Medications

Question 1

How do PPI work?

Answer 1

Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the ‘proton pump’) of the gastric parietal cell.

Question 2

Example of PPI?

Answer 2

Omeprazole
Lansoprazole
Pantoprazole
Rabeprazole
Esomeprazole

Question 3

Side effects of PPI

Answer 3

Risk of osteoporosis,
Abdominal pain, constipation or diarrhoea, dizziness, dry mouth, headache, insomnia nausea and skin reactions

Question 4

Contraindications to PPI

Answer 4

Clopidogrel and warfarin warning as can affect levels and potency of them - hepatic diseases

Question 5

How do H2 antagonists work

Answer 5

Binds to histamine type 2 receptors on the basolateral (antiluminal) surface of gastric parietal cells, interfering with pathways of gastric acid production and secretion.

Question 6

Examples of H2 Antagonists

Answer 6

Famotidine
Nizatidine
Cimetidine

Question 7

Side effects of H2 antagonists

Answer 7

Constipation; diarrhoea; dizziness; fatigue; headache; myalgia; skin reactions

Advised to avoid in pregnancy except for if benefits far outweigh risks.

Question 8

How do Beta 2 Agonists work

Answer 8

Circulating catecholamines activate adrenergic receptors as part of our functional autonomic system to produce parasympathetic and sympathetic physiological responses. Mimicking catecholamines, beta-2 agonists act as ligands to adrenergic receptors with increased selectivity towards beta-2 adrenergic receptors.
Adrenalinacts on thesmooth muscleof the airways to causerelaxation. Stimulating the adrenalin receptors dilates the bronchioles and reverses the bronchoconstriction present in asthma.

Question 9

Examples of SABA

Answer 9

Salbutamol
Terbutaline
Levalbuterol

Question 10

Examples of LABA

Answer 10

Salmeterol
Formoterol
Arformoterol

Question 11

Side effects of B2 agonists

Answer 11

Arrhythmias; headache; palpitations; tremor; Muscle cramps

Question 12

How do ICS work

Answer 12

potent anti-inflammatory activity — they inhibit or prevent inflammatory components of both the immediate and late phases of asthma. Inhaled corticosteroids:

Decrease the formation of cytokines (an inflammatory mediator).

Decrease microvascular permeability.

Inhibit influx of eosinophils into the lung, reducing overall inflammation.

Reduce bronchial hyper-responsiveness.

Question 13

Examples of ICS

Answer 13

Beclometasone - both aerosol and dry powder
Budesonide - dry
Ciclesonide - aerosol

Question 14

How do LAMA work

Answer 14

ause bronchodilation by blocking the bronchoconstrictor effect of acetylcholine on muscarinic receptors in airway smooth muscle.
Acetylcholine receptors are stimulated by theparasympathetic nervous systemand cause contraction of the bronchial smooth muscles. Blocking these receptors dilates the bronchioles and reverses the bronchoconstriction present in asthma.

Question 15

Examples of LAMA

Answer 15

Tiotropium
Aclidinium
Glycopyrrolate

Question 16

Contraindications of LAMA

Answer 16

Men with prostatic hyperplasia and bladder-outflow obstruction — worsened urinary retention has been reported in elderly men.

People with renal impairment — manufacturer advises use only if potential benefit outweighs risk if creatinine clearance less than or equal to 50 mL/minute.

People with angle-closure glaucoma — nebulized mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma.

Pregnancy or breastfeeding — manufacturer recommends avoid, seek specialist advice.

Tiotropium should be used with caution in people with cardiac arrhythmias, heart failure or myocardial infarction in the previous 6 months.

Question 17

Side effects of LAMA

Answer 17

Arrhythmias; constipation; cough; dizziness; dry mouth; headache; nausea

Question 18

How do leukotriene receptor antagonists work

Answer 18

Work by blocking the effects ofleukotrienes. Leukotrienes are produced by the immune system and causeinflammation,bronchoconstrictionandmucus secretionin the airways.

Question 19

Examples of leukotriene receptor antagonists

Answer 19

Montelukast
Zafirlukast

Question 20

Contraindications of Leukotriene receptor antagonists

Answer 20

There are no noted contraindications or cautions for montelukast.

Zafirlukast is contraindicated in people with hepatic impairment or cirrhosis, children under 12, renal impairment.

Drug interactions of zafirlukast:
Aspirin, warfarin, theophylline and erythromycin.

Question 21

Side effects of Leukotriene receptor antagonists

Answer 21

Arthralgia.
Bruising.
Dyspepsia.
Excessive thirst.
Gastrointestinal upset.
Headache.
Hyperkinesia (in young children).
Infections.
Malaise.
Myalgia.
Nose bleeds.

Question 22

How does theophylline work

Answer 22

works by relaxing the bronchial smooth muscle and reducing inflammation, by inhibiting adenosine receptors. Reduces airway responsiveness to histamine, metacholine etc

Question 23

Monitoring of theophylline

Answer 23

Before starting check

Urea and electrolyte levels (paying particular attention to potassium levels).
Liver function.

Five days after starting oral treatment.
Routinely every 6–12 months. Check more regularly in older people or those with heart failure or hepatic impairment.
At least 3 days after any dose adjustments.

Check potassium levels regularly in people taking theophylline alongside beta-2 agonists, corticosteroids, or diuretics, and in all people with severe asthma. Plasma potassium concentrations may be reduced by beta-2 agonists, corticosteroids, and diuretics.

Question 24

Side effects of theophylline

Answer 24

nausea (most common), vomiting, tremor, headache, central nervous system stimulation, insomnia, palpitations, arrhythmias, and convulsion (rare).

Question 25

Side effects or complications of ICS

Answer 25

Oral candidiasis, sore mouth, dysphonia, and hoarseness, especially in high doses.
Paradoxical bronchospasm.

Adrenal suppression, reduced bone mineral density, bruising, cataract, and glaucoma.

Growth suppression — may occur in children on high doses of inhaled corticosteroids, but final adult height does not seem to be affected.

Adrenal crisis, coma, and death — very rarely in children.

Psychological and behavioural changes.

Increased susceptibility to infection.

Reduced bone mineral density.

Question 26

Contraindications of theophylline

Answer 26

People with porphyria.
People with hypersensitivity to xanthines.
Children concomitantly receiving ephedrine.
Infants under 6 months of age.

B2 agonists - hypokalaemia
Lithium - potanised
Fluvoxamine - increased potency of theophylline.
Liver enzyme inhibiting drugs

Question 27

Examples of liver enzyme inhibiting drugs

Answer 27

verapamil, ciprofloxacin, fluconazole, erythromycin, benazepril, enalapril, Ramipril, metronidazole, chloramphenicol.

Question 28

Liver enzyme inducing drugs and how they work

Answer 28

increases the metabolic activity of an enzyme either by binding to the enzyme and activating it, or by increasing the expression of the gene coding for the enzyme.

primidone, phenobarbital, carbamazepine, phenytoin, ritonavir, rifampicin, or St John’s Wort.