Pharmacology of airways disease Flashcards
How do Beta 2 agonists work?
prevent bronchoconstriction
increase cAMP
smooth muscle relaxation
SABA/LABA
Side effects of Beta 2 agonists?
fine tremor
tachycardia/palpitations
hypokalemia
How do anticholinergics work?
activating M3 (muscarinic) receptors causes bronchoconstriction, therefore an antagonist prevents this and prevents bronchoconstriction
Indications for SAMAs/LAMAs
COPD
severe asthma
What does SAMA and LAMA stand for?
short-acting muscarinic antagonist
long-acting muscarinic antagonist
SAMA and LAMA examples
SAMA = ipratropium bromide
LAMA = tiotropium, glycopyrronium, aclidinium
What are the beneficial effects of corticosteroids in airways disease?
reduce inflammatory mediators
increase anti-inflammatory mediators
reduce eosinophils, macrophages, lymphocytes
Adverse effects of corticosteroids
personality changes
hyperglycaemia
CNS irritability
moon face
increased susceptibility to infection
fluid retention
thin skin
GI distress (increased acid)
hirsutism
striae
osteoporosis
bruises + petechiae
What should be done in secondary care for uncontrolled asthma?
check it’s asthma
check inhaler technique
consider biologic therapy
What is an LTRA?
List some examples
leukotriene receptor antagonist
montelukast
zafirlukast
pranlukast
taken as a tablet - asthma only
How does Omalizumab work?
monoclonal antibody
binds circulating IgE
How is Omalizumab given?
SC injection every 2-4 weeks
How does Mepolizumab work?
monoclonal antibody - blocks IL-5
Omalizumab indication
severe/uncontrolled allergic asthma
Mepolizumab indication
uncontrolled eosinophilic asthma
How do xanthines work?
List some examples
inhibit phosphodiesterase
theophylline, aminophylline
bronchodilatory + anti-inflammatory effects
Indication for mucolytics
chronic bronchitis
List 3 mucolytic drugs
carbocisteine
erdosteine
mecysteine
Benefits of inhaled drug over oral
inhaled drug is delivered where it is required
reduces systemic exposure
reduces systemic adverse effects
Name 3 types of inhaler
MDI (metered dose inhaler)
nebuliser
dry powder inhaler
Advantages of using a spacer with an inhaler
coordination: delay in inspiration, exhaling through device (valved spacer)
less oropharyngeal deposition
improved lung delivery
comparable efficacy to nebulisers
Disadvantages of using a spacer with an inhaler
size
cost
assembling (older people/OA/RA)
electrostatic (newly rinsed = less delivery than used)
What should the goal SpO2 be in patients at risk of CO2 retention?
88-92%
What is the normal SpO2 goal for patients (not at risk of CO2 retention)?
94-98%
