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RESPIRATORY > DRUGS > Flashcards

DRUGS Flashcards

1
Q

Oxygen: Description and MoA

A

Used for patients in hypoxemic states or at risk. Increases O2 sats and tissue perfusion- prevent anaerobic metabolism.
Useful in anxiety and stress.

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2
Q

Oxygen: Indications

A
  1. Hypoxia: patients that are SOB or in a state of hypoperfusion
  2. Accelerates reabsorption of pleural gas in pneumothorax
  3. Reduce half life of carboxyhemoglobin in CO poisoning
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3
Q

Oxygen: Adverse Effects and interactions

A
  • Can cause dry throat and mouth
    **Less likely to occur with patient using nasal cannula (always consider in long term).
    V flammable (smokers)
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4
Q

Oxygen: COPD patients

A

Physiologically respiratory drive is hypercapnia. In COPD flips to hypoxic drive so giving oxygen can depress RR and worsen hypoxia.
If it is an emergency COPD will still need oxygen.

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5
Q

Oxygen: Route

A

High flow (15L/min) through non rebreathe mask.
Can be given with reservoir of salbutamol
Venturi valves useful for controlling how much oxygen someone is receiving (good for COPD patients) - they blend oxygen with room air in fixed ratio

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6
Q

Oxygen: Prescribing and Dose

A

Often prescribed retrospectively. In emergency aim for sats 94-98 or 88-92 in COPD
HIGH FLOW: 15L/min (60-80% O2)
NASAL CANNULAE 2-6L/min (25-50%)

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7
Q

Corticosteroids (systemic): Examples

A

Prednisolone, Hydrocortisone, Dexamethasone

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8
Q

Corticosteroids (systemic): Indications

A
  • Allergies or inflammation
  • Autoimmune suppression
  • Part of chemotherapy
  • Hormone replacement for those with adrenal insufficiency
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9
Q

Corticosteroids (systemic): MoA

A

Bind to glucocorticoid receptors which then translate to cell nucleus and regulate gene expression. Up-regulate anti-inflammatory genes.
Suppress action of monocytes and eosinophils

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10
Q

Corticosteroids (systemic): Adverse effects

A
  • Immunosuppression

- Muscle weakness, skin thinning and easy bruising

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11
Q

Corticosteroids (systemic): Dose

A

Prednisolone 5mg = Hydrocortisone 20mg

Prednisolone max dose 40-60mg

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12
Q

Short-acting Beta-2 agonists (Salbutamol): Indications

A
  • Asthma reliever, PRN inhaler
  • SOB relief in COPD
  • Alongside insulin,glucose and calcium gluconate as urgent treatment for hyperkalaemia
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13
Q

Short-acting Beta-2 agonists (Salbutamol): MoA

A
  • Beta-2 receptors found in tubes of body (on SMCs). GPCR which when activated leads to smooth muscle relaxation: dilate bronchioles
  • Stimulate Na+/K+ ATPase pumps on cell surfaces pumping K+ into cellular compartment (hence good in hyperkalaemia)
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14
Q

Short-acting Beta-2 agonists (Salbutamol): Adverse effects

A
  • Tachycardia, palpitations, anxiety and fine tremor (due to effect on heart and blood vessels)
  • Increase serum glucose concentration (difficult for diabetics)
  • Can lead to a rise in lactate levels leading to muscle cramps
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15
Q

Short-acting Beta-2 agonists (Salbutamol): Dose

A
  • 100-200mg inhaled PRN no more than 4 times a day

- 2.5mg can also be nebulised

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16
Q

Long-Acting Beta-2 agonists (Salmeterol): MoA

A

Acts on Beta-2 GPCRs on SMCs to dilate bronchioles and improve ventilation. Also act on Na+/K+ ATPase pumps and move potassium into intracellular compartment: good for treatment for hyperkalaemia

17
Q

Long-Acting Beta-2 agonists (Salmeterol): Indications

A
  1. Asthma (usually 3rd line) after, and in combination with salbutamol and inhaled corticosteroids (beclametasone)
  2. COPD second line therapy after steroids
  3. Hyperkalaemia
18
Q

Long-Acting Beta-2 agonists (Salmeterol): Adverse effects and interactions

A

Tachycardia, Palpitations, Tremor, anxiety, muscle cramps
Increased blood glucose.
Always give at same time as inhaled corticosteroids

19
Q

Long-Acting Beta-2 agonists (Salmeterol): Route

A

Inhaled

20
Q

Long-Acting Beta-2 agonists (Salmeterol): Dose and Prescribing

A

Combined inhaler with corticosteroids

Either as metered dose inhaler or dry powder inhaler

21
Q

Anti-Cholinergics: MoA

A

Block the NT ACh - responsible for PARASYMPATHETIC control in the body including smooth muscle in the lungs.

22
Q

Anti-Cholinergics: Anti-muscarinics

A

type of anti-cholinergic. Reduce smooth muscle tone and reduce secretions in the resp tract helping to relieve symptoms

23
Q

Anti-Cholinergics: Examples

A

Ipratropium, Tiotropium

24
Q

Anti-Cholinergics: Indications

A
  1. COPD - help to relieve symptoms of exacerbations

2. Asthma. Can be added onto beta agonist or corticosteroid therapies

25
Q

Anti-Cholinergics: Adverse effects and interactions

A

Often don’t get into systemic circulation (inhaled) and so don’t have that many adverse effects.
Dry mouth

Use with caution in ANGULAR GLAUCOMA because they can increase IOP

26
Q

Anti-Cholinergics: Route, Prescribing and Dose

A

Inhalation

PRN or QDS standard dose is 40mg

27
Q

Mucolytics: Examples

A

Carbocysteine

28
Q

Mucolytics: MoA

A

Work by reducing the viscosity of the mucus which allows the patient to bring up their sputum much more easily.
This is important because if mucus lingers then this is a risk factor for developing a infection in the chest

29
Q

Mucolytics: Indications

A

Useful for those that have productive coughs and might otherwise be a bit less able to clear their chests

  • The frail
  • COPD

Also useful in patients with CF who have unusually thick and sticks mucus

30
Q

Mucolytics: Adverse effects and interactions

A

Should not be given in patients who are on any medications to dry up their sputum or patients on ANTITUSSIVES

Also don’t give to someone with a peptic ulcer because it can cause gastric bleeding

31
Q

Mucolytics: Route, Prescribing and Dose

A

PO often chewable tablets. Can also be aerosolised

500mg PO chew

32
Q

Theophylline: MoA

A

Useful for COPD management. Phosphodiesterase inhibitor which increases intra-cellular cAMP and inhibits leukotriene synthesis which reduced inflammation in bronchioles

Naturally occurring substance which is structurally similar to caffeine

33
Q

Theophylline: Indications

A
  1. COPD and asthmatics to help reduce inflammation in bronchioles (they also seem to increase steroid sensitivity)
  2. Theophylline is a positive IONOTROPE (increases contractility of the heart)so can be useful in heart failure
  3. Increases blood pressure and renal perfusion
34
Q

Theophylline: Adverse Effects and interactions

A

Theophylline has narrow therapeutic window:
toxicity is increased by some antibiotics including erythromycin and flouroquinolones such as ciprofloxacin

  • Nausea
  • Diarrhoea
  • Tachycardia
35
Q

Theophylline: Route, Prescribing and Dose

A

For asthma: 250-500mg BD PO

RESPIRATORY (2 decks)

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