RESPIRATORY 1. When used in the treatment of chronic obstructive pulmonary disease (COPD), macrolides: inhibit bacterial protein synthesis. Macrolides such as erythromycin (Erytab) and azithromycin (Zithromax) inhibit bacterial protein synthesis and growth by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Macrolides exert several immune-modulatory and anti-inflammatory effects. Penicillins inhibit bacterial cell wall synthesis while fluoroquinolones prevent bacterial DNA from replicating. 2. As a result of its pharmacological effects, theophylline at serum concentrations within the 10 to 20 mcg/mL range modestly increases plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion. 3. Doxycycline (Doryx) may cause esophageal irritation and ulceration. The patient should be instructed to drink fluids liberally. The patient should avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline and to discontinue therapy if phototoxicity occurs. The use of doxycycline might increase the incidence of vaginal candidiasis. 4. Tiotropium (Spiriva HandiHaler), a long-acting antimuscarinic antagonist, enhances the effectiveness of pulmonary rehabilitation in increasing exercise performance. total cholesterol and uric acid levels. Theophylline (Theo-24) may have an effect on the serum concentrations of: may cause esophageal irritation and ulceration. Doxycycline (Doryx), for the treatment of pneumonia,: Tiotropium (Spiriva HandiHaler). Which of the following medications, when combined with pulmonary rehabilitation, enhances exercise performance?