Pharmacology in Respiratory Disease

Question 1

What are dermatophytes?

Answer 1

Fungi which cause common infections of the skin, nails and hair

Question 2

Dermatophytes colonise live tissues. T/F?

Answer 2

False - they only colonise keratinised areas such as the nails and outer skin

Question 3

What is another word for dermatophytes?

Answer 3

Rigworm

Tinea

Question 4

When can oral medication be used to treat dermatophytes?

Answer 4

Severe infection

Nail infections where tropical medication has not worked

Question 5

What are the active ingredients in medications used to treat dermatophyte infection?

Answer 5

Terbinafine
Itraconazole
Ketoconazzole
Miconazole

Question 6

Give examples of systemic fungal infections?

Answer 6

Fungal meningitis
Aspergillus of the lungs
Pneymocystitis

Question 7

Systemic fungal infections affect both healthy and immunocompromised individuals. T/F?

Answer 7

False - it only affects immunocompromised individuals

Question 8

How is cryptococcus Neoformans treated?

Answer 8

2 weeks of IV amphotericin B or fluconazole for meningitis

Flucystone is for non-CNS infections

Question 9

Aspergillus fumigateurs infection is associated with which conditions?

Answer 9

CF

Asthma

Question 10

How is aspergillum fumigatus infection treated?

Answer 10

Prednisolone

Question 11

How is cryptococcus neoformans contracted?

Answer 11

From the environment such as in pigeon droppings

Question 12

How is invasive pulmonary aspergillosis treated?

Answer 12

Voriconazzole and amphotericin B

Question 13

How is aspergilloma treated?

Answer 13

There is no treatment unless bleeding occurs then surgery is used

Question 14

Describe aspergilloma infection?

Answer 14

A fungal ball that develops in an area of past lung disease or lung scarring e.g. tuberculosis or lung abscess

Question 15

What symptoms occur with pneumocystis jiroveci?

Answer 15

Pneumonia with fever, cough, shortness fo breath and rapid breathing

Question 16

How is pneumocystis jiroveci infection treated?

Answer 16

Trimethoprim and sulfamethoxazole

Question 17

Give examples of azole anti-fungal treatments?

Answer 17

Miconazole
Ketoconazzole
Clotrimazzole
Isoconazole
Fluconazole
Itraconazole
Abafungin

Question 18

What is the mechanism of action of azole anti fungal agents?

Answer 18

Inhibitors of 14-methylsterol alpha-demthylase which produces ergosterol. Ergosterol is an essential component of the fungal plasma membrane which is not present in animal or plant cells.

Question 19

Amphotericin B exploits the ergosterol/cholesterol difference similar to azole anti fungals. What is the mechanism of action of amphotericin B?

Answer 19

It forms a pore in fungal membranes which leads to cell death.

Question 20

What pharmacological measures are used to treat a life threatening acute asthma exacerbation?

Answer 20

High flow oxygen
Nebulsied bronchodilators - slamubatol, ipratropium bromide
Oral prednisolone 40mg
Oral doxycycline 200mg. (if chest infection suspicion)
IV magnesium 2g
IV amoophylline

Question 21

Why is IV magnesium given to treat an acute exacerbation of asthma?

Answer 21

Causes smooth muscle relaxation
Blocks histamine release from mast cells
Diminishes ACh release from nerve endings

Question 22

How does IV aminophylline reduce inflammation in acute asthma exacerbations?

Answer 22

Inhibits phosphodiesterase to raise cAMP and activate PKA

Question 23

How is amoxicillin primarily excreted?

Answer 23

Renally

Question 24

What is the side effect of clarithromycin if given IV?

Answer 24

Phelbitis (inflammation of veins)

Question 25

What resistance mechanisms are recorded in associated with doxycycline?

Answer 25

Efflux by ABC transporters | Ribsoome proteins proteins which prevent tetracycline binding

Question 26

What is the mechanism of action of corticosteroids used in asthma management?

Answer 26

Bind to activated glucocorticoid receptors to suppress multiple pro-inflammatory genes which are activated in asthmatic airways by reversing histone acetylation

Question 27

What are the side effects of corticosteroids?

Answer 27

``` Diabetes Osteoporosis Hypertension Muscle wasting Peptic ulceration Cataracts Cushing's syndrome Adrenal suppression Acute pancreatitis Hyperlipidaemia Increased appetite Salt and water retention Immune suppression ```

Question 28

What is the mechanism of action of beta 2 agonists in the treatment of asthma>

Answer 28

Stimulate adenylyl cyclase to increase intracellular cAMP which results in relaxation of bronchial smooth muscle

Question 29

What are the side effects of beta 2 agonists?

Answer 29

``` Tremor Hypokalaemia Hyperglycaemia Hypomagnesaemia Flushing Tachycardia Arrythmias Headache Muscle cramps ```

Question 30

Give examples of short acting beta 2 agonists

Answer 30

Slabutamol | Terbutaline

Question 31

Give examples of long acting beta 2 agonists

Answer 31

Salmeterol Formoterol Vilanterol Indacaterol

Question 32

How can salbutamol be administered?

Answer 32

Inhaled Nebulised Oral IV

Question 33

What is the mechanism of action of anti-muscarinics used in the treatment of asthma?

Answer 33

Antagonists of cholinergic M1 and M3 receptors in the lung which counters direct broncho-constriction.

Question 34

What are the side effects of anti-muscarinics?

Answer 34

``` Blurred vision Dry mouth Urinary retention Nausea Constipation ```

Question 35

What condition can nebuliser ipratropium precipitate?

Answer 35

Acute angle closure glaucoma

Question 36

Give an example of a short acting anti muscarinic?

Answer 36

Ipratropium bromide

Question 37

Give examples of long acting anti muscarinics

Answer 37

Tiotropium, glycopyrronium and umeclidinium

Question 38

How are anti-muscarinics excreted?

Answer 38

Renally

Question 39

What is the mechanism of action of methylxanthines used in the treatment of asthma?

Answer 39

Non-selective inhibition of phosphodiesterase which increases intracellular cAMP leading to bronchial smooth muscle relaxation Immunomodulatory action which improves mucociliary clearance and has an anti-inflammatory effect

Question 40

What are the side effects of methylxanthines?

Answer 40

``` GI upsets Palpitations Tachycardia/arrythmias Headache Insomnia Hypokalaemia ```

Question 41

What is aminophylline?

Answer 41

A mixture in a 2:1 ratio of theophylline and ethylenediamine

Question 42

What is the time to steady state of aminophylline?

Answer 42

2-3 days

Question 43

What is the therapeutic window of aminphylline?

Answer 43

Narrow at 10-20mg/L

Question 44

Why might the dose of theophylline have to be adjusted following smoking cessation?

Answer 44

Smoking increases the clearance of theophylline

Question 45

Give examples of leukotriene receptor antagonists?

Answer 45

Montelukast | Zafirlukast

Question 46

Leukotriene receptor antagonists are only used to treat acute asthma attacks. T/F?

Answer 46

False- they are only used for asthma maintenance and are not to be used in acute attacks

Question 47

What is the mechanism of action of leukotriene receptor antagonists in asthma management?

Answer 47

High affinity antagonists of cysteine leukotriene receptor inhibiting the action fo LT-D4. in smooth muscle cells of the airway and airway Mac prophages which reduces airway oedema and smooth muscle contraction

Question 48

What is omalizumab?

Answer 48

A monoclonal anti-IgE antibody used in severe persistent allergic asthma

Question 49

How is omalizumab administered?

Answer 49

S/C injection every 4 weeks

Question 50

What is the risk of omalizzumab therapy?

Answer 50

Severe hypersensitivity reaction

Question 51

What is mepolizumab?

Answer 51

Anti IL-5 monoclonal antibody which reduces circulating eosinophils

Question 52

How is mepolizumab administered?

Answer 52

S/C infection every 4 weeks

Question 53

When would mepolizumab be used in the treatment of asthma?

Answer 53

In severe refractory eosinophilic asthma

Question 54

Describe the mechanism of action of roflumilast in the treatment of COPD?

Answer 54

Selective inhibitor of phosphodiesterase 4 which inhibits the hydrolysis of cAMP in inflammatory cells which leading to reduced release of pro-inflammatory mediators and cytokines

Question 55

What is the mechanism of action of azithromycin in the treatment of COPD?

Answer 55

Macrolide antibiotic with immuomodulatory and anti-inflammatory effects Inhibits pro-inflammatory AP-1, NFkB and mucin release

Question 56

What is the mechanism of action of carbocysteine in the treatment of COPD?

Answer 56

Mucolytic which increases the concentrations of sialomucin and reduces concentrations of fbucomycins resulting in reduced sputum viscosity

Question 57

Carbocysteine should not be used in conjunction with what type of drug in the treatment of COPD?

Answer 57

Cough suppressants