Respiratory Drugs

Question 1

Albuterol / Terbutaline / Pirbuterol

Answer 1

Inhaled SABA (short acting β2 agonist)

Question 2

Salmeterol / Formoterol

Answer 2

Inhaled LABA (long acting β2 agonist)

Question 3

Ipratropium

Answer 3

Inhaled SAMA (short acting muscarinic antagonist)

Question 4

Tiotropium

Answer 4

LAMA (long acting muscarinic antagonist)

Question 5

Theophylline / Aminophylline

Answer 5

Methylxantines
MOA: increase cAMP and induce bronchodilation via inhibition of PDE
Use: alt therapy for pt w/ persistent asthma
PK: narrow therapeutic window
SE: N/D, tachyarrhythmias, sz, hypokalemia, hyperglycemia

Question 6

Beclomethasone / Budesonide / Flunisolide / Fluticasone / Mometasone / Triamcinolone

Answer 6

Inhaled corticosteroids (ICS)
MOA: inhibit proinflammatory cytokine transcription, inhibit phospholipase A2 and inhibit the transcription of COX-2
Use: prevent desensitization of β-2 receptors in prolonged SABA use

Question 7

Prednisolone / Methylprednisolone

Answer 7

Systemic (oral or oral/IV) corticosteroids
Use: short course for moderate and severe acute exacerbation of asthma to seed recovery and prevent recurrence
SE: hypercortisolism or Cushing’s syndrome

Question 8

Cromolyn sodium / Nedocromil

Answer 8

Release inhibitors
MOA: prevent degranulation of mast cells by inhibiting delayed Cl- channels in membrane
Effect: 👇🏽histamine, 👇🏽LTEs
Use: pt w/ mild persistent asthma, prevent exercise induces bronchospasm
SE: cough, dry mouth, chest tightness, dermatitis, myositis, GI sx’s

Question 9

Omalizumab

Answer 9

Immunomodulator (monoclonal Ab)
MOA: prevents binding of IgE to high-affinity receptors on basophils and mast cells
Effect: 👇🏽activation of basophils and mast cells
Use: pt’s w/ severe persistent asthma w/ evidence of allergy
SE: anaphylaxis

Question 10

Montelukast / Zafirlukast

Answer 10

Leukotriene receptor antagonists (LTRAs)

Question 11

Zileuton

Answer 11

5-LOX inhibitor
Effect: 👇🏽LTEs
Use: management of pt w/ Aspirin-exacerbated respiratory dz
SE: hepatotoxidcity, inhibits CYP450 IA2 so may increase serum concentration of Theophylline

Question 12

N-Acetylcysteine (NAC)

Answer 12

MOA: opens disulfide linkages in mucous
Effect: lowers mucous viscosity

Question 13

Diphenhydramine / Chlorpheniramine

Answer 13

1st generation antihistamines

Question 14

Loratadine / Fexofenadine / Cetirizine

Answer 14

2nd generation antihistamine

Question 15

Montelukast

Answer 15

Leukotriene receptor antagonist (LTRA)
Use: allergic rhinitis
SE: neuropsychiatric changes (depression, anxiety, SI, insomnia)

Question 16

Codeine / Dextromethorphan

Answer 16

MOA: suppression of cough reflex via direct action on cough center in the medulla of the brain
SE: constipation and drowsiness
*Dextromethorphan - safer and lower abuse potential than Codeine