Respiratory Drugs

Question 1

Salmeterol, Formoterol, Indacaterol

Answer 1

Long acting B2 agonists that have an extended lipophilic side chain causing them to remain in tissue for an extended period of time; should only be used for prophylactic therapy and not acute attacks

Indacaterol ➡️ indicated for COPD

***Must prescribe anti-inflammatories to go with this drug

ADRs: Similar to short acting; corticosteroids will help prevent tolerance

Question 2

Ipratropium, Tiotropium

Answer 2

Muscarinic antagonists that prevent the Ach stimulated increase in cGMP respiratory smooth muscle cells

Commonly used in combo w/ b2 agonists as they have mixed results alone; Ipratropium can be used for rhinitis

ADRs: Bitter taste, xerostomia, glaucoma if sprayed in eye

Question 3

Theophylline

Answer 3

PDE inhibitor, adenosine-receptor antagonist, anti-inflammatory, and promotes contraction of diaphragm

-Commonly used on pts. whose asthma is not controlled by SABA/corticosteroid therapy; caffeine (another methylxanthine) can be given to preterm infants

CYP metabolized

ADRs: Low levels- N/V High levels- Seizure, arrhythmia
***LOW TI

Question 4

Beclomethasone, Budesonide, Triamcinolone Acetate

Answer 4

MOA in respiratory disease: Anti-inflammatory by inhibiting production of prostaglandins and leukotrienes
*****UPREGULATE B2 RECEPTOR EXPRESSION
Commonly given as a combo inhaler w/ LABAs

-Indicated for acute exacerbations of asthma and severe COPD

ADRs: Dysphonia, oral/pharyngeal candidiasis

Question 5

Albuterol, Terbutaline

Answer 5

Short acting B2 agonists; used to reverse asthmatic attacks

-Should only be used rarely (acutely), if it is used frequently, it indicates a need for anti-inflammatory therapy (glucocorticoids)

ADRs: Tremors, anxiety, tachycardia, tolerance (downregulation of B2 receptors)

Question 6

Zafirlukast, Montelukast

Answer 6

MOA: Leukotriene receptor antagonists that inhibit bronchoconstriction and smooth muscle contraction

-Alternative to corticosteroids if they are not tolerated

ADRs: Hepatoxicity; Zafirlukast=CYP inhibitor; Montelukast=mildest

Question 7

Zileuton

Answer 7

MOA: Inhibits lipooxygenase

Same uses as Zafirlukast and Montelukast

ADRs: SEVERE hepatotoxicity; fever, chills; CYP inhibition

Question 8

Omalizumab

Answer 8

MOA: IgE antibody tht inhibits its binding to mast cells

-Effective therapy reserved for severe COPD not responding to other therapy

ADRs: Anaphylaxis

Question 9

Drugs used for cough

Answer 9

Opiods (hydrocodone, codeine) that directly inhibit the cough center in the medulla and dextromorphan (inhibits NMDA receptors)

ADRs: Respiratory depression (bad for asthma), dysphoria, fatigue, addiction

Question 10

Guaifenesin

Answer 10

Mucolytic drug that is used as an expectorant (Mucinex)

Question 11

N-acetylcysteine

Answer 11

Mucolytic drug that cleaves disulfide bonds; indicated for acetaminophen OD, chronic bronchitis, and sometimes CF

Question 12

Dornase alpha

Answer 12

DNAse that thins mucous and is the DOC for CF pts.

Question 13

Oxymetazoline, pseudoephrine

Answer 13

Symptomatic adrenergic a-agonist that constrict swollen nasal mucosa

ADRs: Rebound nasal congestion, HTN, tachycardia, nausea

Question 14

Benzonatate

Answer 14

Cough suppressant that works thru stimulation of peripheral vagal fibers

ADRs: Dizziness

Question 15

Pneumoniae assoc. With effusions

Answer 15

Staph and strep

Question 16

SIRS Tx

Answer 16

Antibiotics and FLUIDS

Question 17

Anaerobic suspicion

Answer 17

Poor dentition

Vomiting

Alcohol

Aspiration

Question 18

Hospital assoc. Pneumonia

Answer 18

GNR OR STAPH

Legionella also possible, would see Hyponatremia