Pharmacology

Question 1

Tamsulosin

Answer 1

Renal stone expulsion therapy

Question 2

Ezetimibe

Answer 2

Inhibits intestinal absorption of cholesterol.
Used in combination with statin or alone.
Used in primary hypercholesteraemia

Question 3

Step 1 BTS Asthma guidelines

Answer 3

Mild intermittent asthma - Inhaled short-acting ß2-agonist as required

Question 4

Step 2 BTS Asthma guidelines

Answer 4

Regular preventer therapy - Add an inhaled steroid (200-800 micrograms/day); 400 micrograms is an appropriate starting dose

Question 5

Step 3 BTS Asthma guidelines

Answer 5

Initial add-on therapy -

1. Add on inhaled long-acting ß2 agonist (LABA)
2. 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

Question 6

Step 4 BTS Asthma guidelines

Answer 6

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

Question 7

Step 5 BTS Asthma guidelines

Answer 7

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.

Question 8

Inspired O2 concentration of a low-flow mask, flow rate 6-10 L/min

Answer 8

Up to 60%

Question 9

Inspired O2 concentration of nasal prongs, flow rate 1-2L/min

Answer 9

24-30%

Question 10

Inspired O2 concentration of High-flow, jet-mixing (Venturi) mask, flow rate depends on equipment

Answer 10

24-60%

Question 11

Inspired O2 concentration of Non-rebreathing reservoir mask

Answer 11

Up to 90%

Question 12

Inspired O2 concentration of anaesthetic face mask or endotracheal tube

Answer 12

Up to 100%

Question 13

Definition of COPD

Answer 13

COPD is characterised by airflow limitation that is not fully reversible

Question 14

Lung Function tests in COPD

Answer 14

Fev1/FVC is <80% of predicted

Question 15

4 components to treatment of COPD

Answer 15

1. Assess and monitor the disease
2. Reduce risk factors
3. Manage stable COPD
4. Manage exacerbations

Question 16

Symptomatic treatments of COPD

Answer 16

1. Inhaled short-acting bronchodilating muscarinic receptor antagonists: ipratropium & ß2 adrenoceptor agonists: salbutamol = mainstays of treatment
2. 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
3. Theophylline - in pts with more severe disease
4. Inhaled corticosteroids - not very effective; only recommended in those with a FEV1 <50% of predicted and those with repeated exacerbations

Question 17

Carbocisteine

Answer 17

Mucolytic

Question 18

Most common adverse effect of carbocisteine

Answer 18

Peptic ulceration

Question 19

Dornase alfa

Answer 19

DNase; human deoxyribonuclease 1; only for COPD patients with cystic fibrosis

Question 20

Montelukast

Answer 20

Leukotriene receptor antagonist

Used in treatment of chronic asthma; ‘relievers’

Question 21

Cromones

Answer 21

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.

Question 22

Xanthine derivatives

Answer 22

= 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.