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3. Mondays > 308 Respiratory pharmacology > Flashcards

308 Respiratory pharmacology Flashcards

1
Q

Name some Beta-2 agonist bronchodilators

A

Salbutamol
Salmeterol
Formoterol
Vilanterol

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2
Q

Name some muscarinic antagonists/anticholinergic br0nchodilators

A

Tiotropium (LAMA)

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3
Q

Name some LAMA’s

A

Tiotropium
Aclidinium
Glycopyrronium
Umeclidinium

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4
Q

Name a SAMA

A

Ipratropium

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5
Q

Name a methylxanthine bronchodilator

A

Aminophylline

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6
Q

Name some anti-inflammatory steroids used in the airway

A

Prednisolone (oral))
Beclomethasone (ICS)

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7
Q

What does ICS stand for?

A

Inhaled corticosteroid

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8
Q

What does LAMA stand for?

A

Long-acting muscarinic antagonist

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9
Q

What is a SAMA?

A

Short-acting muscarinic agonist

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10
Q

Name a leukotriene receptor antagonist

A

Montelukast

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11
Q

What are Mucolytic agents?

A

They reduce viscosity of drugs that makes them easier to cough up

Eg. Carbocysteine (tablet), hypertonic saline (via nebuliser)

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12
Q

How do you use a pressurised metered dose inhaler (pMDI)?

A

Deep exhale, inhale and puff
Hold breath for 10 seconds
Exhale slowly
Wait 1 minute before 2nd puff

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13
Q

What is Salbutamol?

A

A short acting bronchodilator (SABA) 3-5hrs duration

It’s inhaled or nebulised in higher doses, can be IV

Used in asthma and COPD

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14
Q

What is the mechanism of action of Salbutamol?

A

It binds to beta-2 receptors in the lungs causing relaxation of bronchial smooth muscle

Salbutamol increases cAMP production by activating adenylate cyclase

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15
Q

What is Salmeterol?

A

A long-acting bronchodilator (LABA)
Begins after 2-30 mins, lasts 10-12hrs

Always used with ICS
Inhaled

Used in asthma and COPD which remains persistent despite SABA

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16
Q

Which medications are combined to form Seretide?

A

Fluticasone (ICS) and salmeterol

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17
Q

What is Formoterol?

A

A long-acting LABA, 10-12hrs duration
Inhaled

Used in asthma and COPD
Always combined with a ICS for asthma

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18
Q

What is Tiotropium?

A

A long acting LAMA, 24hrs duration
Inhaled

Used in stable COPD which has symptoms despite SABA or in Asthma which isn’t improving despite ICS/LABA care

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19
Q

How does Tiotropium work?

A

A LAMA

Works on M3-receptors at the smooth muscle leading to bronchodilatation

Has a similar affinity for M1-M5 subtypes of receptors

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20
Q

What is Ipatropium?

A

A SAMA
Onset: 30min
Duration: 6 hours

Nebulised in acute presentations of COPD and sometimes asthma

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21
Q

What is theophylline?

A

Its a phosphodiesterase inhibitor
5hrs duration

Administered orally or IV

Used orally in COPD and asthma with persistent symptoms
Given IV in medical emergencies for COPD and Asthma

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22
Q

Why does Theophylline use require blood monitoring?

A

It’s to avoid toxicity

Consequences of theophylline intoxication include metabolic disturbances (hypokalemia, hyperglycemia, and metabolic acidosis), nausea, vomiting, and, in severe cases, seizures, cardiac arrhythmias, and death

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23
Q

What are the airway effects of glucocorticoids?

A

Decreases:
-Releases of inflammatory mediators
-Infiltration and action of WBC
-Airway oedema
-Airway mucus production

Increased number and sensitivity of beta-2 receptors

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24
Q

Name some systemic glucocorticoids

A

Prednisolone

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25
Q

Why are inhaled glucocorticoids preferred to systemic ones?

A

Because systemic ones have more side effects, especially with long-term therapy

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26
Q

Name some inhaled glucocorticoids

A

Beclomethasone
Fluticasone
Budesonide

27
Q

Why might systemic glucocorticoids be chosen over inhaled ones?

A

Because the disease may prevent penetration of the drug to affected areas

28
Q

What are some side effects of glucocorticoids?

A

Inhaled: oral candidiasis (white plaques in mouth and dysphonia

General:
-Adrenal suppression
-Bone loss
-Slow growth in children but doesn’t affect ultimate height
-Increased risk of cataracts and glaucoma
-Increased risk of infection
-Gastric ulceration
-Hypertension
-Diabetes
-Mood disturbance

29
Q

What is dysphonia?

A

Disorders of the voice

30
Q

Name some ICS/LABA combination inhalers

A

Formoterol/Budesonide
Formoterol/beclomethasone
Salmeterol/Fluticasone

31
Q

Name some LAMA/LABA combination inhalers

A

Tiotropium/Olodaterol

32
Q

Name some ICS/LABA/LAMA combination inhaler

A

Beclomethasone/formoterol/glycopyrronium

33
Q

What are the steps for the asthma treatment ladder?

A

Step 1
-As needed low dose ICS (formoterol)

Step 2
-Daily low dose ICS and as -needed low dose ICS (formoterol)

Step 3
-Low dose ICS-LABA and as-needed ICS (formoterol)

Step 4
-Medium dose ICS-LABA and as-needed ICS (formoterol)

Step 5
-High dose ICS-LABA and as-needed ICS (formoterol)
-Refer to phenotypic assessment

34
Q

What are the steps for inhalers with COPD?

A
  1. Offer SABA OR SAMA to use as needed
  2. If continues and patient has no features of asthma, offer LABA + LAMA. If symptoms still severe, offer 3 months trail of LAMA + LAMA + ICS
  3. If continues and patient has asthmatic features, consider LAMA + ICS

(LABA + LAMA + ICS is always the last option. if they don’t work, explore other forms of treatment)

35
Q

What are the treatment options for allergic rhinitis?

A

-Antihistamines (H1 antagonists)
Eg, Cetirizine and chlorpheniramine

-Intranasal glucocorticoids
Eg, Beclomethasone (Beconase)

-Montelukast

Sympathomimetics (decongestants)
Eg, Pseudoephedrine (alpha-agonist)
(Problems with abuse)

36
Q

How does Montelukust treat allergic rhinitis?

A

It inhibits leukotriene receptors

This reduces inflammation, bronchoconstriction, oedema, mucus, and recruitment of eosinophils

37
Q

When can over oxygenation occur?

A

In type 2 respiratory failure

38
Q

What is the difference between type 1 and type 2 respiratory failure?

A

Type 1 respiratory failure:
When the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia.

Type 2 respiratory failure:
When the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia

39
Q

What is the difference between bronchitis and pneumonia?

A

Bronchitis affects the bronchial tubes that carry air to your lungs

Pneumonia affects the alveoli, where oxygen passes into your blood

40
Q

What are the different types of respiratory infection?

A

-Bronchitis (COPD and asthma)
-Community acquired pneumonia (CAP)
-Hospital acquired pneumonia (HAP)
-Ventilator acquired pneumonia (VAP)
-Aspiration pneumonia

41
Q

Name some antibiotics used to treat respiratory infections

A

-Penicillin’s: Amoxicillin, Co-amoxiclav
-Tazobactam
-Tetracyclines: Doxycycline
-Quinolone: Ciprofloxacin, Levofloxacin, Moxifloxacin
-Macrolides: Erythromycin, Clarithromycin

42
Q

When is amoxicillin used to treat respiratory infections?

A

-Community acquired pneumonia (typical)
-COPD exacerbations
-Bronchitis

43
Q

Which type of bacteria does amoxicillin work against?

A

It’s a moderate-spectrum, bacteriolytic, Beta-lactam antibiotic

Active against gram negative and positive bacteria

44
Q

What is Co-amoxiclav?

A

A combination of amoxicillin and clavulanic acid (a beta lactamase inhibitor) which prevents the antibiotic from being degraded by the bacteria

45
Q

When is doxycycline prescribed to treat respiratory infections?

A

With atypical infections
Eg, mycoplasma and legionella

Oral route only

46
Q

How does doxycycline work?

A

It inhibits protein synthesis

It’s and broad spectrum gram positive and negative antibiotic

47
Q

What are the side effects of doxycycline?

A

GI upset
Staining teeth
Lupus
Allergy
Photosensitivity

48
Q

How do Quinolone antibiotics work?

A

Eg, Ciprofloxacin, Levofloxacin, moxifloxacin

They cause DNA fragmentation

49
Q

Which bacteria do Quinolones work on?

A

Gram negative and positive bacteria and pseudomonas

50
Q

Which types of bacteria are macrolides used on?

A

Eg, erythromycin, clarithromycin

Used in atypical pneumonia

Work on gram positive bacteria, limited gram negative cover

51
Q

What is the route of administration of macrolides?

A

IV or oral

52
Q

What is the route of administration for Quinolones?

A

IV, oral, or inhaled

53
Q

How do macrolides fight infection?

A

They are protein synthesis inhibitors

54
Q

What are the side effects of Quinolones?

A

GI upset
C difficile
Tendonitis
Liver upset
Prolonged QTc and arrthymias

55
Q

What are the side effects of Macrolides?

A

GI upset
Allergy
liver abnormality
prolonged QTc
Interactions

56
Q

What is the treatment for Tuberculosis?

A

6 month treatment

First 2 months: Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol

After 2 months: Isoniazid and Rifampicin

57
Q

When would the 6 month treatment period for TB be extended?

A

If there is central nervous system involvement the continuation phase of treatment is extended to 10 months making a 12 month full treatment plan

58
Q

How is the TB treatment taken?

A

TB treatment is taken all together on an empty stomach 1 hour before breakfast; compliance is essential for cure

59
Q

What are the side effects of TB therapy?

A

Isoniazid
-Bactericidal and bacteriostatic – inhibits cell wall growth
-Cytochrome P450 inhibitor – interactions!!
fever, peripheral neuropathy and optic neuritis

Rifampicin
-inhibits bacterial DNA-dependent RNA synthesis
-Cytochrome P450 inducer – interactions!!
reddish colour to the urine

Pyrazinamide
-Causes accumulation pf pyrazinoic acid
use with caution in patients with gout

Ethambutol
-Bacteriostatic obstructs development of cell wall
-Peripheral neuropathy, optic neuropathy , gout, AKI

General side effects: Hepatotoxcity, nausea and skin rashes, Allergy

60
Q

Name some types of Interstitial lung disease (ILD)

A

Hypersensitivity pneuomina
Sarcoid
Idiopathic pulmonary fibrosis

61
Q

What is cystic fibrosis?

A

Mutation of the CFTR gene

62
Q

What are the different classes if CFTR mutation?

A

Protein production
Protein processing
Gating
Conduction
Insufficient protein

63
Q

Name some CFTR modulating drugs

A

Kalydeco®(ivacaftor) Class 3 mutation . Increases channel opening probability of G551D CFTR

Orkambi®(lumacaftor/ivacaftor) CFTR corrector, Class II mutation + above

Symdeko®(tezacaftor/ivacaftor) Same as above less SFX

Trikafta®(elexacaftor/tezacaftor/ivacaftor)
Phe508Del + 177 others

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