pulmonary pharmacology

Question 1

3 primary factors for bronchoconstriction

Answer 1

• abnormal bronchomotor tone (bronchospasm)
• inflammation
• mechanical obstruction

Question 2

radius and airway resistance

Answer 2

• R = (length x visoctiy)/radius ⁴

Question 3

bronchomotor tone

Answer 3

• beta 2 stimulation: bronchodilation (fight or flight)
• muscarinic stimulation: bronchoconstriction
• if meds stimulate beta 2 or block muscarinic - bronchodilation
  
  • beta agonist drugs: increase cAMP, decrease intracellular Ca2+, promote smooth muscle relaxation
    
    • albuterol, venotolin, proventil
  • muscarinic antagonist: block parasympathetic stimulation of muscarinic receptor and blocks phosphodiesterase (PDE)
    
    • decrease cGMP and increase cAMP to promote smooth muscle relaxation
    • atrovent

Question 4

short/rapid acting

Answer 4

• rapid onset action but short halflife
• good for emergy use
• “rescue inhaler” - as needed

Question 5

long acting

Answer 5

• delayed onset and a longer halflife
• good for maintenance
  
  • 2 puffs twice a day

Question 6

medications can be given via

Answer 6

• inhaler: local, direct administration into lungs/airways
  
  • directly to source, minor side effects
• oral (PO)
• intravenous (IV): systemic
  
  • more likely to lead to unwanted side effects

Question 7

beta adrenergic agonists

Answer 7

• sympathomimetics
• short-acting/rapid-acting beta agonist (SABA/RABA)
  
  • albuterol/ventolin/proventil
• long-acting beta agonist (LABA)
  
  • servent (salmeterol) - most common
• stimulate Beta2 receptor for bronchodilation
  
  • increase cAMP, decrease intracellular Ca2+, promote smooth muscle relaxation
  • albuterol, venotlin, proventil
• side effects: tachycardia, HTN, tremors, anxiety

Question 8

anticholinergics

Answer 8

• parasympatholytics
• short/rapid-acting muscarinic antagoist (S/RAMA)
  
  • atrovent
• long-acting muscarinic antagonist (LAMA)
  
  • spiriva (tiotropium)
• block muscuarinic receptors and phsophodiesterase (PDE)
  
  • decrease cGMP and increase cAMP to promote smooth muscle relaxation
• side effects: dry mouth, allergic reaction (rare), urinary retention

Question 9

anti-inflammatory

Answer 9

• long term control of inflammation
• corticosteroids: administered often by inhalation (ICS)
  
  • can also be given PO and IV
• prednisone/solumedrol
• beclovent/vanceril/azmacort
• side effcts: opportunistic infection
  
  • immunosuppression, myopathy, hyperglycemia, osteoporosis, insomnia, Na+/H2O retention, emotional liability

Question 10

combination medications

Answer 10

• SABA and SAMA (short acting muscarinic antagonist) combination bronchodilators
  
  • combivent/duoneb (albuterol and ipratropium)
• LAMA (long acting muscarinic antagonist) and LABA (long acting beta agonist)
  
  • anoro (umeclidinium and vilanterol)
  • stiolto (olodaterol and triotropium)

Question 11

management based on GOLD guidelines

Answer 11

• mMRC breathlessness scale: activity and shortness of breath scale
• COPD assessment test (CAT): scale that include symptoms (SOB, chest tightness), cough/sputum, activity levels and sleep

Question 12

pulmonary pharmacotherapy

Answer 12

• smoking cessation
  
  • nicotinic receptor partial agonist - Chantix
  • nictotinic receptor antagonist
• antifibrotics: useful for pulmonary fibrosis
• antibiotics: useful for pulmonary infections (pneumonia, COPD exacerbation)