Respiratory Pharmacotherapy Review

Flashcards covering respiratory infections, asthma, COPD management, and relevant pharmacotherapy based on Unit 5 seminar materials.

What is the most pervasive cause of the common cold?

The human rhinovirus (HRV).

What is the primary prevention tool for influenza?

The influenza vaccine.

non-pharmacologic treatment for the common cold

Includes rest, hydration, and symptomatic relief measures such as humidifiers and nasal saline.

Which antiviral agent acts as a neuraminidase inhibitor for the treatment of influenza?

Oseltamivir (Tamiflu®).

What is the standard adult dose of oseltamivir for influenza treatment?

$75\,mg$ twice daily for $5\,days$.

When is oseltamivir therapy most effective in treating symptoms?

When started within $48\,hours$ of symptom onset.

How long do symptoms typically last in acute rhinosinusitis (ARS)?

Less than $4\,weeks$.

What is the duration threshold for classifying rhinosinusitis as chronic (CRS)?

More than $12\,weeks$.

What are the three most common bacterial pathogens involved in ABRS?

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Name the four hallmark symptoms used to diagnose ARS in adults.

Nasal congestion, nasal discharge, facial pain or headache, and anosmia (loss of smell).

Which symptom replaces anosmia as a hallmark for pediatric rhinosinusitis?

Cough.

According to IDSA, what temperature threshold helps distinguish ABRS from AVRS?

$\geq 102^{\circ}F$.

ABRS vs AVRS

Acute Bacterial Rhinosinusitis (ABRS) is characterized by a fever of $greater\operatorname{th}an102$ or higher, while Acute Viral Rhinosinusitis (AVRS) typically does not present with such a high fever.

What is the recommended treatment duration for uncomplicated ABRS in adults?

$5$ to $7\,days$.

What is the recommended length of ABRS therapy for children?

$10$ to $14\,days$.

What is the mechanism of action for Amoxicillin?

It inhibits the synthesis of the bacterial cell wall by binding to penicillin-binding proteins (PBPs).

Why is clavulanate added to amoxicillin in Augmentin?

To inhibit bacterial beta-lactamases that otherwise inactivate amoxicillin.

Which tetracycline antibiotic is a bacteriostatic alternative for ABRS but not recommended for children $8$ and younger?

Doxycycline.

Which class of antibiotics has a black box warning for tendonitis and tendon rupture?

Fluoroquinolones (e.g., levofloxacin and moxifloxacin).

A lincosamide antibiotic used for ABRS that inhibits bacterial protein synthesis is called what?

Clindamycin (Cleocin).

○      First-line and second-line antibiotics for ABRS

include amoxicillin-clavulanate and doxycycline.

How long can a cough last in self-limiting acute bronchitis?

Up to $6\,weeks$.

Which atypical bacterial organisms occasionally cause bronchitis?

Mycoplasma pneumoniae and Chlamydia pneumoniae.

What is the standard dosing schedule for Azithromycin (Zithromax) for bronchitis treatment?

$500\,mg$ on day one, followed by $250\,mg$ daily for days two through five.

What is the half-life of Azithromycin?

$68\,hours$.

What are three significant drug interactions with macrolides due to CYP3A4 inhibition?

HIV protease inhibitors, warfarin, tacrolimus, and cyclosporine.

What is the standard dose for Clarithromycin (Biaxin) in bronchitis?

$500\,mg$ BID for $7\,days$.

What cardiac side effect is a concern with macrolides and other specific medications?

$QTc$ prolongation.

What is the gold standard for the diagnosis of pneumonia?

Chest radiograph (CXR).

What do the components of the CURB-65 score represent?

Confusion, Urea, Respiratory rate, Blood pressure, and Age ($\geq 65$).

In CURB-65, what blood urea nitrogen level indicates a point for Urea?

$> 20\,mg/dL$ (or $> 19\,mg/dL$).

In CURB-65, what respiratory rate is considered a diagnostic criterion?

$> 30\,breaths/min$.

In CURB-65, what blood pressure reading characterizes a point?

Systolic $< 90\,mmHg$ or Diastolic $< 60\,mmHg$.

What is the empiric outpatient treatment for CAP in patients with comorbidities?

Augmentin plus a Z-pack (Azithromycin) or Levaquin.

common pathogens of CAP

Include Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae.

first and second line treatment of CAP

Include Amoxicillin or Doxycycline, and for severe cases, beta-lactam plus a macrolide or fluoroquinolone.

What primary environmental exposure is related to the development of COPD?

Tobacco smoke.

What is the primary difference in symptom onset between COPD and Asthma?

COPD involves persistent symptoms from noxious gases/particles; Asthma involves variable symptoms from environmental triggers.

Name the four COPD endotypes.

Neutrophilic, Th2, alpha-1 antitrypsin deficiency, and systemic inflammation.

What is the first step in diagnosing asthma via spirometry?

Confirming variable expiratory airflow limitation, such as a reduction in $FEV1$ and $FEV1/FVC$.

A positive bronchodilator reversibility test in adults is defined by what increase in $FEV1$?

An increase of $12\%$ and $200\,mL$.

What spirometry ratio confirms a COPD diagnosis post-bronchodilation?

$FEV1/FVC < 0.70$.

What is the cornerstone class of drug management for asthma?

Inhaled Corticosteroids (ICS).

Are SABA or LABA monotherapies recommended for treating asthma?

No.

When is medium-dose ICS indicated in the GINA guidelines?

When asthma is uncontrolled despite adherence and proper inhaler technique with or without a LABA.

recommended GINA guideline medication regimen for asthma

is a combination of low to medium dose ICS plus a LABA, or a higher-dose ICS alone if control cannot be achieved.

What are the two types of leukotriene modifiers?

$5-LO$ inhibitors and Leukotriene receptor antagonists.

Name two leukotriene receptor antagonists (LTRAs).

Montelukast and zafirlukast.

LABA MOA

is to relax bronchial smooth muscle by activating beta-2 adrenergic receptors, leading to bronchodilation.

What is the preferred treatment for Step 1 intermittent asthma in adults?

SABA PRN (as needed).

What is the preferred treatment for Step 2 persistent asthma?

Daily low-dose ICS.

At what Step in the GINA guidelines is a high-dose ICS + LABA first preferred?

Step 5.

What is the preferred Step 3 asthma treatment for patients $12$ and older?

Low-dose ICS plus LABA or medium-dose ICS.

What frequency of SABA use indicates inadequate asthma control?

$>2\,days$ a week (for relief of symptoms, not exercise-induced bronchospasm).

recommended GOLD guideline medication regimen for COPD

A combination of a long-acting bronchodilator and a short-acting bronchodilator as needed, possibly including inhaled corticosteroids for some patients. This regimen is typically based on patient symptoms, exacerbation history, and severity of airflow limitation.

Which non-pharmacologic therapy is essential to modifying the COPD disease trajectory?

Smoking cessation.

What is the mechanism of action of Muscarinic antagonists?

They competitively block acetylcholine at muscarinic receptors to decrease mucus and cause dilation.

What does the acronym SAMA stand for in respiratory therapy?

Short-acting muscarinic antagonist.

Ipratropium bromide is an example of what drug class?

SAMA (Short-acting muscarinic antagonist).

Name two long-acting muscarinic antagonists (LAMAs).

Tiotropium bromide and umeclidinium bromide.

What is the peak effect time and duration of action for SABAs?

Peak effect at $10\,minutes$; duration of $3-4\,hours$.

Which LABA has a very quick onset of action ($3\,minutes$)?

Formoterol.

What is the standard dose of montelukast for adults $15$ and older?

$10\,mg$ daily in the evening.

What is the mechanism of action for Roflumilast (Daliresp)?

Phosphodiesterase 4 ($PDE-4$) inhibition, which increases intracellular $cAMP$ to modify inflammatory responses.

What is the target therapeutic serum concentration for Theophylline?

$10$ to $20\,mg/L$.

What are the common side effects of Methylxanthines?

Nausea, vomiting, headache, insomnia, diarrhea, irritability, restlessness, and tremor.

what are all of the specific medication classes that treat COPD

Bronchodilators, corticosteroids, phosphodiesterase-4 inhibitors, and mucolytics.

What is the mechanism of Acetylcysteine (Mucomyst)?

It breaks down disulfide bonds to decrease mucus viscosity.

Which monoclonal antibody inhibits IgE binding to mast cells and basophils?

Omalizumab (Xolair).

What is the first-line therapy for treating acute symptoms in both asthma and COPD?

Quick-relief drugs, including SABA and/or SAMA.

SAMA vs SABA vs LABA vs LAMA vs ICS and their indications

These are classifications of bronchodilators and anti-inflammatory medications used in respiratory therapy, where SAMA stands for Short-Acting Muscarinic Antagonists, SABA for Short-Acting Beta Agonists, LABA for Long-Acting Beta Agonists, LAMA for Long-Acting Muscarinic Antagonists, and ICS for Inhaled Corticosteroids.

SAMA vs SABA vs LABA vs LAMA vs ICS indications

These medications are utilized for the management of respiratory conditions such as asthma and COPD, with SAMA and SABA providing immediate relief, while LABA and LAMA offer prolonged control and ICS reduce inflammation. SAMA is used for acute symptom relief, SABA for quick action, LABA and LAMA for maintenance therapy, and ICS primarily for inflammation control.

How long can it take for inhaled controller drugs to reach maximum benefit in asthma/COPD?

$3$ to $4\,months$.

What is a typical regimen for a prednisone burst during an asthma exacerbation?

$40\,mg$ PO daily for $5\,days$.

Why should first-generation antihistamines like diphenhydramine be avoided in the elderly?

They are on the Beers list due to sedating and anticholinergic effects.

Give examples of two non-sedating antihistamines (NSAs).

Loratadine and fexofenadine.

How does Benzonatate (Tessalon) work to suppress cough?

It anesthetizes stretch receptors in the respiratory passages to calm the cough peripherally.

Guaifenesin is a member of which drug class?

Expectorants.

What is the mechanism of action for expectorants like Guaifenesin?

Increases respiratory tract output by decreasing secretion adhesiveness and surface tension.

According to the transcript, what is the first-line antibiotic for sinusitis?

Augmentin ($875\,mg$ BID).

Which drug is mentioned as causing a potential spike in blood pressure as an OTC intranasal compound?

Epinephrine compounds.

Which drug acts centrally on receptors in the cough center of the medulla?

Codeine.

What effect do nasal decongestants have on blood vessels?

They act as vasoconstrictors.

What is a risk of chronic use or overuse of nasal decongestants?

Rebound nasal stuffiness.

Which type of nasal spray is considered most effective for allergic rhinitis?

Nasal-inhaled corticosteroids (e.g., fluticasone).

What are the common side effects of oral decongestants like pseudoephedrine?

Insomnia, irritability, restlessness, palpitations, and increased blood pressure.

What is the second-generation recombinant humanized monoclonal antibody targeting the IL-4 receptor alpha subunit?

Dupilumab.