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Respiratory > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What type of hypersensitivity is the immediate phase of an asthma attack?

A

Type 1 hypersensitivity

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2
Q

What type of hypersensitivity is the delayed phase of an asthma attack?

A

Type 4 sensitivity

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3
Q

What is a SABA and give 2 examples?

A

Short acting beta 2 agonist

Salbutamol and terbutaline

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4
Q

Are SABAs used in asthma or COPD?

A

Mainly asthma but can occasionally be used in COPD

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5
Q

What actions do SABAs have? (5)

A

1) Relax airway smooth muscle by agonising beta 2 adrenoceptors on airway smooth muscle
2) Decrease mucus secretions by agonising beta 2 adrenoceptors on goblet cells
3) Increase mucocillary clearance
4) Reduction in intracellular Ca++ concentration
5) Activation of large conductance potassium channels => hyperpolarisation

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6
Q

Side effects of SABAs?

A

Beta agonist tremor
Tachycardia
Hypokalemia
dysrhythmia

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7
Q

What is a LABA and give 2 examples?

A

Long acting beta agonist

Salmeterol and formoterol

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8
Q

Are LABAs used in asthma or COPD?

A

Both
First line in COPD
Second line in asthma

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9
Q

You can give a LABA as monotherapy in asthma. True or false?

A

False- NEVER give a LABA alone

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10
Q

What is a leukotriene?

A

Leukotrienes are dirived from mast cells and other inflammatory cells and cause mucus secretion, smooth muscle contraction and oedema. Examples include LTC4, LTD4 and LTE4

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11
Q

What is a leukotriene receptor antagonist and give an example?

A

A drug which binds to Cys Leukotriene receptors preventing the binding of leukotrienes and preventing muscle contraction in the airway.
Montelukast

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12
Q

Are leukotriene receptor antagonists used in asthma or COPD?

A

Asthma ONLY
Add on therapy against early and delayed bronchospasm
used in moderate - severe asthma
Can be used in allergic rhinitis

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13
Q

How are leukotriene receptor antagonists administered?

A

Orally

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14
Q

What is the action of methylxanthines and give 2 examples?

A

Have bronchodilator and anti inflammatory actions
Unknown molecular mechanism which may involve inhibition of isoforms of PDE
Aminophyline and theophyline

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15
Q

Are methylxanthines used in asthma or COPD?

A

Asthma mostly but can be used in COPD

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16
Q

Why are methylxanthines not used frequently?

A

High therapeutic index and have many adverse effects involving the CNS, CVS and GI tract.
Drug interactions involving CYP450 (don’t give with erythromycin/ flucloxacillin)

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17
Q

How are methylxanthines administered?

A

Orally

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18
Q

How do steroids work briefly?

A

They have trans activating or transrepressing activity of specific inflammatory or anti-inflamatory genes

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19
Q

Are glucocorticoids used in asthma or COPD?

A

Mostly asthma but also in ACOS- eosinophic mediated COPD

20
Q

What are the common adverse effects for ICS?

A

Dysphonia- horse and weak voice
Orophatyngeal candidiasis (oral thrush)
Both due to deposition in the oropharynx

21
Q

When would an oral steroid such as prednisalone be used?

A

In severe asthma but always in combination with an ICS and only in the short term due to the side effects

22
Q

What is a chromone and give an example?

A

Anti inflammatory drug (non steriodal)
‘Mast cell stabaliser’
Not as effective as ICS
Sodium Chromoglicate

23
Q

When may a chromone be used?

A

In children and young adults with asthma (especcialy exercised induced. Given qds
In rhinitis and rhinorrhoea

24
Q

Give an example of a monoclonal antibody against IgE and its mechanism of action?

A

Omalizumab IV

Binds to IgE via Fc to prevent IgE binding to Fc receptors on mast cells, eosinophils and basophils

25
Q

Give an example of a monoclonal antibody against IL5 and its mechanism of action?

A

Mepolizumab SC

Blocks the effect of TH2 cytokine IL5 which is responsible for eosinophilic inflammation

26
Q

What is a LAMA and give 2 examples?

A

Long acting muscarinic antagonist
Tiotropium
Glycopyrronium

27
Q

How do SAMAs and LAMAs cause smooth muscle relaxation?

A

The block the M3 muscarinic GPCR found on airway smooth muscle.
Activation of this receptor leads to smooth muscle contrition via Gq/11 and phospholipase C

28
Q

Give an example of a SAMA?

A

Ipratropium

29
Q

Why is ipratropium inferior to other muscasrinic receptor antagonists?

A

It is non selective so blocks M1, M2 and M3 muscarinic receptors equally. Blockade of M1 and M3 is beneficial but blockade of M2 is not.
Other muscarinic receptor antagonists are M3 selective

30
Q

Are LAMAs used in asthma or COPD?

A

COPD first line

Asthma second line

31
Q

Give 2 examples of ultra LABAs?

A

Indaterol and Oldaterol

32
Q

What is a phosphodiesterase 4 inhibitor and give an example?

A

It inhibits the PDE enzyme. The PDE enzyme breaks down cAMP which promotes smooth muscle relaxation
Roflumilast

33
Q

Are phosphodiesterase 4 inhibitors used in asthma or COPD?

34
Q

Why are phosphodiesterase 4 inhibitors not commonly used

A

Not well tolerated

Side effects including headache, nausea, vomiting and weight loss

35
Q

What may be the cause of glucocorticoid unresponsiveness in COPD?

A

Oxidative/ nutritive stress due to smoking

36
Q

What are the advantages of a spacer device?

A

1) Avoids coordination problems encountered with an MDI
2) Reduces oropharangeal and larngeal side effects
3) Reduces systemic absorption from swallowed fraction
4) Allows people to take 2-3 breaths rather an 1 What is

37
Q

What is a releiver in asthma?

38
Q

What are the 1st line preventers in asthma?

A

ICS

sodium chromoglicate

39
Q

What are the 2nd line controllers in asthma?

A

LABA/LAMA (first choice)
Theophyline
Leukotriene receptor antagonist
Anti IgE/ Anti IL5

40
Q

What classes of drugs are used to treat rhinitis and rhinorrhoea?

A 
Glucocorticoids (topical spray)
Antihistamines (oral)
Muscarinic receptor antagonists (topical application)
Sodium Chromoglicate
Leukotriene receptor antagonists 
Vasoconstrictors
41
Q

Give an example of a glucocorticoid used in the treatment of rhinitis and rhinorrhoea?

A

Beclomethasone, Fluticasone, Prednisalone

Most effective in seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR)

42
Q

Give an example of a muscarinic antagonist used in the treatment of rhinitis and rhinorrhoea?

A

Ipratropium

Used in PAR and SAR

43
Q

Give an example of a antihistamine used in the treatment of rhinitis and rhinorrhoea?

A

Loretidine, cetirizine and fexofenadine

Used in all allergic rhinitis- SAR, PAR and EAR

44
Q

Give an example of a leukotriene receptor antagonist used in the treatment of rhinitis and rhinorrhoea?

A

Montelukast

Used in PAR and SAR

45
Q

Give an example of a vasoconstrictor used in the treatment of rhinitis and rhinorrhoea?

A

Oxymetazoline

Short term use for reducing congestion

Respiratory (26 decks)

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