Respiratory Pharm

Question 1

What are the first generation H1 blockers?

Answer 1

-en/-ine or en/ate
Diphenhydramine
Dimenhydrinate
Chlorpheniramine

Question 2

What are the uses of H1 antagonist?

Answer 2

Allergy
Motion sickness
Sleep aid

Question 3

What are the side effects of H1 antagonists?

Answer 3

Sedation
Antimuscarinics (constipation; contra in Alzheimer’s)
Anti-alpha- adrenergic (vasodilation)

Question 4

What are the second gen H1 blockers?

Answer 4

-Adines
Loratidine
Fexofenadine
Desloratadine
Cetirizine

Question 5

What are second gen used for?

Answer 5

Allergy

Question 6

What is the advantage of second gen h1 antagonists?

Answer 6

Far less sedating than 1st gen because less entry into CNS (does not cross BBB)

Question 7

What are the drugs for prophylaxis of asthma?

Answer 7

Salmeterol
Formoterol
They are long acting beta-2 agonists

Question 8

What are the side effects of the long acting beta-2 agonists?

Answer 8

Tremor

Arrhythmia

Question 9

What is theophylline?

Answer 9

A methylxanthine
Phosphodiesterase inhibitor –> perpetuates cAMP action
Blocks adenosine
Causes bronchodilation

Question 10

What are the side effects of theophylline?

Answer 10

Cardiotoxicity
Neurotoxicity
Metabolized by P450 so increased by P450 inhibitors (macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir, alcohol, cipro, ketoconazole, sulfonamides, gemfibrozil, quinidine)
this is a problem because theophylline has a low TI
blocks adenosine action

Question 11

What muscarinic antagonist is used for preventing bronchoconstriction, COPD?

Answer 11

Ipratropium and tiotropium

Question 12

What are the corticosteroids used for asthma?

Answer 12

Beclomethasone
Fluticasone
*1st line tx in chronic asthma

Question 13

What is the MOA of beclomethasone in asthma?

Answer 13

Inhibits the synthesis of all cytokines
Inactivates Nf-kb (inducer of transcription of TNF-a)
anti-inflammatory agents

Question 14

What are the anti leukotrienes?

Answer 14

Montelukast
Zafirlukast
Zileuton

Question 15

What are the anti leukotrienes used for?

Answer 15

Aspirin-induced asthma

See nasal polyps

Question 16

What is the MOA of zileuton?

Answer 16

5-lipoxygenaas pathway inhibitor

Blocks the conversion of arachnidonic acid to leukotrienes

Question 17

What is omalizumab?

Answer 17

Monoclonal anti-IgE antibody

Question 18

What is omalizumab used for?

Answer 18

Allergic asthma that is resistant to inhaled steroids and long acting b2 agonists

Question 19

What are guaifenisin and n-acetylcysteine?

Answer 19

Expectorants
They thin respiratory secretions and loosen mucus plugs
Does not suppress cough reflex

Question 20

What is n-acetylcysteine used for?

Answer 20

A mucolytic for CF patients

Antidote for acetaminophen OD

Question 21

What is the MOA of bosentan?

Answer 21

Competitive antagonist of endothelin-1 receptors so decreased pulmonary vascular resistance

Question 22

What is bosentan used for?

Answer 22

Pulmonary Arterial HTN

Question 23

What is dextromethorphan?

Answer 23

Antitussive

Synthetic codeine analog that antagonizes NMDA glutamate receptors.

Question 24

What are pseudophedrine and phenylephrine used for?

Answer 24

Nasal decongestant
Reduce hyperemia, edema, nasal congestion
Open obstructed Eustachian tubes

Question 25

What are the side effects?

Answer 25

``` HTN Anxiety (pseudophedrine = CNS stimulant) ```

Question 26

What are some of the contraindications to first gen H1 antagonists?

Answer 26

Older Vision problems Gait disturbances

Question 27

What is methacholine?

Answer 27

A muscarinic receptor agonist | Used in asthma challenge test

Question 28

What is the MOA of ipratropium?

Answer 28

Blocks M3 receptors in the airway smooth muscle and sub mucosal glands. (m3 works through the Gq pathway with phospholipase C and IP3/DAG) Offers short term relief of asthma

Question 29

What is flunisolide?

Answer 29

A glucocorticoid used for asthma

Question 30

What is the most common side effect of inhaled glucocorticoids?

Answer 30

Oropharyngeal candidiasis

Question 31

What is the MOA of cromolyn and nedocromil?

Answer 31

Inhibits mast cell degranulation

Question 32

What are cromolyn and nedocromil used for?

Answer 32

Prophylaxis of acute attacks of asthma

Question 33

What are the actions of leukotrienes?

Answer 33

``` Vasoconstriction Bronchoconstriction Increased vascular permeability Mucosal edema Mucus hypersecretion ```

Question 34

How do you treat Methemoglobinemia?

Answer 34

Methylene blue

Question 35

How do you treat cyanide poisoning?

Answer 35

Nitrites Thiosulfate (Nitrates oxidize Hb to methemoglobin to bind cyanide and remove from cytochrome oxidase-- allowing it to function) (Thiosulfate binds the cyanide bound to methemoglobin forming thiocyanate which is renally excreted)

Question 36

How do you treat CO poisoning?

Answer 36

100% O2 | Hyperbaric O2

Question 37

How do you treat altitude sickness?

Answer 37

Acetazolamide (carbonic anhydrase inhibitor) | increases renal excretion of bicarb to compensate for respiratory alkalosis in high altitudes

Question 38

How do you treat RDS (neonatal)?

Answer 38

Maternal steroids prior to birth Neonatal artificial surfactant *NO supplemental O2

Question 39

How do you treat ARDS (adult)?

Answer 39

Pure O2

Question 40

What is the MOA of Albuterol?

Answer 40

Short-acting Beta-2 agonist | relaxes bronchial smooth muscle

Question 41

When do you use Albuterol?

Answer 41

Acute exacerbation of asthma

Question 42

What is the risk in using Dextromethorphan?

Answer 42

Mild opioid effect in excess = mild abuse potential | Antidote for OD: Naloxone

Question 43

What is the MOA of n-acetylcysteine

Answer 43

Mucolytic agent that cleaves intermolecular disulfide bonds within mucus glycoproteins