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8. Respiratory > PHARMACOLOGY: Respiratory Drugs > Flashcards

PHARMACOLOGY: Respiratory Drugs Flashcards

1
Q

List the 6 aspects of treatment of asthma.

A
  1. High flow oxygen
  2. Nebulised bronchodilators
  3. IV magnesium
  4. IV salbutamol/aminphylline
  5. Steroids
  6. Possible ventilation
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2
Q

List the 6 aspects of COPD treatment.

What is the most important difference between this and asthma therapy?

A
  1. Controlled oxygen (NOTE: never high flow in case they’re in type 2 resp failure)
  2. Nebulised bronchodilators
  3. IV salbutamol/aminophylline
  4. Mucolytics
  5. Steroids
  6. Consider ventilation
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3
Q

Give 2 examples of steroids used in asthma/COPD.

A

Beclomethasone

Prednisolone

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4
Q

List the 3 classes of bronchodilators.

A

Beta 2 agonists
Anti-muscarinic bronchodilators
Theophylline

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5
Q

Give 3 examples of beta 2 agonists.

Are they long or short acting?

A

SHORT ACTING:
Salbutamol

LONG ACTING:
Salmoterol
Formoterol

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6
Q

Give 2 examples of anti-muscarinic bronchodilators.

Are they long or short acting?

A

SHORT ACTING:
Ipratropium bromide

LONG ACTING:
Tiotropium

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7
Q

What other type of drug might be used in asthma?

Give 2 examples.

A

Leukotriene receptor inhibitors

Examples:
Montelukast
Zafirlukast

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8
Q

What other type of drug might be used in COPD?

Give 1 example.

A

Mucolytic drugs

Example:
Carbocysteine

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9
Q

List 3 antibiotics commonly used in the respiratory system.

A

Amoxacillin
Clarithromycin
Doxycycline
Co-trimoxazole

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10
Q

Give 2 examples of inhalers which combine steroids with long acting beta 2 agonists.

State which drugs are in them.

A

Seretide - fluticasone PLUS salmeterol

Symbicort - budesonide PLUS formoterol

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11
Q

Describe the mechanism of steroids in COPD/asthma. (3)

A
  1. Anti-inflammatory effect, causing decreased cell recruitment, e.g. of
    - T lymphocytes
    - Macrophages
    - Eosinophils
  2. Acts as a transcription factor, causing decreased cytokine production
  3. Causes upregulation of beta 2 adrenoreceptors
    - This causes increased responsiveness to beta 2 agonists
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12
Q

List 3 adverse effects of steroids.

A

Oral candidiasis
Adrenal suppression
Osteoporosis

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13
Q

What would you tell patients when you prescribe them inhaled steroids? (2)

A

If on high doses, they should carry a steroid card

Increased dose during periods of illness

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14
Q

Describe the mechanism of action of salbutamol.

NOTE: other beta 2 agonists work in exactly the same way, even if they’re long acting.

A
  1. Short acting beta 2 agonist (SABA)
  2. Causes relaxation of bronchial smooth muscle
    - This causes bronchodilation
  3. Inhibits cytokine release from mast cells and TNF alpha from monocytes
    - This reduces airway inflammation
  4. Increases mucous clearance from airways by stimulating cilia action
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15
Q

List 6 side effects of salbutamol.

A 
Tremor
Tachycardia
Arrhythmias
Headache
Sleep disturbances
Flushing
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16
Q

List 3 side effects of high dose salbutamol.

A

Hypokalaemia
Hyperglycaemia
Hypomagnesaemia

17
Q

What would you tell the patient when prescribing salbutamol? (2)

A

Check inhaler technique

If blue inhaler is needed more than once daily, then you need to review treatment

18
Q

What would you tell the patient when prescribing salmeterol? (3)

A

Report any deterioration in symptoms

Do not exceed stated dose

Seek medical advice when stated dose fails to control symptoms

19
Q

Describe the mechanism of action of anti-muscarinic bronchodilators. (3)

A
  1. Muscarinic receptor (M3) antagonists
    a. Normally, parasympathetic cholinergic/M2/M3 receptors cause bronchoconstriction
    b. When inhibited, there is bronchodilation
  2. Reduces mucous secretion
  3. May increase mucous clearance by stimulating cilia action
20
Q

List the side effects of anti-muscarinic bronchodilators. Consider:

a) Ipratropium bromide (3)
b) Tiotropium bromide (2)

A

IPRATROPIUM:
Blurred vision
Dry mouth
Decreased gut motility

TIOPTROPIUM:
Dry mouth
Dysuria

21
Q

How should nebulised ipratropium bromide be administered?

Why?

A

Via mouthpiece

Minimises risk of acute angle closure glaucoma (sudden, severe eye pain and reduced vision)

22
Q

Describe the mechanism of action of theophylline. (2)

A
  1. Inhibits phosphodiesterase type 4 enzyme (PDE4)
    a. This causes bronchodilation
  2. Increases mucous clearance by stimulating cilia action
23
Q

List 3 side effects of theophylline.

What are the features of serious drug theophylline? (4)

A

GI irritation
Tachycardia
CNS stimulation

Severe toxicity:

  • Hypokalaemia
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Seizures
24
Q

Which drugs will theophylline have drug interactions with?

A

CYP450 inducers/inhibitors

theophylline is metabolised by CYP450

25
Q

Describe the mechanism of action of leukotriene receptor inhibitors. (2)

A
  1. Block cysteinyl leukotriene receptor (CysLT1) in smooth muscle/macrophages
  2. Inhibit eicosonoids LTC4, LTD4 and LTE4 release from mast cells/eosinophils
26
Q

Describe the mechanism of action of mucolytic drugs. (2)

A
  1. Facilitate expectoration by decreasing sputum viscosity

2. May reduce exacerbations of COPD in some patients

27
Q

What is the main difference between type 1 and type 2 respiratory failure?

What causes the respiratory drive in each?

A

TYPE 1:
Low/normal pCO2
Low pO2
Respiratory drive: high pCO2

TYPE 2:
High pCO2
Low pO2
Respiratory drive: low pCO2 (because body is used to high pCO2)

8. Respiratory (14 decks)

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