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CPT Drugs > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Beclometasone, budesonide

A

Indication: asthma
- regular preventer when reliver alone not sufficient

Class: inhaled corticosteroid

Action:

  • steroid - act at nucelus to modify transcription
  • block phospholipids to arachidonate (prostaglandins)
  • reduce mucosal inflamation, widen airways, reduce mucus
  • reduce symtoms, exacerbations, prevents death

Adverse effects:

  • local immunosupressive action - candidiasis, hoarse voice - can wash out mouth
  • penumonia risk possible im COPD at high doses

Other:

  • high FPM - poor oral bioavailability
  • liophilic side chain, slow dissolution in bronchial fluid, high affinity for gluccorticoid receptor
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2
Q

Salbutamol, terbutaline

A

Indication: asthma
- symptom releif as required

Class: Beta 2 agonist - SABA

Action:

  • beta 2, alpha s, cAMP, PKA
  • bronchodilation of airway smooth muscle
  • increase mucus clearance by cilia
  • prevent bronchoconstrction prior to exercise

Adverse effects:

  • adrenergic - tachycardia, palpitations, tremor, anxiety, increase glycogenolysis, increase renin
  • SVT - increase SAN, HR, decrease refractory period at AVN
  • when used regularly can reduce asthma control
  • tolerance - down regulation of receptors

Interactions: beta blockers reduce effects

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3
Q

Formoterol, salmeterol

A

Indication: asthma
- add on therpy to ICS

Class: Beta 2 agonist - LABA

Action:

  • beta 2, alpha s, cAMP, PKA
  • bronchodilation of airway smooth muscle
  • increase mucus clearance by cilia
  • prevent bronchoconstrction prior to exercise

Adverse effects:

  • adrenergic - tachycardia, palpitations, tremor, anxiety, increase glycogenolysis, increase renin
  • SVT - increase SAN, HR, decrease refractory period at AVN
  • only prescribed alongside ICS - alone can mask airway inflamation and fatal attacks

Interactions: beta blockers reduce effects

Other:

  • formoterol = fast long acting
  • salmeterol = slow long acting
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4
Q

Montelukast

A

Indication: asthma
- alternative to LABA in 2nd step

Class: leukotriene receptor antagonist

Actions:

  • block cysLT1 at cysLTR1(gpcr)
  • Blocks leukrotiene release from mast cells/eosinophils
  • decreases bronchoconstrction, mucus, oedema

Adverse effects:

  • headache
  • GI distrubance
  • dry mouth
  • hyperactivity

Other: useful in 15% of asthmatics - most move onto a LABA

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5
Q

Tiotropium

A

Indication: severe asthma and COPD

Class: long acting muscarinic antagonist - LAMA

Action: blocks vagally mediated contraction of airway smooth muscle (Ach)

Adverse effects:
- Antcholingeric - dry mouth, urinary retention, dry eyes

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6
Q

Theophylline

A

Indication: poorly controlled asthma

Class: adenosine receptor antagonist

Action: decrease bronchoconstrcition

Route: ORAL

Warnings:

  • narrow therapeutic window
  • arrythmias

Interactions: CYP450 inhibtors - increase conc of theophylline

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7
Q

Prednisolone

A

Indication: life threatening asthma

Class: steroid

Action:

  • steroid - act at nucelus to modify transcription
  • block phospholipids to arachidonate (prostaglandins)
  • reduce mucosal inflamation, widen airways, reduce mucus
  • reduce symtoms, exacerbations, prevents death

Other:

  • oral
  • minimum 5 days
  • Continue ics alongside
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8
Q

Ipratropium

A

Indicaton: life threatening asthma

Class: short acting muscarnic antagonist (SAMA)

Action: blocks vagally mediated contraction of airway smooth muscle (Ach)

Other: alongside beta 2 agonist if poor response alone

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9
Q

Aminophylline

A

Indication: life threatening asthma

Class: adenosine receptor antagonist

Action: decrease bronchoconstrcition

Route: IV

Other:

  • near fatal and no sucess with prednislone/ipratropium
  • caution if taking p.o theophylline
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10
Q

Asthma management steps

A
  1. Low dose ICS + SABA prn
  2. Low dose ICS/LABA + SABA prn OR
    Low dose ICS + LTRA + SABA prn
  3. Medium dose ICS/LABA +SABA prn OR
    Maintenance and reliever therapy (stop SABA)
  4. High dose ICS/LABA + SABA + additional therapies
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11
Q

Life threatening asthma management

A
  1. Oxygen - 94-98%
  2. High dose nebulised beta 2 agonist - oxygen driven
  3. Oral steroids - prednisolone
  4. Nebulised ipratropium bromide
  5. IV aminophylline if no success with above
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12
Q

COPD management

A

Confirm diagnosis, smoking cessation, breathlessness score/ offer pulmonary rehabilitation, vaccination, medication

Medication:

  • in acute exacerbations = nebulised salbutamol and/or ipratropium
  • oral steroids (less effective than in asthma, eosinophils vs neutrophils)
  • antibiotics
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CPT Drugs (16 decks)

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