respiratory pharmacology

Question 1

first generation H1 blockers

Answer 1

reversible; diphenhydramine, dimenhydrinate, chlorpheniramine; used for allergies, motion sickness, sleep aid; can cause sedation, antimuscarinic and anti alpha adrenergic things

Question 2

second generation H1 blockers

Answer 2

loratadine, fexofenide, desloratadine, cetirizine; used for allergies; far less sedating than first gen h1 blockers because of decreased entry into the CNS

Question 3

guaifenesin

Answer 3

expectorant (thins resp secretions; does not suppress cough reflex

Question 4

NAC

Answer 4

mucolytic (can loosen mucous plugs in CF patients by disrupting disulfide bonds); also used as an antidote to acetominopehn overdose

Question 5

dextromethorphan

Answer 5

anti-tussive (antagonizeds NMDA glutamate receptors); synthetic codeine analogue; has mild opioid effect when used in excess; naloxone can be given for overdose; mld abuse potential; may cause serotoning syndrome if combined with other serotonergic agents

Question 6

pseudoephedrine, phenylephrine

Answer 6

alpha agonists, used as nasal decongestants; used to reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes. Pseudoephedrine also illicitly used to make methamphetamine; can cause HTN

Question 7

what drugs are used for pulm hypertension?

Answer 7

endothelin receptor antags (bosentean), PDE-5 inhib; prostacyclin analogs

Question 8

endothelin receptor antags

Answer 8

bosentan; lead to decreased pulm vascular resistance; note that these are hepatotoxic (so must monitor LFTs)

Question 9

PDE-5 inhibs

Answer 9

include sildenafil; inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide; also used to treat erectile dysfunction

Question 10

prostacyclin analogs

Answer 10

include epoprostenol, iloprost; prostacyclins (PGI2) with direct vasodilatory effects on pulm and systemic arterial vascular beds; inhibit platelet aggregation. Side effects are flushing and jaw pain

Question 11

beta 2 agonists

Answer 11

albuterol- relaxes smooth muscle, use during acute exacerbation; salmeterol and formoterol- long acting agents used for prophylaxis. Adverse effects are tremor and arrhythmia

Question 12

corticosteroids used for asthma

Answer 12

fluticasone, budesonide; inhibit the synthesis of cytokines; inactivate NF-kB, the transcrip factor that induces production of TNF alpha and other inflamm agents; first line treatment for chronic asthma

Question 13

muscarinic antag used for asthma

Answer 13

ipratroprium; competitively blocks muscarinic receptors, preventing bronchoconstriction; also used for COPD; tiotroprium is long acting

Question 14

antileukotrienes used for asthma

Answer 14

work on the inflammation component of asthma (not so much the broncho dilatory), just like steroids; montelukast, zafirlukast- block leukotriene recepetors (CysLT1), especially good for aspirin-induced asthma; zileutin is a 5-lipoxygenase pway inhibitor that blocks the conversion of arachadonic acid to leukotrienes, hepatotoxic

Question 15

omalizumab

Answer 15

monoclonal anti-IgE antibody; binds most unbound serum IgE and blocks binding to FcERI. Used in allergic asthma resistant to inhaled steroids and LABAs

Question 16

methylxanthines

Answer 16

theophylline; likely causes bronchodilation by inhib phosphodiesterase, leading to increased cAMP levels due to decreased cAMP hydrolysis; narrow therapeutic index (cardio and neurotoxicity); metabolized by cyp450; blocks action of adenosine

Question 17

asthma bronchoconstriction is attacked from two angles: promoting dilaton and preventing constriction. Which drugs work on which>

Answer 17

On the bronchodilation ends, beta ags are pro-cAMP and cause bronchodilation and theophylline is against the breakdown of cAMP; on the constriction end, muscarinic antags and theophylline inhibit constriction; so theophylline works on both

Question 18

methacholine

Answer 18

muscarinic receptor (M3) AGonist; used in bronchial challenge test to help diagnose asthma