resp medicine drugs Flashcards
how do selective B2 agonist work?
- 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
what kind of drug is salbutamol?
SABA
what is the onset and duration of salbutamol?
5 mins- lasting 4-6hrs
what are side effects of salbutamol?
tremor, sinus tachycardia, and hypokalaemia
what are examples of LABA?
tiotropium
sclidinium
glycopyrronium
umeclidinium
what are contraindications for antimuscarinics?
patients with narrow-angle glaucoma due to risk of increased intraocular pressure
what is an example of a SAMA?
ipratropium
what are common side effects of antimuscarnics?
Headache, dry mouth and disturbances in gastrointestinal motility
what is in a COPD combined bronchodilator?
LAMA/LABA
Study has shown LAMA/LABA decreases COPD exacerbations to a greater extent when compared to ICS/LABA (GOLD 2019)
what is the role of inhaled corticosteroids n COPD vs asthma?
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
what are side effects of inhaled corticosteroids?
Oral candidiasis, hoarse voice.
Systemic side effects rare but consider in long term and high dose therapy.
what are the different types of inhaled steroids?
Beclomethasone
Budesonide
Fluticasone
Mometasone
what are in COPD triple combination inhalers?
LAMA+LABA+ICS COPD with asthmatic features/features suggesting steroid responsiveness
what is MART therapy?
- 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
what are the methylxanthines?
- theophylline
- aminophylline- can be IV or Oral
why does theophylline and aminophyline dosing need to be carefully monitored?
- it has a small therapeutic window, side effects include;
- headache
- nausea
- vomiting
- tachycardia
- ventricular arrhythmia
- convulsions
can also cause convulsions
what drugs affect the level of theophylline?
Ciprofloxacin, erythromycin (Increase levels)
rifampicin, ritonavir and smoking reduce levels
what are theophylline used for?
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.
what are examples of leukotriene receptor antagonists
Montelukast
zafirlukast
what are LTRA used for?
additive effect in asthma
what are mucolytics?
carbocisteine
acetylcysteine
reduces goblet cell hyperplasia.
what is the stepwise treatment of asthma?
- SABA
- add ICS
- add LABA- can also increase ICS dose, if doesn’t work stop LABA and increase ICS
- Add methylxanthine or LTRA
- use daily steroid tablet
how to manage COPD?
non asthmatic features: LABA+LAMA asthmatic features: LABA+ICS If still breathless: LAMA+LABA+ICS
what is the ABC approach for AE of COPD?
Antibiotics - only if infective. Amox/doxy for 5 days
Bronchodilators - nebulised salbutamol/ipratropium or salbutamol via aerochamber
Corticosteroids - prednisolone 30mg for 5 days
when would you consider OD azithromycin?
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
