Respiratory Pharmacology Flashcards
antihistamines–mechanism
- reversible inhibitors of H1 histamine receptors
name 3 first generation antihistamines
- diphenhydramine
- dimenhydrinate
- chlorpheniramine
- names contain “-en/-ine” or “-en/-ate”
first generation antihistamines–use
- allergy
- motion sickness
- sleep aid
first generation antihistamines–toxicity
- sedation
- antimuscarinic
- anti alpha adrenergic
name 4 2nd gernation antihistamines
- loratadine
- fexofenadine
- desloratadine
- ceterizine
- names usually end in “-adine”
2nd generation antihitamines–use
- allergy
why are 2nd generation antihistamines less sedating than 1st generation?
- b/c of dec entry into CNS
name 2 expectorants
- guaifenesin
- N-acetylcysteine
guaifenesin–mechanism/use
- expectorant–thins respiratory secretions
- does not suppress cough reflex
N-acetylcysteine–mechanism/use
- mucolytic–liquefies mucus in COPD pts by disrupting disulfide bonds
- also used as an antidote for acetaminophen overdose
dextromethorphan–mechanism
- antitussive–antagonizes NMDA glutamate receptors
- synthetic codeine analog
dextromethorphan–toxicity
- has mild opiod effect when used in excess
- mild abuse potential
- may cause serotonin syndrome if combined with other serotonergic agents
dextromethorphan–antidote
- naloxone can be given for overdose
pseudoephedrine, phenyephrine–mechanism
- alpha adrenergic agonists
- used as nasal decongestants
pseudoephedrine, phenyephrine–use
- reduce hypermia, edema, nasal decongestion
- open obstrucated eustachian tubes
- pseudoephedrine can be used illicitly to make methamphetamine
pseudoephedrine, phenyephrine–toxicity
- HTN
- can be used to cause CNS stimulation/anxiety
- pseudophedrine
name 4 pulmonary hypertension drugs
- Bosentan
- sildenafil
- epoprostenol
- iloprost
BosENtan–mechanism
- competitively antagonizes ENdothelin-1 receptors –> decrease pulmonary vascular resistance
Bosentan–toxicity
- hepatotoxicity
- monitor LFTs
Sildenafil–mechanism
- inhibits cGMP PDE-5
- prolongs vasodilatory effect of nitric oxide
what is another use for Sildenafil beside pulmonary hypertension?
- erectile dysfunction
epoprostenol, isoprost–mechanism
- PGI2 (prostacyclin) with direct vasodilatory effects on pulmonary and systemic arterial vascular beds
- inhibits platelet aggregation
epoprostenol, isoprost–toxicity
- flushing
- jaw pain
how is bronchoconstriction mediated?
- inflammatory processes
- parasympathetic tone
classes of asthma drugs
- beta 2 agonists
- inhaled corticosteroids
- muscarinic antagonists
- antileukotrienes
- anti-IgE monoclonal therapy
- methylxanthines
what are 3 asthma drugs that are beta 2 agonists?
- albuterol
- salmeterol
- formoterol
Albuterol–mechanism
- (beta 2 agonist asthma drug)
- relaxes bronchial smooth muscle–short acting beta 2 agonist
albuterol–use
- (beta 2 agonist asthma drug)
- acute exacerbation
salmeterol, formoterol–use
- (beta 2 agonist asthma drug)
- long acting agent for prophylaxis
salmeterol, formoterol–toxicity
- tremor
- arrhythmia
name 2 inhaled corticosteroids used for asthma
- fluticasone
- budesonide
inhaled corticosteroids–use
- first line for chronic asthma
- fluticasone, budesonide
inhaled corticosteroids–mechanism
- (fluticasone, budesonide)
- inhibit the synthesis of virtually all cytokines
- inactivate NK-kappa B–transcription factor that induces production of TNK-alpha and other inflammatory agents
name the muscarinic antagonist used to treat asthma
- ipratropium
ipratropium–use
- asthma
- COPD
muscarinic antagonists–mechanism
- (ipratropium)
- competitively blocks muscarinic receptors, preventing bronchoconstriction
what is a muscarinic antagonist used for asthma that is long acting?
- tiotropium
name 3 antileukotrienes that are used to treat asthma
- montelukast
- zafirlukast
- zileuton
montelukast, zafirlukast–mechanism
- (antileukotrienes asthma drug)
- block leukotriene receptors (CysLTI)
montelukast, zafirlukast–use
- (antileukotriene)
- aspirin induced astham
zileuton–mechanism
- (antileukotriene)
- 5 lipoxygenase pathway inhibitor
- blocks conversion of arachidonic acid to leukotrienes
zileuton–toxicity
- (antileukotrienes)
- hepatotoxic
name the anti IgE monoclonal therapy used to treat asthma
- omalizumab
omalizumab–mechanism
- (anti IgE monoclonal therapy for asthma)
- binds mostly unbound serum IgE and blocks binding to FcERI
omalizumab–use
- (anti IgE monoclonal therapy)
- used in allergic asthma with increased IgE levels resistant to inhaled steroids and long acting beta 2 agonists
name the methylxanthine used to treat asthma
- theophylline
theophylline–mechanism
- (methylxanthine asthma drug)
- likely causes bronchodilation by inhibiting phosphodiesterase –> inc cAMP levels due to dec cAMP hydrolysis
- metabolized by cytochrome P-450
- blocks action of adenosine
why is the use of theophylline limited?
- (methylxanthine)
- limited b/c of narrow therapeutic index
- cardiotoxicity
- neurotoxicity
methacholine–mechanism
- muscarinic receptor (M3) agonist
methacholine–use
- used in bronchial challenge test ot help diagnose asthma
