Kaplan Pharmacology; Pulmonary

Front 1

List two anticholinergic respiratory therapy agents.

Back 1

Ipratropium
Tiotropium

Front 2

When are the ipratropium or tiotropium the answer?

Back 2

Inhaled anticholinergics with ipratropium or tiotropium are the best answer to the question "What is the best initial therapy for a person with chronic obstructive pulmonary disease (COPD)?
They also offer additional bronchodilation for patients with asthma. While they don't work as rapidly as inhaled beta agonists, they can be added to inhaled beta agonists when the patient needs an acute rescue medication for an asthma exacerbation.
Tiotropium has superior efficacy than Ipratropium.

Front 3

How do ipratropium and tiotropium work?

Back 3

Ipratropium/Tiotropium antagonizes the effect of acetylcholine at muscarinic receptors in the lung. The results in bronchodilation and a decrease in the amount of mucous production. They dilate and dry the bronchi.

Front 4

What are the most common adverse effects of anticholinergic respiratory therapy?

Back 4

Because they are virtually nonabsorbed, these drugs have almost no adverse effects. At high doses, they may cause pupil dilation, tachycardia, constipation, dry mouth, and urinary retention due to their anticholinergic effects.

Front 5

List two anticholinergic respiratory therapy agents.

Back 5

Ipratropium
Tiotropium

Front 6

List three prostacyclin analogs.

Back 6

Epoprostenol
Treprostinil
Iloprost

Front 7

For which question is a prostacyclin analog the correct answer?

Back 7

Prostacyclin analogs are the correct treatment for severe pulmonary hypertension. Look for a patient with slowly progressive shortness of breath that is worse on exertion with a loud P2 heart sound, clear lungs, and pulmonary hypertension on echocardiography.

Front 8

How do prostacyclin analogs work?

Back 8

Prostacyclin analogs cause potent pulmonary artery vasodilation, inhibit platelet aggregation, and inhibit the proliferation of blood vessels.

Front 9

What are the most common adverse effects of prostacyclin analogs?

Back 9

Adverse effects are hypotension, flushing, bradycardia, and dizziness.

Front 10

When is bosentan the answer to the question?

Back 10

Bosentan is the treatment for severe pulmonary hypertension. Look for a patient with severe, progressive SOB and a high pulmonary artery pressure on echocardiogram or right heart catheterization.

Front 11

How does bosentan work?

Back 11

Bosentan is a potent inhibitor of endothelin-1. Endothelin-1 causes vasoconstriction of the pulmonary artery as well as proliferation of the smooth muscle of the artery.

Front 12

What are the most common adverse effects of bosentan?

Back 12

Bosentan is hepatotoxic and extremely teratogenic.

Front 13

A 24 yo woman has asthma that is persistent and is not controlled with an albuterol inhaler.
Which of these medications has the best efficacy? (Inhaled steroids, Salmeterol, Monteleukast, Cromolyn, Theophyline)

Back 13

Inhaled steroids have the best efficacy of all the long-term asthma controlling medications. Inhaled steroids also have the best effect on mortality.

Front 14

A 24 yo woman has asthma that is persistent and is not controlled with an albuterol inhaler.
What are the adverse effects of each medications? Inhaled steroids, Salmeterol, Monteleukast, Cromolyn, Theophyline)

Back 14

Adverse effects and mechanisms:
1) Inhaled steroids: oral thrush and dysphonia
2) Salmeterol: tremor, heart block, and bradycardia
3) Monteleukast: headache
4) Cromolyn: stabilizes mast cells
5) Theophylline: tremors, seizures, and arrhythmias. Theophyline has a narrow therapeutic index. It is very toxic with limited efficacy.

Front 15

A 24 yo woman has asthma that is persistent and is not controlled with an albuterol inhaler.
When would you use each of these medications? Inhaled steroids, Salmeterol, Monteleukast, Cromolyn, Theophyline)

Back 15

Use each medication in the following circumstances:
1) For asthmatics not controlled with albuterol inhalers, inhaled steroids have the best efficacy. If these do not work, long-acting beta agonists, such as salmeterol, should be used.
2) Monteleukast is best when the patient has an atopic, allergic disorder, such as rhinitis.
3) Cromolyn is best when an environmental allergen is at work.
4) Theophyline is rarely used.

Front 16

For what question is omalizumab the correct answer?

Back 16

Omalizumab is the treatment for an asthmatic patient with an extrinsic allergic trigger that is not controlled by inhaled beta agonists combined with inhaled steroids or a leukotriene inhibitor, such as monteleukast. Look for a patient with an elevated IgE level or a positive skin test for a specific allergen.

Front 17

How does omalizumab work?

Back 17

Omalizumab blocks the IgE antibody. This prevents IgE from binding to the mast cell or eosinophil. In this way, it prevents asthma exacerbations. Look for the question to mention a patient who is refractory to inhaled steroids whom you are trying to keep off oral steroids.