Respiratory Drugs

Question 1

They are bronchodilators that are used for acute treatment of bronchospasm (relievers). They are used to prevent nocturnal attacks of asthma. They stimulate adenylate cyclase
SE: Tachycardia, development of tolerance, tremors, restlessness, ankle edema

Answer 1

B2-Agonists

Question 2

B2-Agonists:
Rapid acting, short DOA

Rapid acting, long DOA

Long acting, long DOA

Answer 2

Terbutaline, Salbutamol, Fenoterol

Formoterol

Salmeterol
Bambuterol
Serevent

Question 3

They are the antagonists for M3 receptors and are the first line drugs for COPD. They are used as relievers

Answer 3

Anticholinergics/ Muscarinic Antagonists
Atropine, belladonna alkaloids, ipratropium, tiotropium, oxytropium

Question 4

This is the prototype anticholinergic drug
SE: xerostomia, urinary retention, hypertension, and mydriasis to blindness

Answer 4

Atropine and belladonna alkaloids

Question 5

This is the most readily available anticholinergic that is often combine with salbutamol

Answer 5

Ipratropium

Question 6

This is the most ideal anticholinergic because it is the most selective- it binds to M3 receptors only

Answer 6

Tiotropium

Question 7

This is an anticholinergic that can bind to both M2 and M3 receptors

Answer 7

Oxytropium

Question 8

They are drugs for asthma that are naturally-occurring and have purine rings. they are indicated for nocturnal attacks of asthma and respiratory stimulants of COPD. They are the alternative drugs for status asthmaticus. They inhibit PDE and increase cAMP, inhibit adenosine receptors, and blocks calcium influx

Answer 8

Methylxanthines
Caffeine (1,3,7 dimethylxanthine)
Theobromine (3,7 dimethylxanthine)
theophylline (1,3 dimethylxanthine)

Question 9

They are also known as chromones and are extremely insoluble. They prevent the mast cells from bursting or exploding and are prophylactic agents

Inhaled agents (more common)

Oral agent

Answer 9

Anti-mediator release- mast cell stabilizers

Cromolyn sodium/ sodium cromoglycerate, nedocromil

Ketotifen

Question 10

This drug is a lipoxygenase enzyme inhibitor, decreasing the leukotriene concentration in the blood

Answer 10

Zileuton

Question 11

These drugs are LTD4 antagonists or leukotriene receptor antagonists

One drug causes neuropsychiatric adverse events (black box warning)

Answer 11

Montelukast and zafirlukast

Montelukast

Question 12

They are a mainstay treatment for bronchial asthma. They inhibit PA2 and cytokine release by macrophage. They are made up of the cyclopentanoperhydrophenanthrene ring (CPPP)

One classification of this drug is responsible for the anti-inflammatory effect and is for asthma. They have an OH group at C11. They are long acting

One classification of this drug is responsible for its aldosterone effect (sodium-retained). They have an OH at C21. They are short acting

Answer 12

Steroids

Glucocorticoids (betamethasone and dexamethasone)

Mineralocorticoids (Fludrocorisone)

Question 13

They are drugs for colds that cause vasoconstriction which allows sinus cavities to drain. They are adrenergic agonists. They are available as topical and oral drugs. The length of their therapy should not exceed 3-5 days (topical)
ADR: Rhinitis medicamentosa

Answer 13

Nasal decongestants

Question 14

They are nasal decongestants that are administered through nasal spray

Short acting (frequent administration)

Intermediate acting

Long acting

Answer 14

Topical decongestants

Phenylephrine

Naphazoline, Tetrahydrozoline

Oxymetazoline and Xylometazoline

Question 15

They are nasal decongestants that are given orally
SE: hypertension

Answer 15

Oral or Systemic decongestants
Pseudoephedrine, Phenylpropanolamine, Phenylephrine

Question 16

They are a class of medications that are used to stop the cough reflex. It is indicated only when the cough is non-productive. They act on either the depressed medulla oblongata center or used to increase the threshold of peripheral reflexogenous zone

Answer 16

Antitussive (centrally- or peripherally-acting antitussives)

Question 17

They are antitussives that suppress the cough center found in the medulla of the brain and they increase the threshold

Habit forming centrally acting antitussive

This antitussive is prone to substance abuse

Answer 17

Centrally acting antitussives
Dextromethorphan, Codeine, Noscapine, Butamirate

Dextromethorphan

Codeine

Question 18

They are antitussives that decrease the sensitivity of the peripheral irritant’s receptors

Answer 18

Peripherally-acting antitussives
Levodropropizine, Benzonatate

Question 19

They are used for productive cough as they increase the amount of respiratory tract fluid to exert demulcent action. They stimulate bronchial glands to secrete water thus increasing the water portion of the mucus

Answer 19

Expectorants
Guaifenesin (glyceryl guiacolate)

Question 20

They decrease the viscosity of bronchial secretions and facilitate their elimination. they break the disulfide linkages between mucus molecules as these linkages make the phlegm viscous

One of the drugs is used as an antidote for paracetamol toxicity

Answer 20

Mucolytics
Hypertonic saline, Acetylcysteine

Acetylcysteine

Question 21

They are a subclass of mucolytics that act as 2-in-1: they break disulfide linkages and enhance mucociliary clearance

Answer 21

Mucoregulators
Ambroxol, Bromhexine, Carbocisteine