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Y2 - CPT > Lecture 17 - Respiratory Drugs > Flashcards

Lecture 17 - Respiratory Drugs Flashcards

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1
Q

What is asthma?

A

Chronic inflammatory airway disease with intermittent airway obstruction and hyper-reactivity small airways
Its is reversible broth spontaneously and with drugs

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2
Q

What is considered controlled asthma?

A

Minimal symptoms during day and night
Minimal need for reliever
No limitation of physical activity
Normal lung function

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3
Q

What is uncontrolled asthma?

A

The asthma has an impact on a perosns lifestyle restricting their normal activities

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4
Q

Before stepping up treatment for asthma, what must be done?

A

Ensures correct inhaler technique
Ensure adhering to treatment
Remove triggers

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5
Q

What is the initial add on therapy if a person has uncontrolled asthma?
According to BTS guidelines

A

Give Long Acting Beta Agonist (with their inhaled corticosteroids)

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6
Q

What is the initial add on therapy for a person with uncontrolled asthma according to NICE guidelines?

A

Add Leukotriene Receptor Antagoinst instead of LABA (with their Inhaled corticosteroids)

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7
Q

What are some examples of inhaled corticosteroids?

A

Beclometasone
Budesonide
Fluticasone

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8
Q

What is the general way that inhaled corticosteroids work?

A

Pass through plasma membrane, activate cytoplasmic receptors, activated receptor then passes into neucleus to modify transcription

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9
Q

What do inhaled corticosteroids do?

A

Reduces mucosal inflammation
Widens airways
Reduces mucus
Reduces symptoms, exacerbations preventing death

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10
Q

What are the adverse drug reactions of inhaled corticosteroids?

A

Local immunosuppressive action (candidiasis and hoarse voice)

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11
Q

What are the contraindications for inhaled corticosteroids?

A

Pneumonia risk possible in COPD at high doses

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12
Q

What are the ADRs for inhaled corticosteroids?

A

Very few if taken correctly q

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13
Q

What is the mechanism of action of steroids?

A

Go into the nucleus increasing nuclear transcription increasing B2 receptors and anti-inflammatories

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14
Q

Why is a poor oral biboavialibaltu for inhaled corticosteroids an advantage?

A

Means unlikely to have systemic side effects

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15
Q

What type of eof receptor do inhaled corticosteroids have a high affinity for?

A

Glucocorticoid receptor

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16
Q

What is a fast short acting B2 agonist?

A

Salbutamol

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17
Q

What is an example of a slow long acting B2 agonist?

A

Salmeterol

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18
Q

What do short acting B2 agonists do?

A

Reverse bronchoconstriction relieving symptoms (only to be used p.r.n)

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19
Q

What do Long Actting B2 agonists do (LABA)?

A

Add on therapy to inhaled corticosteroids and p.r.n SABA

Prevents bronchoconstriction before exercise and increases mucus clearance by cilia

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20
Q

What are the adverse effects of B2 agonists?

A

Adrenergic fight or flight effects
Tachycardia (palpitations), anxiety and tremor
Inc glycogenolysis and inc renin in kidney

Supraventricular tachycardia

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21
Q

What are the contraindications for B2 agonists?

A

LABA (Salmeterol) should only be taken alongside inhaled corticosteroids
LABA alone can mask airway inflammation and near fatal; and fatal attacks

The tachycardaia may provoke angina

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22
Q

Why are combined fixed dose inhalers with Inhaled Corticosteroids and LABA benefical?

A

Improves adherence

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23
Q

What drug must LABA (Salmeterol) always be prescribed alongside with?

A

Inhaled corticosteroids

24
Q

What are the drug drug interactions of B2 agonists?

A

B blockers may reduce effects

25
Q

What type of drug is montelukast?

A

Leukotriene receptor antagonist (LTRA)

26
Q

When is montelukast (Leukotriene receptor antagonist) used?

A

As an alternative to LABA in the 2nd step in the NICE guidelines for asthmatics

27
Q

What is the mechanism of action for montelukast (Leukotriene receptor antagonist) in asthma?

A

Leukotrienes are released by mast cells and eosinophils and cause:
-bronchoconstriction
-inc mucus
-oedema

By binding to CysLT1 (GPCR)

So drug blocks CysLT1 receptor at CYSLTR1

28
Q

What are the adverse drug reactions for montelukast (LTRA)?

A

Headache, GI disturbance, dry mouth and hyperactivity

29
Q

What are the contraindications and drug-drug interactions for montelukast (LTRA)?

A

Contra = neuropsychiatric

Drug = no major drug reactions

30
Q

What are long acting muscarinic antagonists used for?

A

Severe asthma
COPD

31
Q

What is an example of Long Acting Muscarinic Antagonist?

A

Tiotropium

32
Q

What is the mechanism of action of Tiotropium (Long Acting Muscarinic Antagonist LAMA)?

A

Blocks vagally mediated contraction of airway smooth muscle

33
Q

What are the adverse drug reactions for Tiotropium (LAMA)?

A

Infrequent anticholinergic effects (dry mouth, urinary retention dry eyes)

34
Q

What is the drug Theophylline used for?

A

Chronic poorly controlled asthma

35
Q

What is the mechanism of action of theophylline?

A

Antagonises adenosine receptor and inhibts phosphodiesterase (cAMP and cGMP levels rise) so more PKA so more MLCK phosphorylated so less MLC phosphylated so causes LESS BRONCHOCONSTRICTION

36
Q

What are the contraindications for theophylline?

A

It has a narrow therapeutic index so can cause potentially life threatening complications like arrhythmias

37
Q

What are the drug drug interaction for theophylline?

A

CYP450 inhibtors so increase concentrations of theophylline

38
Q

When should asthmatic patients self management plans be reviewed?

A

Following treatment for an exacerbation following a hospital discharge

39
Q

What may be the cause of asthma in elite athletes?

A

May be exercise induced bronchospasm
May be due to cold air or pollutants

40
Q

What is considered acute severe?

A

Unable to complete sentences
Resp rate >25min
HR > 110bp/min

41
Q

What is considered life-threatening asthma?

A

All acute severe asthma symptoms +:
Peak flow < 33%
Arterial oxygen sats < 92%
Silent chest, cyanosis, poor Resp effort, arrhythmia, exhaustion

42
Q

What oxygen saturation is considered acute severe and life threatening asthma?

A

94% - 98%

43
Q

What are some steroids used for acute severe and life-threatening asthma?

A

Prednisolone
Hydrocortisone

44
Q

What is the method of administration for prednisolone?

A

Oral

45
Q

What is the method of administration for prednisolone?

A

Oral

46
Q

What is the method of administration for hydrocortisone (glucocorticoid) ?

A

IV

47
Q

What is an example of a short acting Muscarinic antagonist (SAMA) for acute severe and life-threatening asthma?

A

Ipratropium (nebulised)

48
Q

When is IV magnesium sulphate used?

A

Life threatening asthma

49
Q

What is a short acting Muscarinic antagonist (SAMA)?

What is a long acting Muscarinic antagonist (LAMA)?

A

SAMA = ipratropium

LAMA = Tiotropium

I comes before T in the alphabet so SAMA = ipratropium

50
Q

What are the 5 steps to managing COPD?

A

Confirm diagnosis
Smoking cessation
Breathlessness score
Vaccinations
Medication

51
Q

What drugs are given in acute exacerbations of COPD?

A

Nebulised salbutamol
And/or
Ipratropium

52
Q

If a patient with COPD acute exacerbation is hypercapnic or acidotic, what should drive the nebuliser, air or oxygen?

A

Nebuliser with salbutamol and ipratropium should be driven by air

53
Q

Why can oral steroids be less effective than in eosinophilic asthma?

A

Reduced action on neutrophils in many with COPD

54
Q

What are pressurised metered dose inhalers?

A

Have to inhale and push button (can use spacer to help)

55
Q

What are dry powered inhalers?

A

Microionisd drug plus carrier powder

56
Q

Why is technique extremely important when taking inhalers?

A

Drug may not end up in the lungs

Y2 - CPT (30 decks)

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