RAT21- Respiratory Drugs

Question 1

Indacaterol, Vilanterol

Answer 1

Very long-acting (1xD) selective β2 agonist (rapid onset with inda); asthma prophylaxis (steps 3-6) + B-D COPD

Question 2

Tiotropium

Answer 2

Long-acting (1xD), selective muscarinic 3 receptor antagonist, causes bronchial sm. muscle relaxation and inhibits mucus secretion; sever asthma (5-6), COPD (B-D) available both oral/inhalational

Question 3

Phenylephrine, Oxymetazoline, Pseudoephrine

Answer 3

A1 agonists, activates PLC and causes vasoconstriction; nasal decongestion best if applied topically

Question 4

Salmeterol

Answer 4

Slow-acting, long duration (2xD) selective β2 agonist; asthma prophylaxis, used as Advair and in category B-D COPD

Question 5

Albuterol

Answer 5

Rapid-acting, short duration β2 agonist, activates adenyl cyclase; bronchospasm, acute asthma attack, acute exacerbation of COPD *Use for all stages

Question 6

Omalizumab

Answer 6

humanized Ab against IgE- interferes with IgE binding to mast cells in bronchi and basophils; asthma-allergy (consider in 5-6); injected 1/2xM

Question 7

Vilanterol + Fluticasone (Breo Ellipta)

Answer 7

Very long-acting selective β2 agonist + inhaled glucocorticoid; asthma prophylaxis (steps 3-6) + C-D COPD

Question 8

Fluticasone, Beclomethasone, Mometasone, Ciclesonide

Answer 8

Glucocorticoid nasal sprays, inhibits mast cell mediator synthesis and leukocyte chemotaxis; chronic allergy

Question 9

Formoterol

Answer 9

Rapid-acting, long duration (2xD) selective β2 agonist; asthma prophylaxis, used as Symbicort and in category B-D COPD

Question 10

Albuterol + Ipratropium (Combivent)

Answer 10

Rapid-acting, short duration β2 agonist + slow onset short-acting muscarinic antagonist, ipra inhibits bronchial mucosal secretion; severe asthma attack, all stages, and acute COPD

Question 11

Fluticasone, Budesonide, Memetasone

Answer 11

Inhaled glucocorticoids, low bioavailability to limit SE; Asthma (2-6), COPD (C-D) SE: increased risk of pneumonia due to local immunosuppression

Question 12

Loratidine

Answer 12

H1 antagonist (excludes CNS effects); allergy

Question 13

Roflumilast

Answer 13

selective PDE4 inhibitor; prophylaxis of chronic bronchitis, oral

Question 14

Vilanterol + Umedclidnium (Anoro Ellipta)

Answer 14

Very long-acting selective β2 agonist + long-acting muscarinic antagonist provides maximum bronchodilation; B-D COPD when all else fails

Question 15

Montelukast

Answer 15

Anti-leukotriene, CysLT1 receptor antagonist (bronchodilation and anti-inflammatory); asthma (consider in 2-4, add-on in 5), chronic allergy, oral

Question 16

Diphenhydramine, Chlorpheniramine

Answer 16

Oral H1 and muscarinic antagonist (in CNS), chlorpheniramine has less anti-muscarinic; allergy, insomnia, motion sickness, URTI, SE: Sedation

Question 17

Cromolyn, Nedocromil

Answer 17

Mast cell stabilizer by blocking Ca++ dependent Cl- channels on mast cells, inhibits degranulation and leukocyte chemotaxis; asthma + (prophylaxis if given way in advance regularly), oral and inhalational

Question 18

Fluticasone + Salmeterol (Advair)

Answer 18

Inhaled glucocorticoid + slow-acting, long duration β2 agonist; Asthma (3-6), COPD (C-D)

Question 19

Budesonide + Formoterol (Symbicort)

Answer 19

Inhaled glucocorticoid + rapid-acting, long duration β2 agonist; Asthma (3-6), COPD (C-D)

Question 20

Prednisolone

Answer 20

Oral glucocorticoid: 1) inhibits mast cell mediator synthesis, 2) Reduces leukocyte chemotaxis, 3) Upregulates β2 receptor number and sensitivity, 4) Reduce NF-kB expression, 5) Suppress cytokine production; acute asthma attack after Combivent, asthma prophylaxis (step 6) SE: thin skin, osteoporosis, poor wound healing

Question 21

Theophylline

Answer 21

PDE4 inhibitor; asthma prophylaxis (consder 2-4, add-on in 5), oral/IV, SE: Caffeine-like, competes with CYP metabolism

Question 22

Umedclidnium

Answer 22

Long-acting (1xD), selective muscarinic 3 antagonist; COPD (B-D), inhalational