Airway Disease

Front 1

On what receptor does albuterol (short-acting) and salmeterol, formoterol (long-acting) act?

Back 1

Beta-2-adrenergic receptor (agonist).

Front 2

ipratropium bromide, tiotropium

Back 2

Muscarinic antagonists (anti-cholinergic).
Tiotropium is more M3 selective than IB.

Front 3

What are some side effects of methylxanthines (theophylline)?

Back 3

GI probs, tremor, insomnia, leads to arrhythmia, seizures, shock, death.

Front 4

triamcinalone < beclomethasone < fluticasone

Back 4

corticosteroids

Front 5

What is cromolyn sodium used for and what is its mechanism of action?

Back 5

Asthma treatment.
Histamine blocker (stabilizes mast cells, reducing degranulation).

Front 6

Zileuton, Montelukast and Zafirlukast

Back 6

leukotriene inhibitors

Front 7

Omalizumab

Back 7

Antibody that binds IgE, used to treat severe asthma

Front 8

What is the mechanism of action of albuterol?

Back 8

increasing cAMP in bronchial smooth muscle cells.

Front 9

What are some of the side effects of albuterol?

Back 9

Tremor (B1), tachycardia (B2), and tolerance.

Front 10

What is the importance of vagal stimulation of the airways?

Back 10

Vagal stimulation (Ach) maintains normal airway tone via activation of muscarinic (M3) receptors.

Front 11

What is ipratropium used for and what are some side effects (hint: ipratropium is a muscarinic antagonist)?

Back 11

Ipratropium is used for asthma and COPD tx.
SE: Anti-cholinergic (dry, hot, red, mad, blind).
Also, ipratropium is not as effective as B2-agonists and has a relatively short half-life.
Tiotropium has a longer half-life and thus needs to be used only once a day.

Front 12

What are some potential actions of theophylline?

Back 12

decrease inflammatory cell influx
Increase mucocillary clearance
Increase diaphragmatic contractility
Increase CNS respiratory drive

Front 13

What is the most effective treatment for asthma?

Back 13

ICS.

Front 14

What are some side effects of ICS in children?

Back 14

Steroids can suppress growth in children, so watch the growth curve closely when an asthmatic kid is on regularly dosed inhaled corticosteroids.

Front 15

What is prolastin?

Back 15

Prolastin is a protein prepared from pooled human plasma that can be used as a replacement therapy in patients with alpha-1-antitrypsin deficiency.

Front 16

What are three mechanisms for pulmonary anti-hypertensives?

Back 16

Endothelin receptor antagonists (bosentan or ambrisentan), PDE inhibitors (sildenafil) and prostacyclin derivatives (epoprostenol).

Front 17

What is the use of lidocaine, benzonatate in cough suppression?

Back 17

Topical local anesthetics decrease the sensitivity of the nerve endings along the oropharynx so that cough reflex is suppressed.
Codeine acts on central cough receptors.

Front 18

What is the mechanism of codeine, morphine and dextromethorphan?

Back 18

Central cough receptor suppression.

Front 19

What are three common causes of cough?

Back 19

Asthma
Post nasal drip
Gastroesophageal reflux

Front 20

What are some side effects of Pseudophedrine hydrochloride?

Back 20

Hypertension
Atrial fibrillation
Myocardial infarction

Front 21

Why is Oxymetazoline Hydrochloride better than Sudafed?

Back 21

Intranasal delivery, so less systemic effects.

Front 22

What are potential treatments for post-nasal drip?

Back 22

Ipratropium
Azelastin hydrochloride
Futicasone and Triamcinolone

Front 23

What is the mechanism of action of Azelastin hydrochloride on post-nasal drip?

Back 23

H1 receptor blocker blocks the release of histamine in the allergic response

Front 24

What is the mechanism of action of Fluticasone and Triamcinolone?

Back 24

Nasal steroids. Reduces inflammation via many different pathways.

Front 25

What does the H and N in H1N1 refer to?

Back 25

Hemagglutinin and neuroaminadase. Influenza vaccine contains inactivated subvirion hemaglutinin and neuraminidase of 3 circulating strains and therefore is a trivalent vaccine.

Front 26

Against which organism does Pneumovax and Prevnar protect?

Back 26

S. pneumoniae.

Front 27

What is standard therapy for Wegener's Granulomatosis?

Back 27

Prednisolone (IV?) and Prednisone (oral). Methotrexate (oral) is given if limited illness.

Front 28

What is the mechanism of action of methotrexate?

Back 28

Folate antagonist – Reversibly inhibits dihydrofolate reductase
Folate is required for DNA synthesis, repair and replication

Front 29

To whom should methotrexate NOT be given?

Back 29

Patients with severe renal dysfunction (drug is renally excreted).

Front 30

What are some immunosuppresives used for tx of Wegener's granulomatosis?

Back 30

Cyclophosphamide, Methotrexate, and Azothioprine.

Front 31

What is Standard of Care for ILD?

Back 31

no treatment or prednisone and azathioprine.

Front 32

What should patients receiving immunosuppressive therapy for Wegener's be worried about?

Back 32

Pneuomocystis pneumonia - prophylaxis includes TMP/SMX.

Front 33

What are the indications for thrombolytics?

Back 33

Massive PE
MI

Front 34

What are four contraindications for thrombolytics?

Back 34

Recent stroke or hx of hemorrhagic stroke
Intracranial neoplasm
Active internal bleeding
Suspected aortic dissection

Front 35

What is a side effect of streptokinase?

Back 35

risk of antibody formation

Front 36

What is Alteplase and how is it related to Reteplase?

Back 36

tPA. Reteplase is mutated tPA.

Front 37

Why do you need to give heparin with tPA?

Back 37

tPA induces thombogenic state.

Front 38

What are some side effects of prostacyclin (epoprostenol) analogues?

Back 38

Jaw pain, flushing, leg pain, diarrhea, infection, rebound, overdose

Front 39

What does prostacyclin do to pulmonary vessels?

Back 39

vasodilate

Front 40

What does endothelin do to pulmonary vessels?

Back 40

vasocontrict

Front 41

What is the mechanism of prostacyclin on pulmonary vessels?

Back 41

Prostacyclin activates adenyl cyclase - converts ATP to cyclic AMP – decreased intracellular calcium

Front 42

What are some side effects of endothelin analogues (Bosentan)?

Back 42

Decreases sildenafil AUc by ~50%. Hepatotoxicity.
Teratogen.

Front 43

What does nitric oxide do to pulmonary vessels?

Back 43

vasodilate.

Front 44

What is the mechanism of nitric oxide on pulmonary vessels?

Back 44

activates cyclic guanylate cyclase – ↑ cGMP

Front 45

What is the mechanism of oxygen toxicity?

Back 45

Hyperoxia promotes increased reactive oxygen species (ROS) production.
ROS promotes inflammation and can be cytotoxic.

Front 46

What is the mechanism of heparin?

Back 46

Binds to & activates endogenous antithrombin III (ATIII), which then inactivates thrombin (activated factor II) and several other factors including factor X

Front 47

What are some side effects of heparin?

Back 47

Bleeding risk, thrombocytopenia, osteoporosis

Front 48

How is heparin overdose treated?

Back 48

protamine (base)

Front 49

What is warfarin's mechanism of action?

Back 49

Inhibition of the vitamin K-dependent gamma-carboxylation of coagulation factors II, VII, IX and X.

Front 50

What is VKORC1?

Back 50

VKORC1 gene that encodes for the enzyme that is the site of action where warfarin has its effect:
‘AA’ genotype – sensitive
‘AG’ – usual
‘GG’ – resistant

Front 51

What is an example of a methylxanthine?

Back 51

Theophylline.