Resp Drugs

Question 1

Diphenhydramine, Chlorpheniramine

Answer 1

1st generation H1 blockers - reversible
Use: Allergy, motion sickness, sleep aid
Tox: Sedation, anti-muscarinic, anti-alpha-adrenergic

Question 2

Loratadine, fexofenadine, deloratidine, cetirizine

Answer 2

-adines
2nd generation H1 blockers - reversible
Use: Allergy
Tox: less sedating than 1st generation due to decreased entry into CNS

Question 3

Guaifenesin

Answer 3

Expectorant - thins resp secretions; does not suppress cough reflex

Question 4

N-acetylcysteine

Answer 4

Mucolytic - loosen mucous plugs in CF patients; disrupts disulfide bonds
Also antidote for acetaminophen overdose

Question 5

Dextromethorphan

Answer 5

Antitussive (relieve cough)
Antagonizes NMDA glutamate receptors
Codeine analog
Opiod effect if excess; Naloxone for opioid overdose
Can cause Serotonin syndrome

Question 6

Pseudophedrine, phenylephrine

Answer 6

Alpha adrenergic agonists - nasal decongestant

Use: reduce hyperemia, edema, nasal congestion;
open obstructed eustachian tubes
(psuedo used to make meth)

Tox: HTN, CNS stimulation/anxiety

Question 7

Bosentan

Answer 7

Pulmonary hypertension drug

Endothelin receptor antagonists -> decrease pulmonary vascular resistance

Question 8

Sildenafil

Answer 8

Pulmonary HTN drug
PDE5 inhibitor
cGMP PDE5 inhibitor; Prolong Vasodilator effect of NO
Also used to treat Erectile Dysfunction

Question 9

Epoprostenol, Iloprost

Answer 9

Prostacyclin analog (PGI2) - vasodilators
direct pulmonary vasodilator and on systemic arteries
Inhibits platelet aggregation

Tox: Flushing, jaw pain

Question 10

Asthma drug targets

Answer 10

Bronchoconstriction mediated by

1) inflammatory process
2) parasympathetic tone (Ach) -> bronchoconstriction

Question 11

Albuterol

Answer 11

short acting B2 agonist; relaxes bronchial smooth muscle

Use: Acute exacerbation

Question 12

Salmeterol, formoterol

Answer 12

Long acting B2 agonist
Use: prophylaxis

Tox: tremors, arrhythmia

Question 13

Fluticasone, budenoside

Answer 13

Corticosteroids
Inhibit Cytokine synthesis: inactivate NF-kB (Trxn factor) that induce TNF-alpha and other inflammatory agents

Use: 1st line for chronic asthma

Question 14

Ipratropium

Answer 14

Muscarinic antagonist (blocks Ach receptors) -> prevents bronchoconstriction

Use: Asthma. also for COPD

Question 15

Montelukast, Zafirlukast

Answer 15

Antileukotriene
Leukotrience receptor blocker

Use: esp for Aspirin induced asthma

Question 16

Zileuton

Answer 16

Antileukotriene

Moa: 5-lipoxygenase pathway inhibitor; Blocks conversion of Arachidonic acid to leukotrienes
Use: Asthma

Tox: Hepatotoxicity

Question 17

Omalizumab

Answer 17

Monoclonal anti-IgE antibody

BInds IgE on mast cells and unbound IgE
Use: Allergic asthma RESISTANT to inhaled steroids and long acting Beta agonists

Question 18

Theophylline

Answer 18

Methylxanthines

Bronchodilation by Inhibiting PDE -> increase cAMP
(PDE hydrolyzes cAMP)
Also blocks Adenosine (induces bronchoconstriction)

Use: limited due to narrow therapeutic index - causes cardio and neurotoxicity
Metabolized by CytP450

Question 19

Methacholine

Answer 19

M3 agonist

Bronchial challenge test - diagnose asthma