Resp Pharm

Question 1

What is the mechanism of diphenhydramine, dimenhydrinate, chlorphiramine?

Answer 1

1st gen H1 blockers - reversible inhibitors of H1 histamine receptors (found in nasal/bronchioles).

Question 2

What are the clinical uses of diphenhydramine, dimenhydrinate, chlorphiramine?

Answer 2

Allergy, motion sickness, sleep aid.

Question 3

What are the toxicities of diphenhydramine, dimenhydrinate, chlorphiramine?

Answer 3

Sedation, also anti-muscarinic, anti-alphaadrenergic.

Question 4

What is the mechanism of Loratadine, fexofenadine, desloratadine, cetirizine?

Answer 4

2nd gen H1 blockers - reversible inhibitors of H1 histamine receptors (found in nasal/bronchioles). Decreased entry into CNS.

Question 5

What are the clinical uses for Loratadine, fexofenadine, desloratadine, cetirizine?

Answer 5

Allergy. Far less sedating than 1st generation because of decreased CNS penetration.

Question 6

What is the mechanism of guaifenesin?

Answer 6

Expectorant. Thins respiratory secretions, does not suppress cough reflex.

Question 7

What is the mechanism of N-acetylcysteine?

Answer 7

Mucolytic- can loosen CF plugs in CF patients by disrupting disulfide bonds. Also used as antidote for acetominophen overdose.

Question 8

What is the mechanism of dextromethorphan?

Answer 8

Antitussive - antagonists NMDA glutamate receptors. Synthetic codeine analog.

Question 9

What is the toxicity of dextromethorphan?

Answer 9

Mild opiod effect when used in excess. Mild abuse potential. Nalaxone for overdose. MAy cause serotonin syndrome if combined with other drugs.

Question 10

What is the mechanism of Pseudoephedrine, phenylephrine?

Answer 10

α-adrenergic agonists, used as nasal decongestants.

Question 11

What is the clinical use of Pseudoephedrine, phenylephrine?

Answer 11

Reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes. Pseudoephedrine
also illicitly used to make methamphetamine.

Question 12

What is the toxicity of Pseudoephedrine, phenylephrine?

Answer 12

Hypertension. Can also cause CNS stimulation/anxiety (pseudoephedrine).

Question 13

What is the mechanism of drugs such as bosentan?

Answer 13

Endothelin-1-receptor antagonists. Competitively antagonize endothelin-1 receptors Ž pulmonary vascular
resistance.

Question 14

What is the toxicity of bosentan?

Answer 14

Hepatotoxic, monitor LFTs.

Question 15

What is the mechanism of sildenafil?

Answer 15

PDE-5 inhibitors. Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide.

Question 16

What is the clinical use of bosentan?

Answer 16

Pulmonary HTN

Question 17

What is the clinical use of sildenafil?

Answer 17

Pulmonary HTN, erectile dysfunction.

Question 18

What is the mechanism of epoprostenol, iloprost?

Answer 18

Prostacyclin analogs. PGI2 with with direct vasodilatory effects on pulmonary and systemic arterial vascular beds. Inhibit platelet aggregation.

Question 19

What is the clinical use of epoprostenol, iloprost?

Answer 19

Pulmonary HTN

Question 20

What is the toxicity of epoprostenol, iloprost?

Answer 20

Flushing, jaw pain.

Question 21

What is the mechanism of albuterol?

Answer 21

B2-agonist. Relaxes bronchial smooth muscle. Fast-acting.

Question 22

What is the clinical use of albuterol?

Answer 22

Used during acute asthma exacerbation.

Question 23

What is the mechanism of salmeterol, formoterol?

Answer 23

B2-agonists, long-acting agents for prophylaxis of asthma exacerbations.

Question 24

What is the toxicity of salmeterol, formoterol?

Answer 24

Tremor, arrythmia.

Question 25

What is the mechanism of action of fluticasone, budesonide?

Answer 25

Corticosteroids. budesonide—inhibit the synthesis of virtually all cytokines. Inactivate NF-κB, the transcription factor that induces production of TNF-α and other inflammatory agents.

Question 26

What is the clinical use for fluticasone, budesonide?

Answer 26

First line therapy for chronic asthma.

Question 27

What is the mechanism of ipratropium/tiotropium?

Answer 27

Muscarinic antagonists. Competitively blocks muscarinic receptors, preventing bronchoconstriction. Tiotropium is long-acting.

Question 28

What is the clinical use for ipratropium/tiotropium?

Answer 28

Asthma, COPD.

Question 29

What is the mechanism of Montelukast, zafirlukast

Answer 29

Antileukotrienes. —block leukotriene receptors (CysLT1). Especially good for aspirin-induced asthma.

Question 30

What is the mechanism of Zileuton?

Answer 30

Antileukotrienes. 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes..

Question 31

What is the toxicity of Zileuton?

Answer 31

Hepatotoxic

Question 32

What is the mechanism of omalizumab?

Answer 32

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE and blocks binding to FcεRI..

Question 33

What is the clinical use of omalizumab?

Answer 33

Used in allergic asthma resistant to inhaled steroids and long-acting β2 -agonists.

Question 34

What is the mechanism of theophylline?

Answer 34

Methylxanthine. Theophylline—likely causes bronchodilation by inhibiting phosphodiesterase. Blocks adenosine (which increases bronchoconstriction). Ž Decr cAMP levels due to  cAMP hydrolysis.

Question 35

What is the clinical use and toxicity of theophylline?

Answer 35

Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome P-450.

Question 36

What is the mechanism of methacholine?

Answer 36

Muscarinic receptor (M3) agonist.

Question 37

What is the clinical use of methacholine?

Answer 37

Used in bronchial challenge test to help diagnose asthma.