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M103 T4 > M103 T4 L15 > Flashcards

M103 T4 L15 Flashcards

1
Q

What types of drugs are used in bronchodilators?

A

adrenergic agonists (beta-2 agonists)
Muscarinic antagonists / anticholinergics
Methylxanthines

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2
Q

Which four beta-2 agonist drugs can be used in bronchodilators?

A

salbutamol - short acting beta agonist
salmeterol - long acting beta agonist
formoterol - long acting beta agonist
vilanterol - long acting beta agonist

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3
Q

What are examples of muscarinic antagonists?

A 
tiotropium - long acting
aclidinium - short acting
glycopyrronium - short acting
umeclidinium - short acting
ipratropium - short acting
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4
Q

What are examples of muscarinic antagonists?

A

Aminophylline

Theophylline

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5
Q

How are methylxanthines adminstered?

A

orally

IV

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6
Q

What are the three main categories of airway drugs?

A

bronchodilators
anti-inflammatory drugs
mucolytic drugs

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7
Q

What are the three types of anti-inflammatory drugs?

A

Steroids
Leukotriene receptor antagonist
Mucolytic agents

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8
Q

What are examples of steroids?

A

prednisolone (orally)

beclomethasone (an inhaled corticosteroid)

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9
Q

What is an advantage of an inhaled corticosteroid over an orally administered steroid?

A

the drugs get to the airway specifically which might help reduce any side effects

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10
Q

What is an example of a leukotriene receptor antagonist?

A

Montelukast

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11
Q

What is special about leukotriene receptor antagonists?

A

their unique mechanism of action results in a combination of both bronchodilator and anti-inflammatory effects

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12
Q

What are examples of mucolytic agents?

A 
carbocysteine (tablet)
hypertonic saline (given via nebuliser)
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13
Q

What are the two main types of inhalers?

A

Pressurised Metered Dose Inhalers (pMDIs)

Dry-Powder Inhalers

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14
Q

How are Pressurised Metered Dose Inhalers administered?

A

deep exhale / inhale and puff
hold breath for slow ten count
exhale slowly, wait one minute before second puff
used in conjunction with a spacer / aerochamber

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15
Q

How are Dry-Powder Inhalers administered?

A

usually one inhalation, not a puff

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16
Q

How long does it take salbutamol to work? What is the duration of the effects?

A

short acting - begins immediately

duration of 3-5 hours

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17
Q

How does salbutamol work?

A 
binds to b2-receptors in the lungs 
bronchial smooth muscles relax
salbutamol activates adenylate cyclase
cAMP production increases 
the actions of salbutamol are mediated by cAMP
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18
Q

How is salbutamol administered?

A

Inhaled
via a nebuliser (gives a higher dose)
IV is rarely used

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19
Q

How long does it take salmeterol to work? What is the duration of the effects?

A

long acting - begins in begin 2 - 30 min

duration of 10-12 hours

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20
Q

How is salmeterol administered?

A

inhaled

not PRN and always used with ICS in asthma patients

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21
Q

In which asthma patients is salmeterol used?

A

in patients requiring long-term regular bronchodilator therapy on ICS

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22
Q

In which COPD patients is salmeterol used?

A

COPD patients with persistent symptoms despite SABA

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23
Q

How is salmeterol used to treat COPD patients?

A

LABA / LAMA combination

ICS / LABA combination

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24
Q

How long does it take formoterol to work? What is the duration of the effects?

A

long acting - begins in 2 - 30 min

duration of 10-12 hours

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25
Q

How is formoterol administered?

A

inhaled

combined with ICS (always) for asthma

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26
Q

In what patients is formoterol used?

A

Asthma

COPD

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27
Q

What is the duration of the effects of tiotropium? How often is it administered?

A

long acting - lasts for 24 hours

once daily

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28
Q

How is tiotropium administered?

A

Inhaled (dry powder handihaler / mist respimat)

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29
Q

How does tiotropium work?

A

it has an affinity to the subtypes of muscarinic receptors, M1 to M5
in the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilatation

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30
Q

How long does it take ipratropium to work? What is the duration of the effects?

A

it is short acting - begins in 30 minutes

lasts 6 hours

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31
Q

How is ipratropium administered and for what type of patients?

A

Nebulised for acute presentations of COPD and sometimes asthma

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32
Q

What is the half life of theophylline?

A

around 5 hours in healthy adults

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33
Q

How is theophylline administered?

A

orally - for patients with COPD and asthma who have persistent symptoms
IV - for COPD and asthma-medical emergencies

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34
Q

How does theophylline work?

A

it inhibits phosphodiesterase

its level in the blood needs to be monitored via blood tests

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35
Q

When is tiotropium used?

A

for stable COPD patients who have symptoms despite SABA

for asthma patients who aren’t improving despite ICS / LABA-specialist advice from hospital

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36
Q

What are the adverse events of bronchodilators?

A

Tachycardia
Nervousness, Irritability, Tremor
Tachyarrhythmias / Angina

37
Q

What are adverse events of bronchodilators caused by?

A

usually dose related

38
Q

How do the adverse events of bronchodilators vary between the way they are aministered?

A

adverse effects are less common in inhaled preparations

adverse effects are more common in oral (hardly used) and IV preparations

39
Q

What is an example of an orally administered glucocorticoid?

A

prednisolone

40
Q

What is an advantage of inhaled glucocorticoids?

A

localized action - there is more of the drug in the area that it needs to get to
may result in fewer side effects

41
Q

What are the effects of glucocorticoids on the airways?

A

Decrease release of inflammatory mediator
Decrease infiltration and action of white blood cells
Decrease airway oedema
Decrease airway mucus production
Increase number and sensitivity of beta-2 receptors

42
Q

What are examples of an glucocorticoid that are inhaled?

A

Beclometasone
fluticasone
budesonide

43
Q

What is a disadvantage of inhaled glucocorticoids?

A

the presence of the disease may prevent penetration of drug to affected areas

44
Q

What is a disadvantage of inhaled glucocorticoids?

A

the presence of the disease may prevent penetration of drug to affected areas

45
Q

What are two adverse effects of inhaled glucocorticoids?

A

Oral candidiasis

Dysphonia

46
Q

What are two adverse effects of systemically administered glucocorticoids?

A 
Adrenal suppression
Bone loss
Slow growth in children, but not ultimate height
Increase risk of cataracts and glaucoma
Increased risk of infection
Gastric ulceration
Hypertension
Diabetes
Mood disturbance
47
Q

How can patients lower the effect of bone loss caused by systemically administered glucocorticoids?

A

exercise
Vit D
calcium

48
Q

What are the drugs used in ICS and LABA combination inhalers?

A

Formoterol / Budesonide
Formoterol / beclomethasone
Salmeterol / fluticasone

49
Q

What is an example of a drug pair used in LAMA and LABA combination inhalers?

A

Tiotropium

Olodaterol

50
Q

What is an example of the drugs used in ICS, LABA and LAMA combination inhalers?

A

Beclomethasone
formoterol
glycopyrronium

51
Q

What is allergic rhinitis treated with?

A

Antihistamines (H1 antagonists)
Intranasal Glucocorticoids
Montelukast
Sympathomimetics

52
Q

What are two examples of H1 antagonists?

A

Cetirizine

Chlorpheniramine

53
Q

What is an example of a Intranasal Glucocorticoid?

A

Beclometasone (brand name Beconase)

54
Q

What is the brand name of montelukast?

A

Singulair

55
Q

Sympathomimetics (Decongestants)

A

Pseudoephedrine (alpha agonist) Problems with abuse and MAOI

56
Q

What are the side effects of H1 antagonists?

A

Drowsiness
Dry Mouth
Dry Eyes
Confusion

57
Q

What are the side effects of montelukast?

A 
reduce inflammation
reduce bronchoconstriction
reduce oedema
reduce mucus
reduce the recruitment of eosinophils
58
Q

How does montelukast work?

A

it inhibits leukotriene receptors

59
Q

Which conditions will put patients at a higher risk from the adverse effects of excess oxygen?

A

hypercapnia
respiratory failure
type two respiratory failure

60
Q

How is oxygen administered?

A

Venturi mask (controlled administration)
Nasal (uncontrolled administration)
Hudson mask (uncontrolled administration)
Reservoir (uncontrolled administration)

61
Q

Which penicillins are used to cover respiratory infection?

A

Amoxicillin
Co-amoxiclav
Tazobactum

62
Q

What types of pneumonia are there?

A

hospital acquired
ventilator acquired
community acquired

63
Q

How is amoxicillin administered?

A

IV/Oral

64
Q

When is amoxicillin used?

A

community acquired pneumonia (common)
COPD exacerbations
bronchitis

65
Q

What does amoxicillin work against?

A

active against gram negative and gram positive bacteria

66
Q

What does co-amoxiclav contain?

A

amoxicillin

B lactamase

67
Q

When is tazobactum used?

A

in patients with hospital acquired infections

68
Q

When is amoxiclav used?

A

in patients who haven’t responded to first line treatment against respiratory infections

69
Q

What does tazobactum work against?

A

gram neg bacteria

70
Q

What is an example of a tetracycline?

A

doxycycline

71
Q

How does tetracycline work?

A

it inhibits protein synthesis

72
Q

What does tetracycline work against?

A

Broad spectrum action
Gram positive and negative
useful for ‘atypical infections’ e.g. mycoplasma, legionella

73
Q

How is tetracycline administered?

A

Oral route only

74
Q

What are the side effects of tetracycline?

A 
GI Upset
staining teeth
lupus
allergy
photosensitivity
75
Q

What are three examples of quinolones?

A

ciprofloxacin
levofloxacin
moxifloxacin

76
Q

How do quinolones work?

A

cause DNA fragmentation

77
Q

What does quinolone work against?

A

Gram negative and positive coverage (and Pseudomonas)

78
Q

How is quinolone administered?

A

IV
Oral
Inhaled (CF)

79
Q

What are the side effects of quinolone?

A 
GI upset
Clostridium difficile
Tendonitis
Liver upset
Prolonged QTc and arrthymia
80
Q

What are two examples of marcolides?

A

erythromycin

clarithromycin

81
Q

When are marcolides used?

A

in respiratory infection (including aytpical pneumonia)

82
Q

How do marcolides work?

A

inhibit the synthesis of protein

83
Q

How are marcolides administered?

A

IV

oral

84
Q

What do marcolides work against?

A

Gram positive /limited gram negative cover

85
Q

What are the side effects of marcolides?

A 
GI
allergy
liver abnormality
prolonged QTc 
interactions
86
Q

What are some idiopathic interstitial pneumonias treated with?

A

Prednisolone
Azathioprine
MMF

87
Q

How is Idiopathic pulmonary fibrosis treated?

A

Pirfenidone

88
Q

What is the main difference between amoxicillin and penicillin?

A

amoxicillin is effective against a wider spectrum of bacteria compared with penicillin

89
Q

What is the difference between tachycardia and tachyarrhythmia?

A

tachycardia - rapid heart rate itself, regardless of cause, physiologic or pathologic (from exercise or cardiac arrhythmia)
tachyarrhythmia - rapid HR in its pathologic form (caused by a heart rhythm disorder)

M103 T4 (19 decks)

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