Respiratory - Pharmacology Flashcards
Diphenhydramine, Dimenhydrinate, Chlorpheniramine
-ine/-ate
First generation H1 blockers
Tx: Allergies, motion sickness, sleep aid
Side effects: Sedation, anti-muscarinic, anti-alpha adrenergic
LACK EFFICACY IN ASTHMA
Loratidine, Fexofenadine, Desloratadine (-adine)
Second generation H1 blockers
Tx: Allergy
Does not cross CNS barrier, so no sedation
LACK EFFICACY IN ASTHMA
Methylxanthines
Caffeine, Theophylline
Theophylline - Use
Inhibits PDE, increasing cAMP levels and reducing bronchoconstriction
Also inhibits actions of adenosine on lungs (Gi, decreases cAMP)
Anti-inflammatory effect is far less than glucocorticoids
Theophylline - Toxicity
Blocks actions of adenosine (Class V antiarrhythmic) on heart
Narrow therapeutic index
Metabolized by P450
Erythromycin increase serum concentration
Toxicity: Seizures
Beclomethasone, Fluticasone
Corticosteroids
Inhibits synthesis of cytokines, inactivates NF-kB
First line therapy for chronic asthma (after short-acting bronchodilator as needed) - most effective prophylaxis for bronchial asthma
-Lukasts (Montelukast, Zafirlukast)
Block LT receptors; especially good for aspirin-induced asthma
Effects of LC4,D4,E4 –> vasoconstriction (SM on blood vessels), bronchoconstriction (bronchial smooth muscle), increased vascular permeability (pericytes)
Zilueton
5-lipoxygenase pathway inhibitor - blocks conversion of AA to LTs
Omalizumab
Monoclonal IgE antibody that binds mostly unbound serum IgE - used in allergic asthma that is resistant to steroids and long-acting beta agonists
Guaifenesin
Expectorant - induces thinning of respiratory secretions, does not suppress cough reflex
N-acetylcysteine
Mucolytic - can loosen mucous plugs in CF patients by breaking disulfide bonds
Also used as antidote in acetomenaphin overdose (increases GSH)
Bosentan
Used to treat pulmonary HTN
Antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance
Dextromethorphan
Anti-tussive (cough suppressant) Antagonizes NMDA receptors Synthetic codeine analog, has mild opioid effect when used in excess Naloxene given for OD Mild abuse potential
Cromolyn and Nedocromil
Mast cell stabilizer - inhibit degranulation of mast cells
Typically used for prevention of acute attacks
Less efficacious than glucocorticoids
Glycopyrolate
Anticholinergic “Glider Pirate”
Decreases bronchial secretions
Also reduces stomach acid secretion
Ipaptropium
“Eye Patrol”
Tiotropium = Longer acting
Anticholinergic used in COPD and asthma
