OLD Pharm

Question 1

two drug targets in asthma and COPD

Answer 1

inflammation and constricted airways (bronchodilators)

Question 2

6 inhaled corticosteroids

Answer 2

beclomethasone, triamcinolone, flunisolide, fluticasone, budesonide, mometasone

Question 3

IV corticosteroid

Answer 3

solumedrol

Question 4

Oral corticosteroid

Answer 4

prednisone

Question 5

LOX inhibitor

Answer 5

zileuton

Question 6

leukotriene antag

Answer 6

motelukast, zafirlukast

Question 7

omalizumab

Answer 7

IgE antibody

Question 8

mepolizumab

Answer 8

IL-5 antibody

Question 9

dupilumab

Answer 9

IL-4 antibody

Question 10

PDE4 inhib

Answer 10

rolumilast

Question 11

mast cell stabilizer

Answer 11

cromolyn

Question 12

SABAs

Answer 12

albuterol, epi

Question 13

LABAs

Answer 13

salmeterol, formoterol, indacaterol

Question 14

SAMAs (short acting anti cholinergic)

Answer 14

ipratropium

Question 15

LAMAs (long acting anti cholinergic)

Answer 15

tiotropium, aclinidium, umeclidinium, glycopyrronium

Question 16

ANS regulation of bronchiole SM

Answer 16

PSNS: less O2 needed, M3 activation and constriction

SNS: more O2, B2 activatio and dilation

Question 17

M3 agonist

Answer 17

methacholine

Question 18

maintenance therapy for asthma

Answer 18

LABAs, LAMAs, SAMAs

Question 19

indications for epi, target, delivery

Answer 19

hits all SNS receptors, for anaphylaxis

subQ

Question 20

ITD for albuterol (indications, target, delivery)

Answer 20

B2, asthma acute, inhalation prn

Question 21

why albuterol only for rescue?

Answer 21

receptor desensitization/ downregulation w/ regular use

Question 22

differentiate LABAs salmeterol/formoterol from indacaterol w/ ITD

Answer 22

all are B2 selective

first two are indicated for asthma and COPD, second is only COPD

all orally inhaled twice daily except indacaterol is once daily

Question 23

important toxicities of B2 agonists

Answer 23

mainly cardiac for cross agonism of B1 (tachycardia, angina, a fib, etc)

Question 24

strength of B2 agonist on receptor

Answer 24

all partial except epi

Question 25

3 variables for toxicities of inhaled drugs

Answer 25

how much is systemically (blood) absorbed? clearance/metabolism receptor selectivity

Question 26

how is most inhaled drug absorbed

Answer 26

95% swallowed, some is indirectly from mucociliary clearance then swallowed, toxicites occur in systemic circulation

Question 27

most cardiotoxic B2 agonists

Answer 27

epi, indacaterol, then formoterol is moderate

Question 28

which 2 M3 antagonists are indicated for asthma in addition to COPD?

Answer 28

ipratropium (SAMA), tiotropium (LAMA)

Question 29

toxicities of M3 antagonists

Answer 29

parasympathetic related (lowering rest and digest): dry mouth (xerostomia), constipation, tachycardia, Urinary retention (Umeclidinium) except aclidinum?

Question 30

two main aspects of inflammation inhibition from steroids

Answer 30

reduction of cells: eos, mast cells, dendritic cells reduction of cytokines: from t lymphos, macros, epithelial cells, SM

Question 31

consequence of chronic steroid use

Answer 31

infection susceptibility- thrush and pneumonia from oral inhalation

Question 32

pregnancy risk for CS

Answer 32

inhaled options relatively safe, prednisone less so

Question 33

CS combo drugs | why?

Answer 33

LABAs always combined w/ inhaled corticosteroids LABAs alone had higher asthma death rate

Question 34

CS effect on bronchiole SM

Answer 34

increases B2 receptors, higher responsiveness to bronchodilators

Question 35

effect of leukotriene inhibs

Answer 35

reduce Sx of respiratory inflammation

Question 36

zileuton target

Answer 36

LOX enzymes in mast cells and eos- inhibit LT production

Question 37

-lukast target

Answer 37

LT receptors in bronchiole SM, prevent constriction, plasma exudation/mucus

Question 38

CS effect on LK activity

Answer 38

stimulate lipocortin production which inhibts phospholipase A2 and thus all eicosanoids

Question 39

indication for LK inhibs

Answer 39

allergic asthma

Question 40

montelukast toxicities (2)

Answer 40

Churg Strauss syndrome (eosinophilic granulamatosis w/ polyangiitis, autoimmune vasculitis) reports of neuropsych disturbances- suicide (not FDA confirmed)

Question 41

indication of omalizumab

Answer 41

IgE allergic asthma, given once every 4 weeks

Question 42

indication of mepolizumab

Answer 42

severe eosinophilic asthma, once every 4 weeks

Question 43

theophylline moa

Answer 43

bronchodilation: inhibits PDEs (allows for cAMP buildup and more more inhibition of contraction), competitive adenosine antagonist (adenosine causes contraction) also has anti inflammatory mechanisms

Question 44

theophylline toxicities

Answer 44

CNS- headache, seizures cardiac- arrhythmias GI- nausea, diarrhea non selective PDE inhib, low therapeutic index

Question 45

moa of cromolyn

Answer 45

stabilize mast cell and prevent release of inflammatory mediators (in response to IgE/allergen

Question 46

roflumilast moa

Answer 46

PDE4 selective inhib- fewer toxicities than theophylline

Question 47

indications/dosing of roflumilast

Answer 47

for COPD, oral