Respiratory

Question 1

1st Gen H1 blockers

Answer 1

Diphenhydramine; Dimenhydrinate; Chlorpheniramine

MOA:
Reversible inhibitors of H1 histamine R’s

Use:
Allergy, motion sickness, sleep aid

Tox:
Sedation, antimuscarinic, anti-alpha-adrenergic

Question 2

2nd Gen H1 blockers

Answer 2

Loratadine; Fexofenadine; Desloratadine

Use:
Allergy

Tox:
Far less sedating than 1st generation because of decreased entry into CNS

Question 3

Guaifenesin

Answer 3

Expectorant–> thinks reap. secretions; does not suppress cough reflex.

Question 4

N-acetylcysteine

Answer 4

Mucolytic–> can loosen mucous plugs in CF pt’s. Also used as an antidote for acetaminophen overdose.

Question 5

Dextromethorphan

Answer 5

MOA:
Antagonizes NMDA glutamate receptors; synthetic codeine analog

Use:
Antitussive

Tox:

• Has mild opioid effects when used in excess.
• Naloxone can be given for ODs.
• Mild abuse potential

Question 6

Pseudoephedrine, Phenylephrine

Answer 6

MOA:
Sympathomimetic α-agonistic nonprescription nasal decongestants.

Use:
↓ hyperemia, edema, and nasal congestion; open obstructed eustachian tubes.
Pseudoephedrine also used illicitly to make methamhetamine

Tox:
HTN
CNS stimulation/anxiety (psudoephedrine).

Question 7

Drugs used or asthma

Answer 7

β-agonist
Methylxanthines
Muscarinic antagonists
Corticosteroids
Antileukotrienes
Omalizumab
Methacholine
Bosentan

Question 8

Albuterol

Answer 8

MOA:
β2 -agonist; Relaxes bronchial smooth muscle

Use:
During acute asthma exacerbation

Question 9

Salmeterol; Formoterol

Answer 9

MOA:
β2 -agonist; long-acting agents

Use:
Prophylaxis (asthma)

Tox:
Tremor; arrhythmia

Question 10

Theophylline

Answer 10

a methylxanthine

MOA:
Bronchodilation by inhibiting phophodiesterase–> ↑cAMP levels due to ↓cAMP hydrolysis.

Use:
Asthma
Limited use b/c of narrow therapeutic index
Metabolized by cyt P-450
Blocks action of adenosine

Tox:
cardiotoxicity
neurotoxicity

Question 11

Ipratropium

Answer 11

MOA:
Competitive block of muscarinic receptors, preventing bronchoconstriction

Use:
Asthma and COPD

Tiotropium is a long-acting muscarinic antagonist

Question 12

Beclomethasone; Fluticasone

Answer 12

MOA:

• Inhibit the synthesis of all cytokines
• Inactivate NF-kB, the transcription factor that induces the production of TNF-α and other inflam agents

Use:
1st line therapy for chronic asthma

Question 13

Montelukast; Zafirlukast

Answer 13

MOA:
Blocks leukotriene receptors
no vasoconstriction, bronchospasm, ↑permeability

Use:
Good for aspirin-induced asthma

Question 14

Zileuton

Answer 14

MOA:
A 5-lipoxygenase pathway inhibitor
Blocks conversion of arachidonic acid to leukotrienes

Use:
Asthma

Question 15

Omalizumab

Answer 15

MOA:
Monoclonal anti-IgE antiB. Binds mostly unbound serum IgE and blocks binding to FcεRI.

Use:
Allergic asthma resistant to inhaled steroids and long-acting β2-agonists

Question 16

Methacholine

Answer 16

MOA:
Muscarinic receptor agonist

Use:
Bronchial provocation challenge to help Dx asthma.

Question 17

Bosentan

Answer 17

MOA:
Competitively antagonizes endothelin-1 receptors, ↓pulmonary vascular resistance.

Use:
To treat plum arterial HTN.

Question 18

Drugs that cause lung fibrosis

Answer 18

• Amiodarone
• Bleomycin
• Mitomycin C
• Busulphan
• Methylsergide