Pharmacology Flashcards
Tamsulosin
Renal stone expulsion therapy
Ezetimibe
Inhibits intestinal absorption of cholesterol.
Used in combination with statin or alone.
Used in primary hypercholesteraemia
Step 1 BTS Asthma guidelines
Mild intermittent asthma - Inhaled short-acting ß2-agonist as required
Step 2 BTS Asthma guidelines
Regular preventer therapy - Add an inhaled steroid (200-800 micrograms/day); 400 micrograms is an appropriate starting dose
Step 3 BTS Asthma guidelines
Initial add-on therapy -
- Add on inhaled long-acting ß2 agonist (LABA)
- Assess control of asthma:
- Good response to LABA - continue LABA
- Benefit from LABA but control still inadequate: continue LABA and increase inhaled steroid to 800 micrograms/day.
- If control still inadequate, try another therapy –> leukotriene receptor antagonist or modified-release theophylline
Step 4 BTS Asthma guidelines
Persistent poor control -
Consider trials of:
- Increasing inhaled steroid up to 2000 micrograms/day
- Addition of a fourth drug, e.g. a leukotriene receptor antagonist, modified-release theophylline, an oral ß2 agonist
Step 5 BTS Asthma guidelines
Continuous or frequent use of oral steroids -
Use daily oral steroid in the lowest dose that provides adequate control
Maintain high-dose inhaled steroid at 2000 micrograms/day
Consider other treatments to mimimise the use of oral steroid; refer for specialist care.
Inspired O2 concentration of a low-flow mask, flow rate 6-10 L/min
Up to 60%
Inspired O2 concentration of nasal prongs, flow rate 1-2L/min
24-30%
Inspired O2 concentration of High-flow, jet-mixing (Venturi) mask, flow rate depends on equipment
24-60%
Inspired O2 concentration of Non-rebreathing reservoir mask
Up to 90%
Inspired O2 concentration of anaesthetic face mask or endotracheal tube
Up to 100%
Definition of COPD
COPD is characterised by airflow limitation that is not fully reversible
Lung Function tests in COPD
Fev1/FVC is <80% of predicted
4 components to treatment of COPD
- Assess and monitor the disease
- Reduce risk factors
- Manage stable COPD
- Manage exacerbations
Symptomatic treatments of COPD
- Inhaled short-acting bronchodilating muscarinic receptor antagonists: ipratropium & ß2 adrenoceptor agonists: salbutamol = mainstays of treatment
- Long-acting inhaled ß2 agonists: salmeterol or muscarinic antagonists: tiotropium are more effective but more expensive - recommended in pts who remain symptomatic or in those with >2 exacerbations per year
- Theophylline - in pts with more severe disease
- Inhaled corticosteroids - not very effective; only recommended in those with a FEV1 <50% of predicted and those with repeated exacerbations
Carbocisteine
Mucolytic
Most common adverse effect of carbocisteine
Peptic ulceration
Dornase alfa
DNase; human deoxyribonuclease 1; only for COPD patients with cystic fibrosis
Montelukast
Leukotriene receptor antagonist
Used in treatment of chronic asthma; ‘relievers’
Cromones
e.g.: Cromoglicate, Nedocromil
MoA: Cromones stabilise cell membranes: reduces release of histamine from mast cells; reduced allergic responses especially in the bronchial tree (asthma) and gut (food intolerance)
Reduce frequency and severity of attacks when used in combination with inhaled ß2 agonists and inhaled steroids: effect is greater in children than in adults, in whom they are not recommended.
No role in treatment of acute asthma.
Xanthine derivatives
= Non-selective phosphodiesterase inhibitors
- theophylline
- aminophylline
- Can be used for relief of reversible airway obstruction in patients with COPD (reversible component is small, <15%)
- can cause cardiac arrythmias.
