Pulmonology Drugs

A set of flashcards based on lecture notes covering key concepts in pulmonology pharmacology.

What is bronchitis?

Inflammation of one or more bronchi, usually secondary to infection; does not involve bronchioles or alveoli.

Differentiate between acute and chronic bronchitis.

Acute: all ages, often viral; Chronic: mainly in COPD patients.

Common causes of acute bronchitis?

Viral = rhinovirus, coronavirus, influenza, adenovirus

Bacterial (occasional) = Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordatella pertussis, Streptococcus, Staphylococcus, Haemophilus.

How is acute bronchitis treated?

Symptomatic care with analgesics, antipyretics, antitussives, fluids; avoid antihistamines/sympathomimetics.

When are antibiotics considered for acute bronchitis?

When symptoms persist beyond 5 days or if bacterial involvement is suspected.

What is the first-line antibiotic for acute bronchitis?

Doxycycline, preferred if Mycoplasma due to macrolide resistance.

What are alternative antibiotics if needed for acute bronchitis?

Macrolides (azithromycin or clarithromycin)

NOTE: avoid fluoroquinolones unless recent ABX use/resistance concern

How do microbes reach the lungs in community-acquired pneumonia (CAP)?

Aspiration (most common), inhalation of aerosols, hematogenous spread, or direct inoculation.

When should cultures be obtained for CAP?

For hospitalized patients, cultures should be obtained before starting antibiotics.

What are common pathogens for outpatient CAP?

Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and viruses.

What are common pathogens for inpatient (non-ICU) CAP?

Same as outpatient plus Legionella and aspiration.

What pathogens are common in ICU CAP?

Streptococcus pneumoniae, Staphylococcus aureus, Legionella, gram-negative bacilli, and Haemophilus influenzae.

Risk factors for resistant Streptococcus pneumoniae?

Age over 65

Recent β-lactam use

Alcoholism

Comorbidities

Immunosuppression

Daycare exposure.

First-line tx for outpatient CAP with no resistance risk?

Macrolide (azithromycin or clarithromycin) or doxycycline.

Tx for outpatient CAP with resistance risk?

Combination of β-lactam and macrolide or a respiratory fluoroquinolone.

What is the inpatient (non-ICU) CAP treatment?

IV β-lactam (ceftriaxone or ampicillin) plus macrolide or doxycycline.

What to use for ICU CAP treatment?

Same IV regimen as non-ICU, plus MRSA coverage if indicated.

When to suspect MRSA pneumonia?

Post-influenza, presence of cavitary infiltrates, gram-positive cocci in clusters on gram stain.

What is considered nosocomial pneumonia?

Pneumonia occurring more than 48 hours after hospital admission.

What are common pathogens for nosocomial pneumonia?

Gram-negative bacteria including Pseudomonas, E. coli, Klebsiella, Acinetobacter, Enterobacter, and MRSA.

What are major modifiable risk factors for nosocomial pneumonia?

Mechanical ventilation, nasogastric tubes, antacid therapy, previous antibiotics, and re-intubation.

What is the initial treatment principle for nosocomial pneumonia?

Start broad-spectrum antibiotics early and narrow down once cultures are available.

What are limited spectrum empiric coverage options for nosocomial pneumonia?

Ceftriaxone, levofloxacin, ampicillin/sulbactam, or ertapenem.

What is broad spectrum empiric coverage for nosocomial pneumonia with MDR risk?

Antipseudomonal β-lactam plus fluoroquinolone or aminoglycoside; add vancomycin or linezolid for MRSA.

What is the recommended duration of therapy for nosocomial pneumonia?

7–8 days; 10–14 days for Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas.

What is the main pathogen in tuberculosis (TB)?

Mycobacterium tuberculosis, an acid-fast bacillus with a waxy cell wall.

What is the standard TB therapy initial phase?

2 months of INH, Rifampin, Pyrazinamide, and Ethambutol.

What is the continuation phase of TB therapy?

4 months of INH and Rifampin.

Why are multiple drugs used in TB treatment?

To prevent drug resistance and target different phases of bacterial growth.

What is the duration of TB therapy?

6–9 months for pulmonary TB; 9–12 months for HIV+ patients; up to 24 months for extrapulmonary TB.

What is the MOA of Isoniazid (INH)?

Inhibits synthesis of mycolic acid.

What are the adverse effects of Isoniazid (INH)?

Hepatitis, lupus-like syndrome, peripheral neuropathy (prevent with pyridoxine/B6).

What is the MOA of Rifampin?

Inhibits DNA-dependent RNA polymerase.

What are the adverse effects of Rifampin?

Orange secretions, hepatitis, flu-like syndrome, induces CYP450.

What is the MOA of Ethambutol?

Inhibits mycolic acid incorporation.

What are the adverse effects of Ethambutol?

Optic neuritis, decreased red-green discrimination, increased uric acid.

What is the MOA of Pyrazinamide?

Lowers pH to inhibit MTB growth in macrophages.

What are the adverse effects of Pyrazinamide?

Hepatotoxicity and hyperuricemia.

What are the key treatment priorities for anaphylaxis?

Epinephrine first, airway management, IV fluids, adjunct medications.

What is the preferred route and dosage for epinephrine in anaphylaxis?

Intramuscularly (1:1000, 0.3–0.5 mg); IV (1:10,000) for cardiac arrest only.

What is the mechanism of action of epinephrine?

Alpha-1: vasoconstriction; Beta-2: bronchodilation and reduced pruritus/angioedema.

What are adjunct medications used in anaphylaxis?

H1 blockers (benadryl), H2 blockers (famotidine), steroids (methylprednisolone), albuterol (bronchodilator).

What defines asthma?

Reversible airway narrowing, airway inflammation, and hyperresponsiveness.

What are key mediators in asthma?

Histamine, leukotrienes (C4, D4), prostaglandin D2.

What are the three main pharmacologic goals in asthma therapy?

1. Reverse bronchospasm 2. Remove trigger/antigen 3. Control inflammation.

What is the mechanism of action of β₂ agonists?

Increase cAMP leading to bronchodilation.

What are short-acting β₂ agonists?

Albuterol, levalbuterol, used for rescue.

What are long-acting β₂ agonists?

Salmeterol, formoterol, used for maintenance with inhaled corticosteroids.

What are common adverse effects of β₂ agonists?

Tremor, tachycardia, hypokalemia.

What is the mechanism of action of inhaled corticosteroids (ICS)?

Inhibit the inflammatory cascade.

What are some agents used as inhaled corticosteroids (ICS)?

Fluticasone, budesonide, mometasone.

What are the adverse effects of inhaled corticosteroids (ICS)?

Oral thrush, growth suppression, systemic immunosuppression (rare).

What are some examples of combo inhalers?

Advair (fluticasone/salmeterol), Symbicort (budesonide/formoterol).

What is Montelukast?

A leukotriene receptor antagonist; effective for aspirin-induced asthma.

What is Zileuton?

A 5-lipoxygenase inhibitor; rarely used due to hepatotoxicity.

What are the adverse effects of Zileuton?

Headache, hepatic enzyme elevation.

What are Mast Cell Stabilizers used for?

Prevent mast cell degranulation; used for prophylaxis only.

What is Omalizumab?

An anti-IgE therapy used for moderate-severe allergic asthma.

What are the adverse effects of Omalizumab?

Injection site pain, anaphylaxis (rare), urticaria.

What are some newer biologics for asthma treatment?

Anti-IL-5 agents (mepolizumab, benralizumab, reslizumab) and anti-IL-4 (dupilumab).

When are newer biologics used in asthma treatment?

In eosinophilic asthma with eosinophil levels greater than 150 eos/mcL.

What is the mechanism of action of Theophylline (methylxanthine)?

PDE inhibitor that increases cAMP and acts as an adenosine antagonist.

What are the adverse effects of Theophylline?

Narrow therapeutic index, arrhythmias, seizures, insomnia, nausea/vomiting.

What is the therapeutic level of Theophylline?

5–20 µg/mL.

What do anticholinergics do in asthma treatment?

Block muscarinic receptors leading to bronchodilation.

What are short-acting anticholinergics?

Ipratropium (Atrovent).

What are long-acting anticholinergics?

Tiotropium (Spiriva), used only in COPD.

What are chronic obstructive pulmonary disease (COPD) core pathophysiology?

Chronic, partially irreversible inflammation causing airflow limitation.

What is the most important intervention for COPD patients?

Smoking cessation.

What is the mechanism of action of Bupropion SR (Zyban) in smoking cessation?

Inhibits norepinephrine and dopamine reuptake.

What are the adverse effects of Bupropion SR?

Seizures (avoid with history), insomnia.

What should be cautioned with nicotine replacement therapy?

Cardiac disease due to potential tachyarrhythmias.

What are the forms of nicotine replacement?

Patch, gum, spray, inhaler.

What is Varenicline (Chantix)?

A partial nicotine receptor agonist used in smoking cessation.

What are the adverse effects of Varenicline?

Nausea, sleep disturbance, mood changes, suicidal ideation (black box warning).

Which immunizations are recommended for COPD patients?

Influenza (annual) and Pneumococcal vaccine (Pneumovax®).

What is a summary key point about bronchitis?

Usually viral and managed with supportive care.

What is a summary key point about community-acquired pneumonia (CAP)?

Treated with macrolides or doxycycline, and add β-lactam if risk factors for resistance.

What is a summary key point about nosocomial pneumonia?

Start broad-spectrum antibiotics, narrow when cultures are back.

What is a summary key point about tuberculosis (TB)?

RIPE for 2 months, then RI for 4 months.

What is a summary key point about anaphylaxis management?

Epinephrine first, followed by fluids and adjunct medications.

What is a summary key point about asthma management?

Focus on treating bronchospasm, inflammation, and triggers.

What is a summary key point about COPD management?

Emphasize smoking cessation alongside bronchodilator therapy and vaccination.