Cardio-respiratory Medicines (307) Flashcards
exam - 11th July
After how long should you test your inhaler?
If you have not used your inhaler for 5 days or more you should test it.
How do you test your inhaler?
- take the cap off
- give the inhaler a good shake
- point the mouthpiece away from yourself
- press the canister to release a ‘puff’
Where can you find out how many test sprays your specific inhaler needs?
The instructions will specify how many test sprays your inhaler needs.
What is the procedure for using a metered dose inhaler (MDI)?
- test it - remove cap, give inhaler a shake, point it away from yourself, and press down
- take the cap off and check there is nothing inside the inhaler mouthpiece
- shake the inhaler well
- sit or stand up straight and slightly tilt your chin upwards (helps the medication to reach the lungs).
- hold inhaler upright with thumb on the base
- breathe out gently, away from the inhaler until your lungs feel empty
- place your lips around the mouthpiece to form a tight seal
- start to breathe in slowly as you press the canister on the inhaler. Breathe in until lungs feel full
- hold your breath for 10 seconds
- breathe out gently
- replace the cap on the inhaler
What are the advanages of using a metered dose inhaler (MDI)?
+ cheap
+ portable
+ compact
+ short treatment time
+ can be used with accessory
What are the disadvantages of using a metered dose inhaler (MDI)?
- requires coordination
- cannot change concentration
- difficult to determine whether the canister is used up
What are common drugs found in a metered dose inhaler (MDI)?
- salbutamol
- beclometasone
What drug is contained in the brown, preventer inhaler?
Beclometasone is in the brown preventer inhaler.
What drug is contained in the blue, reliever inhalers?
Salbutamol is contained in the blue reliever inhalers.
Which conditions are classed as chronic obstructive pulmonary disease (COPD)?
- bronchitis
- emphysema
What is bronchitis characterised by?
Bronchitis is characterised by the inflammation and irritation of the bronchi.
What is acute bronchitis?
Acute bronchitis is one bout, that is usually severe. It is usually self-limiting and due to a viral infection following a cold or influenza. Occasionally a bacterial infection may occur.
What are usually the causative agents of acute bronchitis?
- streptococcus pneumonae
- haemophilus influenza
What are the symptoms of acute bronchitis?
- cough, productive - green/grey
- sore chest + stomach muscles
- sore throat
- wheeze
- blocked nose
- fever
- headache
- aches + pains
What are the treatments for acute bronchitis?
Does not normally require treatment, but reccommendations may include:
- plenty of rest
- drink lots of fluids
- OTC painkillers
- don’t smoke
- antibiotics if secondary infection
What is chronic bronchitis almost always a result of?
Chronic bronchitis is almost always as a result of smoking and/or prolonged exposure to environmental irritants.
How is chronic bronchitis defined?
Chronic bronchitis is long-standing - it is defined as a chronic cough or mucus production for at least three months in two successive years when other causes have been excluded. It is irreversible obstructive airways disease. Development of the condition is compounded by repeated respiratory tract infections.
What are the symptoms of chronic bronchitis?
- cough a lot
- SOB
- thick, sticky sputum
- chest pain
- fever
- fatigue
What can be done to help chronic bronchitis?
- stop smoking
- avoid irritants
- get infections treated ASAP
- flu jab
What medications can be used to treat chronic bronchitis?
- bronchodilators
- antimuscarinic → tiotropium
- steroid therapy
- beta2 agonists → salbutamol (short acting)
→ salmeterol (long acting)
What is emphysema?
- often follows chronic bronchitis
- lungs lose natural tendency to deflate or spring shut - lose elasticity
- bronchial tubes become swollen and inflamed
- alveoli are destroyed and replaced by scar tissue
- lungs become like ‘large floppy balloons’ unable to squeeze out each breath of air properly
What are the symptoms of emphysema?
- SOB on exertion
- cough → productive
- ‘pursed lip’
What can be done to treat emphysema?
- terminal → can be managed
- infections - antibiotics
- steroids
- asthma treatments
- avoid smoking + pollutants
- short-acting beta2 agonist as required → salbutamol
- long-acting beta2 agonist → salmeterol/formeterol/steroids
- short-acting muscarinic antagonist → ibotropium
- carbocisteine
What is another name given to hayfever?
Another name for hayfever is seasonal allergic rhinitis.
What are the symptoms of hayfever?
- runny nose
- watery eyes
- sneezing
What is hay fever an allergy to?
Hay fever is an allergy to grass or hay pollens usually during the spring or summer.
What general treatment is given for hay fever?
Treatment of hay fever involves taking an antihistamine.
What is the process for using a spacer device?
- remove the dust cap
- shake the inhaler - place the inhaler into spacer
- place the spacer device into mouth, do not bite, form a seal with the lips
- press down on inhaler and breathe normally into the spacer.
What is a metered dose inhaler?
MDI delivers specific amounts of medication into the lungs. It is an aerosolised self-administered medicine.
What is atrial fibrilation?
The heart’s upper chambers (atria) contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the hearts efficiency and performance and the heart does not follow a regular beating pattern.
What are the symptoms of atrial fibrilation?
- tiredness
- not being able to exercise easily due to shortness of breath
What is a healthy blood pressure?
A target healthy blood pressure in 120 / 80.
What does diastolic refer to?
Diastolic refers to the heart at rest.
What can be causes of hypertension?
- stress
- kidney failure
How would you treat hypertension in a patient under 55?
ACE inhibitor
(or angiotensin II receptor antagonist if not tolerated, or beta blockers if both are contraindicated)
↓
ACE inhibitor / angiotensin II receptor antagonist + calcium channel blocker
↓
ACE inhibitor / angiotensin II receptor antagonist + calcium channel blocker + thiazide-related diuretic
↓
RESISTANT
+ low dose spironolactone or high dose thiazide-related diuretic hormone.
How would you treat hypertension in patients over 55?
Calcium channel blocker
(or thiazide-related diuretic if not tolerated)
↓
calcium channel blocker / thiazide-related diuretic + ACE inhibitor / angiotensin II receptor
↓
treat for patients under 55
What is the mode of action of ACE inhibitors?
ACE inhibitors cause vasodilation by inhibiting formation of angiotensin II (angiotensin II is a vasoconstrictor). This increases venous capacity.
What does ACE inhibitor stand for?
Angiotensin converting enzyme
What are some examples of ACE inhibitors?
- enalapril
- ramipril
- lisinopril
- perindopril
What is the mode of action of angiotensin II antagonists?
Angiotensin II antagonists AKA angiotensin receptor blockers stop angiotensin II binding to their receptors and having their action.
Angiotensin II causes blood vessels to narrow and blood pressure to go up.
What drugs are classed as angiotensin II antagonists?
- candesartan
- irbesartan
- losartan
What is the mode of action of calcium channel blockers?
Calcium channel blockers bind to L-type calcium channels located on the vascular smooth muscle. These channels are responsible for regulating the influx of calcium into muscle cells which cause contraction.
By blocking calcium entry into the cell they cause vascular muscle relaxation (vasodilation), decreased heart rate etc.
What drugs are examples of calcium channel blockers?
- amlodipine
- diltiazem
- felodipine
- nipedipine
- verapamil
What blood pressure is considered ‘hypertension’?
> 135 / 85
What is the mode of action of thiazide related diuretics?
They control hypertension in part by inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys by blocking the thiazide-sensitive Na+-Cl− symporter.
Which drugs are examples of thiazide related diuretics?
- chlorothiazide
- indapamide
- metolazone
What is the mode of action of beta blockers?
Beta-blockers are drugs that bind to beta-adrenoceptors which blocks the binding of norepinephrine and epinephrine (adrenaline) to these receptors.
This inhibits normal sympathetic effects that act through these receptors. Therefore, beta-blockers are sympatholytic drugs.
What are some examples of beta blockers?
- atenolol
- bisoprolol
- propranolol
What is hypercholesterolaemia?
Hypercholesterolaemia is defined as the presence of high concentrations of cholesterol in the blood.
What is primary hypercholesterolaemia?
Primary hypercholesterolaemia is associated with an underlying genetic cause; this may be a specific genetic defect, as in familial hypercholesterolaemia (FH), or more commonly, non-familial hypercholesterolaemia where a number of genes interact with dietary and other factors such as smoking and physical inactivity.
What are the two named drugs to know for COPD?
salbutamol + tiotropium
What are the two named drugs to know for hayfever?
Cetirizine + desloratidine
What are the two named drugs to know for atrial fibrilation?
atenolol + digoxin
What are the two named drugs to know for hypertension?
enalapril + candesartan
What are the two named drugs to know for hypercholesterolaemia?
atorvastatin + fenofibrate
What type of drug is salbutamol?
Salbutamol is a short acting beta2 adrenoceptor agonist
What type of drug is tiotropium?
Tiotropium is a long-acting antimuscarinic bronchodilator.
What type of drug is cetirizine?
Cetirizine is an antihistamine.
What type of drug is desloratidine?
Desloratidine is an antihistamine.
What type of drug is atenolol?
Atenolol is a beta-blocker
What type of drug is digoxin?
Digoxin is a cardiac glycoside.
What is the mode of action of cardiac glycosides?
Cardiac glycosides affect the sodium-potassium ATPase pump in cardiac muscle cells to alter their function.
Normally, these sodium-potassium pumps move potassium ions in and sodium ions out. Cardiac glycosides, however, inhibit this pump by stabilising it in the E2-P transition state, so that sodium cannot be extruded: intracellular sodium concentration therefore increases.
What type of drug is enalapril?
Enalapril is an ACE inhibitor.
What type of drug is candesartan?
Candesartan is an angiotensin II antagonist.
What type of drug is atorvastatin?
Atorvastatin is an HMG CoA reductase inhibitors, or statin.
What type of drug is fenofibrate?
Fibrate?
What is the mode of action of the antihistamines cetirizine and desloratidine?
Cetirizine and desloratidine are highly-specific H1 receptor antagonists which stops histamine from reaching its target and having an effect.
What are counseling points for the antihistamines cetirizine and desloratidine?
- they shouldn’t make you drowzy, but if they do avoid manual tasks including driving.
- not recommended during pregnancy and breastfeeding, although no evidence of harm
- use with caution if epileptic (cetirizine)
- contraindicated if history of hypersensitivity to loratidine
What are counseling points for salbutamol?
- how to use a MDI + check nothing obstructing mouthpiece
- use with caution if diabetic (hyperglycaemia + ketoacidosis)
- if you have to use your salbutamol inhaler 3+ times a week see GP
What is the mode of action of salbutamol?
Salbutamol binds to B2 receptors, which are the predominant receptors on the bronchial smooth muscles. Activation of these receptors causes adenylyl cyclase to convert ATP to cAMP, which results in lowering the intracellular concentration of calcium ions. (necessary for muscle contractions)
The increase in cAMP also inhibits inflammatory cells in the airway, such as basophils, eosinophils, and most especially mast cells, from releasing inflammatory mediators and cytokines.
Salbutamol and other β2 receptor agonists also increase the conductance of channels sensitive to calcium and potassium ions, leading to hyperpolarization and relaxation of bronchial smooth muscles.
What is the mode of action of tiotropium?
Tiotropium is a long-acting, antimuscarinic agent, which is often referred to as an anticholinergic.
It has similar affinity to the subtypes of muscarinic receptors, M1 to M5.
In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation.
What are counseling points for the use of tiotropium?
- make sure can use inhaler correctly - some people have inhaled capsule from mouthpiece and choked
- avoid during pregnancy and breastfeeding - limited data?
What are counseling points for atenolol?
- if you feel sick stick to simple foods
- don’t suddenly stop taking beta blockers
- avoid taking whilst pregnant?
What are the counseling points for digoxin?
- if feel nauseous, stick to simple foods
- have blood tests (concentration builds up)
- if dizzy/blurred vision then avoid driving
What are counseling points for enalapril?
- avoid in pregnancy
- take medication at the same time everyday –> might be best at bedtime as can cause dizziness
- vision blurred –> do not drive
What are the counseling points for candesartan?
- do not drive if you feel dizzy
- drinking alcohol may add to the blood-pressure lowering effects which may increase the chances of feeling dizzy
What are the counseling points for atorvastatin?
- avoid grapefruit juice
- avoid high alcohol intake –> damaging to liver
- take lifestyle advice
What are the counseling points for fenofibrate?
- take with food
- avoid in pregnancy (embryotoxicity in animal studies)
- take lifestyle advice
