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Pulmonology > Pulmonary Drugs Flashcards > Flashcards

Pulmonary Drugs Flashcards

1
Q

Albuterol: Class/Type

A

Short-acting beta-2 agonist (SABA)

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2
Q

Albuterol: Mechanism

A

Bronchodilators

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3
Q

Albuterol: Indication

A

Step 1 asthma (intermittent); used in emergency situations to reduce/eliminate SOB, coughing, and wheezing. Symptom relief and increase FEV1 for COPD, acute COPD exacerbation

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4
Q

Albuterol: Side Effects/Toxicity

A

Tachycardia, palpitations, tremor, hypokalemia

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5
Q

Albuterol: Notes

A

Oral administration has more side effects than inhaled. For COPD, albuterol is sometimes used with ipratropium

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6
Q

Terbutaline: Class/Type

A

Short-acting beta-2 agonist (SABA)

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7
Q

Terbutaline: Mechanism

A

Bronchodilators

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8
Q

Terbutaline: Indication

A

Step 1 asthma (intermittent); used in emergency situations to reduce/eliminate SOB, coughing, and wheezing. Symptom relief and increase FEV1 for COPD, acute COPD exacerbation

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9
Q

Terbutaline: Side Effects/Toxicity

A

Tachycardia, palpitations, tremor, hypokalemia

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10
Q

Terbutaline: Notes

A

Oral administration has more side effects than inhaled. For COPD, albuterol is sometimes used with ipratropium

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11
Q

Salmeterol: Class/Type

A

Long-acting beta-2 agonist (LABA)

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12
Q

Salmeterol: Mechanism

A

Bronchodilators

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13
Q

Salmeterol: Indication

A

Used in combination with ICS in persistent asthma, steps 3-6. Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)

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14
Q

Salmeterol: Side Effects/Toxicity

A

Tachycardia, palpitations, tremor, hypokalemia. Increased risk of severe COPD exacerbation and asthma death.

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15
Q

Salmeterol: Notes

A

Sometimes used with glucocorticoid for COPD. FDA recommends only use in combination with other controller meds (such as ICS)

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16
Q

Chromolyn sodium: Class/Type

A

Mast cell stabilizer

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17
Q

Chromolyn sodium: Mechanism

A

Prevents the release of mediators that would normally attract inflammatory cells and stabilizes the inflammatory cells

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18
Q

Chromolyn sodium: Indication

A

Used to prevent wheezing, SOB, and trouble breathing caused by asthma

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19
Q

Chromolyn sodium: Side Effects/Toxicity

A

Sore throat, bad taste, stomach pain, cough, stuffy nose, itching or burning in nasal passages, sneezing, headache

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20
Q

Chromolyn sodium: Notes

A

No longer available for oral inhalation treatment (replaced by LTRAs)

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21
Q

Omalizumab: Class/Type

A

Immunodilator

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22
Q

Omalizumab: Mechanism

A

IgE binding in circulation

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23
Q

Omalizumab: Indication

A

Used in cases of allergic asthma triggers, particularly in steps 5 & 6 persistent asthma

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24
Q

Omalizumab: Side Effects/Toxicity

A

Possible anaphylaxis (rare)

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25
Q

Omalizumab: Notes

A

Possibly associated with Churg-Strauss syndrome (autoimmune disease)

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26
Q

Zafirlukast: Class/Type

A

Leukotriene modifiers (LTRA)

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27
Q

Zafirlukast: Mechanism

A

Leukotriene D4 (LTD4) receptor antagonists

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28
Q

Zafirlukast: Indication

A

Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4

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29
Q

Zafirlukast: Side Effects/Toxicity

A

Cough or hoarseness, fever, chills, lower back or side pain, pain, pain or difficult urination

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30
Q

Montelukast: Class/Type

A

Leukotriene modifiers (LTRA)

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31
Q

Montelukast: Mechanism

A

Leukotriene D4 (LTD4) receptor antagonists

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32
Q

Montelukast: Indication

A

Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4

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33
Q

Montelukast: Side Effects/Toxicity

A

GI disturbances, headaches, hypersensitivity reactions, sleep disorders, bleeding tendency

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34
Q

Montelukast: Notes

A

Possibly associated with Churg-Strauss syndrome (autoimmune disease)

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35
Q

Zileuton: Class/Type

A

Leukotriene modifiers (LTRA)

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36
Q

Zileuton: Mechanism

A

Inhibits 5-lipoxygenase

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37
Q

Zileuton: Indication

A

Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4

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38
Q

Zileuton: Side Effects/Toxicity

A

Sinusitis, nausea, pharyngolaryngeal pain

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39
Q

Prednisone: Class/Type

A

Oral glucocorticoid (systemic)

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40
Q

Prednisone: Mechanism

A

Upregulate expression of anti-inflammatory genes and genes that increase gluconeogenesis and downregulate proinflammatory genes

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41
Q

Prednisone: Indication

A

Used as both emergency and long-term controller situations for asthma

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42
Q

Prednisone: Side Effects/Toxicity

A

Adrenal suppression, growth suppression, osteoporosis, muscle weakness, hypertension, weight gain, diabetes, cataracts, Cushing’s syndrome, dermal thinning

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43
Q

Prednisone: Notes

A

Oral is preferred to IV for patients without altered mental status

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44
Q

Beclomethasone: Class/Type

A

Inhaled glucocorticoid (ICS)

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45
Q

Beclomethasone: Mechanism

A

Upregulate expression of anti-inflammatory genes and genes that increase gluconeogenesis and downregulate proinflammatory genes

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46
Q

Beclomethasone: Indication

A

Used in combination with LABA, LTRA, or theophylline for persistent asthma, steps 2-6. Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)

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47
Q

Beclomethasone: Side Effects/Toxicity

A

Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?

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48
Q

Beclomethasone: Notes

A

Not used in the ED. Sometimes used with LABA for COPD

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49
Q

Budesonide: Class/Type

A

Inhaled glucocorticoid (ICS)

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50
Q

Budesonide: Indication

A

Used in combination with LABA, LTRA, or theophylline for persistent asthma, steps 2-6. Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)

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51
Q

Budesonide: Side Effects/Toxicity

A

Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?

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52
Q

Budesonide: Notes

A

Not used in the ED. Sometimes used with LABA for COPD

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53
Q

Fluticasone: Class/Type

A

Inhaled glucocorticoid (ICS)

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54
Q

Fluticasone: Indication

A

Used in combination with LABA, LTRA, or theophylline for persistent asthma, steps 2-6. Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)

55
Q

Fluticasone: Side Effects/Toxicity

A

Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?

56
Q

Fluticasone: Notes

A

Not used in the ED. Sometimes used with LABA for COPD

57
Q

Ipratropium: Class/Type

A

Short-acting anticholinergic

58
Q

Ipratropium: Mechanism

A

Blocks muscarinic acetylcholine receptors in the smooth muscle of the bronchi of the lungs, allowing the bronchi to stay open

59
Q

Ipratropium: Indication

A

Symptom relief and increases FEV1 for COPD (slower than SABA), acute COPD exacerbation

60
Q

Ipratropium: Side Effects/Toxicity

A

Dry mouth

61
Q

Ipratropium: Notes

A

For COPD, sometimes used with albuterol

62
Q

Tiotropium: Class/Type

A

Long-acting anticholinergic

63
Q

Tiotropium: Mechanism

A

Blocks muscarinic acetylcholine receptors in the smooth muscle of the bronchi of the lungs, allowing the bronchi to stay open

64
Q

Tiotropium: Indication

A

Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)

65
Q

Tiotropium: Side Effects/Toxicity

A

Dry mouth

66
Q

Nicotine patch, lozenge, gum, inhaler, spray: Class/Type

A

Nicotine replacement

67
Q

Nicotine patch, lozenge, gum, inhaler, spray: Mechanism

A

Delivers nicotine so that the patient does not have to smoke to get it

68
Q

Nicotine patch, lozenge, gum, inhaler, spray: Indication

A

Smoking cessation

69
Q

Nicotine patch, lozenge, gum, inhaler, spray: Side Effects/Toxicity

A

Headache, nausea and GI problems, difficulty getting to sleep (with patch especially). May not be safe in pregnancy

70
Q

Nicotine patch, lozenge, gum, inhaler, spray: Notes

A

6-month abstinence rate of 25%

71
Q

Varenicline: Class/Type

A

Nicotine partial agonist

72
Q

Varenicline: Mechanism

A

Orally-available partial agonist at the alpha4beta2 subunit of the nicotinic acetylcholine receptor stimulates nicotinic receptor (reduces withdrawal) and blocks nicotine from binding (reduces reward)

73
Q

Varenicline: Indication

A

Smoking cessation – can quit smoking 1 week after initiating therapy

74
Q

Varenicline: Side Effects/Toxicity

A

Nausea, headache, insomnia, abnormal dreams. Depression, suicidal thoughts and actions. “Small increased risk of cardiovascular adverse events in patients with cardiovascular disease”

75
Q

Varenicline: Notes

A

6-month abstinence rate of 24%

76
Q

Buproprion: Class/Type

A

Antidepressant

77
Q

Buproprion: Mechanism

A

Non-competitive nicotinic antagonist. Increased dopamine transmission in the brain

78
Q

Buproprion: Indication

A

Smoking cessation – reduces severity of nicotine cravings and withdrawal symptoms

79
Q

Buproprion: Side Effects/Toxicity

A

Insomnia and headache. Changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts

80
Q

Buproprion: Notes

A

6-month abstinence rate of 33%

81
Q

Diltiazem: Class/Type

A

Calcium channel blockers

82
Q

Diltiazem: Mechanism

A

Block L-type calcium channel receptors in vascular smooth muscle, resulting in vasodilatation

83
Q

Diltiazem: Indication

A

PAH for patients who are highly vasoreactive (robust acute responder)

84
Q

Diltiazem: Side Effects/Toxicity

A

Dizziness, headache, flushing, weakness, bradycardia, GI sx, coughing

85
Q

Verapamil: Class/Type

A

Calcium channel blockers

86
Q

Verapamil: Mechanism

A

Block L-type calcium channel receptors in vascular smooth muscle, resulting in vasodilatation

87
Q

Verapamil: Indication

A

PAH for patients who are highly vasoreactive (robust acute responder)

88
Q

Verapamil: Side Effects/Toxicity

A

Don’t take verapamil with beta blockers due to risk of severe bradycardia

89
Q

Epoprostenol: Class/Type

A

Prostacyclin analogue

90
Q

Epoprostenol: Mechanism

A

Mimics the properties of prostacyclin in the prostacyclin pathway via stimulation of adenylate cyclase à increased cAMP to result in vasodilatation, antiproliferation, and anti-platelet aggregation

91
Q

Epoprostenol: Indication

A

Improves hemodynamics, functional capacity, and survival in patients with pulmonary artery hypertension, high and lower risk patients

92
Q

Epoprostenol: Side Effects/Toxicity

A

Headache, dizziness, flushing, nasal congestion.Jaw pain, delivery system problems. Cautious use in hypotensive patients, intrinsic lung disease, elevated LA pressure. Always wean gradually to avoid abrupt medication withdrawal

93
Q

Epoprostenol: Notes

A

IV

94
Q

Bosentan: Class/Type

A

Endothelin receptor antagonists

95
Q

Bosentan: Mechanism

A

Block endothelin A and B receptors on smooth muscle cells, cardiac myocytes, and endothelial cells (B only), preventing sustained vasoconstriction and proliferation of vascular smooth muscle cells

96
Q

Bosentan: Indication

A

Improve hemodynamics and functional capacity in PAH patients

97
Q

Bosentan: Side Effects/Toxicity

A

Teratogenic, peripheral edema, anemia

98
Q

Bosentan: Notes

A

Newer drug

99
Q

Sildenafil: Class/Type

A

Phosphodiesterase inhibitor

100
Q

Sildenafil: Mechanism

A

Inhibits PDE-5, therefore inhibiting the deactivating of cGMP in the NO pathway and causing vasodilation and antiproliferation

101
Q

Sildenafil: Indication

A

Improves hemodynamics and functional capacity in patients with pulmonary artery hypertension, high and lower risk patients

102
Q

Sildenafil: Side Effects/Toxicity

A

Headache, dizziness, flushing, nasal congestion. Cautious use in hypotensive patients, intrinsic lung disease, elevated LA pressure. Always wean gradually to avoid abrupt medication withdrawal

103
Q

Sildenafil: Notes

A

Oral, IV

104
Q

Roflumilast: Class/Type

A

Phosphodiesterase inhibitor

105
Q

Roflumilast: Mechanism

A

Oral PDE-4 inhibitor that decreased airway inflammation and promotes airway smooth muscle relaxation

106
Q

Roflumilast: Indication

A

Improves FEV1 and decreases exacerbation rate in COPD

107
Q

Roflumilast: Side Effects/Toxicity

A

Diarrhea, weight loss

108
Q

Roflumilast: Notes

A

Has not been studied in combination with ICS

109
Q

Unfractionated heparin (UFH): Class/Type

A

Antithrombin agents

110
Q

Unfractionated heparin (UFH): Mechanism

A

Complexes with antithrombin to inactivate thrombin

111
Q

Unfractionated heparin (UFH): Indication

A

Initial therapy fro DVT

112
Q

Unfractionated heparin (UFH): Side Effects/Toxicity

A

Bleeding

113
Q

Unfractionated heparin (UFH): Notes

A

IV, narrow therapeutic window, reversible with protamine, does not cross placenta

114
Q

Low molecular weight heparin (LMWH): Class/Type

A

Antithrombin agents

115
Q

Low molecular weight heparin (LMWH): Mechanism

A

Complexes with antithrombin to inactivate factor Xa

116
Q

Low molecular weight heparin (LMWH): Indication

A

Initial therapy for DVT, but reduces VTE and bleeding compared to UFH. Tx for PE in unstable patients and those with high risk of bleeding. VTE prevention (also heparin)

117
Q

Low molecular weight heparin (LMWH): Side Effects/Toxicity

A

Caution in specific populations, such as pregnant women, elderly, obese, renal disease

118
Q

Low molecular weight heparin (LMWH): Notes

A

Subcutaneous injection

119
Q

Fondaparinux: Class/Type

A

Antithrombin agents

120
Q

Fondaparinux: Mechanism

A

Complexes with antithrombin to inactivate factor Xa

121
Q

Fondaparinux: Indication

A

Initial therapy for DVT, with equal efficacy to LMWH. TX for PE in hemodynamically stable patients

122
Q

Fondaparinux: Side Effects/Toxicity

A

Caution in specific populations, such as pregnant women, elderly, obese, renal disease

123
Q

Fondaparinux: Notes

A

Subcutaneous injection

124
Q

Warfarin: Class/Type

A

Oral anticoagulant

125
Q

Warfarin: Mechanism

A

Inhibits vitamin K depended gamma-carboxylation of factors II, VII, IX, and X

126
Q

Warfarin: Indication

A

Prevention of recurrent DVT and PE

127
Q

Warfarin: Side Effects/Toxicity

A

Interactions with genetics, diet, multiple drugs. Teratogenic

128
Q

Pirfenidone: Class/Type

A

Drugs in IPF

129
Q

Pirfenidone: Mechanism

A

Inhibits release of pro-inflammatory cytokines, attenuates fibroblast proliferation, inhibits release of TGF-beta, and inhibits collagen synthesis

130
Q

Pirfenidone: Indication

A

Shown to slow the course of disease progression in IPF

131
Q

Nintenadib: Class/Type

A

Drugs in IPF

132
Q

Nintenadib: Mechanism

A

Growth factor/angiokinase inhibitor at the vascular endothelial growth factor, fibroblast growth factor, and platelet derived growth factor receptors

133
Q

Nintenadib: Indication

A

May have efficacy in IPF

Pulmonology (3 decks)

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