Respiratory Drugs

Question 1

Name the 1st generation H1 blockers

Answer 1

“-en/-ine” or “-en/-ate”

diphenhydramine, dimenhydrinate, chlorpheniramine

Question 2

Uses of 1st gen H1 blockers

Answer 2

allergy, motion sickness, sleep aid

Question 3

Toxicity of 1st gen H1 blockers

Answer 3

sedation, antimuscarinic, anti-alpha-adrenergic

Question 4

Name the 2nd gen H1 blockers

Answer 4

“-adine”

loratadine, fexofenadine, desloratidine

Question 5

Uses of 2nd gen H1 blockers

Answer 5

allergy

Question 6

Toxicty of 2nd gen H1 blockers

Answer 6

far less sedating than 1st gen because of decreased CNS entry

Question 7

Guaifenesin use

Answer 7

expectorant

things respiratory secretions; does NOT suppress cough reflex

Question 8

N-acetylcysteine use

Answer 8

mucolytic - can loosen mucus plugs in CF patients by disrupting disulfide bonds
also used as antidote for acetaminophen overdose

Question 9

Mechanism of of dextromethorphan

Answer 9

antitussive (antagonizes NMDA glutamate receptors)

synthetic codeine analog

Question 10

Use of dextromethorphan

Answer 10

has mild opioid effect when used in excess

Question 11

Toxicity of detromethorphan

Answer 11

naloxone can be given for overdose
mild abuse potential
may cause serotonin syndrome if combined with other serotonergic agents

Question 12

Mechanism of pseudoephedrine, phenylephrine

Answer 12

alpha-adrenergic agonist

Question 13

Use of pseudoephedrine, phenylephrine

Answer 13

nasal decongestant (reduce hyperemia, edema)
open obstructed eustachian tubes

Question 14

Toxicity of pseudoephedrine, phenylephrine

Answer 14

hypertension

can also cause CNS stimulation/anxiety (pseudoephedrine)

Question 15

Name the pulmonary HTN drug classes

Answer 15

Endothelin receptor antagonists
PDE-5 inhibitors
prostacyclin analogs

Question 16

Name the endothelin receptor antagonists

Answer 16

bosentan

Question 17

Mechanism of endothelin receptor antagonists

Answer 17

competitively antagonize endothelin-1 receptors –> decrease pulmonary vascular resistance

Question 18

Toxicity of endothelin receptor antagonists

Answer 18

hepatotoxic (monitor LFTs)

Question 19

Name the PDE-5 inhibitors

Answer 19

Sildenafil

Question 20

Mechanism of sildenafil/PDE-5 inhibitors

Answer 20

inhibit PDE5 from breaking down cGMP so it lasts longer and prolongs the vasodilatory effect of nitric oxide

Question 21

Use of sildenafil/PDE-5 inhibitors

Answer 21

pulmonary HTN

erectile dysfunction

Question 22

Name the prostacyclin analogs

Answer 22

epoprostenol, iloprost

Question 23

Mechanism of prostacyclins

Answer 23

PGI2 with direct vasodilatory effects on pulmonary and systemic arterial vascular beds
inhibit platelet aggregation

Question 24

Toxicity of prostacyclins

Answer 24

flushing, jaw pain

Question 25

Asthma drugs target pathways

Answer 25

1. inflammatory processes | 2. parasympathetic tone

Question 26

Classes of asthma drugs

Answer 26

``` Beta2-agonists corticosteroids muscarinic antagonists antileukotrienes Omalizumab Methylxanthines Methacholine ```

Question 27

Short-acting beta2 agonists

Answer 27

albuterol

Question 28

Mech and use of albuterol for asthma

Answer 28

relaxes bronchial smooth muscle | used for acute exacerbation

Question 29

Long-acting beta2 agonists

Answer 29

salmeterol and formoterol

Question 30

Mech and use of salmeterol and formoterol

Answer 30

long-acting for prophylaxis

Question 31

Adverse effects of long-acting beta2 agonists

Answer 31

tremor and arrhythmia

Question 32

Name the corticosteroids for asthma

Answer 32

Fluticasone, budesonide

Question 33

Use of corticosteroids for asthma

Answer 33

1st-line therapy for chronic asthma

Question 34

Mech of corticosteroids for asthma

Answer 34

inhibit synthesis of virtually all cytokines | inactivate NF-kappaB, the transcription factor that induces production of TNF-alpha and other inflammatory agents

Question 35

Mech of ipratropium

Answer 35

competitively inhibits muscarinic receptors, preventing bronchoconstriction

Question 36

Use of ipratropium

Answer 36

asthma and for COPD tiotropium is same but long acting

Question 37

Mech of montelukast, zafirlukast

Answer 37

block leukotriene receptors (CysLT1)

Question 38

Use of montelukast, zafirlukast

Answer 38

good for aspirin-induced asthma

Question 39

Mech of zileuton

Answer 39

5-lipooxygenase pathway inhibitor | blocks conversion of AA to leukotrienes

Question 40

Toxicity of zileuton

Answer 40

hepatotoxic

Question 41

Mech of Omalizumab

Answer 41

monoclonal ab against IgE | binds unbound serum IgE and blocks binding to Fc receptor

Question 42

Use of omalizumab

Answer 42

allergic asthma resistant to inhaled steroids and long-acting beta2-agonists

Question 43

Mech of theophylline

Answer 43

likely causes bronchodilation by inhibiting PDE --> increase in cAMP levels doe to decreased cAMP hydrolysis (via PDE)

Question 44

Use of theophylline

Answer 44

limited due to narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrom p-450 blocks the action of adenosine

Question 45

Methacholine Challenege Test

Answer 45

muscarinic receptor (M3 agonist), used in bronchial challenge to help diagnose asthma