Asthma Flashcards
1
Q
Normal Value for FEV1
A
> 80%
2
Q
Normal Value for FVC
A
Adults can empty 80% of air in 6 seconds
3
Q
Normal Value for FEV1/FVC
A
Within 5% of predicted value (based on age, height, sex, gender)
4
Q
Which spirometry test can be done at the patients home?
A
Peak Flow/ PEFR = Peak expiratory flow rate
5
Q
Which Spirometry value determines if the disease is obstructive of restrictive
A
FEV1/FVC
6
Q
what are obstructive diseases vs restrictive diseases of the lung
A
obstruct: asthma/COPD
restrict: pulmonary fibrosis
7
Q
If the FEV1/FVC is low what kind of lung disease is it - obstructive or restrictive
A
obstructive
8
Q
If the FEV1/FVC is normal what kind of lung disease is it - obstructive or restrictive
A
restrictive
9
Q
If the FEV1/FVC is high what kind of lung disease is it - obstructive or restrictive
A
restrictive
10
Q
Asthma or COPD - has DRY cough
A
asthma
11
Q
Asthma or COPD - signs of atopy
A
asthma (atopy is basically allergies…)
12
Q
Possible Asthma triggers
A
- Exercise
- Stress
- pets
- Emotions
- Pollution
- Insects/fecal matter
- Dust
13
Q
How to Classify Asthma
A
Intermittent or Persistant
within Persistant - mild, moderate, severe
14
Q
COPD - what 3 main factors cause the airflow limitation
A
- chronic bronchitis
- emphysema
- inflammation
15
Q
Describe Emphysema
A
Abnormal enlargement of the airspaces in alveoli - leads to destruction of alveolar walls
- the structural changes/destruction of alveoli lead to REDUCED ELASTICITY
16
Q
Definition of Chronic Bronchitis (number wise…)
A
Cough and Sputum production for at least 3 MONTHS in each of 2 CONSECUTIVE YEARS
17
Q
Chronic bronchitis causes structural changes which will __________ the airways due to FIBROSIS
A
narrow
18
Q
Inflammation in COPD - comes from irritants -
causes 2 things that will lead to making of fibroblasts
A
Oxidative stress (more oxidants) Protease - antiprotease imbalance (more proteases than antiproteases
19
Q
Asthma or COPD - reversible
A
asthma
20
Q
Asthma or COPD - irreversible
A
COPD
21
Q
Hallmark symptoms of COPD
A
Chronic cough; dyspnea; SPUTUM PRODUCTION
22
Q
Typically patient of COPD
A
> 40 years of age w/ common symptoms of COPD;
Hx of exposure to risk factors (smoke)
Family hx of COPD
23
Q
COPD Signs
A
BARREL CHEST! Increase Resp. Rate Use of accessory muscles to breath Decreased breath sounds Prolonger Expiration Lips pursing on expiration
24
Q
Particles that can cause COPD
A
CIGARETTE SMOOOOKE
Occupational dust/fumes
Indoor pollution
25
Spirometry is REQUIRED to diagnose _______
COPD
26
A post-bronchodilator FEV1/FVC has to be _______ to be diagnosed as COPD
< 0.7
27
Assessment Categories for COPD
- Spirometry
- Symptoms
- Exacerbation Risk
- Comorbidities
28
What do Inhaled beta agonists do
cause bronchodilation by relaxing bronchial smooth muscle
29
What are the SABAs (short acting beta 2 agonists)
Albuterol and Levalbuterol
30
What is the onset of action for SABAs
3 - 5 minutes
31
SABAs are best for _______ asthma symptoms
acute
32
Brand for Levalbuterol
Xopenex
33
Xopenex is what kind of asthma drug
SABA - short acting beta2 agonist (levoalbuterol)
34
What are the Long acting Beta 2 agonists (LABAs)
```
Salmeterol
Formoterol
Arformoterol
Indacterol
Olodaterol
(there are combo products with inhaled corticosteroids and LAMAs)
```
35
What is the onset of action for LABAs (and peak effect time)
15 - 30 minutes - up to 3 hours for peak effect!!
36
Side effects of Beta 2 agonists for asthma
Hyped up pts = tachycardia, skeletal muscle tremors, palpitations
HYPOKALEMIA
HYPERGLYCEMIA
37
What is the Boxed Warning for LABAs
LABA canNOT be used as monotherpay for asthma patients!! Increased risk for asthma induced death
LABA monotherapy is OK for COPD patients tho
38
Brand: ?
Generic: Salmeterol
Serevent Diskus
39
Brand: ?
Generic: Formoterol
Foradil Aerolizer
40
Brand: ?
Generic: Arfomoterol
Brovana Nebulizer
41
Brand: ?
Generic: Indacterol
Arcapta Neohaler
42
Brand: ?
Generic: Olodaterol
Striverdi Respimat
43
Brand: Serevent Diskus
Generic: ?
Salmeterol
44
Brand: Foradil Aerolizer
Generic: ?
Formoterol
45
Brand: Brovana Neublizer
Generic: ?
Arformoterol
46
Brand: Arcapta Neohaler
Generic: ?
Indacterol
47
Brand: Striverdi Respimat
Generic: ?
Olodaterol
48
What are the SAMAs (short acting Antimuscarinics)
Ipratropium; Ipratropium + Albuterol
49
What are the LAMAs (long acting Antimuscarinics)
```
Tiotropium
Umeclidinium
Aclidinium
Glycopyrrolate
(there are combo products with LABAs)
```
50
Brand: ?
Generic: Tiotropium
Spiriva
51
Brand: ?
Generic: Umeclidinium
Incruse Elipita
52
Brand: ?
Generic: Aclidinium
Tudorza Pressair
53
Brand: ?
Generic: Glycopyrrolate
Seebri Nebulizer
54
Brand: Spiriva
Generic: ?
Tiotropium
55
Brand: Incruse Elipta
Generic: ?
Umeclidinium
56
Brand: Tudorza Pressair
Generic: ?
Aclidinium
57
Brand: Seebri Neohaler
Generic: ?
Glyccopyrrolate
| remmeber this one bc seebri - like sebring and glyccopyrolate normally for GI -and mom has a sebring and GI issues...
58
Brand: ?
Generic: Ipratropium
Atrovent
59
Brand: ?
Generic: Ipratropium and Albuterol
Combivent
60
Brand: Atrovent
Generic: ?
Ipratropium
61
Brand: Combivent
Generic: ?
Ipratropium and Albuterol
62
If a COPD patient is Group A - how do you treat it?
bronchodilator ---> try another class
63
If a COPD patient is Group B - how do you treat it?
Long acting bronchodilator --> LABA + LAMA
64
If a COPD patient is Group C - how do you treat it?
LAMA --> LABA + LAMA
| can go to LAMA + ICS but try to hold off on ICS as much as possible in COPD pts
65
If a COPD patient is Group D - how do you treat it?
LABA + LAMA --> LABA + LAMA + ICS
| Maybe Dalrisep or Macrolide Abx
66
An asthma patient that is intermittent will fall into Step ___ for asthma treatment
1
67
An asthma patient that is persistent - mild will fall into Step ___ for asthma treatment
2
68
An asthma patient that is persistent - moderate will fall into Step ___ for asthma treatment
3 or 4
69
An asthma patient that is persistent - severe will fall into Step ___ for asthma treatment
5 or 6
70
Asthma Treatment Guidelines:
| Step 1
No control agent; Use SABA prn
71
Asthma Treatment Guidelines:
| Step 2
Low ICS as control agent; SABA prn
72
Asthma Treatment Guidelines:
| Step 3
Low ICS/LABA; SABA prn
73
Asthma Treatment Guidelines:
| Step 4
Med or high ICS/LABA; SABA prn
74
Asthma Treatment Guidelines:
| Step 5
Med or high ICS/LABA; SABA prn and maybe add on:
- tiotropium
- Anti-IgE
- Anti-IL5
75
Alternate Controller Options for Asthma:
| When would a leukotriene modifier be utilized?
Steps 2 - 4
76
Alternate Controller Options for Asthma:
| When would low dose oral corticosteroid be utilized?
Step 5
77
3 main treatment strategies for Asthma
Bronchodilation; anti-inflammation; Inhibit mast cell degranulation
78
Treatment strategies for Asthma:
| What drugs are used for bronchodilation
- Beta2 agonists
- Anticholinergics
- Methylxanthines
79
Treatment strategies for Asthma:
| What drugs are used for anti-inflammation
Glucocorticoids
| Antileukotriene Agents
80
Treatment strategies for Asthma:
| What drugs are used to inhibit mast cell degranulation
Cromolyn- like drugs
| Xolair (Omalizumab)
81
what does LTRA stand for
leukotriene receptor antagonist
82
what does A1R stand for
adenosine receptor
83
what does CysLT stand for
cysteine leukotrienes
84
what does CystLT-1R stand for
cysteine leukotriene receptor
85
what does MAO stand for
monoamine oxidase
86
what does COMT stand for
catechol-O-methyltransferase
87
Sympathomimetic Amines aka
B2 adrenergic receptor agonists
88
Primary activity of sympathomimetic amines
relax bronchial smooth muscle
89
Secondary activities of sympathomimetic amines
inhibit release of mediators from mast cells, inhibit microvascular leakage, increase microcilliary transport of mucus
90
what pathway do B2 agonists stimulate/what is the pathway
they stimulate the GaS pathway - which increases the amount of cAMP --> more PKA --> PKA will phosphorylate MLCK to make it inactive --> causes relaxation
91
SABAs are resistant to (COMT/MAO/BOTH)
COMT
92
LABAs are resistant to (COMT/MAO/BOTH)
BOTH
93
Patients should not be using albuterol more than ____ times per week unless its for exercise induced asthma
2
94
inhalational drugs allow for more _____ action and fewer _______ effects
local; systemic
95
Adverse effects of Selective B2 adrenergic agonists
- tachycardia/palpitations
| - skeletal muscle tremors
96
Glucocorticoid MOA:
| alter __________ of proteins involved in the ______ process
gene expression; inflammatory
97
Glucocorticoid MOA:
| what 3 type of cells will be found in the bronchial epithelium and submucosa and will be decreased via glucocorticoids
eosinophils, macrophages, mast cells
98
Glucocorticoid MOA:
| will inhibit synthesis of what ________ and ________
prostaglandins; Leukotrienes
99
Glucocorticoids should not be used for patients under ____ years old
12
100
How does theophylline work to cause bronchodilation?
antagonizes the adenosine receptor and inhibits PDE4
101
What happens when the adenosine receptor is BLOCKED/antagonized by theophylline
the Gq pathway is NOT stimulated and not IP3/No Ca is released --> Myosin LC kinase does not work to activate myosin LC --> NO CONTRACTION
102
what happens when PDE4 is inhibited by theophylline
if PDE4 doesn't work - cAMP is not made into AMP = more cAMP = more PKA = it will INHIBIT myosin LC kinase = no activated mysoin LC = no contraction = relaxation
103
why is theophylline not used as often anymore?
it has a narrow therapeutic range
104
the half-life of theophylline is _______ in patients with _________
increased; CHF
105
_________ will delay the absorption of theophylline
Mg and Al antacids
106
Theophylline may aggravate pre-existing __________
seizure disorders
107
What agents increase theophylline levels by competition
- cimetidine
- allopurinol
- erythromycin
- fluroquinolones
- propranolol
- leukotriene inhibitors (Zileutin)
108
primary use for theophylline
prevent asthma attacks
109
usual therapeutic range for theophylline
10 - 15 ug/mL
110
when do you start to see adverse effects of theophylline
20 ug/mL
111
Mechanism of Mast Cell degranulation process/what is needed
```
1- IgE Ab bind to FcR
2- binding of antigen to IgE Ab
3 - clustering of FcR receptors
4 - influx of Ca2+ via CRAC (Calcium released activated channels)
5 - ATP
```
112
Ways to Inhibit Mast Cell Degranulation
Cromolyn and Xolair
113
Cromolyn is very _____ (stable/unstable) but extremely _______ (soluble/insoluble)
stable; insoluble
114
Is cromolyn used to treat an attack or used as preventative?
preventative --- can't
| re-granulate a mast cell.....
115
What is Xolair and how does it work
it is an anti-human IgE ab
| Xolair will bind to IgE abs so that IgE cannot bind to the FcR1 receptors on mast cells
116
Xolair is indicated for who?
patients over 12 y.o with moderate - severe persistent asthma and has been unresponsive to inhaled steroids
117
xolair causes a 96% _______ in free _____ levels
reduction; IgE
118
Brand for Zileuton
Zyflo
119
what does Zileuton do
it is a selective inhibitor of 5-lipoxygenase --> inhibits synthesis of leukotrienes (LTB4, LTC4, LTD4)
120
Zileuton - for acute attack or nah?
nah
121
Zileuton is indicated for what?
the prophylaxis and treatment of chronic asthma
122
Zileuton will _______ the blood levels of theophylline
double
123
What are some Leukotriene inhibitors
Zieluton
Montelukast
Zafirlukast
124
Accolate is brand for?
Zafirlukast
125
how do zafirlukast/montelukast work?
the selectively and competitively inhibit CysLT1 receptor
126
zafirlukast/montelukast are known to inhibit the ____ phase of _________
late; bronchoconstriction
127
If zafirlukast/montelukast black the CysLt1R - what happens cellularly/in a pathway?
IF CysLt1R is inhibited - there is no Gq pathyway stimulated --> no IP3/Ca --> no muscle contraction
128
CysLT1R antagonists (aka zafirlukast/montelukast) are metabolized by the ______
liver
129
Food _______ the bioavailability zafirlukast/montelukast
reduces
130
zafirlukast/montelukast - (should/should not) be abruptly substituted for inhaled/oral corticoisteroids
should NOT
131
Drugs that are used to treat COPD
- inhaled antimuscarinic agents
- LABA
- SABA
(rare: a1 antitrypsin replacement)
132
Ipratropium and Tiotropium are antimuscarinics used for ______ - their structures are both _____________ which ______ systemic absorption
COPD; quaternary ammonium compound; decreases
133
___________ (Ipratropium or Tiotropium) has higher affinity and is more selective for the M1/M3 receptors
tiotropium
134
how do antimuscarinics works? (pathway etc...)
they BLOCK Ach from working @ M1/M3 receptors - prevents Gq pathway --> no IP3/No Ca --> No contraction
135
Iptratropium is given ______ time(s) per day
| Tiotropium is given _____ time(s) per day
3 - 4; 1
136
used for COPD, Asthma, or Both?
| Formoterol
both (but remember cannot use JUST a LABA in asthma!!!)
137
used for COPD, Asthma, or Both?
| Salmerterol
both (but remember cannot use JUST a LABA in asthma!!!)
138
used for COPD, Asthma, or Both?
| Indacaterol
COPD only
139
Remodeling in COPD - what kind of things occur
- fibrosis of small airways
- hyperinflation of lungs
- Alveolar enlargement/wall destruction (emphysema)
- mucus hypersecretion
140
what is the drug Ivacaftor?
it is a CFTR regulator - will potentiate Cl current through CFTR in response to cAMP
141
Adverse Events for ICS
oral thrush, cough, dysphonia (hoarse voice)
142
which ICS product has a built in spacer
Aerospan
143
Counseling tip for ICS
rinse and SPIT after use
144
Clinical pearl about pulmicort respules
should use Jet nebulizer and should not be mixed with other nebulizer solutions
145
want to titrate to the ________ effective dose because at ______ doses there is an increase for systemic side effects
lowest; high
146
Boxed warnings for LABA agents
1) monotherapy of LABA with asthma patients can increase risk of asthma related death
2) increasing hospitalization in pediatric and adolescent patients
147
adverse effects for LABA agents
tachycardia; headache; tremor; irritability
148
LABA agents: _______ seen with intentional overdoses
prolonged QT
149
LABA (may or may not) be useful for exercise induced bronchospasm
may
150
Taken once or twice a day?
| brovana
twice
151
Taken once or twice a day?
| foradil
twice
152
Taken once or twice a day?
| arcapta neohaler
once
153
Taken once or twice a day?
| striverdi respimat
once
154
Taken once or twice a day?
| Serevent
twice
155
Taken once or twice a day?
| Turdoze
twice
156
Taken once or twice a day?
| Spiriva
handihaler - once
| respimat - once
157
Taken once or twice a day?
| Incruse ellipta
once
158
Taken once or twice a day?
| QVAR
twice
159
Taken once or twice a day?
| Budesonide DPI/Flexhaler
twice
160
Taken once or twice a day?
| Alvesco
once
161
Taken once or twice a day?
| Aerospan
twice
162
Taken once or twice a day?
| Flovent
twice
163
Taken once or twice a day?
| Armon Air
twice
164
Taken once or twice a day?
| Arnuity Ellipta
twice
165
Taken once or twice a day?
| Asmanex
twice for adults
166
Taken once or twice a day?
| Budesonide nebulizer
once (divided dose maybe...)
167
Adverse effects of LAMA
dry mouth dizziness, blurred vision, upper RTIs; paradoxical bronchospasms
168
_______ (a antimuscarinic) has been approved for use in asthma as an add-on option in steps ___ or ____ (IF has Hx of exacerbations despite ICS and LABA use)
tiotropium; 4;5
169
Taken once or twice a day?
| Advair
twice
170
Taken once or twice a day?
| airduo
twice
171
Taken once or twice a day?
| symbicort
twice
172
Taken once or twice a day?
| dulera
twice
173
Taken once or twice a day?
| Breo Ellipta
once
174
Taken once or twice a day?
| Stiolto Respimat
once
175
Taken once or twice a day?
| Anoro Ellipta
once
176
Taken once or twice a day?
| Utibron Neohaler
twice
177
Taken once or twice a day?
| Bevespi Aerosphere
twice
178
Adverse effects of SABAs
tachycardia; hypokalemia; skeletal tremors; irritability
179
May mix albuterol nebulizer solution with what other things?
cromolyn solution;
| budesonide inhalant suspension; ipratropium solution
180
Levoalbuterol and albuterol comparison
levoalbuterol at 1/2 mg dose of albuterol will provide comparable efficacy and safety
181
Adverse effects of SAMAs
Dry mouth; urinary retention; infection; sinusitis; bronchitis
182
which is first line therapy for severe exacerbations?
| albuterol or ipratropium
albuterol
183
Adverse effects of systemic corticosteroids
short term use: Hyperglycemia; increased appetite; fluid retention; demargination of WBCS; psychiatric disturbances;
184
Drug interactions with oral corticosteroids
warfarin INR increases; efficacy of vaccines decreases
185
can oral corticosteroids and ICS be used together?
yes if ICS was being used before hospital exacerbation
186
contraindications of oral corticosteroids
systemic fungal infections; administration of live vaccine
187
why are "bursts" of oral corticosteroids used
to establish control when initiating therapy or during period of gradual deterioration
188
when can you do an injection of systemic corticosteroids
injection may be used in place of burst if adherence or vomiting is an issue
189
main causes of exacerbations
RTIs; Air pollution; unknown;
190
how to treat an exacerbation
1) short acting bronchodilators and Systemic Corticosteroids
(albuterol/ipratropium and prednisone 40 mg x 5 days)
2) Abx if CARDINAL SX PRESENT
191
what abx are typically used for treating the cardnial symptoms of an exacerbation
macrolides; tetracyclines; amoxicillin/clauvulanate;
192
how long are abx typically used for treating the cardnial symptoms of an exacerbation
5 - 7 days
193
Cardinal Symptoms needed in order to give Abx to an exacerbation patient
sputum purulence; sputum volume; dyspnea
| need all 3 or at least 2 and one of them mst be sputum purulence
194
Pathogenesis of Asthma:
| Early reaction
early - IMMEDIATE bronchoconstriction
| antigen binding to IgE Abs will release contents from mast cells/bronchial smooth muscle contraction/vascular leakage
195
Pathogenesis of Asthma:
| Delayed Reaction:
2 - 8 hours
- sustained bronchoconstriction
- activation of TH2 lymphocytes
- mucus hypersecretion
- cellular infiltration
196
when TH2 lymphocytes get activated during the delayed reaction of asthma - what is released
GM-CSF; IL-4; IL-5; IL-13
197
pathophysiology of asthma:
| PAF = platelet activating factor and it causes what?
hyper-responsiveness
198
pathophysiology of asthma:
| ECP = eosinophil cationic protein - what is it?
cytotoxic and a marker of inflammation
199
what is periostin?
a matrix protein biomarker
200
how does hypersecretion of mucus in asthma happen?
TH2 cells release cytokines --> cytokines causes hyperplasia of goblet cells --> hypersecretion of mucus
201
Hypersecretion of asthma:
| what molecule causes the maintenance of hyperplasia?
Bcl-2
202
Hypersecretion of asthma:
| what molecule causes the development of hyperplasia
EGFR; CLCA
203
Genetics and Goblet Cell Hyperplasia
IL-4a can have a mutation where Q576 becomes R576 this causes an enhanced response to IL-13;
~50% of African Americans are homozygous for R576 in IL-4a
204
_________ promotes chronic allergic inflammation in response to Th2 cytokines
Periostin
205
Airway Remodeling in Asthma:
| what happens to the EPITHELIUM?
mucous hyperplasia and hypersecretion
206
Airway Remodeling in Asthma:
| what happens to the basement membrane?
thickening
207
Airway Remodeling in Asthma:
| what happens to the smooth muscle
hypertrophy
208
```
Remodeling in COPD:
_______ of small airways
________ of lungs
Alveolar _________ and ________
_______ hypersecretion
```
fibrosis; hyperinflation; enlargement; wall destruction; mucus
209
why is a deficiency of alpha-1-antitrypsin bad for COPD pts?
NORMALLY alpha-1-antitrypsin INHIBITS neutrophil elastase and limits lung tissues damage
210
What is a cardinal early sign of cystic fibrosis?
excessively salty sweat
211
Loss of CFTR function in airway epithelium causes _________
thickening of mucus because of dehydrated ASL (airway surface liquid)
212
Lumen of Sweat Duct - how does it normally operate
CFTR brings Cl- into the cell and Na+ also comes into the cell via ENaC
213
2 main inflammatory mediators that will stimulate the Gq/IP3/Ca/Contraction pathway
LTC4/LTD4 and Histamine
214
Serum Levels of Theophylline and Adverse effects seen there:
| 20 ug/mL
20 ug/mL - nausea/vomiting/nervousness
| /abdominal cramping
215
Serum Levels of Theophylline and Adverse effects seen there:
| > 25 ug/mL
cardiac arrythmias; hypotension; CNS stimulation
216
Serum Levels of Theophylline and Adverse effects seen there:
| 40 - 100 ug/mL
seizures/CV arrest
217
what dosage forms does theophylline come in?
ER tablet; ER Capsule; Liquid
218
Adverse effects of Theophylline
(THINK OF COFFEE!!) insomnia; GI upset; hyperactivity; hypotension
219
Dose related toxicities of Theophylline (according to Miller)
Tachycardia; nausea; vomiting; headache; seizures; arrhytmias
220
Contraindications of theophylline
- peptic ulcers disease
- Arrhythmias
- seizure disorders
221
Drug interactions of theophylline:
| Theophylline is a major _______ for what CYP enzyme(s)
substrate; 3A4; 1A2; 2E1
222
Drug-Interactions of Theophylline:
| will increase the concentration of what drugs?
- cimetidine
- erythromycin
- clarithromycin
- ciprofloxacin
- ticlopidine
223
Miller's target range for theophylline
5 - 15 mcg/mL
224
Drug-Interactions of Theophylline:
| will decrease the concentration of what drugs?
- phenobarbitol
- phenytoin
- carbamazepine
- rifampin
- smoking
225
_____________ is likely the cause for hypotension/tachycardia/nausea seen from theophylline
PDE III inhibition
226
For COPD or Asthma?
| Daliresp
COPD
227
things to monitor with Daliresp
Liver function tests; Weight
228
Adverse effects of Xolair
- Headache
- injection site reactions
- arthralgias
- thrombocytopenia
- pharyngitits
- sinusitis
- upper RTIs
229
Xolair: Do not administer more than _______ per injection site
150 mg
230
Who is Xolair FDA approved for?
moderate - severe asthma patients w/ a positive skin test/reactivity in a perennial aeroallergen and Sx that are inadequately controlled with ICS
231
Adverse events for Nucala
- headache
- infection site reactions
- arthralgias
- Herpes Zoster infection
232
when is Nucala used for an add-on maintenance treatment?
when the patient has severe asthma with an EOSINOPHILIC phenotype
233
when is Cinqair used for an add-on maintenance treatment?
when the patient has severe asthma with an EOSINOPHILIC phenotype
234
Adverse events of Cinqair
- injection site reactions
- myalgias
- increased creatine phosphokinase
235
Which monoclonal Ab has a boxed warning for malignancies?
Cinqair
236
Formoterol or Salmeterol?
| Which one has a longer duration? and why
Salmeterol - it has more lipophilcity
237
Formoterol or Salmeterol?
| Which one has the greater receptor affinity?
Salmeterol
238
Formoterol or Salmeterol?
| Which one has greater water solubility/moderate lipophilicity?
formoterol (will have shorter duration of action)
