Respiratory Drugs

Question 1

Physiological Bronchial Tone Regulation

Answer 1

Acetylcholine - Muscarinic R (para)’ Stimulation causes CONSTRICTION

Epinephrine - B2 R (symp); Stimulation causes DILATION

Histamine/Leukotrienes - H-1 & LTD4/LTE4 R; Stimulation causes CONSTRICTION

Prostaglandins - PGE2 cuases DILATION; PGF2a causes CONSTRICTION

Question 2

Short-acting Beta-2-selective agonist (SABAs)

Answer 2

-Albuterol (ok pregnancy)
-Levalbuterol/Pirbuterol
Given by inhalation for acute bronchospasm
Minimal cardiac effects
Bronchodilator

Question 3

Long-acting beta-2-selective agonist (LABA)

Answer 3

-Salmeterol (ok pregnancy)
-Nocturnal asthma, exercise-induced bronchospasm if many hours of activity
-Inhibits late-phase allergen bronchoconstri
-Not suitable for monotherapy
Bronchodilator

Question 4

Cholinergic Antagonists

Answer 4

-Ipratropium/ Tiotropium: Muscarinic antagonist
-Best for COPD
Synergistic with B2 blockers (Duoneb)
Adverse: Nasal/mouth dryness, Urine retention especially Males w/ BOH or Prostate CA
Bronchodilator

Question 5

Theophylline

Answer 5

-Methylxanthine class (caffeine)
-Phosphodiesterase inhibitor - Increase cAMP, a dilator
-2ndary actions: Inhibits mucus secretion, Decreases histamine release
Adverse: CNS&Cardiac stimulation; GI irritation; No antidote for OD
Bronchodilator

Question 6

Glucocorticoids

Answer 6

Multiple Mechanisms: Decr Inflammation

Question 7

Outpatient: CAP

No abx in past 3 months

Answer 7

Macrolide
(azithromycin, -thromycin)
- Inhibit bacterial protein synthesis (50s)

Question 8

Outpatient: CAP

Co-morbidity or abx used in prev 3 mnths

Answer 8

Fluoroquinolone
(levofloxacin, -floxacin)
- Inhibit DNA gyrase and Type IV topoismerase

OR
B-lactam (amoxicillin or ceftriaxone) + macrolide

Question 9

Inpatient, non-ICU: CAP

Answer 9

Fluoroquinolone (-floxacin)
Ceftriaxone (or amp-sulbactam) + macrolide

Ceph 3; inhibits cell wall synth, extended spectrum pen + B-lactamase inhib, Protein synth inhib

Question 10

Inpatient, ICU: CAP

Answer 10

Ceftriaxone (or AMP-sublactam)
+
Azithromycin (or fluoroquinolone)

Question 11

Streptococcus pneumonia

Answer 11

-Levofloxacin
fluoroquinolone
Inhibits DNA gyrase and Type IV topoisomerase

Question 12

Mycoplasma pneumoniae

Answer 12

-Azithromycin
Macrolide
Inhibits bacterial protein synthesis (50s)

-Doxycycline
Tetracycline
(30s)

-Levofloxacin (+)
Fluoroquinolone
Inhibits DNA gyrase/IV topoisomerase

Question 13

Haemophilus influenzae

Answer 13

Cefotaxime or Ceftriaxone

3rd gen Cephalosporins
Inhibits cell wall synthesis

Question 14

Moraxella catarrhalis

Answer 14

Amoxicillin + Calvulanate (Augmentin)
AMOX: extended spectrum pen; inhibits cell wall synthesis
CL: B-Lactamase inhib

Question 15

Klebsiella pneumoniae

Answer 15

Imipenem
carbapenem, which is a pen-like abx
Broad spectrum and resistant to many B-lactamases
Cilastatin included to prevent renal dehydropeptidase inactivation

Question 16

Yersinia pestis

Answer 16

Gentamicin
aminoglycoside
inhibits protein synthesis

Question 17

Bacillus anthracis

Answer 17

Ciprofloxacin
fluoroquinolone
inhibits DNA gyrase and IV topoisomerase

Question 18

Bordetella pertussis

Answer 18

Azithromycin
Macrolide
inhibits bacerial protein syn
(50s)

Question 19

Corynebacterium diphtheriae

Answer 19

Erythromycin
macrolide
(50s)

Penicillin also effective

Question 20

Streptoccosus pyogenes

GAS

Answer 20

-Pen V
B-lactam abx
Narrow-spectrum pen
Inhibits cell wall synthesis

-Amoxicillin (taste)
-Macrolide if pen allergy
CONFIRM GAS before ABX

Question 21

Pseudomonas aeruginosa

Answer 21

-Piperacillin + Tazobactam
PIP: extended, antipseudomonal pen
TZ: B-lactamase inhib

-Imipenem
carbapenem, pen like abx
broad spectrum and resistant to many B-lactamases
cilastatin for inactivation by renal

-Cefepime
4th gen cephalosporin
inhibits cell wall synth

-Tobramycin
Aminoglycoside
inhibits protein synthesis

Question 22

Legionella pneumophila

Answer 22

Levofloxacin
fluoroquinolone
inhibits DNA gyrase and IV topoisomerase

Question 23

Adverse effects:
Penicillin G/V
Amoxicillin
Piperacillin + Tazobactam

Answer 23

Pen: GI, hypersensitivity

Amoxicillin: GI distress, hypdersensitivity

Pip+ Tzbm: GI, yeast infection

Question 24

Adverse effects:
Cefotaxime/Ceftriaxone
Levofloxacin/Cipro
Doxycycline

Answer 24

Cef: hypersensitivity, yeast inf, cross-sensitivity w/ pen
-floxacin: GI, tendonitis, photo, prolonged QT interval, seizures
Doxy: phototoxicity, discoloration of teeth

Question 25

Adverse effects: Azithromycin/erythro Gentamicin/Tobramy Imipenem

Answer 25

Azithr: GI distress, Erythro binds receptors for gastric hormone, inducing uncoordinated peristalsis Gent: nephrotoxic, ototoxic Imip: hypersensitivity, cross-sensitivity w/ penicillins

Question 26

1st line drugs for TB

Answer 26

Isoniazid Ethambutol Pyrazinamide Rifampin resistance: Fluoroquinolone

Question 27

TB Newly dx Latent

Answer 27

Newly dx: isoniazid Exposed neonates: isoniazid 3 mo Latent in TST with HIV

Question 28

Active TB

Answer 28

Isoniazid, rifampin, ethambutol and pyrazinamide | PZA reduces to 6 mo therapy

Question 29

Isoniazed

Answer 29

Inhibits synthesis of mycolid acid Activated by mycobacterial catalase peroxide (katG gene) Isoniazid complex is formed which INHIBITS enoyl reductase key metabolizing enzyme is acetyltransferase (rate gene determined)

Question 30

Rifampin

Answer 30

Broad spectrum abx Binds DNA-dependent RNA polymerase Results in the inhibition of DNA transcription selective for bacterial RNA polymerase

Question 31

Influenza

Answer 31

Oseltamivir -Neuraminidase inhibitor (give within 48hrs) Amantadine/Rimantadine -Blocks M2 proton selective ion channels prevents acidification of virus and fusion of membranes required for UNCOATING and transfer of viral NA's

Question 32

RSV

Answer 32

Palivizumab -Ab directed at FUSION PROTEIN ON RSV virus cannot enter cell

Question 33

Blastomyces dermatidis

Answer 33

Liposomal Amphotericin B -Polyene abx Selectively binds ergosterol in fungal membranes increases membrane permeability

Question 34

Cryptococcus neoformans

Answer 34

Fluconazole -inhibits enzyme responsible for converting lanosterol to ergosterol Amphotericin B -Polyene abx Selectively binds ergosterol in fungal membranes increases membrane permeability

Question 35

Asperfillus fumigatus

Answer 35

Voriconazole | inhibits enzyme responsible for converting lanosterol to ergosterol

Question 36

Pneumocystis jirovecii

Answer 36

Trimethoprim + Sulfamethoxazole (TMP-SMX) | Antimetabolites that inhibit folate synthesis in bacteria

Question 37

``` Adverse effects: Isoniazid Rifampin Oseltamivir Palivizumab ```

Answer 37

Isoniazid: liver toxicity, peripheral neuritis (need B6 supplementation) Rifampin: liver toxicity, reddish-orange body fluids, induces P450 Oseltamivir: rare Palvizumab: fever, rash

Question 38

``` Adverse effects: Fluconazole Vorconazole Amphotericin B TMP-SMX ```

Answer 38

Fluconazole: many drug interactions (P450) Vorconazole: many drug interactions (P450); Liver toxicity visual disturbances Amphotericin B: Nephrotoxic TMP-SMX: GI distress, Stevens-Johnson syndrome, megaloblastic anemia, photoxicity