, antimuscarinic, anti-a-adrenergic

Question 19

Loratidine, fexofenadine, desloratadine, cetirisine

Answer 19

Second generation anti-histamines
Reversible inhibitor of H1 receptor
Use: allergy
Side effects: LESS sedating than 1st generation because decreased CNS entry

Question 20

Guafenesin

Answer 20

Exoectorant - thins respiratory secretions, does not suppress cough reflex

Question 21

N-acetylcysteine

Answer 21

Mucolytic - liquifies mucus in chronic bronchopulmonary diseases (COPD, CF), by disrupting disulfide bonds
Antidote for acetaminophen overdose

Question 22

Dextromorphan

Answer 22

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

Question 23

Psuedoephedrine, phenylephrine

Answer 23

alpha adrenergic agonist
USE: Nasal decongestant, reduce hyperemia, reduce edema, open onstructed eustachian tube
Adverse Effects: HTN, rebound congestion, CNS stimulation/anxiety (pseudoephedrine)

Question 24

Bosentan

Answer 24

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

Question 25

Terbutaline

Answer 25

SABA

Increases cAMP

Question 26

Metaproterenol

Answer 26

SABA

Increases cAMP