Pulmonary Pharmacology

Question 1

β2 Agonists: Long-acting
β2 Agonists: Short-acting

(Activate adenylate cyclase → ↑cAMP → relax bronchiole smooth muscle

for asthma

Answer 1

• Short acting: Albuterol (Nebulizer or inhaler)
• Long acting: Salmeterol, Formoterol and always with ICS

Question 2

2 Muscarinic Antagonists to tx asthma or COPD:

(Block M receptor → Vagal nerve → Ach → Bronchoconstriction)

Answer 2

1. Ipratropium
2. Tiotropium

Question 3

Steroids used to tx asthma or COPD:
* Inhaled:
* Oral: Prednisone
* IV:

(↓ expression many interleukins, IFN-γ, TNF-α, GM-CSF → inactivation NF-KB and induces production of TNF-α)

Answer 3

Beclomethasone, Fluticasone, Budesonide

Methylprednisolone (Solumedrol)

Question 4

Leukotriene receptor antagonists (PO) that tx asthma

Answer 4

Montelukast (Singulair)

(Useful in aspirin sensitive asthma)

Question 5

Asthma drug that inhibits 5-lipoxygenase → blocks conversion of arachidonic acid to leukotrienes

Answer 5

Zileuton (PO)

Question 6

Theophylline (Methylxanthines) increases bronchodilation likely through inhibition PDE which causes less …

Answer 6

hydrolysis (breakdown) cAMP
↑cAMP → smooth muscle relaxation

rarely used d/t drug-drug interactions

Question 7

theophylline (methylxanthine like caffeine) toxicities (3)

Answer 7

1. GI toxicity: Nausea, vomiting
2. Neurotoxicity: seizures
3. Cardiotoxicity: atrial tachycardia, atrial flutter (blocks adenosine receptors, like caffeine)

Question 8

Patient with asthma/COPD presents with SVT.
Adenosine is administered and fails to slow heart rate. What is the offending agent?

Answer 8

theophylline (overdose, blocks adenosine action)

rare in real life, common on boards

Question 9

Roflumilast (PO) MOA

Answer 9

• Phosphodiesterase-4 (PDE-4) inhibitor
• Decreases inflammation

(theophylline is a PDE inhibitor)

Question 10

COPD: Chronic Therapy for moderate disease

Answer 10

asthma not based on FEV1

Question 11

COPD: Chronic Therapy for severe disease

Answer 11

asthma not based on FEV1

Question 12

Treatment of community-acquired pneumonia (uncomplicated)

Answer 12

1. Amoxicillin
2. Doxycycline
3. Macrolide (Azithromycin or Clarithromycin)

afebrile in 48 hours

Question 13

Community Acquired PNA
(Complicated) treatment

(COPD, CKD, Diabetes, CHF, Alcoholism)

Answer 13

Fluoroquinolone (levofloxacin)
OR
Amoxicillin plus azithromycin

Question 14

treatment of nosocomial pneumonia

(pseudomonal)

Answer 14

Cefepime or Ceftazidime
Imipenem or Meropenem
Piperacillin-tazobactam (Zosyn)

Question 15

• RSV prevention:
• RSV treatment:

Answer 15

• Prevention: Palivizumab
• Treatment: Ribavirin: Inhibits synthesis of guanine nucleotides

Question 16

treatment of pneumothorax

Answer 16

100% O2: displaces N2 from the airspace and shrinks the pneumothorax
If that doesn’t work: chest tube

Question 17

treatment options for SVC syndrome (4)

Answer 17

Various treatment options:

1. Anticoagulation
2. Steroids (lymphoma)
3. Chemo/Radiation
4. Endovascular stenting

Question 18

Cystic fibrosis treatments (6)

Answer 18

1. Inhaled DNase (dornase alfa)
2. Inhaled saline
3. N-acetylcysteine
4. Vacaftor (tablets): Only for patients with G551D mutation
5. Exacerbations are treated with antibiotics
6. Lung transplantation

Question 19

4 treatments of sarcoidosis

Answer 19

1. Steroids
2. Methotrexate
3. Azathioprine
4. Mycophenolate

(short-term use is best for steroids)

Question 20

Treatment DVT/PE

Answer 20

• Initial treatment with heparin or LMWH
• Transition to warfarin (oral)
• Massive PE: thrombolysis (tPA)