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Pharm > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Beta 2 adrenoceptor agonist names?

A

Epinephrine
Salbutamol SABA fast-acting
Formoterol LABA fast-acting
Salmeterol LABA slow-acting

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2
Q

ADR of beta 2 adrenoceptor agonists?

A

“Sympathomimetic effects from systemic absorption:

Tremor and muscle cramps

Peripheral vasodilation - flushing

Palpitations, tachycardia (beta-1 effects)

Hypokalemia / Hyperglycaemia - usually transient

Beta-2 adrenoceptor tolerance - relievers may not work during attacks “

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3
Q

Muscarinic receptor agonist names?

A

Ipratropium bromide SAMA
Tiotropium bromide LAMA

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4
Q

Use of Ipratropium and Tiotropium?

A

Adjunct to inhaled B2 agonists and inhaled glucocorticoids

Patients intolerant of B2 agonists

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5
Q

ADR of Ipratropium and Tiotropium?

A

Typical parasympatholytic effects - dry mouth, urinary retention etc.

Limited systemic ADR
Bad taste

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6
Q

Methylxanthine names?

A

Theophylline
Aminophylline

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7
Q

MOA of methylxanthines?

A

Inhibit Phosphodiesterases (PDEs)

Block adenosine receptors, preventing bronchoconstriction

Increase adrenaline release from adrenal medulla

CNS stimulant effect on respiration

Anti-inflammatory effects on mast cells and T cells

Lower microvascular leakiness”

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8
Q

Uses of methylxanthines?

A

Less effective than B2 agonists

Used as Adjunct for severe COPD

Not used clinically as anti-inflammatory drug”

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9
Q

ADR of methylxanthines?

A

GI: Nausea, vomiting, anorexia, discomfort

CNS: Nervousness, tremor, seizures, insomnia, anxiety

CVS: Arrhythmias

Many DDRs

Narrow therapeutic window (5-20mg/L)
Seizures in children only slightly above therapeutic range

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10
Q

Cysteine-Leukotriene (CysLT) receptor Antagonist name?

A

Montelukast

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11
Q

MOA of montelukast?

A

Relax airways in mild asthma
Effective in aspirin-sensitive asthma
Effective in exercise-induced asthma”

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12
Q

Use of Montelukast?

A

Adjunct therapy for mild to moderate asthma
About 1/3 as effective as salbutamol
Additive effects with B2-adrenoceptor agonist

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13
Q

Magnesium sulphate uses?

A

Adjunct treatment of severe acute asthma

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14
Q

Inhaled corticosteroids names?

A

Budesonide
Fluticasone
Ciclesonide

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15
Q

MOA of inhaled corticosteroids?

A

“Reduce pro-inflammatory mediators in airways: e.g. T cells, mast cells, eosinophils, PLA2, pro-inflammatory cytokines, COX2, 5-LOX, Inducible NO synthase, Lower shedding of epithelial cells, lower mucus secretion

Increase Anti-inflammatory mediators:
1. Annexin A2
2. B2 adrenoceptors

  1. Do not relax smooth muscle directly
  2. Possibly prevent airway wall remodeling
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16
Q

Uses of inhaled corticosteroids?

A

First line prophylactic for asthma
For nocturnal asthma
For advanced COPD with acute exacerbation or high eosinophilic content

High receptor binding affinity (low dose needed)
High lipophilicity

Lower need for B2 agonist
Lower risk of death from asthma
Lower airway hyper-responsiveness in 4-6 weeks”

17
Q

ADR of inhaled corticosteroids

A

“1. Oropharyngeal Candidiasis - opportunistic infection due to localized immunosuppression
2. Dysphonia - due to localized muscle wasting
3. Cough / throat irritation
4. Adrenal suppression - fluticasone
5. Easy bruising (elderly)
6. Posterior subcapsular cataracts
7. Osteoporosis

  1. ADR rare if inhaled, due to limited systemic absorption”
18
Q

Leukotriene pathway inhibitors names?

A

Montelukast
Zileuton

19
Q

Uses of leukotriene pathway inhibitors?

A

“1. Prophylaxis and chronic treatment of asthma
2. Aspirin-induced/NSAID exacerbated asthma
3. Exercise-induced asthma

  1. Less effective than glucocorticoids
  2. Less frequent asthma attacks
  3. Lower use of inhaled steroids
  4. Lower use of B2 agonist
  5. Lower peripheral blood eosinophil levels”
20
Q

ADR of leukotriene pathway inhibitors

A

“Side effects few and mild

  1. Headache
  2. GI disturbances
  3. Associated with Churg-Straus Syndrome (systemic vasculitis + eosinophilia)
  4. Withdrawal or reduce glucocorticoid stepwise
  5. Suicidial thoughts and neuropsychiatric ADR (rare)”
21
Q

Cromoglicic acid name?

A

Cromolyn

22
Q

MOA of Cromolyn?

A

“1. Lower mast cell degranulation by IgE-mediated FceRI crosslinking
2. Lower secretion of inflammatory mediators from eosinophils, neutrophils and macrophages
3. Control Chloride channels to inhibit cellular activation
4. Raise Annexin A1 secretion - inhibit prostaglandin and Leukotriene production from mast cells”

23
Q

Uses of Cromolyn?

A

“1. Prophylactic control of asthma (inhalation only)
2. Prophylactic control of allergic rhinitis, allergic conjunctivitis, vernal keratoconjunctivitis

  1. Prevent Ag, cold, dry air and exercise-induced bronchospasm
  2. Single-dose before Ag-challenge or exercise prevents bronchospasm
  3. Low bronchial hyper-reactivity in 4 weeks
  4. Less need for bronchodilator therapy
  5. Less effective than inhaled glucocorticoids”
24
Q

ADR of Cromolyn?

A

Throat and nasal irritation, mouth dryness, cough
Bad taste

25
Q

Can mucolytics like acetylcysteine and carbocisteine be used for respi?

A

Yes.

26
Q

PDE-4 inhibitor name?

A

Roflumilast

27
Q

MOA of Roflumilast?

A
  1. Prevent breakdown of cAMP
  2. Less inflammatory cell activity (main)
  3. Inhibit fibrosis (main)
  4. Relax smooth muscle
28
Q

ADR of Roflumilast?

A
  1. Headaches, Dizziness, insomnia
  2. Weight loss, diarrhoea, nausea, decreased appetite
  3. Anxiety, suicidal thoughts (rare)
  4. Caution in hepatic impairment
29
Q

Anti-IgE monoclonal Ab name?

A

Omalizumab

30
Q

Use of omalizumab - Anti IgE mAb?

A

For severe asthmatics with allergies and high IgE level

31
Q

Name of Anti-IL5 / IL4 mAb?

A

Reslizumab

Pharm (20 decks)

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