resp medicine drugs

Question 1

how do selective B2 agonist work?

Answer 1

• stimulate B2 adrenoreceptor in airway smooth muscle
• to stimulate adenylyl cyclase
• this increases CAMP
• which activates protein kinase
• which leads to inhibition of myosin light chain kinase
• which inhibits smooth muscle contraction
• resulting in bronchial smooth muscle relaxation

Question 2

what kind of drug is salbutamol?

Answer 2

SABA

Question 3

what is the onset and duration of salbutamol?

Answer 3

5 mins- lasting 4-6hrs

Question 4

what are side effects of salbutamol?

Answer 4

tremor, sinus tachycardia, and hypokalaemia

Question 5

what are examples of LABA?

Answer 5

tiotropium
sclidinium
glycopyrronium
umeclidinium

Question 6

what are contraindications for antimuscarinics?

Answer 6

patients with narrow-angle glaucoma due to risk of increased intraocular pressure

Question 7

what is an example of a SAMA?

Answer 7

ipratropium

Question 8

what are common side effects of antimuscarnics?

Answer 8

Headache, dry mouth and disturbances in gastrointestinal motility

Question 9

what is in a COPD combined bronchodilator?

Answer 9

LAMA/LABA

Study has shown LAMA/LABA decreases COPD exacerbations to a greater extent when compared to ICS/LABA (GOLD 2019)

Question 10

what is the role of inhaled corticosteroids n COPD vs asthma?

Answer 10

Reduce airway inflammation
Asthma: Improves symptoms, lung function and quality of life, reduces frequency
of exacerbations.
Associated with increased risk of pneumonia
COPD: Withdraw if no improvement

Question 11

what are side effects of inhaled corticosteroids?

Answer 11

Oral candidiasis, hoarse voice.

Systemic side effects rare but consider in long term and high dose therapy.

Question 12

what are the different types of inhaled steroids?

Answer 12

Beclomethasone
Budesonide
Fluticasone
Mometasone

Question 13

what are in COPD triple combination inhalers?

Answer 13

LAMA+LABA+ICS COPD with asthmatic features/features suggesting steroid responsiveness

Question 14

what is MART therapy?

Answer 14

• maintainance and reliever therapy- so combines ICS with a reliever (LABA/LAMA) so person doesn’t have to use 2 inhalers

is a therapy for asthma

Question 15

what are the methylxanthines?

Answer 15

• theophylline

- aminophylline- can be IV or Oral

Question 16

why does theophylline and aminophyline dosing need to be carefully monitored?

Answer 16

• it has a small therapeutic window, side effects include;
• headache
• nausea
• vomiting
• tachycardia
• ventricular arrhythmia
• convulsions
  can also cause convulsions

Question 17

what drugs affect the level of theophylline?

Answer 17

Ciprofloxacin, erythromycin (Increase levels)

rifampicin, ritonavir and smoking reduce levels

Question 18

what are theophylline used for?

Answer 18

COPD: Small bronchodilator effect in stable COPD.

Asthma: Theophyllines may improve lung function and symptoms, but side effects occur more commonly
COPD: Small bronchodilator effect in stable COPD.

Question 19

what are examples of leukotriene receptor antagonists

Answer 19

Montelukast

zafirlukast

Question 20

what are LTRA used for?

Answer 20

additive effect in asthma

Question 21

what are mucolytics?

Answer 21

carbocisteine
acetylcysteine
reduces goblet cell hyperplasia.

Question 22

what is the stepwise treatment of asthma?

Answer 22

1. SABA
2. add ICS
3. add LABA- can also increase ICS dose, if doesn’t work stop LABA and increase ICS
4. Add methylxanthine or LTRA
5. use daily steroid tablet

Question 23

how to manage COPD?

Answer 23

non asthmatic features: LABA+LAMA
asthmatic features:
LABA+ICS
If still breathless:
LAMA+LABA+ICS

Question 24

what is the ABC approach for AE of COPD?

Answer 24

Antibiotics - only if infective. Amox/doxy for 5 days
Bronchodilators - nebulised salbutamol/ipratropium or salbutamol via aerochamber
Corticosteroids - prednisolone 30mg for 5 days

Question 25

when would you consider OD azithromycin?

Answer 25

If exacerbations are not managed with optimised non-pharmacological management and inhaled therapies, vaccinations and PR and continue to have 1 more of the following;
frequent (typically 4 or more per year) exacerbations with sputum production
prolonged exacerbations with sputum production
exacerbations resulting in hospitalisation.[NICE 115 2018]Azithromycin 250mg OD on a Monday, Wednesday and Friday