M103 T4 L15 Flashcards
What types of drugs are used in bronchodilators?
adrenergic agonists (beta-2 agonists)
Muscarinic antagonists / anticholinergics
Methylxanthines
Which four beta-2 agonist drugs can be used in bronchodilators?
salbutamol - short acting beta agonist
salmeterol - long acting beta agonist
formoterol - long acting beta agonist
vilanterol - long acting beta agonist
What are examples of muscarinic antagonists?
tiotropium - long acting aclidinium - short acting glycopyrronium - short acting umeclidinium - short acting ipratropium - short acting
What are examples of muscarinic antagonists?
Aminophylline
Theophylline
How are methylxanthines adminstered?
orally
IV
What are the three main categories of airway drugs?
bronchodilators
anti-inflammatory drugs
mucolytic drugs
What are the three types of anti-inflammatory drugs?
Steroids
Leukotriene receptor antagonist
Mucolytic agents
What are examples of steroids?
prednisolone (orally)
beclomethasone (an inhaled corticosteroid)
What is an advantage of an inhaled corticosteroid over an orally administered steroid?
the drugs get to the airway specifically which might help reduce any side effects
What is an example of a leukotriene receptor antagonist?
Montelukast
What is special about leukotriene receptor antagonists?
their unique mechanism of action results in a combination of both bronchodilator and anti-inflammatory effects
What are examples of mucolytic agents?
carbocysteine (tablet) hypertonic saline (given via nebuliser)
What are the two main types of inhalers?
Pressurised Metered Dose Inhalers (pMDIs)
Dry-Powder Inhalers
How are Pressurised Metered Dose Inhalers administered?
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
How are Dry-Powder Inhalers administered?
usually one inhalation, not a puff
How long does it take salbutamol to work? What is the duration of the effects?
short acting - begins immediately
duration of 3-5 hours
How does salbutamol work?
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
How is salbutamol administered?
Inhaled
via a nebuliser (gives a higher dose)
IV is rarely used
How long does it take salmeterol to work? What is the duration of the effects?
long acting - begins in begin 2 - 30 min
duration of 10-12 hours
How is salmeterol administered?
inhaled
not PRN and always used with ICS in asthma patients
In which asthma patients is salmeterol used?
in patients requiring long-term regular bronchodilator therapy on ICS
In which COPD patients is salmeterol used?
COPD patients with persistent symptoms despite SABA
How is salmeterol used to treat COPD patients?
LABA / LAMA combination
ICS / LABA combination
How long does it take formoterol to work? What is the duration of the effects?
long acting - begins in 2 - 30 min
duration of 10-12 hours
How is formoterol administered?
inhaled
combined with ICS (always) for asthma
In what patients is formoterol used?
Asthma
COPD
What is the duration of the effects of tiotropium? How often is it administered?
long acting - lasts for 24 hours
once daily
How is tiotropium administered?
Inhaled (dry powder handihaler / mist respimat)
How does tiotropium work?
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
How long does it take ipratropium to work? What is the duration of the effects?
it is short acting - begins in 30 minutes
lasts 6 hours
How is ipratropium administered and for what type of patients?
Nebulised for acute presentations of COPD and sometimes asthma
What is the half life of theophylline?
around 5 hours in healthy adults
How is theophylline administered?
orally - for patients with COPD and asthma who have persistent symptoms
IV - for COPD and asthma-medical emergencies
How does theophylline work?
it inhibits phosphodiesterase
its level in the blood needs to be monitored via blood tests
When is tiotropium used?
for stable COPD patients who have symptoms despite SABA
for asthma patients who aren’t improving despite ICS / LABA-specialist advice from hospital
What are the adverse events of bronchodilators?
Tachycardia
Nervousness, Irritability, Tremor
Tachyarrhythmias / Angina
What are adverse events of bronchodilators caused by?
usually dose related
How do the adverse events of bronchodilators vary between the way they are aministered?
adverse effects are less common in inhaled preparations
adverse effects are more common in oral (hardly used) and IV preparations
What is an example of an orally administered glucocorticoid?
prednisolone
What is an advantage of inhaled glucocorticoids?
localized action - there is more of the drug in the area that it needs to get to
may result in fewer side effects
What are the effects of glucocorticoids on the airways?
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
What are examples of an glucocorticoid that are inhaled?
Beclometasone
fluticasone
budesonide
What is a disadvantage of inhaled glucocorticoids?
the presence of the disease may prevent penetration of drug to affected areas
What is a disadvantage of inhaled glucocorticoids?
the presence of the disease may prevent penetration of drug to affected areas
What are two adverse effects of inhaled glucocorticoids?
Oral candidiasis
Dysphonia
What are two adverse effects of systemically administered glucocorticoids?
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
How can patients lower the effect of bone loss caused by systemically administered glucocorticoids?
exercise
Vit D
calcium
What are the drugs used in ICS and LABA combination inhalers?
Formoterol / Budesonide
Formoterol / beclomethasone
Salmeterol / fluticasone
What is an example of a drug pair used in LAMA and LABA combination inhalers?
Tiotropium
Olodaterol
What is an example of the drugs used in ICS, LABA and LAMA combination inhalers?
Beclomethasone
formoterol
glycopyrronium
What is allergic rhinitis treated with?
Antihistamines (H1 antagonists)
Intranasal Glucocorticoids
Montelukast
Sympathomimetics
What are two examples of H1 antagonists?
Cetirizine
Chlorpheniramine
What is an example of a Intranasal Glucocorticoid?
Beclometasone (brand name Beconase)
What is the brand name of montelukast?
Singulair
Sympathomimetics (Decongestants)
Pseudoephedrine (alpha agonist) Problems with abuse and MAOI
What are the side effects of H1 antagonists?
Drowsiness
Dry Mouth
Dry Eyes
Confusion
What are the side effects of montelukast?
reduce inflammation reduce bronchoconstriction reduce oedema reduce mucus reduce the recruitment of eosinophils
How does montelukast work?
it inhibits leukotriene receptors
Which conditions will put patients at a higher risk from the adverse effects of excess oxygen?
hypercapnia
respiratory failure
type two respiratory failure
How is oxygen administered?
Venturi mask (controlled administration)
Nasal (uncontrolled administration)
Hudson mask (uncontrolled administration)
Reservoir (uncontrolled administration)
Which penicillins are used to cover respiratory infection?
Amoxicillin
Co-amoxiclav
Tazobactum
What types of pneumonia are there?
hospital acquired
ventilator acquired
community acquired
How is amoxicillin administered?
IV/Oral
When is amoxicillin used?
community acquired pneumonia (common)
COPD exacerbations
bronchitis
What does amoxicillin work against?
active against gram negative and gram positive bacteria
What does co-amoxiclav contain?
amoxicillin
B lactamase
When is tazobactum used?
in patients with hospital acquired infections
When is amoxiclav used?
in patients who haven’t responded to first line treatment against respiratory infections
What does tazobactum work against?
gram neg bacteria
What is an example of a tetracycline?
doxycycline
How does tetracycline work?
it inhibits protein synthesis
What does tetracycline work against?
Broad spectrum action
Gram positive and negative
useful for ‘atypical infections’ e.g. mycoplasma, legionella
How is tetracycline administered?
Oral route only
What are the side effects of tetracycline?
GI Upset staining teeth lupus allergy photosensitivity
What are three examples of quinolones?
ciprofloxacin
levofloxacin
moxifloxacin
How do quinolones work?
cause DNA fragmentation
What does quinolone work against?
Gram negative and positive coverage (and Pseudomonas)
How is quinolone administered?
IV
Oral
Inhaled (CF)
What are the side effects of quinolone?
GI upset Clostridium difficile Tendonitis Liver upset Prolonged QTc and arrthymia
What are two examples of marcolides?
erythromycin
clarithromycin
When are marcolides used?
in respiratory infection (including aytpical pneumonia)
How do marcolides work?
inhibit the synthesis of protein
How are marcolides administered?
IV
oral
What do marcolides work against?
Gram positive /limited gram negative cover
What are the side effects of marcolides?
GI allergy liver abnormality prolonged QTc interactions
What are some idiopathic interstitial pneumonias treated with?
Prednisolone
Azathioprine
MMF
How is Idiopathic pulmonary fibrosis treated?
Pirfenidone
What is the main difference between amoxicillin and penicillin?
amoxicillin is effective against a wider spectrum of bacteria compared with penicillin
What is the difference between tachycardia and tachyarrhythmia?
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)
