Respiratory/MSK

Question 0

Salmeterol

Answer 0

Long-acting B2-agonist
Inhaled
Manage moderate persistent and severe asthma
Never used alone in monotherapy; always with glucocorticoid
2-4 hour onset with 12 hour duration (never for acute relief)
Tremor, tachycardia and hypokalemia at high doses

Question 1

Albuterol

Answer 1

Short-acting B2-agonist
Inhaled
Treat acute bronchospasm/Symptomatic relief
1-5 minute onset with 2-6 hour duration

Question 2

Fluticasone

Answer 2

Inhaled glucocorticoid
Mainstay for chronic asthma
Weeks to months required for best effects
Candida, bone density loss, skin thinning and dysphonia (dose-dependent)
Nasal sprays and topical preps for allergic rhinitis and skin conditions

Question 3

Prednisone

Answer 3

Systemic glucocorticoid
Manage chronic, severe asthma and episodes requiring hospitalization
6-12 hour duration
Little toxicity unless used long-term

Question 4

Cromolyn Sodium

Answer 4

Inhibit mast cell degranulation
MOA unknown
Inhaled
Rare side effects
Less effective than glucocorticoids

Question 5

Montelukast

Answer 5

Leukotriene inhibitor
Competitive antagonist of CysLT1 receptor
Oral
Liver metabolism
Less effective than glucocorticoids and B-agonists

Question 6

Zileuton

Answer 6

Leukotriene inhibitor
5-lipoxygenase antagonist
Oral
Liver metabolism - associated with liver toxicity
Less effective than glucocorticoids and B-agonists

Question 7

Theophylline

Answer 7

Bronchodilator
Methylxantine (CNS stimulant)
MOA?? = cAMP PDE and adenosine receptor antagonist
Oral
Many side effects (caffeine-like)
2nd or 3rd line asthma therapy
Very inexpensive

Question 8

Omalizumab

Answer 8

Anti-IgE
Humanized monoclonal Ab against Fc region
Reduces free IgE more than 95%
Used for moderate to severe persistent asthma
Reduce dependency on corticosteroids and decrease episodes
Treat other allergic disorders (rhinitis and food allergies)
SubQ injection every 2-4 weeks
Rare side effects - Injection site reactions, anaphylaxis and malignancy
Expensive

Question 9

Histamine

Answer 9

H1 - Immediate hypersensitivity reactions
H2 - Gastric acid secretion
Rapid breakdown in serum (short term local effects)
H receptors have basal activity (antagonists = inverse agonists)

Question 10

Diphenhydramine

Answer 10

First generation H1 competitive antagonist
CNS penetration
Treat hypersensitivity reactions, motion sickness and urticaria
Sedation, GI effects, and antimuscarinic effects

Question 11

Loratadine

Answer 11

Second generation H1 antagonist
Better specificity with fewer side effects
No drowsiness or antimuscarinic effects
Treat hypersensitivity

Question 12

Cromolyn

Answer 12

Inhibition of mast cell activation
Prophylaxis for allergic bronchial asthma
Take weeks for effectiveness
Not useful for many individuals

Question 13

Ranitidine

Answer 13

Competitive H2 antagonist
Treat gastric ulcers and GERD
Rare side effects (diarrhea, dizziness, muscle pain, rash, gynecomastic, CNS effects)
Effects on acid secretion changes F/absorption for other drugs

Question 14

Isoniazid

Answer 14

Most active anti-TB drug
Pro-drug activated by mycobacterial catalase
Inhibits fatty acid elongation (two enzymes) and DHFR
Acetylated in liver - bimodal distribution of half-life (high rate dominant)
Neurological toxicity - competes with B6 metabolism
Hepatic toxicity

Question 15

Rifampin

Answer 15

Inhibits RNA polymerase
Deacetylated in liver and excreted in bile
Turns secretions orange, can cause jaundice and strong inducer of p450

Question 16

Pyrazinamide

Answer 16

Inhibits trans-translation
Prevents stalled ribosomes from recovering and recycling
Hepatic toxicity and inhibits uric acid excretion

Question 17

Ethambutol

Answer 17

Inhibits synthesis of arabinogalactans - cannot incorporate arabinose
Oral
Optic neuritis most common side effect - check for color blindness

Question 18

Streptomycin

Answer 18

Aminoglycoside
30S inhibitor
IM
Demoted to 2nd line therapy
Ototoxicity and nephrotoxicity

Question 19

Moxifloxacin

Answer 19

Fluoroquinolone

Now first-line