Respiratory

Question 1

Beta2 adrenergic agonists SABA

Answer 1

Drugs- albuterol, levalbuterol
Relax smooth muscle in airway
Quick relief for asthma symptoms
Onset 5-30 minutes, last 4-6 hours
No anti inflammatory effects
ADE- tachycardia; elevated BS; low potassium; low magnesium, tremors,
“SABA”

Question 2

Beta 2 adrenergic agonist LABAs

Answer 2

Long term control” LABA”
Drug- salmeterol, arformoterol; indacaterol, olodaterol
12 hours duration of action
Mono therapy contraindicated in asthma
Often used with inhaled steroids
ADE- similar to SABAS

Question 3

Corticosteroids

Answer 3

DOC for asthma
Drug- fluticasone, beclomethasone, budesonide, ciclesonide, mometasone, triamcinolone
MOA- inhibit release of arachiodonic acid and direct anti inflammatory properties
PO/inhaled/Iv
ADE- oral candidiasis,

Question 4

Leukotriene modifiers

Answer 4

MOA- part of inflammatory cascade, that cause constriction of smooth muscle, endothelial permeability, and mucus production.
Drugs- montelukast, zafirukast
Uses- asthma symptoms when immediate bronchodilator not needed, allergies
ADE- elevated LFTs, HA, dyspepsia, churg Strauss syndrome
D-D- CYP450

Question 5

Cromolyn

Answer 5

Preventive anti inflammatory agent that inhibits mast cell degradation and release of antihistamines
Neb/PO
Not fast acting
ADE- minor cough; irritation, unpleasant taste

Question 6

Cholinergic antagonist SAMA

Answer 6

MOA- blocks vagally medicated contractions of smooth airway muscle and mucus production
Drugs- ipratropium (atrovent), tiotropium (spiriva)
Not used for acute bronchospams
Often used with albuterol
ADE- xerostomia; bitter taste

Question 7

Theophylline

Answer 7

Bronchodilator that relives airflow obstruction
May possess anti inflammatory activity
Narrow therapeutic index,
Many ADE, OD and seizures

Question 8

Monoclonal antibodies

Answer 8

Drugs- omalizumab (xolair), mepolizumab (nucala), bentalizumab (fascenra), reslizumab (cinqair), dupliumab (dupixent)
MOA- binds to IgE
Use is limited by cost
ADE- severe anaphylaxis, rash, infections

Question 9

Roflumilast (daliresp)

Answer 9

Oral PDE4 inhibitors for severe COPD to reduce exacerbations
Reduce inflammation by increased levels of cAMP in lungs
Not a bronchodilator
ADE- many, weight loss, nausea, diarrhea; HA

Question 10

1st generation antihistamine

Answer 10

Drugs- diphenhydramine (benadryl), chlorpheniramine (chlor timeton), hydroxyzine (vistari/atarax), cyproheptadine (periactin), meclizine (antivert), doxylamine (sominex), dimenhydrinate (dramamine)
MOA- blocked h1 receptors fast onset
ADE- sedation, performance impairment; anticholinergic

Question 11

2 nd generation antihistamine

Answer 11

Drugs- azelastine (astelin), cetrizine (zyrtec), desloratidine (clarinex), fexofenadine (allegra), loratidine (Claritin)
Better tolerate than 1st

Question 12

Nasal steroids

Answer 12

Onset 3-36 hours after 1st dose, 1-2 weeks to max effects
Intra nasal most likely effective for AR
Drugs- ciclesonide (zetonna), beclomethasone (beconase), budesonide (rhinicort), fluticasone (flovent), mometasone (nasonex), flunisolide (nasalrel), triamcinolone
Few ADE- nasal irritation; nose bleed, sore throat; candidiasis

Question 13

Alpha adrenergic agonist

Answer 13

Short acting decongestants
Drugs- pseudoephedrine, phenylephrine, neo synephrine, afrin
Rapid onset do not use longer than 3 days rebound congestion

Question 14

Opioids

Answer 14

Codeine for cough decreases sensitivity in cough center in CNS

Question 15

Dextromethorphan

Answer 15

For cough
Synthetic derivative of MSO4 with no analgesic effect
Fewer ADE than codeine
Low doses has potentially addictive effects

Question 16

Guafenesin

Answer 16

Expectorant
Used in combo with codeine or dextromorphan

Question 17

Benzonatate (tessalon pearls)

Answer 17

Suppresses cough reflex through peripheral action
Anesthetizes the stretch receptor located in the respiratory passes of lungs and pleura
ADE- dizziness, numbness of tongue, mouth throat,