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Pulmonology > SM 180 Pulmonary Pharmacology > Flashcards

SM 180 Pulmonary Pharmacology Flashcards

1
Q

Are LABA’s first line for Asthma?

A

No, LABA’s are second line for Asthma

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2
Q

Which is better, LABA/LAMA or LABA/ICS?

A

LABA/LAMA works better than LABA/ICS

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3
Q

How do spacers work?

A

They decrease the velocity of discharged particles and allow the aerosol to expand in the spacer itself, improving delivery to the lung

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4
Q

When are LABA’s used for Asthma?

A

LABA’s are used for Asthma only if a patient’s symptoms persist despite an ICS

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5
Q

What are LABA’s first line for?

A

Salmetrol and Formeterol are first line for COPD

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6
Q

What do Beta2 mediate?

A

Bronchodilation via relaxation of smooth muscle

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7
Q

What are the three pathophysiologic hallmarks of COPD?

A

Fibrosis of the small airways (bronchiolitis), alveolar wall destruction (emphysema), and mucus hypersecretion

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8
Q

What class of drug is Tiotropium?

A

LAMA

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9
Q

What is the most common PDE-4 inhibitor?

A

Rofluminast is the most common PDE-4 inhibitor and is used to reduce exacerbations in patients with class D COPD

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10
Q

When are Leukotriene Antagonists not used?

A

Montelukast is not used for COPD

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11
Q

What cells underlie the inflammation in COPD?

A

Mast cells, eosinophils, T-lymphocytes, macrophages, and neutrophils

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12
Q

List the SABA’s?

A

Albuterol and Levalbuterol

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13
Q

How does smoking cessation alter lung function?

A

Smoking cessation slows the decline in FEV1 associated with age, regardless of when a person stops, and improves life expectancy/disability

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14
Q

How do ICS levels change in Asthma treatment?

A

ICS doses increase with progressively worse Asthma

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15
Q

What is a rescue inhaler?

A

SABA

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16
Q

What are Leukotriene Antagonists?

A

Leukotriene antagonists like Montelukast block the effects of Leukotrienes and are used for Allergies and Asthma, but not COPD

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17
Q

What are PDE-4 inhibitors indicated for?

A

Late stage COPD, chronic bronchitis, and as an addon to Triple Therapy in COPD

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18
Q

What are Leukotriene Antagonists indicated for?

A

Leukotriene antagonists like Montelukast are indicated for Allergies and Asthma, not COPD

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19
Q

What is the first line for treatment of patients with COPD?

A

LABA’s like Salmeterol and Formeterol (or LAMA’s)

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20
Q

What are the effects of corticosteroids on the respiratory system itself?

A

Less inflammatory cells in the airway, limit mucus hypersecretion, and decrease capillary leak

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21
Q

Are Muscarinic Receptor Antagonists reversible or irreversible?

A

SAMA and LAMA are reversible and lead to bronchodilation

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22
Q

List the LABA’s?

A

Salmeterol and Formoterol

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23
Q

What class of drug is Levalbuterol?

A

SABA

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24
Q

What class of drug is Ipratropium?

A

SAMA

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25
Q

What are LABAs?

A

Long Acting Beta2 Agonists that can last up to 24 hours

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26
Q

Where are b1R found?

A

The heart, where they increase CO and Renin release

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27
Q

What is the first line treatment for COPD?

A

LAMAs

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28
Q

What is the major perk of Montelukast?

A

Minimal drug-drug interactions and favorable side effect profile

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29
Q

Which trial indicates why LABA’s are not first line for Asthma and why?

A

The SMART trial found that patients who took LABA’s had an increased risk for respiratory related deaths, but that there was no increased risk in LABA+ICS or ICS therapy

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30
Q

What are SAMA’s?

A

Short Acting Muscarinic Antagonists like Ipratropium

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31
Q

What is the effect of a PDE-4 inhibitor?

A

Blocks PDE and leads to increases in cAMP, resulting in relaxation of smooth muscle

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32
Q

What are LAMA’s?

A

Long Acting Muscarinic Antagonists

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33
Q

How do LABAs compare in their utility for COPD and Asthma?

A

LABA are first line in COPD and added to ICS as a second line in Asthma

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34
Q

Where are b3R found?

A

Adipose tissue, where they increase lipolysis

35
Q

If LABA’s increase respiratory risk in Asthma, why are they second line agents?

A

No increase in risk for LABA’s if taken with ICS, never use LABA monotherapy

36
Q

What is the first line treatment for Asthma?

A

Inhaled Corticosteroids

37
Q

What class of COPD requires a PDE-4 inhibitor?

A

PDE-4 inhibitors like Rofluminast are indicated in Class D COPD that does not respond to triple therapy

38
Q

What are spacers?

A

A form of non-pharmacologic pharmacologic that improves inhaled drug delivery

39
Q

What is the common adverse effect of ICS?

A

ICS suppress the immune system and predispose Thrush and Pneumonia

40
Q

Are LAMAs the first line treatment for COPD?

A

Yes

41
Q

What does Zileaton inhibit?

A

5 Lipoxygenase, but rarely used due to hepatic dysfunction as a side effect

42
Q

How do b2 agonists work?

A

They bind the b2 GPCR and increase generation of cAMP and PKA, leading to opening of K channels and bronchodilation

43
Q

What class of drug is Salmeterol?

A

LABA

44
Q

Where is the M3 muscarininc receptor found?

A

The M3R is found in the respiratory system, making it a good target for SAMA’s and LAMA’s

45
Q

What are SABAs?

A

Short Acting Beta2 Agonists

46
Q

How do ICS compare in their utility for COPD and Asthma?

A

ICS are last line in COPD and first line in Asthma

47
Q

What class of drug is Formoterol?

A

LABA

48
Q

How do ICS work?

A

Inhaled corticosteroids bind the cytoplasmic corticoid receptor and translocate to the nucleus, where they increase transcription of anti-inflammatory genes and decrease expression of inflammatory signals

49
Q

What are common ICS?

A

Common inhaled corticosteroids include Budesonide, Mometasone, Fluticasone

50
Q

What is non-pharmacologic pharmacotherapy?

A

Addressing barriers to treatment such as inhaler technique and adherence, as well as smoking cessation

51
Q

How are ICS used in COPD?

A

ICS are only used as a triple therapy if the LABA/LAMA combination does not work

52
Q

What is Theophylline?

A

Theophylline is a nonselective PDE inhibitor with narrow therapeutic windows and risk for fatal arrhythmias and seizures

53
Q

What should always be done when providing a new inhaler?

A

Watch the patient demonstrate how to use it so you can verify it works correctly

54
Q

What ionic derangement can b2 agonists treat?

A

Because b2 agonists can cause hypokalemia, they can be used to treat hyperkalemia

55
Q

Which should be used as a first line treatment for COPD?

A

LAMAs are generally used first, and then LABAs are added on as a second line

56
Q

What are SABAs used for?

A

Symptomatic control of immediate symptoms

57
Q

What receptor do SAMA’s and LAMA’s target?

A

The M3 Muscarinic receptor, leading to vasodilation

58
Q

When should LAMAs and LABAs not be prescribed?

A

If they are already on an anti-cholinergic, since muscarinic receptor antagonists have anti-cholinergic effects

59
Q

What does the M3R normally bind?

A

The M3R is a Muscarinic Receptor that binds Acetylcholine

60
Q

What suffix do Beta agonsists end with?

A

-erol = Beta Agonist

61
Q

What is the normal effect of ACh binding to M3R?

A

ACh binding to M3R leads to Ca influx and bronchoconstriction

62
Q

What kind of side effects can b2 agonists cause?

A

Tremors, tachycardia, palpitations, and hypokalemia

63
Q

What does Montelukast inhibit?

A

Montelukast inhibits the Cysteinyl Leukotriene-1 Receptor

64
Q

What are the major side effects of PDE-4 inhibitors?

A

GI side effects

65
Q

When are Leukotriene Antagonsts used in the treatment of Asthma?

A

Montelukast is added onto low dose ICS as a second in Asthma

66
Q

What characteristics of SABAs allow for their effectiveness in immediate symptom relief?

A

SABAs are delivered via inhaled aerosol to maximize delivery to the lungs while minimizing systemic delivery and potential side effects

67
Q

What are a potential adverse effect of Muscarinic Receptor Antagonist?

A

Unilateral dilated pupils which can be mistaken for a stroke, due to anti-cholinergic effects

68
Q

When can LABA’s not be a monotherapy?

A

LABA’s cannot be a monotherapy in the treatment of Asthma, and must be used as a second line agent with ICS

69
Q

What type of protein are Beta receptors?

A

GPCR’s which regulate cAMP levels

70
Q

What does the -tropium suffix indicate?

A

Muscarinic Receptor Antagonist

71
Q

What does the Beta Blockade refer to?

A

Beta Blockade refers to unintentional crossover and inhibition of different Beta-acting drugs; smokers need b1 antagonists for HF but also need b2 agonists for COPD, so concern for crosstalk

72
Q

Which type of BetaR mediates bronchodilation?

A

Beta2 Receptors

73
Q

What constitutes the Anticholinergic Toxidrome?

A

BMDRH

Blind as a Bat
Mad as a Hatter
Dry as a Bone
Red as a Beat
Hot as a Dessert
74
Q

What class of drug is Albuterol?

A

SABA

75
Q

Why do b2 agonists cause side effects?

A

Binding of a b2 agonist in the systemic circulation can lead to side effects

76
Q

Does COPD benefit from bronchodilators?

A

Although COPD is traditionally characterized as “fixed”, patients do get some benefit from bronchodilators

77
Q

How long do SABAs take to act and how long do they last?

A

SABA’s take 5-15 minutes to take action and last 4-6 hours

78
Q

How do Leukotriene Antagonists work?

A

They prevent the breakdown of Arachidonic acid

79
Q

How does COPD present?

A

Wheezing, breathlessness, chest tightness, and coughing

80
Q

What are LABAs used for?

A

Long term control of COPD and Asthma on a day to day basis

81
Q

How do LAMAs compare in their utility for COPD and Asthma?

A

LAMAs are first line in COPD and added to LABA/ICS in Asthma

82
Q

Are beta blockers safe in COPD?

A

Yes; normally, we treat COPD with b2 agonists, but a b1 antagonist used to treat smoking simultaneously does not worsen COPD surprisingly

83
Q

What causes symptoms in COPD?

A

Inflammation

84
Q

Are LAMA’s used in Asthma?

A

Generally no, and only as a last line salvage therapy in Asthma after ICS and LABA with persistent symptoms

Pulmonology (22 decks)

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