FA Respiratory

Question 1

H1 Blockers

Answer 1

1st generation: Diphenhyrdamine, dimenhydrinate, chlorpheniramine
2nd generation: Loratadine, fexofenadine, desloratadine, cetirizine

Question 2

Diphenhydramine, Dimenhydrinate, Chlorpheniramine Mechanism

Answer 2

H1 Blocker, first generation - reversible inhibitors of H1 histamine receptors

Question 3

Diphenhydramine, Dimenhydrinate, Chlorpheniramine Use

Answer 3

Allergy, motion sickness, sleep aid

Question 4

Diphenhydramine, Dimenhydrinate, Chlorpheniramine Toxicity

Answer 4

Sedation, antimuscarinic, anti-α-adrenergic

Question 5

Loratadine, Fexofenadine, Desloratadine, Cetirizine Mechanism

Answer 5

H1 Blocker, second generation - reversible inhibitors of H1 histamine receptors

Question 6

Loratadine, Fexofenadine, Desloratadine, Cetirizine Use

Answer 6

Allergy

Question 7

Loratadine, Fexofenadine, Desloratadine, Cetirizine Toxicity

Answer 7

Far less sedating that 1st generation because of ↓ entry into CNS

Question 8

Expectorants

Answer 8

Guaifenesin, N-acetylcysteine

Question 9

Guaifenesin Use

Answer 9

Expectorant - thins respiratory secretion; does not suppress cough reflex

Question 10

N-acetylcysteine Use

Answer 10

Mucolytic - can loosen mucous plugs in CF patients. Also used as an antidote for acetaminophen overdose.

Question 11

Dextromethorphan Use

Answer 11

Antitussive

Question 12

Dextromethorphan Mechanism

Answer 12

Antagonizes NMDA glutamate receptors. Synthetic codeine analog.

Question 13

Dextromethorphan Toxicity

Answer 13

Mild opioid effect when used in excess. Naloxone can be given for overdose. Mild abuse potential.

Question 14

Pseudoephedrine Mechanism

Answer 14

Sympathomimetic α-agonistic nonprescription nasal decongestant

Question 15

Pseudoephedrine Use

Answer 15

Reduce hyperemia, edema, and nasal congestion; open obstructed eustachian tubes. Also illicitly used to make methamphetamine.

Question 16

Pseudoephedrine Toxicity

Answer 16

Hypertension. Can also cause CNS stimulation/anxiety.

Question 17

Phenylephrine Mechanism

Answer 17

Sympathomimetic α-agonistic nonprescription nasal decongestant

Question 18

Phenylephrine Use

Answer 18

Reduce hyperemia, edema, and nasal congestion; open obstructed eustachian tubes.

Question 19

Phenylephrine Toxicity

Answer 19

Hypertension

Question 20

β2-agonists

Answer 20

Albuterol, salmeterol, formoterol

Question 21

Albuterol Mechanism

Answer 21

Relaxes bronchial smooth muscle (β2)

Question 22

Albuterol Use

Answer 22

Acute asthma exacerbation.

Question 23

Salmeterol, Formoterol Use

Answer 23

Long-acting agents for asthma prophylaxis.

Question 24

Salmeterol, Formoterol Toxicity

Answer 24

Tremor and arrhythmia

Question 25

Methylxanthines

Answer 25

Theophylline

Question 26

Theophylline Mechanism

Answer 26

Likely causes bronchodilation by inhibiting phosphodiesterase → ↑ cAMP levels due to ↓ cAMP hydrolysis.

Question 27

Theophylline Use

Answer 27

Asthma; usage limited because of narrow therapeutic index.

Question 28

Theophylline Toxicity

Answer 28

Usage limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome P-450. Blocks actions of adenosine.

Question 29

Ipratropium Mechanism

Answer 29

Competitive block of muscarinic receptors, preventing bronchoconstriction

Question 30

Ipratropium Use

Answer 30

Asthma, COPD.

Question 31

Muscarinic Antagonists [Asthma]

Answer 31

Ipratropium, Tiotropium (long-acting)

Question 32

Corticosteroids [Asthma]

Answer 32

Beclomethasone, fluticasone

Question 33

Corticosteroids Mechanism [Asthma]

Answer 33

Inhibit the synthesis of virtually all cytokines. Inactivate NF-κB, the transcription factor that induces the production of TNF-α and other inflammatory agents.

Question 34

Corticosteroid Use [Asthma]

Answer 34

1st-line therapy for chronic asthma.

Question 35

Antileukotrienes

Answer 35

Montelukast, zafirlukast, zileuton

Question 36

Montelukast, Zafirlukast Mechanism

Answer 36

Block leukotriene receptors

Question 37

Montelukast, Zafirlukast Use

Answer 37

Asthma, especially for aspirin-induced asthma.

Question 38

Zileuton Mechanism

Answer 38

5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.

Question 39

Zileuton Use

Answer 39

Asthma

Question 40

Omalizumab Mechanism

Answer 40

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE and blocks binding to FcεRI.

Question 41

Omalizumab Use

Answer 41

Used in allergic asthma resistant to inhaled steroids and long-acting β2-agonists.

Question 42

Methacholine Mechanism

Answer 42

Muscarinic receptor agonist. Stimulates muscarinic receptors in airway when inhaled.

Question 43

Methacholine Use

Answer 43

Used in bronchial provocation challenge to help diagnose asthma.

Question 44

Bosentan Use

Answer 44

Used to treat pulmonary arterial hypertension.

Question 45

Bosentan Mechanism

Answer 45

Competitively antagonizes endothelin-1 receptors, ↓ pulmonary vascular resistance.