COPD

Question 1

** disorder **: Destruction of alveoli and elastin fibres in the lung. May be caused by proteases released during the inflammatory response. Causes respiratory failure. Destruction of alveoli impairs gas transfer

Answer 1

Empyhsema

Question 2

** Disorder **
* Attacks of winter morning cough
* Progresses to chronic cough with intermittent exacerbations
* Often initiated by an upper respiratory
infection

Answer 2

Bronchitis

Question 3

main aim in COPD treatment

Answer 3

to reduce the progression of the disease, however does not supress inflammation or prevent the development of Emphysema

Question 4

1st step in management of COPD

Answer 4

1) Smoking cessation –>Slows the progress of COPD
2) Immunizations –> Superimposed infections are potentially lethal

Question 5

Drugs used in the treatment of COPD

Answer 5

1) Bronchodilators - β2 Adrenoreceptor agonists
2) Muscarininc receptor anatgonsits
3) Corticosetroids (CS)

Question 6

short-acting drugs used in the tx of COPD

Answer 6

Short-acting drugs
1) Short-acting anti-muscarinic antagonists (SAMA):
Ipratropium
2) Short-acting beta agonists (SABA): salbutamol

Question 7

Long-acting drugs used in the tx of COPD

Answer 7

Long-acting drugs
1) Long-acting anti-muscarinic antagonists (LAMA) :
Tiotropium
2) Long-acting beta agonists (LABA): salmeterol or
formoterol (LABA)

Question 8

Muscarinic receptor antagonists used in the tx of COPD?

Answer 8

1) Ipratropium (Short-Acting Muscarinic Antagonist-SAMA)
2) Tiotropium (Long-Acting Muscarinic Antagonist-LAMA)

Question 9

Adm of Ipratropim

Answer 9

• Inhalational
• Maximum effect: approximately 30 min after inhalation
• Persists for 3–5 h

Question 10

Max effect of Ipratropium starts approx. —– after inhalation

Answer 10

30 min

Question 11

Duration of Action of Ipratropium

Answer 11

3-5 hrs

Question 12

Adm of Tiotropium

Answer 12

Inhalation

 Longer-acting (t1/2=35 hours)
 More potent than ipratropium

Question 13

Which is more potent Ipratropium or Tiotropium?

Answer 13

Tiotropium

Question 14

Duration of action of Tiotropium

Answer 14

Longer-acting (t1/2=35 hours)

Question 15

AE of Muscarinic receptor agonists

* Ipratropium, Tiotropium

Answer 15

1) Dry mouth
2) Dry eyes
3) Raised intraocular pressure and blurred vision
(Caution in glaucoma)
4) Metallic taste
5) Constipation
6) Tachycardia (Caution in CV disease)
7) Urinary retention (Caution)
8) Cough/hoarse voice

Question 16

Contraindications of Muscarinic receptor agonists

Answer 16

1) Glaucoma (raised intraocular pressure and blurred vission)
2) CV disease (Tachycardia)
3) Urinary retention

Question 17

CU of Tiotropium

Answer 17

1) LAMA added w/ LABA when control insufficient
2) COPD

Question 18

CU of Ipratropium

Answer 18

1) In Acute sever asthma, SAMA added w/ SABA which aguments (increases) bronchodilation of SABA
2) COPD

Question 19

treatment approach to reduce inflammation in COPD

Answer 19

ICS (inhaled corticosteroids)

• note: oral corticosteroids should not be given to patients with stable COPD

Question 20

MoA of inhaled corticosteroids in the management of COPD

Answer 20

1) Aim is to temper inflammation about COPD (tx not monotherpay)
2) Decrease frequency of exacerbation and improve quality of life

* not as effective in asthma

Question 21

CU of Theophylline in COPD

Answer 21

tx of asthma and COPD esp in patients who tend to reatins CO2

  not recommended due to its uncertain benefits!!!

Question 22

What can you to give patients w/ sever COPD and Hypoxaemia?

Answer 22

Long-term O2 therapy (Adm at home)

Question 23

Tx approach for Acute COPD exacerbation

Answer 23

1) Inhaled O2
2) Broad-spectrum abx if there is evidence of infection
3) Inhaled bronchodilators for symptomatic
improvement (SABA)
4) Oral prednisolone (CS)

Question 24

Anti-Histamine 1st generation examples

Answer 24

diphenhydramine,
promethazine,
chlorpheniramine,
meclizine,
dimenhydrinate,
hydroxyzine

Question 25

MoA of 1st gen Anti-Histamins

Answer 25

Reversible competitive antagonists of H1 receptors **(cross BBB)**

Question 26

AE of Anti-Histamine

Answer 26

1) **Sedation** caused by CNS histamine receptor blockage 2) **Blurred vission, Dry mouth, Urinary retention** --> Muscarinic receptor blockade 3) **Headache** -> α1-Adrenergic receptor blockade

Question 27

MoA of Hitamine-1 Recptors

Answer 27

1) Bronchoconstriction 2) Increased vascular permeability 3) Itching 4) Nasal irritation/sneezing/ congestion 5) Vasodilation

Question 28

CU of 1st gen Anti-Histamins

Answer 28

1) Allergic reactions, rhinitis, urticaria 2) Cold medication (tx of symptoms) 3) Sleep aid 4) **Pre-op sedation** 5) Nausea/vomiting 6) Motion sickness, vertigo

Question 29

2nd gen Anti-histamines

Answer 29

Loratadine Desloratadine Fexofenadine Cetirizine -adine

Question 30

CU of 2nd gen Anti-Histamines

Answer 30

allergy

Question 31

why are 2nd gen Anti-Histamines preferred over 1st gen?

Answer 31

Because they are less sedative as they have decreased penetrance into CNS

Question 32

AE of 2nd gen Anti-Histamines

Answer 32

Uncommon

Question 33

main aim in the treatment of Cough supression

Answer 33

Best to treat underlying cause rather than cough

Question 34

drugs used to supress cough

Answer 34

**weak Opoids** Codeine Pholcodeine Morphine

Question 35

CU of Morphine in respiratory disease

Answer 35

Palliative (soothing) care in **lung cancer cough**

Question 36

which opoids are the most to least addictive **Codeine, Morphine, Pholcodeine**

Answer 36

least --> most **Phlocodeine < Codeine < Morphine**

Question 37

AE of Opiods

Answer 37

1) Constipation 2) Drowsiness 3) Dry mouth 4) **Miosis ("pin point pupil")** 5) Nausea/vomiting 6) **Respiratory depression**

Question 38

Opiods are avoided in?

Answer 38

**chronic pulmonary infection and asthma** why? * Thickening of mucus and retention * Risk of **respiratory depression**

Question 39

Morphine Derivative

Answer 39

Dextromethorphan

Question 40

AE of Dextromethorphan

Answer 40

Uncommon; dizziness, nausea, vomiting, or GI disturbance

Question 41

MoA of Dextromethrophan

Answer 41

* **Binds σ receptors** * Also binds serotonergic receptors -> **inhibits reuptake of serotonin**

Question 42

Contraindications of Dextromethorphan

Answer 42

**serotonergic agents** --> may cause **Seratonin syndrome**

Question 43

Dextromethorphan at high doses can antagonize **--------** receptors

Answer 43

**Glutamate NMDA**

Question 44

class of N-acetyl cysteine

Answer 44

Mucolytic

Question 45

CU of N-acetyl cysteine

Answer 45

1) Antidote for patracetamol 2) Cystic Fibrosis

Question 46

MoA of N-acetyl cysteine (as a mucolytic)

Answer 46

1) Depolymerizes the mucin glycoprotein oligomers via disulfide bond hydrolysis 2) **Decreases mucus viscosity**

Question 47

AE of N-acetyl cysteine

Answer 47

nausea, vomiting, flushing, rash

Question 48

peptide Mucolytic

Answer 48

Dornase alfa

Question 49

MoA of Dornase alfa

Answer 49

depolymerizes DNA

Question 50

CU of Dornase alfa

Answer 50

Cystic fibrosis

Question 51

class of Hypertonic Saline

Answer 51

Mucolytic

Question 52

# * i dont think its important MoA of Hypertonic saline

Answer 52

* Disrupts ionic bonds within the mucus gel * Dissociates DNA from mucoproteins allowing natural proteolytic enzymes to digest the mucoprotein

Question 53

**------**: a type of cough medicine used to help clear mucus (phlegm) from your airway

Answer 53

Experctorant

Question 54

Experctorant example

Answer 54

**Guaifenesin**

Question 55

CU of Guaifenesin

Answer 55

symptomatic relief of acute **productive cough**

Question 56

MoA of Guanifenesin

Answer 56

* Increases the volume of respiratory secretions * Decreases the viscosity of bronchial secretions * Does not suppress the cough reflex

Question 57

How are Guaifenesin used?

Answer 57

Used alone or in combination with antihistamines, cough suppressants, and decongestants

Question 58

Decongestants examples

Answer 58

Pseudoephedrine Phenylephrine

Question 59

Moa of Phenylephrine

Answer 59

**Selective α1 adrenergic agonist** (Less CNS stimulation than pseudoephedrine)

Question 60

ΜοΑ of Pseudoephedrine

Answer 60

α1 adrenergic agonist -> release of norepinephrine

Question 61

ΑΕ of Pseudoephedrine

Answer 61

**CNS stimulation**, anxiety, hypertension, urinary retention, tachycardia, nausea/vomiting

Question 62

Pseudoephedrine is a **--------** precursor

Answer 62

Methamphetamine