PHARMACOLOGY - Pulmonology

What is the primary Mechanism of Action (MOA) of Alpha-1 agonists in treating common colds?

Vasoconstriction

Name three examples of Alpha-1 agonists used for colds

Phenylephrine, Phenylpropanolamine, and Pseudoephedrine

Which Alpha-1 agonist is considered an effective nasal decongestant but is unavailable in the Philippines because it is a precursor to "shabu"?

Pseudoephedrine

What is the MOA of Mucolytics, and what is the "truest" example of one?

They break down disulfide bridges in mucus to liquefy it

• N-Acetylcysteine (NAC)

How are the breakdown products of N-Acetylcysteine excreted?

saliva, feces, and urine

They increase mucociliary clearance (helping move phlegm out)

Mucokinetics

Name three examples of Mucokinetic drugs

• Ambroxol

• Bromhexine

• Carbocisteine

They increase the production of respiratory fluid to make phlegm easier to expel

Expectorants

What is a common example of an Expectorant?

Guaifenesin

Where do Centrally-acting antitussives exert their effect?

Cough center of the Medulla

Which Centrally-acting antitussive is an opioid and which is a non-addictive OTC opioid-derivative?

• Opioid: Codeine

• OTC: Dextromethorphan

Name a non-opioid centrally-acting antitussives

Butamirate (Sinecod)

What is the MOA of Peripherally-acting antitussives?

They inhibit cough receptors located in the lungs

Give an example of a Peripherally-acting antitussive

Levodropropizine (Levopront)

At what age is it generally contraindicated to give cough and cold preparations?

Children less than 4 years old

<6 months old = don't give = increase risk for botulinum poisoning

What are the four primary characteristics of Asthma?

• Inflammatory disease (genetic)

• Bronchoconstriction

• Mucus hypersecretion

• Reversible airflow limitation

What is the primary cause of Chronic Obstructive Pulmonary Disease (COPD)?

Prolonged exposure to noxious substances (e.g., smoking, vaping, biomass fuels, air pollutants)

How does the nature of airflow limitation differ between Asthma and COPD?

• Asthma is reversible

• COPD is progressive and irreversible.

Which molecule is listed as a primary driver of Bronchodilation?

cAMP (cyclic Adenosine Monophosphate)

Name five factors or substances that contribute to Bronchoconstriction

Inflammation

Acetylcholine

Leukotrienes

Adenosine

AMP

Which substance is noted as the most "potent" factor in causing constriction?

Leukotrienes

True or False: Acetylcholine causes bronchodilation

False; it causes bronchoconstriction

What is the clinical goal of "Reliever" medications?

Treatment of acute signs and symptoms (PRN dosing)

What is the clinical goal of "Controller" medications?

To prevent acute attacks and alter the underlying pathophysiology

Which pharmacological class acts as both a Reliever and a Controller?

SABA (Short-Acting Beta-2 Agonists)

What does SABA stand for, and what are three examples?

Short-Acting Beta-2 Agonist

• Salbutamol

• Levalbuterol

• Fenoterol

Apart from respiratory use, what is another clinical use for SABAs like Terbutaline, Isoxsuprine, and Ritodrine?

Tocolytics (to suppress premature labor)

What does LABA stand for, and what are four examples?

Long-Acting Beta-2 Agonist

• Formoterol

• Salmeterol

• Bambuterol

• Indacaterol

Which LABA combination is used specifically as a "Reliever" due to its rapid onset and long-acting action?

ICS-Formoterol

What are the three primary adverse effects (WOF) to watch for with Beta-2 Agonists?

• Tachycardia

• Tachyphylaxis

• Palpitations

What is the dual Mechanism of Action (MOA) for Methylxanthines?

• PDE-3 antagonist (increases cAMP)

• Adenosine antagonist (blocks bronchoconstriction)

Name four examples of Methylxanthines

• Theophylline

• Aminophylline

• Doxofylline

• Caffeine

Which Methylxanthine is specifically used for infants with apnea?

Caffeine

What is the relationship between Theophylline and Aminophylline?

Aminophylline is the salt form of Theophylline

List six side effects (WOF) associated with Methylxanthines

Palpitations

Tremors

Insomnia

Increased GI motility

Diuresis

Tolerance

Name the five classes of medications listed as "Relievers."

1. SABA (Short-Acting Beta-2 Agonists)

2. SAMA (Short-Acting Muscarinic Antagonists)

3. Methylxanthines

4. Oral Corticosteroids

5. LABA (with a specific caveat/star, likely referring to Formoterol when used with ICS)

Name the six classes of medications listed as "Controllers."

1. SABA

2. LABA (Long-Acting Beta-2 Agonists)

3. Inhaled CS (Corticosteroids)

4. Mast cell stabilizers

5. Anti-Leukotrienes

6. Anti-IgE

How do the administration routes generally differ between the corticosteroids listed as Relievers versus those listed as Controllers?

Relievers use Oral Corticosteroids (for acute exacerbations)

Controllers use Inhaled Corticosteroids (for long-term maintenance)

Which "Anti-" classes are strictly used as Controllers?

Anti-Leukotrienes and Anti-IgE

Where do Mast cell stabilizers fit into this management scheme?

Controllers

What is the specific Mechanism of Action (MOA) for Antimuscarinics?

M3 antagonist

Which SAMA is used as a "Reliever" for COPD?

Ipratropium Br

Name two LAMAs used as "Controllers" for COPD

Tiotropium and Glycopyrronium

Inhibits degranulation of Mast cells and prophylaxis for acute attacks

Mast Cell Stabilizers

Give two examples of Mast Cell Stabilizers

Cromolyn Na

Nedocromil

In which clinical scenario are Leukotriene Receptor Antagonists (LTRAs) like Montelukast and Zafirlukast particularly indicated?

Asthma in children and NSAID-induced asthma

What is the MOA of Zileuton, and which enzyme does it inhibit?

LOX inhibitor; it inhibits the Lipoxygenase (LOX) enzyme

What is the primary MOA of Corticosteroids?

Phospholipase A2 inhibitor (inhibits the conversion of Phospholipids to Arachidonic Acid)

Which drug class is considered the "Cornerstone therapy" for Asthma?

Inhaled Corticosteroids (e.g., Budesonide, Fluticasone)

What is the most common side effect (WOF) of Inhaled Corticosteroids, and what is the causative microorganism?

Oral thrush (Oral candidiasis); caused by Candida albicans

What should a patient do after every use of an inhaled corticosteroid to prevent oral thrush?

Gargle with water every after use

When are IV Corticosteroids specifically indicated?

Status Asthmaticus (attacks lasting ≥ 5 mins)

What is Omalizumab pharmacologically classified as?

monoclonal antibody

It inhibits the IgE receptor on Mast cells, which leads to the inhibition of degranulation

Omalizumab

What is the specific clinical use for Omalizumab?

Refractory asthma (asthma that is difficult to treat or does not respond to standard therapy)

What is the most critical side effect (WOF) to monitor for after administering Omalizumab?

Anaphylaxis

Compare the target of Mast Cell Stabilizers vs. Anti-IgE

While both ultimately prevent degranulation, Mast Cell Stabilizers (Cromolyn) inhibit the process directly, whereas Anti-IgE (Omalizumab) works upstream by blocking the IgE receptor itself