Raymond Parker Flashcards

Question

MICA of ultibro breezhaler

Answer 1

M: Bronchodilators. LAMA - Bind to muscarinic receptors and act as a competitive inhibitor of acetylcholine. Muscarinic ACh receptors are G-protein coupled receptors that act through 2nd messengers. M3 muscarinic receptors found on smooth muscle cells in airway and when activated, they cause bronchoconstriction. By blocking this pathway, the LAMAs reduce smooth muscle tone and act as bronchodilators. LABA - B2 receptors found in smooth muscle in bronchi. They are Gs-protein coupled receptors which inhibit myosin light chain kinase and lead to smooth muscle relaxation. Long acting beta 2 agonists relax smooth muscles in lungs increasing airway diameter for up to 12 hours (salbutamol a SABA only works for up to 3 hours) I - LAMA helps prevent breathlessness and exacerbations in COPD. LAMAs can be added to high dose inhaled corticosteroids and LABAs as maintenance treatment in pts who have had one or more severe asthma exacerbations in the past year. LABA used as treatment combined with corticosteroids for chronic asthma when corticosteroids alone are insufficient. Second line therapy for COPD to improve symptoms and reduce exacerbations. C - LAMA - Should be used with caution in pts with angle-closure glaucoma, arrhythmias & urinary retention (but most pts can take them as long as its by inhalation and not oral/IV) LABA - Associated with increased asthma deaths when not used alongside corticosteroids in chronic asthma. Care should be taken for pts with cardiovascular disease, in whom tachycardia may provoke angina or arrhythmia. A - LAMA - Irritation of respiratory tract with nasopharyngitis, sinusitis and cough; GI disturbance including dry mouth, constipation, urinary retention, blurred vision and headaches. LABA - Activation of Beta receptors in other tissues results in tachycardia, palpitations, anxiety and tremor. LABAs also can cause muscle cramps.

Answer 2

MOA: tetracyclines such as doxycycline are thought to inhibit translation by binding to the 16S rRNA portion of the ribosome, preventing binding of tRNA to the RNA-30S bacterial ribosomal subunit, which is necessary for the delivery of amino acids for protein synthesis. As a result of the above actions, the initiation of protein synthesis by polyribosome formation is blocked. This stops the replication of bacteria and produces a bacteriostatic effect Indications: infections such as chlamydia and mycoplasma, severe infections including refractory UTI, acute sinusitis, acute cough, pneumonia,acute exacerbation of bronchiectasis and COPD, mild diabetic foot infection, cellulitis, acne, leg ulcer infection, rosacea, syphilis, PID, lyme disease, prophylaxis of malaria CIs: pregnancy and breast feeding due to teratogenicity. Cautions include alcoholism and children 8-11 (only use when no alternative) Adverse effects: Dyspnoea, hypotension, peripheral oedema, tachycardia, GI discomfort

Answer 3

M: The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation.4 Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days. Glucocorticoids inhibit neutrophil apoptosis and demargination; they inhibit phospholipase A2, which decreases the formation of arachidonic acid derivatives; they inhibit NF-Kappa B and other inflammatory transcription factors; they promote anti-inflammatory genes like interleukin-10 I: acute exacerbation of COPD, croup, mild to moderate acute asthma, suppression if inflammation and allergic disorders, ITP, UC C: bowel perforation, extensive fistulas, recent intestinal anastamosis A: diarrhoea, dizziness, hiccups, hypoT, malaise

Answer 4

M: By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, penicillin G inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that penicillin G interferes with an autolysin inhibitor I: infection, endocarditis, anthrax, meningitis C: allergy A: fever, Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting

Answer 5

Mechanism of action: it inhibits bacterial protein synthesis by binding to the bacterial 50s ribosomal subunit. Binding inhibits peptidyl transferase activity and interferes with amino acid translocation during the translation and protein assembly process. Clarithromycin may be bacteriostatic (stops bacterial growth) or bactericical depending on the organism and drug concentration Indications: 1) Treatment of respiratory, skin and soft tissue infections as an alternative to penicillin when use is contraindicated. 2) In severe pneumonia added to a penicillin to cover atypical organisms including Legionella pneumophila and Mycoplasma pneumoniae 3) Eradication of H.pylori in combination with a proton pump inhibitor and either amoxicillin or metronidazole Contraindications - Avoid in people who are allergic to macrolides or inactive ingredient in tablets - People with a history of cholestatic jaundice and/or liver dysfunction associated with prior clarithromycin use. - Renal impairment Adverse effects: - Nausea, vomiting, diarrhoea, and abdominal pain when taken orally - Allergy - Antibiotic associated colitis - Ototoxicity at high doses

Answer 6

central pattern generator (CPG), sometimes also referred to as the 'respiratory pattern generator' (RPG).

Answer 7

``` Chronic bronchitis (a type of COPD) • Asthma • Pulmonary edema • Airway obstruction, such as aspiration (e.g., choking on food, swallowing a toy) • Pneumonia • Sleep apnea • COPD Pulm HT ```