Respiratory Drugs

Question 1

When a drug is inhaled ____ goes to the lungs and ____ is swallowed or absorbed into systemic circulation.

Answer 1

• 10-30%

- 70-90%

Question 2

albuterol mechanism

Answer 2

• B2 agonist - raises cAMP production from adenylyl cyclase
• limits airway edema
• short acting (SABA)

Question 3

salmeterol, formoterol mechanism

Answer 3

• B2 agonist - raises cAMP production from adenylyl cyclase
• limits airway edema
• long acting (LABA)

Question 4

use of albuterol

Answer 4

prn for acute asthma exacerbation

Question 5

use of salmeterol, formoterol

Answer 5

• prophylaxis for asthma with ICS
• alone for COPD
• before exercise to prevent EIA

Question 6

fluticasone, budesonide

Answer 6

inhaled corticosteroids

Question 7

mechanism of fluticasone, budesonide

Answer 7

inactivation of NF-kB which is the transcription factor that induces cytokine production, so inhibits synthesis of cytokines

Question 8

use of fluticasone, budesonide

Answer 8

• 1st line for chronic asthma to decrease airway hyper-responsiveness

Question 9

SEs of fluticasone, budesonide

Answer 9

• topical - oral candidiasis, horseness

Question 10

mechanism of ipatropium

Answer 10

M3 antagonist - prevents ACh binding and bronchoconstriction

Question 11

uses of ipatropium

Answer 11

• asthma

- COPD

Question 12

SEs of iptropium

Answer 12

• dry mouth
• urinary retention
• increased IOP

Question 13

mechanism of montelukast, zafirlukast

Answer 13

leukotriene receptor antagonists

Question 14

mechanism of zileuton

Answer 14

inhibits 5-lipoxygenase, blocks leukotriene synthesis

Question 15

mechanism of omalizumab

Answer 15

monoclonal IgE ab - binds unbound IgE and IgE on mast cells and basophils (prevents mast cell degranulation)

Question 16

use of omalizumab

Answer 16

allergic asthma

Question 17

mechanism of theophylline

Answer 17

• causes bronchodilation by inhibiting phosphodiesterase degradation of cAMP
• adenosine antagonist which causes bronchoconstriction

Question 18

SEs of theophylline

Answer 18

low therapeutic window - GI irritation, seizures, tachycarida

Question 19

mechanism of methacholine

Answer 19

M3 agonist used in bronchial challenge to diagnose asthma

Question 20

______ are preferred in peds instead of ICS.

Answer 20

leukotriene mediators

Question 21

The leukotrienes involved in asthma are:

Answer 21

C4, D4, E4

Question 22

mechanism of (-prost-) drugs: beraprost, epoprostenol, iloprost

Answer 22

prostacyclin analogues that induce vasodilation (pulmonary and systemic arterial vascular beds and prevent platelet aggregation

Question 23

SEs of (-prost-) drugs: beraprost, epoprostenol, iloprost

Answer 23

flushing, jaw pain

Question 24

clinical use of (-prost-) drugs: beraprost, epoprostenol, iloprost

Answer 24

pulmonary HTN

Question 25

mechanism of -sentan drugs: bosentan

Answer 25

competitive endothelin-1 receptor antagonist - prevents vasoconstriction and lowers pulmonary vascular resistance

Question 26

SEs of -sentan drugs: bosentan

Answer 26

hepatotoxicity

Question 27

clinical use of -sentan drugs: bosentan

Answer 27

pulmonary HTN

Question 28

mechanism of sildenafil

Answer 28

PDE5 inhibitor - prevents breakdown of cGMP and so prolongs vasodilation via NO

Question 29

clinical use of sildenafil

Answer 29

ED (oral), pulm HTN (inhaled)

Question 30

mechanism of riociguat

Answer 30

guanalyl cyclase stimulator –> more cGMP –> more vasodilation

Question 31

clinical use of riociguat

Answer 31

pulmonary HTN