Respiratory Pharmacology

Question 1

what is asthma

Answer 1

reversible airway obstruction as a result of bronchial hyper-reactivity, airway inflammation, mucous plugging, and smooth muscle hypertrophy

Question 2

how does bradykinin cause an increase in cough

Answer 2

• increase prostaglandins (PGE2-PG12)
• increase leukotrienes
• increase histamine
• activate type J receptors at peripheral vagal afferent endings/ non myelinated or C fibers

Question 3

drug used to diagnose asthma

Answer 3

methacholine

Question 4

inadequate surfactant lead to RDS so how then can that be prevented in women about to give birth

Answer 4

give them dexamethasone (glucocorticoids)

Question 5

test used to check fetal lung maturity

Answer 5

lecithin to sphingomyelin > 2 in amniotic fluid indicates matured fetal lung

Question 6

drugs used in asthma

Answer 6

bronchodilators: beta 2 agonists, antimuscarinics, methylxanthines

anti inflammatory agents: corticosteroids, leukotriene inhibitors, mast cell stabilizers, anti IgE antibody

Question 7

beta 2 adrenergic agonists (classify by short acting for acute and long acting for non acute symptoms)

Answer 7

short acting: albuterol, pirbuterol, and terbutaline

long acting: salmeterol and formoterol

Question 8

long acting beta 2 agonists can be taken in combination with what for control and prevention of symptoms in moderate to severe persistent asthma

Answer 8

inhalational corticosteroids

Question 9

drugs used for exercise induced bronchoconstriction (EIC)

Answer 9

short acting beta 2 agonist
long acting beta 2 agonist
montelukast

Question 10

adverse effects of beta 2 agonists

Answer 10

• most common: tremor, tachycardia, arrhythmias, hyperglycemia
• tolerance with excessive use
• paradoxical bronchospasm

Question 11

anticholinergics that are used as bronchodilators and conditions they are used

Answer 11

ipratropium - short acting for asthma, QID (4 times a day)

tiotropium - long acting for COPD

Question 12

mechanism of anticholinergics in bronchial SM

Answer 12

parasympathetic stimulation –> bronchial constriction and mucous secretion so anticholinergics block the muscarinic receptors in SM –> bronchial dilation of airway

Question 13

adverse effects of ipratropium

Answer 13

dry mouth

caution with glaucoma, BPH, and bladder neck obstruction

Question 14

methylxanthines used to treat asthma

Answer 14

theophylline

aminophylline

Question 15

mechanism of methylxanthines (name them again)

Answer 15

theophylline and aminophylline

inhibit phosphodiesterase hence increasing cAMP –> bronchodilation

also block adenosine receptors

Question 16

drugs that increase theophylline plasma levels

Answer 16

cimetidine, erythromycin, and ciprofloxacin

Question 17

drugs that decrease theophylline plasma levels

Answer 17

phenytoin, phenobarbitone, and carbamazepine

Question 18

complications of theophylline overdose

Answer 18

tremor, insomnia, GI distress, nausea, hypokalemia, hyperglycemia

seizures and arrhythmias

Question 19

corticosteroids used in asthma

Answer 19

BF2 DP

beclomethasone
budesonide
fluticasone
flunisolide
dexamethasone
prednisolone

Question 20

drug given for uncontrolled allergic asthma

Answer 20

omalizumab

Question 21

what is corticosteroids relationship to beta receptors

Answer 21

it increases beta 2 responsiveness and help reduce the need for beta 2 agonists

prevent remodeling of the respiratory tract

Question 22

adverse effects of inhaled corticosteroids (ICS)

Answer 22

• more limited than systemic steroids

- cough, oral thrush, and dysphonia (difficulty speaking)

Question 23

what are the systemic corticosteroids and their importance

Answer 23

• dexamethasone and prednisolone: life saving in status asthmaticus
• oral glucocorticoids: short course used for exacerbations with incomplete response to beta 2 agonists

Question 24

adverse effects of systemic corticosteroids and how do you minimize these effects

Answer 24

abnormalities in glucose metabolism
increased appetite
weight gain
hypertension
adrenal suppression

limiting systemic therapy to few days

Question 25

risk of uncontrolled asthma in pregnant women

Answer 25

pre eclampsia perinatal mortality pre term labor low birth weight hence tx pregnant woman with asthma as aggressively as women who are not preggo

Question 26

effects of inhaled corticosteroids during first trimester

Answer 26

congenital abnormalities | endocrine and metabolic abnormalities

Question 27

leukotriene inhibitors

Answer 27

zileuton zafirlukast montelukast

Question 28

mechanism of leukotriene inhibitors

Answer 28

either block synthesis of leukotrienes or block the leukotriene receptors - zileuton inhibits 5-LOX which forms leukotriene from arachidonic acid - zafirlukast and montelukast are LTD4 receptor antagonist

Question 29

clinical uses of leukotriene inhibitors (name them again)

Answer 29

zileuton, zafirlukast, montelukast - prevent exercise, antigen, and aspirin induced asthma - prevent bronchoconstriction and airway inflammation long term but not useful in acute bronchospasm

Question 30

adverse effects of zileuton

Answer 30

elevated liver enzymes

Question 31

adverse effects of zafirlukast and montelukast

Answer 31

vasculitis and systemic eosinophilia resembling churg strauss

Question 32

what is omalizumab

Answer 32

anti IgE antibody (on mast cells) that prevents activation by triggers - prevents release of LTs and other mediators

Question 33

uses of omalizumab

Answer 33

prophylactic management in asthmatic pts | and in cases of inadequate control with ICS

Question 34

adverse effects of omalizumab

Answer 34

causes anaphylaxis - life threatening systemic allergic rxn

Question 35

release inhibitors used in asthma

Answer 35

cromolyn | nedocromil

Question 36

mechanism of release inhibitors in asthma (name them again)

Answer 36

cromolyn and nedocromil prophylactic agent that stabilize the membrane of mast cells and prevent release of inflammatory mediator

Question 37

uses of cromolyn and nedocromil

Answer 37

not for acute attacks of asthma pretreatment blocks allergen and exercise induce bronchoconstriction prevents food allergy and hay fever

Question 38

adverse effects of cromolyn

Answer 38

infrequent laryngeal edema cough wheezing

Question 39

adverse effects of nedocromil

Answer 39

unpleasant taste