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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
Why are inhaled glucocorticoids preferred to systemic ones?
Because systemic ones have more side effects, especially with long-term therapy
26
Name some inhaled glucocorticoids
Beclomethasone Fluticasone Budesonide
27
Why might systemic glucocorticoids be chosen over inhaled ones?
Because the disease may prevent penetration of the drug to affected areas
28
What are some side effects of glucocorticoids?
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
What is dysphonia?
Disorders of the voice
30
Name some ICS/LABA combination inhalers
Formoterol/Budesonide Formoterol/beclomethasone Salmeterol/Fluticasone
31
Name some LAMA/LABA combination inhalers
Tiotropium/Olodaterol
32
Name some ICS/LABA/LAMA combination inhaler
Beclomethasone/formoterol/glycopyrronium
33
What are the steps for the asthma treatment ladder?
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
What are the steps for inhalers with COPD?
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
What are the treatment options for allergic rhinitis?
-Antihistamines (H1 antagonists) Eg, Cetirizine and chlorpheniramine -Intranasal glucocorticoids Eg, Beclomethasone (Beconase) -Montelukast Sympathomimetics (decongestants) Eg, Pseudoephedrine (alpha-agonist) (Problems with abuse)
36
How does Montelukust treat allergic rhinitis?
It inhibits leukotriene receptors This reduces inflammation, bronchoconstriction, oedema, mucus, and recruitment of eosinophils
37
When can over oxygenation occur?
In type 2 respiratory failure
38
What is the difference between type 1 and type 2 respiratory failure?
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
What is the difference between bronchitis and pneumonia?
Bronchitis affects the bronchial tubes that carry air to your lungs Pneumonia affects the alveoli, where oxygen passes into your blood
40
What are the different types of respiratory infection?
-Bronchitis (COPD and asthma) -Community acquired pneumonia (CAP) -Hospital acquired pneumonia (HAP) -Ventilator acquired pneumonia (VAP) -Aspiration pneumonia
41
Name some antibiotics used to treat respiratory infections
-Penicillin's: Amoxicillin, Co-amoxiclav -Tazobactam -Tetracyclines: Doxycycline -Quinolone: Ciprofloxacin, Levofloxacin, Moxifloxacin -Macrolides: Erythromycin, Clarithromycin
42
When is amoxicillin used to treat respiratory infections?
-Community acquired pneumonia (typical) -COPD exacerbations -Bronchitis
43
Which type of bacteria does amoxicillin work against?
It's a moderate-spectrum, bacteriolytic, Beta-lactam antibiotic Active against gram negative and positive bacteria
44
What is Co-amoxiclav?
A combination of amoxicillin and clavulanic acid (a beta lactamase inhibitor) which prevents the antibiotic from being degraded by the bacteria
45
When is doxycycline prescribed to treat respiratory infections?
With atypical infections Eg, mycoplasma and legionella Oral route only
46
How does doxycycline work?
It inhibits protein synthesis It's and broad spectrum gram positive and negative antibiotic
47
What are the side effects of doxycycline?
GI upset Staining teeth Lupus Allergy Photosensitivity
48
How do Quinolone antibiotics work?
Eg, Ciprofloxacin, Levofloxacin, moxifloxacin They cause DNA fragmentation
49
Which bacteria do Quinolones work on?
Gram negative and positive bacteria and pseudomonas
50
Which types of bacteria are macrolides used on?
Eg, erythromycin, clarithromycin Used in atypical pneumonia Work on gram positive bacteria, limited gram negative cover
51
What is the route of administration of macrolides?
IV or oral
52
What is the route of administration for Quinolones?
IV, oral, or inhaled
53
How do macrolides fight infection?
They are protein synthesis inhibitors
54
What are the side effects of Quinolones?
GI upset C difficile Tendonitis Liver upset Prolonged QTc and arrthymias
55
What are the side effects of Macrolides?
GI upset Allergy liver abnormality prolonged QTc Interactions
56
What is the treatment for Tuberculosis?
6 month treatment First 2 months: Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol After 2 months: Isoniazid and Rifampicin
57
When would the 6 month treatment period for TB be extended?
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
How is the TB treatment taken?
TB treatment is taken all together on an empty stomach 1 hour before breakfast; compliance is essential for cure
59
What are the side effects of TB therapy?
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
Name some types of Interstitial lung disease (ILD)
Hypersensitivity pneuomina Sarcoid Idiopathic pulmonary fibrosis
61
What is cystic fibrosis?
Mutation of the CFTR gene
62
What are the different classes if CFTR mutation?
Protein production Protein processing Gating Conduction Insufficient protein
63
Name some CFTR modulating drugs
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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