Pulmonary Pharm

Question 1

H1 blockers – Antihistamines

Answer 1

Reversible inhibitors of H1 histamine receptors

Neutral antagonists or inverse agonists

Question 2

First generation anthistamines

Answer 2

“-en/-ine” or “-en/-ate”

Diphenhydramine
Dimenhydrinate
Chlorpheniramine
Doxylamine

Uses: allergy, motion sickness, vom in preggers, sleep aid

AE: sedation, antimuscarinic, anti-a-adrenergic

Question 3

Second generation antihistamines

Answer 3

“-adine”

Loratadine
Fexofenadine
Desloratadine
Cetirizine

Uses: allergy
AE: far less sedating that 1st gen because of decreased entry into CNS

Question 4

Dextromethorphan

Answer 4

Antitussive (antagonizes NMDA glutamate receptors)

Codeine analog
Mild opiate effect in excess
Serotonin syndrome w/ serotonergic agents

Question 5

Pseudoephedrine
Phenylephrine

Answer 5

Activation of alpha-adrenergic receptors in nasal mucosa –> local vasoconstriction

Use: reduce hyperemia, edema, open obstructed eustachian tubes

AE: hypertension. rebound congestion if used more than 4-6 days

assoc: tachyphylaxis
Can cause CNS stim/anxiety

Question 6

Pulmonary HTN drugs

Answer 6

Endothelin receptor antagonists

PDE-5 inhibitors

Prostacyclin analogs

Question 7

Inhaled B2 agonists

Answer 7

Albuterol (short act - acute)
Salmeterol
Formoterol

Relax bronchial smooth muscle

Use: Asthma

Question 8

Inhaled glucocorticoids

Answer 8

Fluticasone
Budesonide

Inhibit synth of all cytokines (inactivates NfKB transcription fx for TNF-a)

1st line tx of chronic asthma

Question 9

Muscarinic Antagonists

Answer 9

Tiotropium (long acting)
Ipratropium

Competitively block muscarinic receptors, preventing bronchoconstriction

Use: asthma & COPD

Question 10

Antileukotrienes

Answer 10

Montelukast
Zafirlukast

Block leukotriene receptors (CysLT1)

Esp. good for exercise/aspirin induced asthma

Zileuton: 5-lipoxygenase inhibitor decrease conversion of arachidonic acid to leukotrienes – hepatotoxic

Question 11

Anti-IgE monoclonal therapy

Answer 11

Omalizumab

Binds mostly unbound serum IgE and block binding of FcERI

Use: allergic asthma w/ elevated IgE resistant to inhaled glucocorticoids and long acting B2 agonists

Question 12

Chromones

Answer 12

Cromolyn

Prevents mast cell degranulation

Use: Asthma (rarely used)

Question 13

PDE-4 inhibitors

Answer 13

roflumilast

Inhibits phosphodiesterase –> increased cAMP –> bronchodilation, decreased airway inflammation

Uses: Asthma, COPD

Question 14

Methylxanthines

Answer 14

Theophylline

Question 15

Anti-IL-5 monoclonal therapy

Answer 15

Mepolizumab
Resilzumab

Benralizumab (anti IL-5 receptor a)