Respiratory

Question 1

Which muscarinic antagonists can be used for the respiratory system?

Answer 1

Ipratropium and tiotropium

Question 2

Which 3 categories of medications are commonly used for pulmonary hypertension? Hint: PPE

Answer 2

• PDE-5 inhibitors (sildenafil)
• Prostacyclin analogs (epoprostenol, iloprost)
• Endothelin receptor antagonists (bosENtan)

Question 3

Bosentan MOA

Answer 3

Competitive antagonization of endothelin-1 receptors
= less pulmonary vascular resistance

Question 4

MOA Sildenafil

Answer 4

Inhibit PDE-5 —> more cGMP —> NO vasodilatory effect lasts longer

Question 5

NEVER take _____ with sildenafil because _____

Answer 5

Nitrates

It can cause severe hypotension

Question 6

MOA iloprost

Answer 6

PGI2 (prostacyclin) —> direct vasodilation

Also: inhibition of platelet aggregation

Question 7

Main side effect of beta agonists

Answer 7

Tremor, arrhythmia

Question 8

MOA of inhaled corticosteroids

Answer 8

Inactivate NF-kB —> less transcription of TNF-a and other proinflammatory

Question 9

Mouth rinse must be done after using ICS because of the risk of _____

Answer 9

Oral thrush

Question 10

Fluticasone is a ____

Answer 10

ICS

Question 11

Which is long acting: tiotropium or ipratropium?

Answer 11

Tiotropium

Question 12

Antileukotrienes are mostly used for which types of asthma?

Answer 12

Aspirin or exercise induced

Question 13

MOA zileuton

Answer 13

Inhibits 5-lipoxygenase pathway
= no conversion of arachidonic acid —> leukotrienes

Question 14

MOA montelukast

Answer 14

Block leukotriene receptor CysLT1

Question 15

When is omalizumab given?

Answer 15

Allergic asthma with:
- high IgE levels
- resistance to ICS
- resistance to b2-agonists

Question 16

2 examples of methyxantines are:

Answer 16

• theophylline
• caffeine

Question 17

MOA theophylline

Answer 17

Inhibit phosphodiesterase —> more cAMP, block adenosine

Question 18

Why is theophylline rarely used?

Answer 18

• Narrow therapeutic index
• HIGHLY CARDIOTOXIC
• Neurotoxic

Question 19

MOA mepolizumab and uses related to it

Answer 19

Monoclonal vs IL-5

Maintenance therapy in severe eosinophilic asthma

Others: reslizumab, benralizumab (receptor)

Question 20

Which medication must be given in an ACUTE asthma?

Answer 20

SABA

Question 21

Most common maintenance asthma medication

Answer 21

ICS

Question 22

Acute COPD exacerbation medication and other indications

Answer 22

SABA with or without SAMA (ipratropium)

Consider O2, steroids, and antibiotics

Question 23

COPD maintenance medication

Answer 23

LABA or LAMA

Question 24

When should triple therapy (ICS+LABA) be considered for COPD?

Answer 24

FEV1 <50%

Question 25

When are mastocyte inhibitors used?

Answer 25

As asthma attacks preventatives before exercise