Respi pharm Flashcards by Matthew Chang

What are the first line drugs for asthma

SABA (relief) + LABA (control) + ICS (anti-inflammatory)

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What is used as an adjunct for severe acute asthma

MgSO4

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What is the MOA of B2 agonist

B2 receptor activation => Increase Adenyl Cyclase activity => Increase ATP-> cAMP => Bronchodilation

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Name 2 SABAs and 2 LABAs and describe their selectivity and duration of action

SABA
- Adrenaline (non-selective) = 1-3h
- Salbutamol (B2 selective) = 3-6h

LABA
- Formoterol and Salmeterol (B2 selective) = 12h

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What are the indication of B2 agonist bronchodilators

Adrenaline = emergency
Salbutamol = Relieve bronchospasm
Formoterol = Relief and control
Salmaterol = Maintenance control

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What are the adverse effects of B2 agonists

Tremor
Flushing
Hypokalaemia/Hyperglycaemia
B2R tolerance

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Why should LABAs never be prescribed alone and instead what should they be prescribed with

Alone LABAs decrease B2R => Decreases effectiveness
ICS

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What are the second line bronchodilators

Musarinic R antagonists (Ipratropium = SAMA, Glycopyronium = LAMA)
Theophylline
LTR antagonists

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What is the MOA and a/e of muscarinic R antagonists

Antagonise M3 receptors => Decrease parasympathetic activity => Decrease bronchoconstriction

Dry mouth, Urinary retention (elderly)

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What is the MOA and a/e of Theophylline

Decrease bronchoconstriction
PDE blocker that prevents cAMP -> AMP => Bronchodilation

Arrythmias, GIT issues

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Name 2 ICS

Fluticasone
Budenoside

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What is the MOA of ICS

Increase Annexing-A1 and B2R expression
Mast cell stabilisation
Decrease microvascular leakiness
Increase mucociliary clearance

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What makes a good ICS and why is inhalation the preferred route of administration

Limit side effects

High affinity
Extensive metabolic first pass
High lipophilicity

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What are the adverse effects of ICS

Immunosuppression => Oral candiasis
Adrenal suppression (Fluticasone)
Dysphonia

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What is Ciclesonide

Soft steroid => Inactive in systemic circulation

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Name 2 LT pathway inhibitors

Montelukast
Zileuton

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What are the adverse effects of LT pathway inhibitors

Churg-Strauss syndrome
Suicidal and neuropsychiatric effects

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What is the route of administration of LT pathway inhibitors

Oral

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Name an anti-IgE antibody

Omalizumab

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What are the adverse effects of anti-IgE antibody

Heart attacks
Blood clots
Anaphylaxis

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Name an anti-IL5 antibody

Reslizumab

What is the adverse effect of anti-IL5 antibody

Oropharyngeal pain

What are the indications of anti-IL5 antibody

Persistent eosinophilic asthma in patients above 18

What are the treatments for COPD

A = 0-1 moderate exacerbations, mMRC 0-1; CAT <10 => Bronchodilator

B = 0-1 moderate exacerbations, mMRC >2; CAT >10
=> LABA + LAMA

E = 2 moderate exacerbations/ >1 leading to hospitalisation => LABA + LAMA

E = >2 moderate exacerbations/ 1 leading to hospitalisation; EOS >300 => LABA + LAMA + ICS

What are the contraindications against ICS use

Repeated pneumonia Blood eosinophils <100 cells/microL Mycobacterial infection history

What antibiotic is prescribed in COPD

Macrolide

How does macrolide help in COPD

Broad spectrum Anti-fibrotic Muscle relaxant

What drugs are prescribed for rhinorrhea

Antihistamine (Chlopheniramine) and decongestant (Oxymetazoline, phenylephrine) Mucoregulator (Ipratropium) and mast cell stabiliser (Cromoglicic acid) for severe

What are the adverse effects and contraindications of macrolides

Diarrhoea Avoid hepatic dysfunction CYP450 metabolisers (except azithromycin)

What is the MOA of antihistamines

Inverse H1 agonists => Prevents degranulation of histamine through crosslinking of FCER1 bound IgE on mast cells

What are the adverse effects of antihistamines

Drowsy Dry mouth (M) Hypotension(A)

What are the contraindications of chlorpheniramine

Glaucoma

What is the MOA of mucoregulators

M3 antagonist => decrease goblet cell activation => decrease mucus

What are the adverse effects of decongestants

Rebound congestion Restlessness Hypertension

What is the MOA of decongestants

A1-agonist -=> increase NE release => vasoconstriction => Decrease mucus secretion and inflammation

What are the adverse effects of mucoregulators

Dry mouth Urinary retention (elderly)

What is the MOA of mast cell stabilisers

Block IgE Ca2+ channels => blocks histamine and cytokine release Increase annexin-A1

What are the adverse effects of mast cell stabilisers

Dry mouth Cough Nasopharynx irritation

What are the drugs prescribed for cough

Dry cough = antitussives - Opoid = codeine - Non-opoid = Dextromethorphan, Diphenyhydramine Productive cough - Expectorant - Mucolytics

What is the MOA of opioid antitussives

Binds to opioid receptors in CNS => Suppress cough

What is the MOA of non-opioid antitussives

Dextromethorphan = Binds to opioid receptors in CNS => Suppress cough Diphenhydramine = unknown

What are the adverse effects of opioid antitussives

Sedation Abuse Respiratory depression Avoid CYP2D6 metabolisers

What are the adverse effects of dextromethorphan

Sedation Nausea, vomitting Abuse

What are the adverse effects of diphenhydramine

Sedation Dry mouth Urinary retention

Name an expectorant

Guaifenesin

What is the MOA of expectorants

Increase respiratory tract fluid => Liquefy and discrease mucus viscosity

What are the adverse effects of expectorants

GI disturbances and nausea

Name a mucolytic

Acetyl cysteine

What is the MOA of mucolytics

Frees sulfhydryl group => Opens disulphide bonds => Decrease mucus viscosity

What are the adverse effects of mucolytics

Bronchospasm => avoid asthma Anaphylactoid rxns GI issues