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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
beta-2 agonists action?
activate beta-2 receptors on bronchial smooth muscle cells
26
2 categories of beta-2 agonist drugs?
short acting (salbutamol) long acting
27
anti-muscarinic drugs action?
activate muscarinic M3 receptors
28
phosphodiesterase inhibitors action?
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
rarely-used bronchodilators?
magnesium sulphate - given intravenously for emergency asthma treatment
30
2 types of inhaler devices in common use?
metered-dose inhalers (MDIs) dry powder inhalers (DPIs)
31
what are the benefits to inhaled drugs
drug delivered directly to site of action with limited collateral effects on other tissues
32
how can inhaled medicines be delivered for people who can't use an inhaler?
nebuliser device
33
how do beta-2 agonists function
activate beta-2 receptors, activates enzyme adenylate cyclase which generates cAMP from ATP. This ultimately inhibits smooth muscle contraction
34
clinical indications for prescribing beta-2 agonists?
conditions associated with bronchospasm - asthma, COPD
35
adverse effects of beta-2 agonists
dose-related tremor in skeletal muscle increased heart rate and palpitations, arrhythmias, hypokalaemia, hyperglycaemia
36
mechanism of action - antimuscarinics? administration?
muscarinic M3 receptor antagonists, reduces IP3, then calcium, leading to decreased smooth muscle contraction and glandular secretion. inhaled
37
adverse effects of antimuscarinics?
dry mouth blurred vision tachycardia constipation urinary retention glaucoma
38
clinical indications for phosphodiesterase inhibitors? administration?
only administered for chronic asthma and COPD where symptoms of airway obstruction continue in spite of other treatment. administered orally twice daily
39
adverse effects of phosphodiesterase inhibitors
tachycardia, palpitations, cardiac arrhythmia, tremor, hypokalaemia, nausea, anxiety, headache, insomnia
40
magnesium sulphate clinical indications? administration?
emergency treatment of severe acute asthma (rarely used). administered as intravenous solution
41
leukotriene receptor antagonists - mechanism of action?
inhibition of leukotriene receptors. anti-inflammatory, bronchodilation
42
what diseases involve regular inhaled corticosteroid therapy
chronic asthma COPD
43
what asthma and COPD treatment keeps inflammation under control and prevents exacerbations
corticosteroids
44
how often should inhaled corticosteroids for respiratory disease be administered
daily
45
systemic corticosteroids for acute exacerbations
prednisolone PO hydrocortisone IV
46
mechanisms of corticosteroids?
bind to intracellular receptors to alter translation of DNA. macrophages and T cells are key cell targets in inflammation
47
when should COPD patients be given corticosteroids
only in addition to long acting beta-2 agonist and long-acting muscarinic antagonist for patients having severe exacerbation
48
indications for corticosteroids
inflammatory diseases like asthma, COPD, exacerbations, RA, SLE, IBS. allergic emergencies, adrenal insufficiency
49
adverse effects of corticosteroids
pneumonia, growth suppression, taste alteration
50
what type of bronchodilators inhibit the degradation of cAMP?
methylxanthines
51
leukotriene receptor antagonists action?
inhibit leukotrienes actions, therefore are anti-inflammatory and have some bronchodilator action too
52
what are often prescribed for allergic rhinitis (nose inflammation)
mast cell stabilising drugs, histamine-1 receptor antagonists
53
cystic fibrosis treatment?
mucolytic drugs break up thick mucous secretions ivacaftor affects chloride ion transport reducing excessively viscous secretions
54
example of respiratory suppressants
opioids
55
drugs for acute anaphylaxis
oxygen adrenaline histamine-1 antagonist corticosteroid (IV) beta-2 agonist (SABA)
56
adverse effects that drugs can cause on the lungs
bronchoconstriction pneumatises & fibrosis respiratory suppression laryngeal myopathy, mucosal congestion
57
what drugs cause bronchoconstriction?
non-selective beta-blockers selective beta-1 blockers NSAIDs (aspirin, ibuprofen etc) cholinesterase inhibitors beta-2 agonists (paradoxical bronchospasm - phenomenon)
58
how does aspirin cause bronchoconstriction
inhibits cyclooxygenase (COX), reducing formation of prostaglandins therefore synthesising leukotrienes which may promote bronchoconstriction and inflammation
59
drugs that are directly toxic to the lungs?
nitrofurantoin (antibiotic) methotrexate (anti-rheumatic drug) many chemotherapy drugs amiodarone
60
what drugs suppress respiration
opioid analgesics hypnotic drugs ethanol oxygen drugs causing paralysis

Sustaining life (13 decks)

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