Respiratory drugs

Question 1

SABAs

Answer 1

Albuterol: Proventil
Levalbuterol:

Question 2

LABAs

Answer 2

Salmeterol:
Formoterol:
Arformoterol:
Olodaterol:
Indacaterol: Arcapta
Vilanterol: Breo

Question 3

SABAs onset, peak, duration

Answer 3

onset: immediate
peak: 30-60 min
duration: 3-5 hours

Question 4

SAMA

Answer 4

Ipratropium (Atrovent®, generics)

Question 5

LAMAs

Answer 5

Tiotropium (Spiriva®)
Glycopyrrolate (Seebri Neohaler, DPI)
Aclidinium (Tudorza, DPI)
Umeclidinium (Incruse Ellipta)

Question 6

How do B2 agonists relax bronchiolar smooth muscle?

Answer 6

• Decreased mast cell degranulation
• Decreased release of inflammatory cytokines

Question 7

How do LABAs work longer?

Answer 7

• Lipophilic side chains increase duration and decrease degradation
• dosing based on fixed schedule, not PRN

Question 8

B2 Agonist AEs

Answer 8

tremor
tachycardia
cardiac arrythmias (rare)

Question 9

why is there a black box warning with LABA Monotherapy?

Answer 9

Death risk associated with beta adrenergic genetic variants. Need to take a combo medication

Question 10

AE of antimuscarinics

Answer 10

dry mouth
cough
bitter taste

Question 11

Current guidelines suggest starting new patients on what for asthma rather than rescue inhaler?

Answer 11

combo drug of ICS/LABA

Question 12

what is better for COPD?

Answer 12

antimuscarinics slightly better or equally effective as B2 agonists, but not in asthma.

Question 13

MOA of ICS

Answer 13

• limit cytokine release
• decrease transcription of pro-inflammation
• increase transcript of anti-inflammation
• decrease vascular permeability
• decrease secretions and eicosanoid production

Question 14

AE of ICS

Answer 14

HPA suppression
bone resorption
skin thinning
purpura* - main one for ICS
dysphonia* - main one for ICS
candidiasis
growth delays

Question 15

AE of: Prednisone and methylprednisolone

Answer 15

cushings, adrenal suppression, osteoporosis, glaucoma, cataracts, hyperglycemia

Question 16

leading cause of cushings?

Answer 16

overuse of oral glucocorticoids

Question 17

why should oral glucocorticoids be tapered?

Answer 17

• Long-term Treatment with oral glucocorticoids can cause suppression of endogenous cortisol production.
• Long-term usage of oral GCs should be tapered in order to allow adrenals to recover

Question 18

what drug class decreases both COX and lipoxygenase?

Answer 18

glucocorticoids

Question 19

what are potential effects of NSAIDS on leukotriene activity?

Answer 19

aspirin exacerbated respiratory disease (AERD)

Question 20

MOA - montelukast (Singulair)

Answer 20

blocks leukotriene receptor that causes bronchoconstriction

Question 21

drugs that trigger an asthma attack

Answer 21

nonselective Beta adrenergic antagonists (propranolol)
ASA/NSAID (with asthma, nasal polyps)
morphine, meperidine, succs, atracurium
sulfite derivatives

Question 22

1st Gen sedating antihistamines

Answer 22

diphenhydramine
chlorpheniramine
hydroxyzine

Question 23

2nd Gen Antihistamines

Answer 23

certirizine (Zyrtec)
Loratadine (Claritin)
fexofenadine (Allegra)

Question 24

decongestants MOA

Answer 24

stimulate alpha adrenergic receptors causing vasoconstriction

Question 25

decongestants

Answer 25

pseudoephedrine phenylephrine