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Respiratory - Week 2 > Respiration: Pharmacotherapy of airflow obstruction > Flashcards

Respiration: Pharmacotherapy of airflow obstruction Flashcards

1
Q

How can the drugs for the treatment of airflow obstructions be divided?

A

Preventers

Relievers

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2
Q

Why are oral steroids generally avoided in the treatment of airflow obstructions?

A

Poor therapeutic Window

Adverse side effects

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3
Q

What drugs are used when the symptoms of airflow obstruction are not controlled by an inhaled steroid?

A 
Anti-IgE
LABA
LAMA
Theoph
Leukotriene receptor anatagonist
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4
Q

What medication is given to act as anti -inflammatories?

A

Corticosteroids

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5
Q

What are corticosteroids used in the treatment of, in terms of airway obstruction diseases?

A

Asthma

COPD

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6
Q

What corticosteroids is used generally for asthma and COPD?

A

Prednisolone

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7
Q

What is the disadvantage of Prednisolone?

A

Low therapeutic ratio. The amount you need for efficacy is the same amount that causes adverse side effects

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8
Q

When are corticosteroid administered?

A

 only used for acute exacerbations (i.e. short amounts of time such as 2 weeks)

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9
Q

What are the side effects of corticosteroids?

A 
Weight Gain 
Fat deposits
Break down of skin collagen 
Osteoporosis 
Cataracts
Hypertension
Glucose Intolerance
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10
Q

What inhaled steroids are used for maintenance therapy?

A

Beclomethasone

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11
Q

What is the problem with topical inhaled route of drug delivery?

A

There will be systemic absorption directly into the lungs

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12
Q

What are the actions of the spacer device?

A
  • It makes the drug particles smaller and slower as they bounce around the spacer
  • Avoids coordination problems with pMDI (pressurised metered dose inhalers)
  • Reduces oropharyngeal and laryngeal side effects (e.g. laryngeal atrophy)
  • Reduces systemic absorption from swallowed fraction
  • It acts as a holding chamber so patient doesn’t need to worry about technique to the same extent
  • Larger particles also get stuck, this reduces the chance of infection due to the local immunosuppression that comes with steroids (e.g. oral thrush)
  • Improves lung deposition (drug distribution improves)
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13
Q

What anti-inflammatory is used in asthma as they work on the allergic response mechanism?

A

Cromones (e.g. cromoglycate)

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14
Q

How do Cromones work?

A

Mast cell stabiliser

Weak anti-inflammatory

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15
Q

What type of patient is cromoglycate effective for?

A

Atopic asthma in children

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16
Q

What are Leukotrine receptor anatagonists used for?

A

Used for asthma

Act as an anti-inflammatory

17
Q

What Leukotriene receptor antagonist is generally used in asthma?

A

Montelukast

18
Q

What are Leukotriene receptor anatgonists effect against?

A

Bronchospasm

Allergic rhinitis

19
Q

How is allergic rhinitis treated?

A

LTRA

Anti-histamine

20
Q

What type of antagonists are antihistamines?

A

 H1 (Histamine-1) receptor antagonists

21
Q

How are antihistamines administered?

A

Oral route

22
Q

What does the anti-IgE monoclonal antibody do?

A

 Omalizumab inhibits the binding to the high-affinity IgE receptor and inhibit mediator release from basophils and mast cells

23
Q

What are the types of bronchodilators?

A 
Short acting (SABA)
Long acting (LABA)
24
Q

What receptor do bronchodilators work on?

A

Beta 2 receptor

25
Q

What does stimulation of Beta 2 receptor cause?

A
  • Stimulate bronchial smooth muscle B2-receptors: increases cAMP
26
Q

What is the purpose of the M1 receptors?

A

M1-receptors enhance the cholinergic reflex

27
Q

What is the purpose of the M2 receptors?

A

M2-receptors inhibit acetylcholine release

28
Q

What is the purpose of the M3 receptors?

A

M3-receptors mediate bronchoconstriction and mucus secretion

29
Q

What anti-cholinergic drugs are there what do they affect?

A
  • Block post junctional end plate M3 receptors

Ipratropium - SAMA
Tiotropium - LAMA

30
Q

What are anticholinergic drugs mainly used for?

A

Used in the treatment of COPD to reduce exacerbations in a LAMA/LABA combo or on its own.

Used in triple therapy for Asthma

31
Q

What is done for the treatment of chronic asthma?

A
  • AIMS: Abolish symptoms, min β2-use, normalise FEV1, reduce PEF variability, reduce exacerbations, prevent long term airway remodelling
  • Avoid triggers
  • Suppress inflammatory cascade with inhaled steroid
  • +/- Non-steroidal anti-inflammatory therapy –e.g. theophylline ,anti-leukotriene, cromoglycate
  • Stabilise smooth muscle with LABA/LAMA –only once optimal anti-inflammatory therapy in place
32
Q

What is done for the treatment of acute asthma?

A
  • Oral prednisolone (or iv hydrocortisone )
  • Nebulised high dose salbutamol, ± Neb ipratropium, ± iv aminophylline/magnesium
  • 60% O2
  • ITU Assisted mechanical intubated ventilation if falling PaO2 and rising PaCO2
     never use respiratory stimulant
33
Q

What are the non-pharmacological treatments for COPD?

A 
	Smoking cessation 
o	+/- nicotine/bupoprion 
	Immunisation-Influenza/Pneumococcal 
	Physical activity 
	Oxygen –Domiciliary 
	Venesection
	Lung volume reduction surgery 
	Stenting
34
Q

What is the treatment of acute COPD?

A
  • Nebulised high dose salbutamol + ipratropium
  • Oral prednisolone
  • Antibiotic (amoxycillin/doxycycline) if infection
  • 24-28% O2 titrated against PaO2/PaCO2
  • Physiotherapist to aide sputum expectoration
  • Non-invasive ventilation to allow higher FiO2
  • ITU Intubated assisted ventilation only if reversible component (e.g . pneumonia)
35
Q

What are the Pharmacological treatments for COPD?

A

 LAMA: Tiotropium/Aclidinium
 LABA: Salmeterol/Formoterol
 LAMA-LABA combo: Aclidinium/Formoterol
 LABA-ICS combo: Beclometasone-Formoterol
 PDE4I-Roflumilast
 Mucolytic – Carbocisteine
 Antibiotics-Azithromycin – frequently given over winter months

Respiratory - Week 2 (8 decks)

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