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Sustaining life > drugs and the respiratory system (W5) > Flashcards

drugs and the respiratory system (W5) Flashcards

1
Q

name for part of lungs involved in gas exchange?

A

lung parenchyma

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2
Q

what innervates the respiratory airways

A

pre-ganglionic parasympathetic nerves originating from the vagus nerve

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3
Q

where are parasympathetic ganglia located in the lungs?

A

walls of bronchi and bronchioles

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4
Q

what nervous system favours contraction of the bronchial smooth muscle

A

parasympathetic

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5
Q

what do post-ganglionic parasympathetic fibres innervate in the lungs

A

airway & vascular smooth muscle, mucosal glands

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6
Q

what neurotransmitters and receptor mediate bronchoconstriction and mucus secretion in the lungs

A

acetylcholine, muscarinic M3 receptors

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7
Q

what is the predominant influence on smooth muscle tone at rest?

A

parasympathetic nervous system

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8
Q

what local factors can influence airway tone

A

leukotrienes
prostanoids
histamine
nitric oxide

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9
Q

physical factors influencing airways tone

A

temperature
particulates

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10
Q

what mainly influences dilation of bronchial smooth muscle and how

A

sympathetic nervous system via circulating adrenaline released from adrenal glands acting on beta-2 adrenoreceptors in bronchial smooth muscle

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11
Q

what does spirometry measure

A

volume and speed of air that can be inhaled and exhaled

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12
Q

spirometry common measurements

A

forced vital capacity (FVC)
forced expiratory volume in 1 second (FEV1)
FEV1/FVC ratio
peak expiratory flow rate (PEFR)

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13
Q

important tests other than spirometry?

A

carbon monoxide transfer coefficient (KCO)
arterial blood gas analysis

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14
Q

what is forced vital capacity

A

volume of air that can be forcibly blown out after full inspiration measured in litres

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15
Q

obstructive disease effects on FEV1/FVC ratio

A

FEV1 diminished due to increased resistance to expiratory flow.
FVC may be diminished but to a lesser extent.

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16
Q

restrictive disease effects on FEV1/FVC ratio

A

both reduced proportionately therefore value may be normal/increased

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17
Q

peak expiratory flow rate?

A

max flow rate that can be generated (L/min), corresponds to steepest section of volume-time plot.

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18
Q

carbon monoxide transfer coefficient (KCO) serves as marker of what? what does a low KCO suggest?

A

marker of alveolar gas exchange. low KCO suggests impaired gas exchange efficiency

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19
Q

arterial blood gas analysis measures what?

A

circulating partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2).

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20
Q

what does decreased PaO2 alone suggest

A

type 1 respiratory failure

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21
Q

what does decreased PaO2 and increased PaCO2 indicate

A

type 2 respiratory failure

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22
Q

diseases affecting the respiratory system

A

asthma
COPD
interstitial lung disease
infections
lung cancer
pleural fibrosis
pulmonary embolism
pulmonary hypertension

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23
Q

definition of bronchodilators?

A

drugs that increase the diameter of the respiratory airways by relaxing the layer of smooth muscle surrounding the bronchi and bronchioles

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24
Q

3 groups of bronchodilators

A

beta-2 agonist drugs
anti-muscarinic drugs
phosphodiesterase inhibitors

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25
Q

beta-2 agonists action?

A

activate beta-2 receptors on bronchial smooth muscle cells

26
Q

2 categories of beta-2 agonist drugs?

A

short acting (salbutamol)
long acting

27
Q

anti-muscarinic drugs action?

A

activate muscarinic M3 receptors

28
Q

phosphodiesterase inhibitors action?

A

target the enzyme phosphodiesterase (PDE) that is responsible for the breakdown of cAMP (cAMP is the secondary messenger for beta-2 adrenoreceptors and relaxes smooth muscle cells)

29
Q

rarely-used bronchodilators?

A

magnesium sulphate - given intravenously for emergency asthma treatment

30
Q

2 types of inhaler devices in common use?

A

metered-dose inhalers (MDIs)
dry powder inhalers (DPIs)

31
Q

what are the benefits to inhaled drugs

A

drug delivered directly to site of action with limited collateral effects on other tissues

32
Q

how can inhaled medicines be delivered for people who can’t use an inhaler?

A

nebuliser device

33
Q

how do beta-2 agonists function

A

activate beta-2 receptors, activates enzyme adenylate cyclase which generates cAMP from ATP. This ultimately inhibits smooth muscle contraction

34
Q

clinical indications for prescribing beta-2 agonists?

A

conditions associated with bronchospasm - asthma, COPD

35
Q

adverse effects of beta-2 agonists

A

dose-related tremor in skeletal muscle
increased heart rate and palpitations, arrhythmias, hypokalaemia, hyperglycaemia

36
Q

mechanism of action - antimuscarinics? administration?

A

muscarinic M3 receptor antagonists, reduces IP3, then calcium, leading to decreased smooth muscle contraction and glandular secretion. inhaled

37
Q

adverse effects of antimuscarinics?

A

dry mouth
blurred vision
tachycardia
constipation
urinary retention
glaucoma

38
Q

clinical indications for phosphodiesterase inhibitors? administration?

A

only administered for chronic asthma and COPD where symptoms of airway obstruction continue in spite of other treatment. administered orally twice daily

39
Q

adverse effects of phosphodiesterase inhibitors

A

tachycardia, palpitations, cardiac arrhythmia, tremor, hypokalaemia, nausea, anxiety, headache, insomnia

40
Q

magnesium sulphate clinical indications? administration?

A

emergency treatment of severe acute asthma (rarely used). administered as intravenous solution

41
Q

leukotriene receptor antagonists - mechanism of action?

A

inhibition of leukotriene receptors. anti-inflammatory, bronchodilation

42
Q

what diseases involve regular inhaled corticosteroid therapy

A

chronic asthma
COPD

43
Q

what asthma and COPD treatment keeps inflammation under control and prevents exacerbations

A

corticosteroids

44
Q

how often should inhaled corticosteroids for respiratory disease be administered

A

daily

45
Q

systemic corticosteroids for acute exacerbations

A

prednisolone PO
hydrocortisone IV

46
Q

mechanisms of corticosteroids?

A

bind to intracellular receptors to alter translation of DNA. macrophages and T cells are key cell targets in inflammation

47
Q

when should COPD patients be given corticosteroids

A

only in addition to long acting beta-2 agonist and long-acting muscarinic antagonist for patients having severe exacerbation

48
Q

indications for corticosteroids

A

inflammatory diseases like asthma, COPD, exacerbations, RA, SLE, IBS. allergic emergencies, adrenal insufficiency

49
Q

adverse effects of corticosteroids

A

pneumonia, growth suppression, taste alteration

50
Q

what type of bronchodilators inhibit the degradation of cAMP?

A

methylxanthines

51
Q

leukotriene receptor antagonists action?

A

inhibit leukotrienes actions, therefore are anti-inflammatory and have some bronchodilator action too

52
Q

what are often prescribed for allergic rhinitis (nose inflammation)

A

mast cell stabilising drugs, histamine-1 receptor antagonists

53
Q

cystic fibrosis treatment?

A

mucolytic drugs break up thick mucous secretions
ivacaftor affects chloride ion transport reducing excessively viscous secretions

54
Q

example of respiratory suppressants

A

opioids

55
Q

drugs for acute anaphylaxis

A

oxygen
adrenaline
histamine-1 antagonist
corticosteroid (IV)
beta-2 agonist (SABA)

56
Q

adverse effects that drugs can cause on the lungs

A

bronchoconstriction
pneumatises & fibrosis
respiratory suppression
laryngeal myopathy, mucosal congestion

57
Q

what drugs cause bronchoconstriction?

A

non-selective beta-blockers
selective beta-1 blockers
NSAIDs (aspirin, ibuprofen etc)
cholinesterase inhibitors
beta-2 agonists (paradoxical bronchospasm - phenomenon)

58
Q

how does aspirin cause bronchoconstriction

A

inhibits cyclooxygenase (COX), reducing formation of prostaglandins therefore synthesising leukotrienes which may promote bronchoconstriction and inflammation

59
Q

drugs that are directly toxic to the lungs?

A

nitrofurantoin (antibiotic)
methotrexate (anti-rheumatic drug)
many chemotherapy drugs
amiodarone

60
Q

what drugs suppress respiration

A

opioid analgesics
hypnotic drugs
ethanol
oxygen
drugs causing paralysis

Sustaining life (13 decks)

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