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AAClinical school conditions > Pharmacology - respiratory and GI > Flashcards

Pharmacology - respiratory and GI Flashcards

1
Q

Classes of bronchodilators

A

B2 agonists,
antimuscarinics
theophylline

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2
Q

Name a type of mucolytics

A

Carbocisteine, N-acetylcysteine.

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3
Q

Example of anti-inflammatory drug classes for asthma

A

Steroids, phosphodiesterase-4 inhibitors.

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4
Q

Example of anti-fibrotics

A

Perfenidone

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5
Q

Asthma management

A

Short acting B-agonist such as Salbutamol 200 mg.
Add low dose inhaled steroid such as betclometasone.
Add either a long-acting B agonist (salmeterol) or increase dose of ICS.
Increase steroids or add leukotriene receptor antagonist.
Under specialist guidance, start oral corticosteroid therapy.

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6
Q

Adverse effects of salbutamol

A

Commonly muscle tremors and tachycardia,

Rarely hypokalaemia, esp with interactions e.g. high dose corticosteroidds or diuretics.

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7
Q

Treatment of COPD if FEV1 is less than 50% of predicted

A

Either long acting antimuscarinic bronchodilator or long acting Beta2 agonist with corticosteroid.

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8
Q

Adverse effects of beclometasone

A

Cough and oral candidiasis.

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9
Q

Example of leukotriene receptor antagonists

A

Montelukast

Zafirlukast

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10
Q

Action of leukotriene receptor antagonist

A

Prevent leukotriene mediated bronchoconstriction.

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11
Q

Treatment of allergic IgE mediated asthma

A

Omalizumab as an add on to optimised standard therapy.

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12
Q

Theophylline action

A

Inhibition of PDE, adenosine receptor blockade, inhibition of inflammatory cells

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13
Q

Example of a phosphodiesterase inhibitor

A

Methylxanthine.

Rofumilast

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14
Q

Treatment of COPD when FEV1 is 50% or more of predicted.

A

Either long acting antimuscarinic bronchodilator or long acting Beta2 agonist.

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15
Q

COPD treatment if unable to use inhaler

A

Oral theophylline
Mucolytic drug
Oxygen therapy.

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16
Q

Treatment of GORD

A

Lifestyle modifications
Stop exacerbating drugs
Acid neutralisation
Mechanical prevention

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17
Q

Methods of acid neutralisation

A

Antacids
Acid suppression with H2 blockers
Proton pump inhibitors
Prokinetics

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18
Q

Mechanisms of antacids

A

Direct neutralisation by Mg or aluminium salts.

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19
Q

Mechanism of actions on H2 antagonist

A

Competitively inhibit histamine actions at all H2 receptors.

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20
Q

Examples of H2 antagonists

A

Cimetidine, Ranitidine.

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21
Q

Examples of proton pump inhibitors

A

Omeprazole 20mg/day, Esomeprazole 40mg/day
Lansoprazole 30mg/day
Pantoprazole 40 mg/day

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22
Q

Prokinetics used in GORD

A

Metoclopramide, domperidone

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23
Q

Prokinetics used in GORD - mechanisms

A

Dopamine antagonists.

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24
Q

Treatment of peptic ulcer disease

A

Helicobacter Pylori eradication
A PPI, amoxicillin and clarithromycin or metronidazole. (unless penicillin allergic. Then no amoxicillin, and both the third options.
Other drugs include bismuth chelate, sucralfate ad misoprostol.

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25
Q

Antiemetic drug classes - 1 2 3

A

M1 antagonists
Histamine H1 antagonists
D2 antagonists
5 HT3 receptor antagonists

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26
Q

Anticholinergic M1 antagonists

A

Scopolamine

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27
Q

H1 receptor antagonists

A

Cyclizine, promethiazine.

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28
Q

5 HT3 receptor antagonists

A

Ondansetron, granisteron

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29
Q

Classes of laxatives

A

Osmotic
Bulk-forming
Softeners
Stimulant

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30
Q

Treatment of severe acute asthma: OBC

A

Oxygen
B2 agonist by large volume spacer or nebs
Corticosteroid
(aminophylline infusion if not on theophylline)

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31
Q

Treatment of IECOPD

A

 Nebulised bronchodilators and oxygen
 Aminophylline
 Corticosteroids
 Abx.

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32
Q

Treatment of opiate overdose

A

Naloxone

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33
Q

Treatment of paracetamol overdose

A

Acetylcysteine.

If severe organ damage escalate.

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34
Q

Overdose causing drowsiness, ataxia, slurred speech, coma, RESP DEPRESSION and hypotension. Vomiting if combined w alcohol

A

Benzodiazepine

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35
Q

Treatment of benzodiazepine overdose

A

Protects airway and monitor

Flumezenil if marked resp depression, but beware of seizures.

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36
Q

Severe organ damage signs in paracetamol overdose

A

INR > 3.0
ALT > 1000 U/L
Hypotensive
Increased serum creatinine.

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37
Q

What is seretide?

A

Fluticasone 250 mcg and Salmeterol 50 mc. An asthma treatment - steroids and LABA.

38
Q

What is cetirizine used for and at what dosage?

A

Allergies. 10 mg OD for adults.

39
Q

Recommended treatment for severe CAP, patient

A

Initially IV therapy.
Coamoxiclav
Erythromycin (or clarithromycin)

40
Q

What local anaesthetics could you use for a pleural effusion drain?

A

Lidocaine and prilocaine have fast onset and actions last an hour.
Bupivacaine has slower onset but lasts longer.

41
Q

Usual dose of 1% lidocaine for local anaesthesia

42
Q

What is it important to do when administering lidocaine.

A

Draw back plunger to ensure not in vascular compartment.

43
Q

Toxic effects of local anaesthesia occur when serum levels get too high. What are the effects?

A

Feeling of inebriation, lightheadedness, sedation, circumoral paraesthesia and twitching.

44
Q

Osteoporosis prophylaxis

A

Bisphosphonate such as alendronic acid.

Consider when on long term steroids.

45
Q

GI side effects of bisphosphonates

A

Oesophageal ulceration. Stay upright for 1/2 hour, drink full glass of water with it.

46
Q

How does paracetamol overdose cause hepatotoxicity?

A

Alternative pathways become saturated, so paracetamol metabolism is shifted to the CYP450 pathway. Large amounts of NAPQI are therefore produced. Endogenous glutathione is insufficient to deactivate the large amounts of NAPQI, so this causes hepatotoxicity.

47
Q

How does acetylcysteine IV infusion prevent hepatotoxicity in paracetamol overdose?

A

It is a precursor to glutathione, increasing capacity to conjugate NAPQI

48
Q

When would you use a reducing dose of prednisolone?

A

Short term: to reduce the durations of morbidity in IECOPD or acute flare of asthma.
Long term: suppress the immune system in IgE mediated asthma.

49
Q

Why would you use a reducing dose of prednisolone in IECOPD or an acute flare of asthma.

A

Reduce risk of relapse caused by acute withdrawal.

Ensure minimum effective dose is given.

50
Q

Why would you use a reducing dose of prednisolone in IgE mediated asthma

A

Prevent Addisonian effects if a patient is steroid-dependent

51
Q

Discuss different ways of weaning prednisolone.

A

A normal wean-off; takes days.
A slow wean; pt will experience some adrenal suppression.
If prednisolone dose approaches 7.5 mg OD then weaning needs to be VERY slow.

52
Q

Indications for bronchoscopy

A

Suspected carcinoma, slowly resolving pneumonia, pneumonia in the immunosuppressed and interstitial lung disease.

53
Q

Diagnostic indications for bronchial lavage

A

suspected malignancy, pneumonia in immunosuppressed, suspected TB, interstitial lung disease.

54
Q

Percutaneous needle biopsy is used for…

A

Peripheral lung and pleural lesions.

55
Q

Transbronchial biopsy is used to diagnose…

A

Diffuse lung diseases.

56
Q

At risk groups who should get pneumococcal vaccine

A

More than 65 years.
Chronic cardiac, hepatic, renal or resp patients
DM
Immunosuppressed
AIDS
CONTRAINDICATED in pregnancy or lactation.

57
Q

Treatment for mild or moderate CAP

A

Amoxicilin or clarithromycin or doxycycline. If moderate, give former together.

58
Q

Treatment for legionella pneumonia

A

fluoroquinolone with clarithromycin or rifampicin.

59
Q

Treatment for chlamydophila pneumonia

A

Tetracycline

60
Q

Treatment for HAP

A

Aminoglycoside and penicillin

61
Q

Treatment for aspiration pneumonia

A

cephalosporin and metronidazole.

62
Q

Treatment for staph pneumonia

A

flucloxacillin and rifampicin (if MRSA, consider vancomycin).

63
Q

Treatment for mycoplasma pneumonia

A

Clarithromycin or doxycycline.

64
Q

Complications of pneumonia: treating type 1 resp failure

A

High flow oxygen (60%). Careful in COPD patients. Transfer to ITU if not improving.

65
Q

Complications of pneumonia: hypotension

A

Due to dehydration and vasodilation.
If systolic BP is less than 90, give IV fluid challenge. If BP does not rise, consider a central line and give IV fluids to maintain systolic BP above 90.

66
Q

Complications of pneumonia: AF

A

Usually resolves with treatment of pneumonia. Sometimes B-blocker or digoxin is used to slow ventricular response rate in short term.

67
Q

Complications of pneumonia: pleural effusion

A

Drainage only if large and symptomatic or infected.

68
Q

Complications of pneumonia: empyema - qualities of aspirated pleural fluid

A

Yellow and turbid, with low pH and glucose, and high LDH.

69
Q

Treatment of allergic bronchopulmonary aspergillosis

A

Prednisolone. Sometimes itraconazole with corticosteroids.

70
Q

Treatment for aspergilloma

A

Surgical excision if symptomatic.

71
Q

Invasive aspergillosis

A

Voriconazole

72
Q

Asthma management

A

Short acting B2-agonist
Inhaled steroid
Long acting B2-agonist and increase steroid
Oral B2-agonist, leukotriene receptor antagoinst, oral theophylline or high dose steroids.
Oral steroids.

73
Q

COPD treatment

A

B2-agonist and/or long acting muscarinic such as tiotropium.
Severe - add long acting B2 agonist and corticosteroids.

74
Q

Acute respiratory distress syndrome - causes

A

Pneumonia, aspiration, inhalation, injury, vasculitis, contusion.
Shock, septicaemia, haemorrhage, multiple transfusions, DIC, and many others.

75
Q

ARDS - clinical features

A

Cyanosis, tachypnoea, tachycardia, peripheral vasodilation, bilateral inspiratory crackles.

76
Q

ARDS - investigations

A

FBC, U&Es, LFTs, amylase, clotting, CRP. (underlying cause).
Blood cultures, ABG.
CXR shows bilateral pleural infiltrates.
Pulmonary artery catheter to measure pulmonary cap wedge pressure.

77
Q

ARDS - diagnostic criteria

A

Acute onset
CXR with bilateral infiltrates
Pulmonary cap wedge pressure less than 19mmHg or lack of CCF
Refractory hypoxaemia.

78
Q

ARDS management

A

Admit to ITU - respiratory support e.g. mech ventilation, circulatory support, check for and treat sepsis, nutritional support.
Treat underlying cause.

79
Q

PE treatment

A

LMW heparin; stop when INR is greater than 2.
Start warfarin.
For massive PE needing thrombolysis, use alteplase.
Vena caval filter only if recurrent on anti-coagulation.

80
Q

Inhibitors of the P450 system include

A 
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine, omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
81
Q

Opioids should be used with caution in patients with chronic kidney disease. What is preferred?

A

Alfentanil, buprenorphine and fentanyl are preferred

82
Q

Morphine breakthrough dose should be what proportion of daily dose?

83
Q

To convert from codeine to morphine, what do you divide by?

84
Q

How much should you increase opioid dose if you need to increase it?

85
Q

Which antibiotic is a common cause of cholestasis?

A

Co-amoxiclav

86
Q

Which antibiotic classes may atypical pneumonias not respond to?

A

Penicillins and cephalosporins.

87
Q

When is IV magnesium sulphate useful?

A

In acute asthma

88
Q

What antibiotic should you use for an animal bite?

A

Co-amoxiclav

89
Q

Treatment for ulcerative colitis - inducing remission

A

treatment depends on the extent and severity of disease
rectal (topical) aminosalicylates or steroids: for distal colitis rectal mesalazine has been shown to be superior to rectal steroids and oral aminosalicylates
oral aminosalicylates
oral prednisolone is usually used second-line for patients who fail to respond to aminosalicylates. NICE recommend waiting around 4 weeks before deciding if first-line treatment has failed
severe colitis should be treated in hospital. Intravenous steroids are usually given first-line

90
Q

Ulcerative colitis - maintaining remission

A

oral aminosalicylates e.g. mesalazine
azathioprine and mercaptopurine
methotrexate is not recommended for the management of UC (in contrast to Crohn’s disease)
there is some evidence that probiotics may prevent relapse in patients with mild to moderate disease

91
Q

Which TB treatment inhibits the P450 system?

AAClinical school conditions (32 decks)

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