Pulm Flashcards
(230 cards)
1
Q
Epinephrine: Mechanism of Action
A
Nonselective Beta Activation
2
Q
Epinephrine: Clinical Application
A
Bronchodilator (obsolete)
3
Q
Epinephrine: Toxicities
A
Excess cardiac stimulation (tachycardia, arrythmias, etc)
4
Q
Albuterol: MOA
A
Beta 2 Selective Agonist for bronchodilation
5
Q
Albuterol: Clinical Application
A
Drug of Choice for Rescue inhaler
6
Q
Albuterol: Duration
A
2-4 Hours
7
Q
Albuterol: Toxicity
A
Tachycardia, tremor
8
Q
Salmeterol: MOA
A
Beta 2 agonist (long Acting)
9
Q
Salmeterol: Clinical App.
A
Asthma Prophylaxis (Not Rescue) *Combined w/ corticosteroids
10
Q
Salmeterol: Duration
A
12-24 hours
11
Q
Salmeterol: Toxicity
A
Tremor, Tachycardia, Cardiac Toxicity
12
Q
Formoterol: MOA
A
Beta 2 agonist (long Acting)
13
Q
Formoterol: Clin. App.
A
Asthma Prophylaxis (Not Rescue) *Combined w/ corticosteroids
14
Q
Formoterol: Duration
A
12-24 hr
15
Q
Formoterol: Tox.
A
Tachy, Tremor, *Cardiac Events
16
Q
Ipratropium: MOA
A
Competitive muscarinic antagonist (inhibits bronchoconstriction)
17
Q
Ipratropium: Clin. App.
A
Asthma and COPD
18
Q
Ipratropium: Duration
A
hours
19
Q
Ipratropium: Toxicities
A
Dry Mouth, Cough, eye dilation
20
Q
Theophylline: MOA
A
PDE inhibitor (blocks leukotriene synth and red. inflam.) and adenosine antagonist
21
Q
Theophylline: Clin. App.
A
Asthma: Prophylactic against attacks Small Therapeutic Index
22
Q
Theophylline: Duration
A
Slow-Release (12 hr)
23
Q
Theophylline: Toxicities
A
Dangerous arrythmias and seizures. Small Therapeutic index. Insomnia and tremor also.
24
Q
Cromolyn Sodium: MOA
A
Reduces release of inflammatory mediators from mast cells
25
Cromolyn Sodium: Clin. App.
Rarely Used: Prophylaxis for asthma and allergies. Esp. useful in exercise induced asthma.
26
Cromolyn Sodium: Duration
3-6 hr. by inhaler
27
Cromolyn Sodium: Toxicities
Cough (basically none)
28
Beclomethasone: MOA
Inhaled Corticosteroid: Inhibits Phospholipase A2 and cyclooxygenase production. Reduces inflammation
29
Beclomethasone: Clin. App.
Drug of Choice for asthma prophylaxis. Often combined with LABA
30
Beclomethasone: Duration
10-12 hr
31
Beclomethasone: Toxicities
Pharyngial immunosuppression (Candidiasis)
32
Prednisolone (Prednisone): MOA
Systemic Corticosteroid: inhibits synthesis of pro-inflammatory signals.
33
Prednisolone (Prednisone): Clin. App.
Used to treat severe, refractory asthma. Status Asthmaticus. *No More than 2 weeks*
34
Prednisolone (Prednisone): Duration/Pharmacokinetics
IV/Oral lasts 12-24 hours
35
Prednisolone (Prednisone): Toxicities
Immune suppression. Inhibits growth. Can cause cushing syndrome if used long term. Last resort here.
36
Montelukast: MOA
LTD4r antagonist (reverses bronchoconstriction)
37
Montelukast: Clin. App.
Prophylaxis of Asthma
38
Montelukast: Duration
12-24 hours
39
Montelukast: Toxicities
May cause suicidal ideation
40
Zileuton: MOA
Inhibits Lipoxygenase to prevent formation of LTC/D/E4. This prevents bronchoconstriction.
41
Zileuton: Clin. App.
Prophylaxis of Asthma
42
Zileuton: Duration
12 hr
43
Zileuton: Toxicities
*Liver Damage (Elevation of Liver enzymes)*
44
Omalizumab: MOA
Monoclonal Ab against IgE on mast cells to prevent reaction to antigen
45
Omalizumab: Clin. App
*Expensive* Prophylaxis of severe asthma not helped by other meds.
46
Omalizumab: Duration/Pharmacokinetics
IV administered in several courses of injections
47
Omalizumab: Toxicities/Concerns
Extremely expensive and *can cause anaphylaxis up to one week after admin*
48
Diphenhydramine: MOA
Antihistamine (H1 blocker) CNS and peripheral. Also blocks other muscarinic and alpha receptors to prevent motion sickness
49
Diphenhydramine: Clin. App.
*Allergies* plus motion sickness and insomnia
50
Diphenhydramine: Duration
6 hr
51
Diphenhydramine: Toxicities
Sedation, autonomic block, Rare CNS excitation (counterintuitive)
52
Dimenhydrinate: MOA
H1 Blocker (1st gen)
53
Dimenhydrinate: Clin App.
Allergies, motion sickness, sleep aid, etc.
54
Dimenhydrinate: Duration
6 hr
55
Dimenhydrinate: Toxicities
Sedation, Autonomic block, CNS Excitation (Rare, counterintuitive)
56
Chlorpheniramine: MOA
H1 Blocker (late 1st gen)
57
Chlorpheniramine: Clin. App.
Allergies *No motion sickness or sedative effects*
58
Chlorpheniramine: Duration
6 hr
59
Chlorpheniramine: Toxicities
Fewer CNS effects, so no sedation or autonomic block centrally
60
Hydroxyzine: MOA
Potent H1 blocker
61
Hydroxyzine: Clin App
Antianxiety, motion sickness, refractive allergies
62
Hydroxyzine: Duration
6 hr
63
Hydroxyzine: Toxicities
Autonomic block, sedation
64
Fexofenadine, Desloratadine: MOA
Peripheral H1 Blocker (2nd gen.)
65
Fexofenadine, Desloratadine: Clin. App.
Allergies
66
Fexofenadine, Desloratadine: Duration
12-24 hr
67
Fexofenadine, Desloratadine: Toxicities
None *No CNS Penetration*
68
Cetirizine: MOA
Peripheral H1 Blocker (2nd gen.)
69
Cetirizine: Clin. App.
Allergies
70
Cetirizine: Duration
12-24 hr
71
Cetirizine: Toxicities
None *No CNS Penetration
72
Azelastine: MOA
Inhaled H1 Blocker
73
Azelastine: Clin. App.
Allergic Rhinitis (Allergies). *More potent and effective than oral meds*
74
Azelastine: Duration
24 hr
75
Azelastine: Toxicities
Headache and Nasal Burning
76
Isoniazid: MOA
Prodrug that inhibits mycolic acid synthesis. Resistance through katG and inhA genes
77
Isoniazid: Clin. App.
Bactericidal. Good for latent TB and primary drug in RIPE
78
Isoniazid: ADME
Oral or IV. Some people are *Fast Acetylators* and clear it faster. These need higher doses.
79
Isoniazid: Drug Interactions
Inhibits Metab. of Carbamazepine, phenytoin, and warfarin
80
Isoniazid: Toxicities
Liver toxicity, *peripheral neuropathy (Tx w/ pyridoxine)*, and hemolysis in G6PD deficiency
81
Rifampin: MOA
Inhibits DNA-Dependent RNA Polymerase. Rapid Resistance if used alone
82
Rifampin: Clin. App.
Bactericidal. Optional for Latent TB, but primary drug in RIPE for active TB
83
Rifampin: ADME
Can be oral or IV. Enterohepatic cycling.
84
Rifampin: Drug Interactions
Induces CYP450s and reduces metab of many other drugs
85
Rifampin: Toxicities
*Orange secretions* Rash, nephritis, cholestasis, thrombocytopenia, *flu-like syndrome if intermittently dosed*
86
Ethambutol: MOA
Prevents formation of Arabinoglycan (Component of MTB Cell wall). Rapid Resistance if used alone
87
Ethambutol: Clin. App.
Bacteriostatic. Used in Combo with RIPE
88
Ethambutol: ADME
Renal Clearance, so dose must be reduced if these organs are damaged
89
Ethambutol: Toxicities
Dose-dependent visual disturbances (Color changes, Reversible). Headache, confusion, hyperuricemia, and peripheral neuritis.
90
Pyrazinamide: MOA
Prodrug with uncertain mechanism of action
91
Pyrazinamide: Clin. App.
Bacteriostatic component of RIPE
92
Pyrazinamide: ADME
Hepatic and Renal Clearance (Reduce dose if damaged)
93
Pyrazinamide: Toxicities
*Polyarthralgia (40%)*, myalgia, rash, photosensitivity, *Contraindicated in Pregnacy*
94
Cycloserine: MOA
Blocks incorporation of D-Ala into peptidoglycan
95
Cycloserine: Clin. App.
Second Line therapy in Multidrug resistant TB
96
Cycloserine: Toxicities
Neurotoxic (Tremors, seizures, psychosis)
97
Amoxicillin: MOA
Bactericidal, incorporated via Penicillin Binding Proteins into cell wall where they block cross-linking and enhance autolysis of cell wall.
98
Amoxicillin: Clin. App.
Used with penicillinase inhibitors (Clavulonic Acid, etc.) and can treat a broad range of infections. Also has some effect on G- bacteria.
99
Amoxicillin: ADME
Rapid renal elim. Short half lives. Requires frequent dosing. Can be taken with food.
100
Amoxicillin: Toxicities
*Hypersensitivity (5-6%)* GI distress
101
Ampicillin-sulbactam: MOA
Bactericidal, incorporated via Penicillin Binding Proteins into cell wall where they block cross-linking (inhibits transpeptidase) and enhance autolysis of cell wall. Sulbactam is a beta-lactamase that prevents beakdown of drug.
102
Ampicillin-Sulbactam: Clin. App.
Can treat a broad range of infections. Synergistic w/ aminoglycosides (gentamicin, etc.)
103
Ampicillin-Sulbactam: ADME
Frequent dosing required
104
Ampicillin-Sulbactam: Toxities
*Hypersensitivity (5-6%)*, maculopapular Rash
105
Carbapenem: MOA
Bactericidal, incorporated via Penicillin Binding Proteins into cell wall where they block cross-linking (inhibits transpeptidase) and enhance autolysis of cell wall. *Resistant to Beta-lactamases*
106
Carbapenem: Clin. App.
Good broad spectrum antibiotic. *Works against some Penicillin resistant Strep pneumoniae*. Also effective against G- and anaerobes (except ertapenem)
107
Carbapenem: ADME
Must be given parenterally. Usually renally eliminated (not degraded though)
108
Carbapenem: Toxicities
Some cross-reactivity with penicillin hypersensitivities. *CNS effects including confusion and Seizures*
109
Ceftriaxone: MOA
Bind PBPs and inhibit cell wall formation. Bactericidal against susceptible organisms
110
Ceftriaxone: Clin. App.
3rd tier drug for pneumonia and meningitis. Reserved to prevent resistance
111
Ceftriaxone: ADME
IV Admin w/ renal elimination. Short t1/2. Enters CNS
112
Ceftriaxone: Toxicity
GI distress and some susceptibility to penicillin hypersensitivity
113
Clarithromycin: MOA
Bacteriostatic macrolide antibiotic. Binds 50s subunit and prevents synthesis.
114
Clarithromycin: Clin. App.
Comm. Acq. Pneumonia, pertussis, corynebacteria, and chlamydia
115
Clarithromycin: ADME
Oral admin. Hepatic metab and renal elimination. Short t1/2 (6 hr)
116
Clarithromycin: Toxicity
GI and Hepatic dysfunction. *QT Elongation* CYP450 inhibition
117
Doxycycline: MOA
Bacteriostatic tetracycline antibiotic. Binds 30s Ribosomal Subunit
118
Doxycycline: Clin. App.
Chlamydia and mycoplasma. Also, prevention of CAP and Tx of same. *Anthrax prophylaxis (Although for this test say Ciprofloxacin)*
119
Doxycycline: ADME
Oral Long t1/2. Fecal elimination.
120
Doxycycline: Toxicity
GI Sensitivity and tooth deposition (no kids younger than 8)
121
Erythromycin: MOA
Bacteriostatic, macrolide antibiotic. Binds 50s subunit.
122
Erythromycin: Clin. App.
CAP, legionella, diphtheria, mycoplasma, chlamydia, pertussis
123
Erythromycin: ADME
IV admin with short t1/2. Eliminated in Bile. Can be given orally with protective coat.
124
Erythromycin: Toxicity
Mainly GI upset *Only macrolide that can be used in renal failure*
125
Imipenem/Meropenem: MOA
Bactericidal, incorporated via Penicillin Binding Proteins into cell wall where they block cross-linking (inhibits transpeptidase) and enhance autolysis of cell wall. *Resistant to Beta-lactamases*
126
Imipenem/Meropenem: Clin. App.
Imipenem administered with cilastatin (meropenem w/out) to treat many diseases. Good broad spectrum antibiotic. *Works against some Penicillin resistant Strep pneumoniae*. Also effective against G- and anaerobes (except ertapenem)
127
Imipenem/Meropenem: ADME
Imipenem normally quickly degraded in kidney, but not so bad if combined with cilastatin. This gives it a longer t1/2. Meropenem doesn't need this.
128
Imipenem/meropenem: Toxicity
GI distress, Skin rash, CNS toxicity (Imipenem high doses)
129
Levofloxacin: MOA
Bactericidal fluoroquinolone. Inhibits DNA replication by binding DNA gyrase (G-) and Topoisomerase IV (G+).
130
Levofloxacin: Clin. App.
CAP
131
Levofloxacin: ADME
Oral or IV. Renally eliminated
132
Levofloxacin: Toxicity
QT prolongation
133
Moxifloxacin: MOA
Bactericidal. Inhibits DNA replication by binding DNA gyrase (G-) and Topoisomerase IV (G+).
134
Moxifloxacin: Clin. App.
CAP
135
Moxifloxacin: ADME
Oral or IV. *Hepatic Elimination*
136
Moxifloxacin: Toxicity
QT prolongation
137
Penicillin: MOA
Bactericidal, incorporated via Penicillin Binding Proteins into cell wall where they block cross-linking (inhibits transpeptidase) and enhance autolysis of cell wall.
138
Penicillin: Clin. App.
Strep Pneumo
139
Penicillin: ADME
Rapid Renal Elim.
140
Penicillin: Toxicity
*Hypersensitivity (5-6%)*
141
Cyclophosphamide: MOA
Forms DNA cross-links preventing DNA Synthesis and function
142
Cyclophosphamide: Clin. App.
Inflammatory Restrictive Lung Disease, Lung Cancer
143
Cyclophosphamide: Toxicity
Myelosupression, alopecia, Hemorrhagic Cystitis (Tx Mesna)
144
Ambrisentan: MOA
Block binding of Endothelin-1 and prevent prolieration of vascular smooth muscle and vasoconstriction in Pulm. HTN
145
Ambrisentan: Clin. App.
Pulm. HTN
146
Ambrisentan: ADME
Oral T1/2= 5hr. Hepatic Elim.
147
Ambrisentan: Toxicities
Some Hepatic Toxicity (less than bosentan), but mainly *Pregnancy Cat. X*
148
Beractant: MOA
Purified animal surfactant. Used to lower surface tension in NRDS.
149
Beractant: Clin. App.
NRDS
150
Epoprostenol: MOA
Replaces Prostanoids to prevent LT formation and vasodilate
151
Epoprostenol: Clin. App.
Pulm. HTN
152
Epoprostenol: ADME
Continuous IV infusion (t1/2 <5 min)
153
Epoprostenol: Toxicity
*hypotension, muscle pains, headache, and flushing. Monitor for bleeding*
154
Tadalafil: MOA
Prevents breakdown of cGMP and leads to vasodilation
155
Tadalafil: Clin. App.
Pulm. HTN. Erectile dysfunction
156
Tadalafil: ADME
Oral 17hr t1/2. CYP3A4 metab.
157
Tadalifil: Toxicity
Headache, back pain, dyspepsia. *Do not take with organic nitrates*
158
Methotrexate: MOA
Dihydrofolatereductase inh. (increases adenosine). Suppresses the immune system.
159
Methotrexate: Clin. App.
Sarcoidosis (not front-line therapy), Cancer
160
Methotrexate: Toxicity
Severe skin reactions, birth defects (*Cat. X*), lymphoma, and *pulmonary fibrosis*
161
Iloprost: MOA
Replaces prostanoids
162
Iloprost: Clin. App.
Pulm HTN
163
Iloprost: ADME
Short t1/2. Requires 6-9 10 min vaporizer doses daily.
164
Iloprost: Toxicity
Cough, flushing, headaches, *Hemoptysis*
165
Diltiazem: MOA
Non-DHP CCB. Works by preventing smooth muscle contraction.
166
Diltiazem: Clin. App.
Pulm. HTN (Not first choice), Arrythmias
167
Diltiazem: ADME
T1/2 4-6 hr Oral
168
Diltiazem: Toxicity
Arrythmias, hypotension, headache, *Reactive bronchoconstriction possible, so vasodilator challenge sometimes reqd.*
169
Rituximab: MOA
MAb that binds CD20 lymphs and reduces inflammation
170
Rituximab: Clin. App.
Granulomatosis w/ polyangiitis (Wegeners)
171
Rituximab: ADME
Long lasting effect (6-9 mo.)
172
Rituximab: Toxicity
Immunosuppression
173
Treprostinil: MOA
Replaces Prostaglandins causing vasodilation
174
Treprostinil: Clin. App.
Pulm. HTN
175
Treprostinil: ADME
Continuous IV Influsion Reqd. Dec. Cl. w/ Gemfibrozil, and *Inc. with Rifampin*
176
Treprostinil: Toxicity
Bleeding, Jaw pain, general malaise
177
Azathioprine: MOA
DNA and RNA synthesis inhibitor
178
Azathioprine: Clin. App.
Granulomatosis w/ polyangiitis
179
Azathioprine: Toxicity
Associated with neoplastic, mutagenic, leukopenic & thrombocytopenic toxicity. Increases
risk of infection
180
Bosentan: MOA
Endothelin-1 antagonist
181
Bosentan: Clin. App.
Pulm. HTN (Reduces vasoconstriction b/c prevents binding of endothelin-1)
182
Bosentan: ADME
Oral BID
183
Bosentan: Toxicity
*Significant Hepatic toxicity and anemia. Monitor LFTs. Preg. Cat. X*
184
Amlodipine: MOA
DHP Calcium Channel Blocker. Prevents smooth muscle contraction
185
Amlodipine: Clin. App.
Pulm. HTN
186
Amlodipine: ADME
Oral once a day
187
Amlodipine: Toxicity
fatigue, hypotension, *No bradycardia*
188
Verapamil: MOA
Non DHP CCB
189
Verapamil: Clin. App.
Arrythmias, *Not Pulm. HTN*
190
Acetaminophin: MOA
Weak COX inhibitor. Reduces fever and pain
191
Acetaminophen: Clin. App.
Cold, flu, etc.
192
Acetaminophen: ADME
Hepatically eliminated via CYP2E1. Major cause of liver failure in western world
193
Acetaminophen: Toxicity
*Liver*. Causes liver failure due to depletion of glutathione. Worse in alcoholics.
194
Dextromethorphan: MOA
Binds NMDA receptors. Treats cough as well as codeine without being addictive
195
Dextromethorphan: Clin. App.
Acute debilitating Cough
196
Dextromethorphan: ADME
Effects last about 1 hr
197
Dextromethorphan: Toxicity
Reduces cough reflex and is toxic in overdose (hallucinations, confusion, excitation, etc). Wide margin of safety, however. No one on MAOI
198
Codeine: MOA
Binds mu receptors. Antitussive
199
Codeine: Clin. App.
Acute Persistent Cough, Pain
200
Codeine: ADME
Duration of about 1 hr
201
Codeine: Toxicity
Reduces cough reflex, toxic in overdose, addictive, Constipation
202
Camphor: ADME
Rub on to sooth cough or use lozenges
203
Menthol: ADME
Rub on to sooth cough or use lozenges
204
Pseudoephedrine: MOA
Releases norepinephrine from sympathetic nerve endings
205
Pseudoephedrine: Clin. App.
Decongestant
206
Pseudoephedrine: ADME
Short t1/2 not metabolized, but excreted unchanged
207
Pseudoephedrine: Toxicity
Potential for abuse as meth. High BP. Restlessness and insomnia. *Rebound Congestion*
208
Phenylephrine: MOA
Directly stimulates nerve endings of sympathetic nerves
209
Phenylephrine: Clin. App.
Decongestant
210
Phenylephrine: ADME
Rapidly metabolized short t1/2
211
Phenylephrine: Toxicity
Potential for abuse as Meth, High BP, Restlessness, insomnia, and Rebound Congestion all possible
212
Oxymetazoline: MOA
Vasoconstricts, leading to more open airways and less transudate from vessels
213
Oxymetazoline: Clin. App.
Decongestant
214
Oxymetazoline: ADME
Nasal mist administration
215
Oxymetazoline: Toxicity
*Pregnancy Class C*, Rebound Congestion Do not take more than 3-5 days to prevent rhinitis medicamentosa.
216
Guaifenasin: MOA
Loosens and thins secretions by increasing volume and lowering viscosity.
217
Guaifenasin: Clin. App.
Expectorant, increases productivity of cough *Not for chronic cough*
218
Guaifenasin: ADME
Oral or syrup
219
Guaifenasin: Toxicity
Dizziness, Dry Mouth, others *Uric Acid Nephrolithiasis in large doses*
220
Acetyl Cysteine: MOA
Breaks bonds by substituting sulfhydryl Radical. Makes mucous production increase and be more easily cleared
221
Acetyl Cysteine: Clin. App.
Mucolytic (Orally to counteract Tylenol Overdose)
222
Acetyl Cysteine: ADME
Given by aerosol or via endotracheal tube
223
Acetyl Cysteine: Toxicity
*May cause bronchospasm*, incompatible with antibiotics, bad odor
224
Amiloride: MOA
Na Channel Blocker. Thought to be useful for Cystic fibrosis
225
Amiloride: Clin. App.
Cystic Fibrosis (not proven)
226
Amiloride: ADME
Vaporized. Very Short Acting
227
Desloratidine: MOA
2nd gen H1 blocker
228
Desloratidine: Clin. App.
Allergies
229
Desloratidine: ADME
Once daily dosing
230
Desloratidine: Toxicities
Fatigue, dry mouth
