Reverse Pharm Respiratory

Question 1

1st generation H1 blockers

Reversible inhibitors of H1 histamine receptors

Allergy, motion sickness, sleep aid

Sedation, antimuscarinic, anti alpha adrenergic

Answer 1

What class of drugs are diphenhydramine, demenhydrinate, and chlorpheniramine? Clinical uses? Mechanism? Toxicity?

Question 2

2nd generation H1 blockers

Reversible inhibitors of H1 histamine receptors

Allergy

Far less sedating than 1st generation b/c of decr. entry into CNS

Answer 2

loratadine, fexofenadine, desloratadine, cetirizine

Question 3

expectorant: thins resp. secretions. Does not suppress cough reflex

Answer 3

guaifenesin

Question 4

Mucolytic-Can loosen mucous plugs in CF patients by disrupting Disulfide bonds

Antidote for Acetaminophen overdose

Answer 4

N-acetylcysteine

Question 5

Antitussive (antagonizes NMDA glutamate receptors)

Synthetic codeine analog
Mild opioid effect in excess
Naloxone for overdose
Mild abuse potential

Serotonin syndrome when given with other serotonergic agents

Answer 5

dextromethorphan

Question 6

Alpha adrenergic agonists, used as nasal decongestants

Reduce hyperemia, edema, nasal congestion
Open obstructed eustachian tubes

1 is used to make meth

Hypertension
1 can cause CNS stim/anxiety

Answer 6

pseudoephedrine (1) and phenylephrine

Question 7

Endothelin receptor antagonists
Competitively antagonize endothelin 1 receptors leading to decr. pulm. vasc. resistance

Pulm. hypertension

Hepatotoxic (monitor LFTs)

Answer 7

Bosentan

Question 8

PDE-5 inhibitor

Inhibit cGMP PDE5 and prolong vasodilatory effect of nitric oxide.

Pulmonary hypertension
Erectile dysfunction

Answer 8

Sildenafil

Question 9

Prostacyclin analogs

PGI2 with direct vasodilatory effects on pulmonary and systemic arterial vasc. beds
Inhibit platelet aggregation

Flushing
Jaw pain

Answer 9

epoprostenol and iloprost

Question 10

Beta 2 agonists

1=relaxes bronchial smooth muscle. Acute exacerbation

2=same, but long acting agent. Prophylaxis.
Tremor and arrhythmia

Answer 10

albuterol (1), salmeterol (2), and formoterol (3)

Question 11

Inhibit synth of virtually all cytokines
Inactivate NF-kappa beta, the transcription factor that induces production of TNF-alpha and other inflamm agents.

1st line therapy for chronic asthma

Answer 11

fluticasone and budesonide

Question 12

Muscarinic antagonist
Competetively block musc. receptors
Prevent bronchoconstriction

Asthma
COPD

2 is long acting

Answer 12

ipratropium (1) and tiotropium (2)

Question 13

Antileukotrienes

Block LT receptor

Asthma, especially asthma induced

Answer 13

montelukast, zafirlukast

Question 14

antileukotriene

5-lipoxygenase pathway inhibitor.
Blocks conversion of AA to LT

Hepatotoxic

Answer 14

zileuton

Question 15

Monoclonal anti-IgE Ab
Binds mainly unbound serum IgE preventing it from binding Fc epsilon RI

Allergic asthma resistant to inhaled steroids and long acting beta 2 agonists

Answer 15

omalizumab

Question 16

methylxanthine

Bronchodilation by inhibiting phosphodiesterase which increases cAMP which increases bronchodilation.
Blocks actions of adenosine (which is a bronchoconstrictor)

Usage limited due to narrow therapeutic index
Cardiotoxic, neurotoxic
P450

Answer 16

theophylline

Question 17

M3 agonist. Used in bronchial challenge test for diagnosis of asthma

Answer 17

methacholine