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syspharm > Respi > Flashcards

Respi Flashcards

1
Q

Classes of drugs for sneeze

A

Antihistamines, decongestants, mast cell stabillizers

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2
Q

Why are 2nd gen antihistamines preferred over 1st gen for cough and cold treatment? (side effects, onset)

A

2nd gen used for allergy, no CNS effects because increased affinity for PGP pump, does not cross BBB.
Also shorter onset (1-2h) and longer DOA (12-24h).

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3
Q

Antihistamines: side effect

A

1st gen: sedative, dry mouth

2nd gen: dry mouth

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4
Q

Sympathomimetic agents: Class, names, MOA, ADR

A

Nasal decongestants
Pseudoephedrine, phenylephrine, oxymetazoline
Sympathetic NS causes blood vessels to constrict and lessen edema, these drugs act as direct alpha adrenoreceptor agonists
Hypertension, tachycardia, anxiety

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5
Q

Nasal glucocorticoids: Class, names, MOA

A

Nasal decongestants
Fluticasone, mometasone
Anti-inflammatory effects, decrease mucus secretion

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6
Q

Psudoephedrine, phenylephrine: Mode of administration

A

Oral

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7
Q

Cromoglicic acid: Class, MOA, ADR

A

Mast cell stabilizer (mucoregulator)
Targets IgE-FceRI mast cell degranulation, increases annexin a1 (anti-inflammatory).
Used for severe symptoms like 2nd line anti-inflammatory in asthma (not normal flu).
Bitter taste, may be difficult bc it’s an inhaled drug

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8
Q

Ipratropium: Classes, MOA, ADR

A

SAMA, mucoregulator

M3 receptor blocker. Used to treat mucus hypersecretion

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9
Q

Cough reflex pathway

A

Stimulation at mechano, chemoreceptors in larynx, trachea, bronchi
Carried by afferent C fibres in vagus nerve
Cough centre in medulla
Efferent fibres in vagus nerve
Respiratory muscles

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10
Q

Opioids: Class, name, MOA, ADR, contraindications

A

Antitussive (dry cough)
Codeine
Target opioid receptors in CNS cough centre to suppress cough, depress CNS by acting as agonists.
Sedation, constipation, urinary reten
Risk of substance abuse at high doses
Cannot take with alcohol (CNS depressant)
Cannot use in pts with respi insufficiency, head injury, pregnant women, children bc of underdeveloped respi centres

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11
Q

Non-opioids: Class, name, MOA, ADR

A

Antitussive (dry cough)
Dextromethorphan
Target CNS by blocking N-methyl-D-aspartate receptors to suppress cough
Risk of substance abuse at high doses (not as risky as codeine)
Nausea, drowsiness, dizziness

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12
Q

Types of mucoactives

A

Mucolytics, mucokinetics, mucoregulators, expectorants

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13
Q

Mucolytics: Class, name, MOA, ADR, contraindications

A

Mucoactives (productive cough)
-cysteines
Prodrugs. Mucus-thinning, breaks up mucus for easier expulsion
ADR: Bronchospasm, cannot use in asthmatics

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14
Q

Mucokinetics: Class, name, MOA, contraindications

A

Mucoactives (productive cough)
Bromhexine -> Ambroxol
Targets ciliary escalator, increases ciliary beat frequency to increase transportability
Contraindications: Asthmatics, caution in <6yo, cannot use <2yo

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15
Q

Guaifenesin: Class, MOA, ADR, contraindications

A

Expectorant (Productive cough)
Increase water content of phlegm by producing more respiratory liquids, promote expulsion of mucus
ADR: kidney stones
Contraindications: caution in <6yo

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16
Q

Pathogenesis of 2 types of asthma

A

Type 1 (allergic): IL-4, IL-13 produced by T helper cells stimulate B cells for more antibody production. IgE-FceRI crosslinking of mast cells lead to histamine production

Type 2 (eosinophilic): IL-5 by T helper cells stimulate eosinophil infiltration in lungs

17
Q

Pathogenesis of asthma: early and late phase

A

early: bronchoconstriction and mucus secretion due to cytokines
late: epithelial damage and airway narrowing due to eosinophil recruitment which produce more cytokines

18
Q

Morphological changes in chronic asthma

A

Airway remodelling due to repeated bouts of allergen exposure and immune reactions
Hyperplasia of smooth muscle and goblet cells, hence mucus overproduction and airway hypersensitivity

19
Q

Why can’t LABAs be used alone for asthma maintenance therapy?

A

Constant use of LABA leads to tolerance, downregulation of B2 receptors over time. Dangerous because in the event of an attack, insufficient receptors for B2 agonist. ICS protects against this bc upregulates B2R expression.

20
Q

Name 1 SABA, DOA

A

Salbutamol, 3-6h

21
Q

Formoterol vs indacaterol

A

Both are LABAs with fast onset. Formoterol DOA is 12h but Indacaterol DOA is 24h

22
Q

LABA with slow onset, lipophilic

A

Salmeterol

23
Q

B2 Agonists: Class, names, MOA, ADR, contraindications

A

1st line bronchodilator for asthma
Salbuterol, Formoterol, Indacaterol, Salmeterol
Activates adenylyl cyclase, increase cAMP for smooth muscle relaxation
Tremors, peripheral vasodilation bc B2R present on blood vessels
LABAs should not be prescribed alone

24
Q

Muscarinic antagonists: Class, name, MOA, ADR,

A

2nd line bronchodilator for asthma
Ipratroprium (SAMA), Tiotroprium bromide (LAMA)
Antagonists to M3 receptors, decrease vagus nerve-related mucus secretion and bronchoconstriction
Dry mouth, urinary retention

25
Q

Methylxanthines: Class, name, MOA, ADR, contraindications

A

2nd line bronchodilator for asthma
Theophylline
Phosphodiesterase inhibitor, inhibits formation of AMP from cAMP. More cAMP, more smooth muscle relaxation
Cannot take with caffeine which is also a methylxanthine, will have additive effects
Narrow TI

26
Q

Cysteinyl-leukotriene R antag: Class, name, MOA,

A

2nd line bronchodilator and anti-inflammatory for asthma
Montelukast
More anti-inflammatory as Cyst-L receptors are present on mast cells, but also a weak bronchodilator
Neurological effects, suicidal thinking

27
Q

Which ICS may cause adrenal suppression?

A

Fluticasone

28
Q

ADR of ICS

A

Immunosuppressant, increases risk of oral candidiasis and Cushing’s syndrome

29
Q

ICS: Class, name, MOA

A 
1st line anti-inflammatory for asthma
Fluticasone, ciclesonide
Decrease T cells, eosinophils, mast cells
Decrease mucus secretion
Decrease PLA2
Decrease COX2 (prostaglandins)
Decrease 5-LOX (leukotrienes)
Increase annexin A1
Increase B2R
30
Q

Chemical properties of ICS (so that can be inhaled)

A

Low lipophilicity
Low first pass (less systemic side effects)
High receptor affinity (low dose)

31
Q

5-LOX inhibitors: Class, name, MOA, ADR, contraindications

A

2nd line anti-inflammatory for asthma
Zileuton. 5-LOX catalyses synthesis of leukotrienes from arachidonic acid
Neurological effects, suicidal thinking

32
Q

Anti-IgE monoclonal antibody: Class, name, MOA, ADR

A 
2nd line anti-inflammatory for asthma
Omalizumab
Only given if pt does not respond to ICS
EXPENSIVE, subq injection
Potential for anaphylaxis
33
Q

Anti-IL5 monoclonal antibody: Class, name, MOA, ADR

A

2nd line anti-inflammatory for asthma
Reslizumab
Potential for anaphylaxis

34
Q

Characteristic features of COPD

A 
Pink puffers (emphysema), blue bloaters (bronchitis)
Inflammation, alveolar destruction, mucus hypersecretion
35
Q

Why are muscarinic antagonists preferred over B2 agonists for COPD treatment?

A

Goal is to lower secretions and increase bronchodilation, by stimulating sympathetic and lowering muscarinic.

36
Q

2nd line COPD drugs

A

ICS, methylxanthine, PDE-4 inhibitors, azithromycin

37
Q

PDE-4 Inhibitors: Name, MOA, ADR

A

Roflumilast
Same as theophylline, but also slows down fibrosis.
Caution for hepatic impairment

38
Q

Azithromycin: MOA, ADR

A

Has anti-fibrotic and smooth muscle relaxant properties.

Disrupts GI flora, risk of diarrhoea, nausea, vomiting, cardiac arrythmia

syspharm (10 decks)

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