Chapter 3- Respiratory System Flashcards
Two advantages of giving drugs via the respiratory tract
Dose required is smaller
Side effects are reduced
True or false - budesonide ans beclometasone are approximately equivalent in clinical practice
True but there may be variations with different drug delivery devices
Fluticasone and mometasone provide equal activity to beclometasone and budesonide at what dose
Half of the dose
In children, high doses of inhaled corticosteroids can be associated with what systemic side effects
Growth failure
Reduced bone mineral density
Adrenal suppression
Four symptoms of asthma
Cough
Wheezing
Chest tightness
SoB
What 3 things define moderate acute asthma
Increasing symptoms
Peak flow > 50-75% best or predicted
No signs of severe acute asthma
What 4 things define severe acute asthma
Peak flow 33-50% best or predicted
RR >25/min
HR >110/min
Inability to complete sentences
Name two inhaled short acting b2 agonists
Salbutamol
Terbutaline
Name a less selective b2agonist less appropriate for use as a bronchodilator due to risk of causing arrhythmias
Ephedrine/adrenaline
Name two long acting b2 agonists used in asthma
Formeterol
Salmeterol
Which has a quicker onset of action: salmeterol or formeterol
Formeterol - similar to the speed of salbutamol
Name 2 long acting b2agonists indicated in COPD
Indacaterol
Olodaterol
Which act quicker - SABA or SAMA
SABAAAA
Ipratroprium inhalation reaches peak effect when and lass how long
30-60mins after use
Lads 3-6 hours
Combination of b2 agonists + theophylline increase risks of what
HYPOkalaemia
List 7 indications where a lower concentration of oxygen therapy may be required
COPD
Advanced cystic fibrosis
Severe non CF bronchiectasis
Severe kyphoscoliosis or severe ankylosing spondylitis
Severe lung scarring from TB
Musculoskeletal disorders with respiratory weakness
Overdose of opioids, BZ or others causing resp depression
Name 4 types of oxygen therapy
Emergency oxygen
Short burst (intermittent)
Long term
Ambulatory
What’s the caution on ipratropium
Acute angle-closure glaucoma : ensure to keep nebuliser solution away from eyes
Bambuterol is a prodrug of what
Terbutaline
High doses of salbutamol can cause what type of acidosis
Lactic acidosis
True or false: QVAR has extra fine particles and is more potent than other beclometasone containing inhalers- it is three times as potent as clenil
True apart from it’s TWICE as potent as clenil
Name three monoclonal antibodies used in severe asthma
Mepolizumab
Omalizumab
Reslizumab
Name two leukotriene receptor antagonists used in asthma
Montelukast
Zafirlukast
How does montelukast and zafirlukast work
They are leukotriene receptor antagonists so they block the effects of cysteinyl leukotrienes in the airways
What is roflumilast
Phosphodiesterase type 4 inhibitor used as an adjunct in COPD
What do you need to do when dosing aminophylline in extremes of body weight
Use ideal weight for height
The plasma theophylline concentration is increased in what 3 conditions
Heart failure
Hepatic impairment
Viral infections
True or false: the plasma theophylline level is increased in smokers
False it’s decreased in smokers
True or false: the plasma theophylline level is decreased by alcohol consumption
True
Signs of overdose of theophylline
Vomiting Agitation Restlessness Dilated pupils Sinus tachycardia Hyperglycaemia Haematemesis Convulsions Supraventricular and ventricular arrhythmias Hypokalaemia
Name 8 non-sedating antihistamines
Acrivastine Bilastine Cetirazine Desloratadine Fexofenadine Levocetirizine Loratadine Mizolastine
What’s the caution with high doses of the sedating antihistamine: alimemazine
Photosensitivity - avoid exposure to sunlight
MHRA warning about chlorphenamine
Children under 6 should not be given OTC cough and cold medicines containing chlorphenamine
True or false: many antihistamines should be avoided in acute porphyrias
True! - some are thought to be safe though
MHRA warning with hydroxyzine
Risk of QT prolongation and torsade de pointes
Risk factors for QT prolongation
Electrolyte imbalances Bradycardia CVD Family history of cardiac death Concomitant drugs that prolong QT
MHRA warning advice with promethazine
Children under 6 years should not be given OTC cough and cold medicines containing promethazine
Contraindication of mucolytics
Active peptic ulceration
What is dornase alpha
Mucolytic used in cyatic fibrosis
What drug is indicated for the treatment of cystic fibrosis in patients who have a G551D mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene
Ivacaftor
