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Flashcards in Respiratory Pharm Deck (43):
1

What are the first generation H1 blockers?

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

2

What are the uses of H1 antagonist?

Allergy
Motion sickness
Sleep aid

3

What are the side effects of H1 antagonists?

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

4

What are the second gen H1 blockers?

-Adines
Loratidine
Fexofenadine
Desloratadine
Cetirizine

5

What are second gen used for?

Allergy

6

What is the advantage of second gen h1 antagonists?

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

7

What are the drugs for prophylaxis of asthma?

Salmeterol
Formoterol
They are long acting beta-2 agonists

8

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

Tremor
Arrhythmia

9

What is theophylline?

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

10

What are the side effects of theophylline?

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

11

What muscarinic antagonist is used for preventing bronchoconstriction, COPD?

Ipratropium and tiotropium

12

What are the corticosteroids used for asthma?

Beclomethasone
Fluticasone
*1st line tx in chronic asthma

13

What is the MOA of beclomethasone in asthma?

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

14

What are the anti leukotrienes?

Montelukast
Zafirlukast
Zileuton

15

What are the anti leukotrienes used for?

Aspirin-induced asthma
(See nasal polyps)

16

What is the MOA of zileuton?

5-lipoxygenaas pathway inhibitor
Blocks the conversion of arachnidonic acid to leukotrienes

17

What is omalizumab?

Monoclonal anti-IgE antibody

18

What is omalizumab used for?

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

19

What are guaifenisin and n-acetylcysteine?

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

20

What is n-acetylcysteine used for?

A mucolytic for CF patients
Antidote for acetaminophen OD

21

What is the MOA of bosentan?

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

22

What is bosentan used for?

Pulmonary Arterial HTN

23

What is dextromethorphan?

Antitussive
Synthetic codeine analog that antagonizes NMDA glutamate receptors.

24

What are pseudophedrine and phenylephrine used for?

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

25

What are the side effects?

HTN
Anxiety (pseudophedrine = CNS stimulant)

26

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

Older
Vision problems
Gait disturbances

27

What is methacholine?

A muscarinic receptor agonist
Used in asthma challenge test

28

What is the MOA of ipratropium?

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

29

What is flunisolide?

A glucocorticoid used for asthma

30

What is the most common side effect of inhaled glucocorticoids?

Oropharyngeal candidiasis

31

What is the MOA of cromolyn and nedocromil?

Inhibits mast cell degranulation

32

What are cromolyn and nedocromil used for?

Prophylaxis of acute attacks of asthma

33

What are the actions of leukotrienes?

Vasoconstriction
Bronchoconstriction
Increased vascular permeability
Mucosal edema
Mucus hypersecretion

34

How do you treat Methemoglobinemia?

Methylene blue

35

How do you treat cyanide poisoning?

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)

36

How do you treat CO poisoning?

100% O2
Hyperbaric O2

37

How do you treat altitude sickness?

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

38

How do you treat RDS (neonatal)?

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

39

How do you treat ARDS (adult)?

Pure O2

40

What is the MOA of Albuterol?

Short-acting Beta-2 agonist
relaxes bronchial smooth muscle

41

When do you use Albuterol?

Acute exacerbation of asthma

42

What is the risk in using Dextromethorphan?

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

43

What is the MOA of n-acetylcysteine

Mucolytic agent that cleaves intermolecular disulfide bonds within mucus glycoproteins