Pulmonary Drugs Lesson 2

Pulmonary Drug Flashcards

Which inhaled anticholinergic is the only SAMA and what is its indication?

Ipratropium (Atrovent HFA) - maintenance treatment of COPD; also used in moderate/severe asthma with ICS/LABA.

What is a key adverse effect of Tiotropium (Spiriva)?

Nonspecific chest pain.

Which LAMA is contraindicated in patients with moderate to severe renal impairment?

Tiotropium - caution due to systemic effects.

Which anticholinergic is only available in combination products?

Glycopyrrolate.

Which anticholinergic has fecal > urinary excretion and hepatic metabolism?

Umeclidinium (Incruse Ellipta).

Which anticholinergic has a unique delivery via nebulizer and is not part of any combination product?

Revefenacin (Yupelri).

What is the therapeutic range for theophylline and its main adverse effects?

5-15 mcg/mL; GI distress, CNS stimulation, cardiac stimulation.

What increases theophylline levels?

CHF, liver disease, CYP inhibitors like cimetidine, ciprofloxacin, zileuton, and macrolides.

Which drugs lower theophylline levels?

Antiepileptics (carbamazepine, phenytoin, phenobarbital), rifampin, ritonavir.

Why is serum theophylline monitoring essential?

Due to narrow therapeutic index, risk of toxicity, and drug interactions.

Which leukotriene inhibitor carries a black box warning for neuropsychiatric events?

Montelukast (Singulair).

Which leukotriene inhibitors are contraindicated in hepatic impairment?

Zafirlukast and Zileuton.

How does zileuton differ from montelukast and zafirlukast in mechanism?

Zileuton inhibits 5-lipoxygenase to prevent leukotriene formation.

What are common adverse effects of leukotriene inhibitors?

HA, dizziness, abdominal pain, up LFTs, URTIs.

Which leukotriene inhibitors increase theophylline levels?

Zafirlukast and Zileuton.

What is cromolyn's mechanism of action?

Blocks calcium influx into mast cells preventing degranulation.

Why is cromolyn not preferred for routine asthma maintenance?

Lower efficacy compared to other therapies.

What are common side effects of cromolyn?

Cough, congestion, sneezing, wheezing, throat irritation.

What is the indication for Roflumilast (Daliresp)?

Reduce COPD exacerbations in chronic bronchitis with prior exacerbations.

What are Roflumilast's main adverse effects?

Diarrhea, nausea, weight loss, headache, neuropsychiatric symptoms.

What is a major contraindication for Roflumilast?

Severe hepatic impairment.

What drug interactions must be considered with Roflumilast?

Caution with CYP inducers (rifampin) and inhibitors (erythromycin).

Which antileukotriene agents have warnings for systemic eosinophilia, allergic granulomatous, and vasculitis (Churg-Strauss syndrome)?

Zafirlukast and Zileuton

Which LAMA has the longest half-life and is used once daily for COPD?

Tiotropium (Spiriva) — half-life: 25–44 hrs