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Respiratory > Pharmacology in Respiratory Disease > Flashcards

Pharmacology in Respiratory Disease Flashcards

1
Q

What are dermatophytes?

A

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

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2
Q

Dermatophytes colonise live tissues. T/F?

A

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

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3
Q

What is another word for dermatophytes?

A

Rigworm

Tinea

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4
Q

When can oral medication be used to treat dermatophytes?

A

Severe infection

Nail infections where tropical medication has not worked

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5
Q

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

A

Terbinafine
Itraconazole
Ketoconazzole
Miconazole

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6
Q

Give examples of systemic fungal infections?

A

Fungal meningitis
Aspergillus of the lungs
Pneymocystitis

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7
Q

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

A

False - it only affects immunocompromised individuals

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8
Q

How is cryptococcus Neoformans treated?

A

2 weeks of IV amphotericin B or fluconazole for meningitis

Flucystone is for non-CNS infections

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9
Q

Aspergillus fumigateurs infection is associated with which conditions?

A

CF

Asthma

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10
Q

How is aspergillum fumigatus infection treated?

A

Prednisolone

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11
Q

How is cryptococcus neoformans contracted?

A

From the environment such as in pigeon droppings

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12
Q

How is invasive pulmonary aspergillosis treated?

A

Voriconazzole and amphotericin B

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13
Q

How is aspergilloma treated?

A

There is no treatment unless bleeding occurs then surgery is used

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14
Q

Describe aspergilloma infection?

A

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

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15
Q

What symptoms occur with pneumocystis jiroveci?

A

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

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16
Q

How is pneumocystis jiroveci infection treated?

A

Trimethoprim and sulfamethoxazole

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17
Q

Give examples of azole anti-fungal treatments?

A 
Miconazole
Ketoconazzole
Clotrimazzole
Isoconazole
Fluconazole
Itraconazole
Abafungin
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18
Q

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

A

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.

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19
Q

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

A

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

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20
Q

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

A

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

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21
Q

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

A

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

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22
Q

How does IV aminophylline reduce inflammation in acute asthma exacerbations?

A

Inhibits phosphodiesterase to raise cAMP and activate PKA

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23
Q

How is amoxicillin primarily excreted?

A

Renally

24
Q

What is the side effect of clarithromycin if given IV?

A

Phelbitis (inflammation of veins)

25
Q

What resistance mechanisms are recorded in associated with doxycycline?

A

Efflux by ABC transporters

Ribsoome proteins proteins which prevent tetracycline binding

26
Q

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

A

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

27
Q

What are the side effects of corticosteroids?

A 
Diabetes
Osteoporosis
Hypertension
Muscle wasting
Peptic ulceration
Cataracts
Cushing's syndrome
Adrenal suppression
Acute pancreatitis
Hyperlipidaemia
Increased appetite 
Salt and water retention
Immune suppression
28
Q

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

A

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

29
Q

What are the side effects of beta 2 agonists?

A 
Tremor
Hypokalaemia
Hyperglycaemia
Hypomagnesaemia
Flushing
Tachycardia
Arrythmias
Headache
Muscle cramps
30
Q

Give examples of short acting beta 2 agonists

A

Slabutamol

Terbutaline

31
Q

Give examples of long acting beta 2 agonists

A

Salmeterol
Formoterol
Vilanterol
Indacaterol

32
Q

How can salbutamol be administered?

A

Inhaled
Nebulised
Oral
IV

33
Q

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

A

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

34
Q

What are the side effects of anti-muscarinics?

A 
Blurred vision
Dry mouth
Urinary retention
Nausea
Constipation
35
Q

What condition can nebuliser ipratropium precipitate?

A

Acute angle closure glaucoma

36
Q

Give an example of a short acting anti muscarinic?

A

Ipratropium bromide

37
Q

Give examples of long acting anti muscarinics

A

Tiotropium, glycopyrronium and umeclidinium

38
Q

How are anti-muscarinics excreted?

A

Renally

39
Q

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

A

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

40
Q

What are the side effects of methylxanthines?

A 
GI upsets
Palpitations
Tachycardia/arrythmias
Headache
Insomnia
Hypokalaemia
41
Q

What is aminophylline?

A

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

42
Q

What is the time to steady state of aminophylline?

A

2-3 days

43
Q

What is the therapeutic window of aminphylline?

A

Narrow at 10-20mg/L

44
Q

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

A

Smoking increases the clearance of theophylline

45
Q

Give examples of leukotriene receptor antagonists?

A

Montelukast

Zafirlukast

46
Q

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

A

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

47
Q

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

A

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

48
Q

What is omalizumab?

A

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

49
Q

How is omalizumab administered?

A

S/C injection every 4 weeks

50
Q

What is the risk of omalizzumab therapy?

A

Severe hypersensitivity reaction

51
Q

What is mepolizumab?

A

Anti IL-5 monoclonal antibody which reduces circulating eosinophils

52
Q

How is mepolizumab administered?

A

S/C infection every 4 weeks

53
Q

When would mepolizumab be used in the treatment of asthma?

A

In severe refractory eosinophilic asthma

54
Q

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

A

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

55
Q

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

A

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

56
Q

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

A

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

57
Q

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

A

Cough suppressants

Respiratory (10 decks)

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