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Clinical Pharmacology And Therapeutics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the side effects of inhaled corticosteroids

A

Throat infections, hoarseness

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2
Q

Some counselling points for inhaled corticosteroids

A

Should have a gradual withdrawal when used for >3 weeks

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3
Q

What are the leukotriene receptor antagonists

A

Leukotrienes cause bronchoconstriction and inflammation

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4
Q

What is omalizumab

A

A monoclonal antibody which is directed against free IgE but not bound IgE

Prevents IgE from binding to immune cells which leads to allergen-induced mediator release in allergic asthma

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5
Q

How can NSAIDs irritate asthma

A

They can increase leukotriene production

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6
Q

What has the greatest impact in the management of patients with COPD

A

Smoking cessation and flu vaccinations

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7
Q

Who is CAP most common in

A

Males
Elderly
Alcoholics
Chronic disease

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8
Q

What is the aetiology of CAP

A

60-80% caused by conventional bacteria
Atypical bacteria causes 10-20%
10-20% also caused by viruses

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9
Q

What are the steps in investigating CAP

A

Confirm diagnosis: CXR, microbiological samples,
Assess severity of disease
Define aetiological agent
Identify complications

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10
Q

What microbiological investigations are involved in diagnosing CAP

A
  • sputum analysis and culture
  • immunofluorescence on sputum samples
  • blood cultures
  • urinary pneumococcal and legionella antigen
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11
Q

Describe the CURB 65 criteria

A

Confusion (mini mental test score of 8 or less)

Urea >7mmol/L due to infection impairing renal function

Resp rate >30 severe breathlessness

BP: <90/60

Age >65

Each counts for 1 point

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12
Q

What does a CURB65 score of 0 or 1 mean for treatment

A

Amoxicillin 500mgs qds for 5 days or doxy 200mgs loading then 100mg of

IV amoxicillin 500mg tds if can’t take oral

If penicillin allergy give ciprofloxacin 400mg bd + vancomycin

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13
Q

What treatment do you give someone with a CURB 65 score of 2

A

Amoxicillin 500mg qds for 7 days + clarithromycin 500mg bd for 7 days or doxycycline 200mg loading then 100mg od

If unable to take oral therapy: benzylpenicillin + iv clarithromycin

If severe allergy penicillin ciprofloxacin 400mg bd + vancomycin

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14
Q

What treatment do you give to someone with CURB 65 >3

A
  1. Co amoxiclav 1.2g tds + clarithromycin 500mg bd iv 10 days
  2. Levofloxacin 500mg bd + vancomycin 1g bd

Treat for 10 days extending to 14-21 for legionella, staphylococcal or gram -ve bacteria

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15
Q

What is tuberculosis

A

The most important infectious disease in recent world history

9.6M new cases and 1.5 million deaths annually

Most often affects immigrant populations

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16
Q

Mode of action of rifampicin (antimycobacterial)

A

Inhibits mycobacterial RNA polymerase

Rifampicin 450mg of <50kg or 600mg od >50kg

Is bactericidal

Causes hepatitis, rash, fever, flu syndrome and multiple drug interactions

17
Q

Mode of action of isoniazid

A

Poorly understood
- inhibits cell wall mycolic acid synthesis
- associated with hepatitis, peripheral neuropathy and cutaneous hypersensitivity
- has a rapid and bactericidal effect

18
Q

What is pyrazinamide (antimycobacterial)

A

Mode of action unknown
Dose of 1.5g od <50kg or 2g od >50kg
- can cause hepatitis, anorexia, flushing, cutaneous hypersensitivity and hyperuricaemia
- plays a key role in sterilising inflammatory tissue

19
Q

What is ethambutol (antimycobacterial)

A

Inhibits synthesis of cells wall polysaccharides
Dose 15mg/kg daily

Most important effect is optic neuritis
Moderate bactericidal effect

20
Q

What is streptomycin (antimycobacterial)

A

Binds to mycobacterial ribosome (16S rRNA and S12 protein) and inhibits protein synthesis
- must be given parenterally (15mg/kg) and blood levels should be measured in renal impairment

Bactericidal

Side effect: ototoxicity

21
Q

What are the 2 principles of chemotherapy

A
  • mycobacteria within an infected individual are in different phases of replication
  • the mycobacterial population contains naturally occurring resistance mutants
22
Q

What are the antituberculous regimens

A

Rifampicin, isoniazid, pyrazinamide and ethambutol given for a 2 month period
Followed by
Rifampicin and isoniazid for 4 months

23
Q

What is DOT

A

Directly observed therapies
Use a nurse or surrogate to directly observe all doses being taken

24
Q

Who is at risk of drug resistant TB

A

Individuals previously treated for TB

Known contact with a case of drug resistant TB

Acquisition of infection in a country or group with high prevalence of drug resistance

Patients who fail to make a response to adequate conventional treatment

Clinical Pharmacology And Therapeutics (7 decks)

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