Respiratory

Question 1

Ipratropium, tiotropium

Answer 1

Competitive block of M3 receptors preventing bronchoconstriction in asthma

poorly absorbed so few systemic anticholinergic effects
Tiotropium: Used for COPD
Tio is longer acting

Question 2

Guaifenesin

Answer 2

Expectorant
Thins respiratory secretions

Does not suppress cough reflex

Question 3

Loratadine, fexofenadine, desloratadine, cetirizine

Answer 3

2nd generation reversible histamine inhibitors

Clinical: Allergy

Less sedation because they don’t cross BBB

Question 4

Salmeterol, formoterol

Answer 4

B2 agonists
long acting agents for prophylaxis of asthma

Adverse effects: tremor and arrhythmia

Question 5

Crizotinib

Answer 5

Targets fusion protein of EML4 and ALK in a particular non small cell carcinoma inhibiting constitutive tyrosine kinase activity

Question 6

Theophylline

Answer 6

Methylxanthine-used in asthma
Causes bronchodilation by inhibiting phosphodiesterase increasing cAMP levels due to decreased cAMP hydrolysis (leads to decreased leukotriene synthesis)

Usage limited due to narrow therapeutic index (cardiotoxicity and neurotoxicity)

Metabolized by Cytochrome p-450

Blocks actions of adenosine (adenosine causes bronchoconstriction)

Side effects: acute-arousal and insomnia
Intoxification: abdominal pain, vomiting, diarrhrea, cardiac arrhythmias, seizures (major morbidity and mortality cause)

Treatment of toxicity: gastric lavage, activated charcoal and cathartic a

Interactions with cimetidine, ciprofloxacin, erythromycin, clarithromycin, verapamil which can raise concentration

Question 7

Pseudopephedrine, phenylephrine, xyloetazoline, oxymetazoline

Answer 7

Sympathomimetic a-agonistic nonprescrition nasal decongestants

Clinical: reduce hyperemia, edema and nasal congestion, open obstructed eustachian tubes

Pseudopephedrine can be used to make meth

Toxicity: hypertension, CNS stimulation/anxiety (pseudo)

Decrease in effect after a few days of use (tachyphylaxis) leading to decreases endogenous NE (decreased negative feedback) which leads to vasodilation and subsequent edema and congestion exacerbating nasal symptoms (stop using the medication)

Question 8

Bosentan

Answer 8

Used to treat pulmonary arterial hypertension.
Competitively antagonizes endothelin-1 receptors,
Decreases pulmonary vascular resistance

Question 9

N-acetylcysteine

Answer 9

Mucolytic

Can loosen mucous plugs in CF patients

Antidote for acetaminphen overdose

Question 10

Montelukast, zafirlukast

Answer 10

Block leukotriene receptors

Especially good for aspirin induced asthma

Question 11

Cromolyn sodium

Answer 11

Prevents mast cell and nedocromil degranulation

Used in asthma prophylaxis
Less effective than corticosteroids

Used for seasonal symptoms, aspirin hypersensitivity, and exercise induced asthma

Question 12

Methacholine

Answer 12

Muscarinic receptor agonist
Used in bronchial provocation challenge to help diagnose asthma

Decrease in FEV1 >20%
Sensitive-Used to rule out

Question 13

Diphenhydraine, dimenhydrinate, chlropheniraine, meclinzine

Answer 13

1st generation reversible histamine inhibitors

Clinical: allergy, motion sickness (Dimenhydrinate-less sedation), sleep aid

Toxicity: sedation, antimuscarinic, anti-a-adrnergic (dry mouth)

Question 14

Zileuton

Answer 14

antileukotriene
used in asthma
5-lipoxygenase pathway inhibitor
Blocks conversion of arachidonic acid to leukotrienes

Question 15

Albuterol

Answer 15

Relaxes bronchial smooth muscle
B2 agonist

Used during acute asthma exacerbation

Question 16

Omalizumab

Answer 16

Monoclonal anti IgE antibody
Binds mostly unbound serum IgE and blocks binding to FcERI
Used in allergic asthma that isresistant to inhaled steroids and long-acting B2 agonists

Question 17

Dextromethorphan

Answer 17

Antitussive
MOA: antagonizes NMDA glutamate receptors

Synthetic codeine analog-abuse potential

Has mild opioid effect when used in excess

Nalaxone given for overdose

Question 18

flunisolide, beclomethasone, flutiscasone

Answer 18

Corticosteroids
Initial treatment of chronic asthma

inhibit synthesis of virtually all cytokines
inactivate NF-kB the transcription factor that induces the production of TNF-a and other inflammatory agents

AE: oral candidiasis-rinse mouth and use spacer
Dysphonia