Respiratory pharmacology Flashcards by c k

H1 blockers - first gen

Diphenhydramine
dimenhydrinate
chlorpheniramine

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When to use H1 blockers (diphenhydramine, dimenhydrinate, chlorpheniramine) - first gen

allergy, motion sickness, sleep aid

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toxicity of H1 blockers - first gen

sedation, antimuscarinic, anti-alpha-adrenergic

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second generation H1 blockers

loratadine
fexofenadine
cetrizine

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clinical use H1 - 2nd gen

allergy

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guaifenesin

expectorant - thins respiratory secretions; does not suppress cough

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N-Acetylcysteine

expectorant - can loosen mucous plugs in CF patient by dirupting disulfide bonds. Also used as an antidote for acetaminophen overdose

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antidote for acetaminophen overdose

N-acetylcysteine

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Dextromethorophan

Antitussive (antagonizes NMDA glutamate receptors) - synthetic codeine analog. Has mild opioid effect when used in excess. Naloxone can be given for overdose. Mild abuse potential
may cause serotonin syndrome if combined with other serotonergic agents

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pseudoephedrine / phenylephrine

alpha adrenergic agonists - used as nasal decongestants -

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clinical use of pseudoephedrine / phenylephrine

reduce hyperemia, edema, nasal congestion, open obstructed eustachian tubes

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pulmonary hypertension drugs

endothelin receptor antagonists
PDE-5 inhibitors
Prostacyclin analogs

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endothelin receptor antagonists

Bosentan

competitively antagonize endothelin-1 receptors which leads to decreased pulmonary vasculature resistance

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what do you need to worry about with endothelin receptor antagonists? (bosentan)

hepatotoxic montior LFT

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PDE5 inhibitors

(like sildenafil - the boner drug) - used in pulmonary hypertension - inhibits cGMP PDE5 and prolong vasodilatory effect of NO

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Prostacyclin analogs

include epoprostenol and iloprost
These are lovely because prostacyclins (PGI2) have direct vasodilatory effects on the pulmonary vasculature and inhibit platelet aggregations

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epoprostenol

prostacyclin analog used in Pulmonary htn
also use iloprost
direct vasodilatory effect of pulm

side effects of prostacyclin analogs (epoprostenol, iloprost)

flushing and jaw pain

albuterol

asthma drug - relaxes bronchial smooth muscle (b2 agonist) used during acute exaceration

what are the two long acting beta-2 agonists used in the treatment of asthma for prophylaxis?

salmeterol
formoterol

note: adverse side effects include tremor and arryhthmia

Corticosteroids used in teh treatment of astchma

fluticasone

budesonide

how do gluticasone and budesonide help asthmatics

they inhibit the synthesis of all cytokines - they inactivate NF-kB, the transcription factor that induces the production of TNF-alpha and other inflammatory agents
FIRST LINE THERAPY

Ipratropium (tiotropium)

This is a muscarinic antagonist used in the treatment of asthma - it works by competetiviely blocking muscarinic receptors, preventing bronchoconstirction, - also used in COPD

Long acting version ()

Montelukast

Zafirlukast

These are antiluekotrienes used in the treatment of asthma - the block leukotriene receptors (CysLT1) - espcially good for aspirin induced asthma

Zileuton

This is an antiluekotriene used in teh treatment of asthma - it is a 5-lipoxgenase pathway inhibitor - blocks the coversion of arachnidonic acid to leukotrienes - DANGER HEPATOTOXIC

Omalizumab

this is a monoclonal IgE antibody used in the treatment of asthma it binds mostly to unbound serum IgE and blocks binding to FcER1 - used in alleric asthma resistant to inhaled steroid and long acting b2 agonists

what is theophyilline?

This is a methylxanthine used in the treatment of asthma - it likely causes bronchodilation by inhibiting phosphodiesterase which increases cAMP also blocks the actions of adenosine (adenosine causes bronchoconstriction)

Worries about theophyilline

even though it is lovely that theophylline causes bronchodilation it is also CARDIOTOXIC NEUROTOXIC metabolized by p450

methacholine

this is a muscarininc receptor (M3) agonist - used in bronchial challenge to help diagnose asthma

Glucocorticoids (inhaled) are lovely but can increase the risk of? and so what do we do

increase risk of oral candidiasis so rinse your mouth

Bosentan

endothelin receptor antagonist - used in the treatment of PAH - endothelin is a potent vasocontrictor that also stimulates endothelial proliferation - makes shit worse

If you are an alcoholic and inhale / aspirate something and get a lung abscess, what is a nice AB for me to give you so that I cover not only typical shit like STREP but also common mouth flora (anaerobes like bacteroides)

Clindamycin - 50s :) | nice coverage of both gram positive aerobes and also oral anaerobes

Prophylaxis in AIDS for MAC - acid fast grows best at 41 - causes diarrhea and reticuloendothelial shit

Azithromycin

Prophylaxis in AIDS for Histoplasma

Itraconzole

Prophylaxis in AIDS for Pneumocystis jirovecii?

TMP-SMX

Prophylaxis in AIDS for Toxoplama gondii

TMP-SMX

Why would I give someone with thrush nystatin and not griseofulvin

griseofulvin is for dermatophytes | nystatin can be swished and swallowed :)

why wouldnt we use ciprofloxacin or cefazolin (first gen ceph) in an alcoholic who aspirated

because not good against anaerobes

Specific marker = chromogranin | what are you thinking?

small cell lung cancer

Reid index

for bronchiectasis | mucous layer : (epithelium through to (to to) cartilage)