Step 1 Pulmonary Pharmacology

Front 1

Diphenhydramine, Dimenhydrinate, Chlorpheniramine
Class?
Clinical Uses?
Toxicity?

Back 1

Diphenhydramine, Dimenhydrinate, Chlorpheniramine

Class: First Generation H1 blockers - reversibly block H1 histamine receptors

Clinical Uses: Allergies, Motion Sickness, sleep aid

Toxicity: Sedation, Antimuscarinic, anti-alpha adrenergic

Front 2

Loratadine, Fexofenadine, Desloratadine, Cetirizine
Class?
Clinical Uses?
Toxicity?

Back 2

Loratadine, Fexofenadine, Desloratadine, Cetirizine

Class: Second generation reversible inhibitor of H1 Receptor

Clinical Use: Allergies

Toxicity: Far less sedating than first generation because of decreased entry to CNS

Front 3

Isoproterenol
Class?
Mechanism?
Toxicity?

Back 3

Isoproterenol

Class: Beta-1, Beta-2 agonist

Mechanism: Relaxes bronchial smooth muscle (Beta-2)

Toxicity: Adverse effect is Tachycardia -- it is an agonist at Beta-1

Front 4

Albuterol
Class?
Clinical Use?

Back 4

Beta-2 agonist - short acting

Clinical - used during acute asthma exacerbation

Front 5

Salmeterol, formoterol
Class?

Use?
Adverse Effects?

Back 5

Long acting Beta-2 agonist

Use: Asthma prophylaxis

Adverse Effects: tremor and arrhythmia

Front 6

Theophylline
Class?
Mechanism?
Toxicity?

Back 6

Class: Methylxanthine

Mechanism: Causes bronchodilation by inhbiting phosphodiesterase, thereby decreasing cAMP hydrolysis --> Smooth muscle relaxation (increased cAMP)

Toxicity:
1. Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity)
2. Metabolized by P450s
3. Blocks the action of adenosine

Front 7

Ipratropium
Class?
Mechanism?
Clinical Use?

Back 7

Class: Muscarinic Antagonist

Mechanism: Competitive block of muscarinic receptors, preventing bronchoconstriction.

Clinical use: Astham and COPD

Tiotropium-long acting

Front 8

Cromolyn
Mechanism?
Clinical use?

Back 8

Mechanism: Prevents the release of mediators from mast cells. Effective only for the prophylaxis against asthma.

Clinical use: Prophylactic treatment of asthma. Cannot be used once the attack has started.

Toxicity is rare

Front 9

Zileuton
Class?
Mechanism?

Toxicity

Back 9

Class: Antileukotrienes

Mechanism: 5-Lipoxygenase inhibitor. Blocks the conversion of arachidonic acid to leukotrienes

Hepatotoxic

Front 10

Zafirlukast, Montelukast
Class?
Mechanism?

Back 10

Class: Antiluekotriene

Mechanism: Blocks leukotriene receptors (CysLT1)

Clinical use: Especially good for aspirin induced asthma

Front 11

Guaifenesin
Class?
Mechanism?

Back 11

Guaifenesin

Class: Expectorant

Mechanism: thins respiratory secretions, does not suppress cough reflex

Front 12

N-Acetylcysteine
Class?
Mechanism?
Clinical Uses?

Back 12

N-Acetylcysteine

Class: Mucolytic

Mechanism: Helps to loosen mucous plugs in CF patients by breaking down Di-sulfide bonds.

Clinical:
1. CF patients to break up mucous
2. Acetaminophen overdose - acts like glutathione and helps liver recover

Front 13

Bosentan
Mechanism?
Clinical Use?

Toxicity?

Back 13

Mechanism: Competitively antagonizes endothelin-1 receptors --> decrease pulmonary vascular resistance

Clinical Use:
1. Treat pulmonary HTN

Hepatoxic

Front 14

Dextromethorphan
Class?
Mechanism
Toxicity?

Back 14

Dextromethorphan

Class: Antitussive (Antagonizes NMDA glutamate receptors) - Synthetic codeine analog

Mechanism: Mild opioid effects when used in excess.

Toxicity:
1. Naloxone can be given in the event of an overdose.
2. Mild abuse potential

3. Serotonin syndrome with other serotogenic agents

Front 15

Pseudophedrine, Phenylephrine
Class?
Clinical use?
Toxicity?

Back 15

Pseudophedrine, Phenylephrine

Class: Sympathomimetic alpha adrenergic agonist

Use:
1. Reduces hyperemia, edema, and nasal congestion
2. Opens obstructed Eustachian tubes
3. Pseudophedrine is also a stimulant

Toxicity:
1. HTN
2. Can also cause CNS Stimulation/anxiety (pseudophedrine)

Front 16

Methacholine
Class?
Clinical Use

Back 16

Methacholine

Class: Muscarinic 3 receptor agonist

Clinical Use: Methacholine challenge to diagnose asthma

Front 17

Sildenafil

Mechanism

Use

Back 17

Mech: Inhibits cGMP PDE-5 and prolongs vasodilatoryeffect of nitric oxide

Use:

1) Pulmonary HTN

2) Erectile dysfunction

Front 18

Epoprostenol, iloprost

Mechanism

Use

Adverse effects

Back 18

Mech: PGI2 (prostacyclin) with direct vasodilatoryeffects on pulmonary and systemic arterialvascular beds. Inhibits platelet aggregation.

Use:

1) Pulmonary HTN

Tox: Flushing, jaw pain

Front 19

Fluticasone, budesonide

Class

Mechanism

Use

Back 19

Inhaled corticosteroids

Mech: inhibit the synthesis of virtually all cytokines. Inactivate NF-κB, the transcription factor that induces production of TNF-α and other in ammatory agents

Chronic Asthma

Front 20

Omalizumab

Class

Use

Back 20

Anti-IgE monoclonal antibody

Mech: binds mostly unbound serum IgE and blocks binding to FcεRI.

Use: allergic asthma with IgE levels resistant to inhaled steroids and long-acting β2-agonists.