Respiratory

Question 0

What is seretide?

Answer 0

Preventer product containing fluticasone (glucocorticoid) and salmeterol (long acting beta 2 agonist)

Question 1

Asthma

Answer 1

Yourface

Question 2

Pseudoephidrine mechanism of action

Answer 2

1) enters noradrenergic nerve and is taken up into storage vesicles in exchange for NA.
2) NA acts on post synaptic membrane and acts on alpha 1 receptors - causes vasoconstriction therefore decreased odema and fluid leakage.

Question 3

Name two short acting beta agonsists

Answer 3

Salbutamol

Terbutaline

Question 4

Name two long acting beta agonists

Answer 4

Salmeterol

Formoterol

Question 5

Name two examples of M receptor antagonists

Answer 5

Ipratropium

Tiotropium

Question 6

Three examples of inhaled glucocorticoids

Answer 6

Budesonide
Fluticasone propionate
Beclomethasone Dipropionate

Question 7

Two examples of oral glucocorticoids

Answer 7

Prednisolone

Hydrocortisone

Question 8

Mechanism of action of Beta-2 adrenoreceptor agonist

Answer 8

Binds to GPCR Beta-2 adrenoreceptors on lining of airways.
Activates Gs pathway -> increased adenylate cyclase activation -> PKA activation -> decrease intracellular Ca ions + dephosphorylation of MLCK -> decreased excitability of cells -> BRONCHODILATION

Question 9

Mechanism of action of Glucocorticosteroids

Answer 9

Bind to GRalpha receptor (homodimerized complex) in cytoplasm. This complex moves into nucleus.
Transactivation:
- complex binds to positive GRE within promoter -> upregulates transcription of anti-inflammatories
Transrepression:
- complex binds to negative GRE -> displaces bound transcription factors -> reduce transcription of pro-inflammatories

Question 10

What is the difference between SABA and LABA

Answer 10

Short acting beta agonists:
- effective in minutes
- 3-5 hr duration
- reliever medication for attacks
Long acting beta agonists
- effective in 10-20 minutes
- 8-12 hr duration
- symptom control/preventer

Question 11

Mechanism of action of M receptor antagonists

Answer 11

Prevent binding of ACh -> prevent activation of Galphaq pathway -> decrease PLC -> decrease IP3 -> decrease intracellular Ca ions -> dephosphorylation of MLCK -> muscle relaxation

Question 12

Mechanism of action of Pseudoephedrine

Answer 12

• Enters cytoplasm of noradrenergic nerve terminals via Uptake 1 transporter
• Taken up into vesicles via VMAT in exchange for noradrenaline (NA) into the cytoplasm
• Some NA degraded by MAO enzyme, the rest exits nerve terminal via Uptake 1 in exchange for pseudo
• Pseudo also inhibit NA reuptake
• In the synapse, NA acts on postsynaptic receptors to cause vasoconstriction
• Pseudo is resistant to MAO breakdown
• It is used to treat non-allergic rhinitis

Question 13

Mechanism of action of Antihistamines

Answer 13

Reversible competitive antagonism of histamine at H1 receptors

• decrease vascular permeability
• decrease pruritus
• relaxation of smooth muscle in resp and GI tract

-They are used to treat allergic rhinitis

Question 14

What makes an antihistamine non-sedating?

Answer 14

Decreased lipophilicity -> less able to cross BBB -> less CNS side effects

Question 15

Examples of non-sedating oral antihistamines

Answer 15

Fexofenadine
Cetirizine and Levocetirizine
Loratadine and Desloratadine

Question 16

Examples of sedating oral antihistamines

Answer 16

Azatadine
Pheniramine
Chlorpheniramine
Dexchlorpheniramine
Cyproheptadine
Promethazine

Question 17

Mechanism of action of intranasal anticholinergics

Answer 17

.

Question 18

Mechanism of action of Mast cell stabilisers

Answer 18

reduces hyperreactivity and reduces immediate & delayed phases of asthma

Question 19

Under what cirumstances would you refer patient to doctor?

Answer 19

• White or yellow spots on a bright red throat
• Swollen tonsils or lymph nodes
• Pain when swallowing
• Fever (over 38.3 degrees)
• Sudden, severe sore throat
• Difficulty breathing
• Dysphagia
• Persistant sore throat
• Persistant thrush

Question 20

Expectorant examples

Answer 20

expectorants improve the ability to expectorate mucosal secretions

• hydration with steam
• Gauiphenesin (decreases viscosity of phlegm)
• Ammonium Chloride (avaliable as “Senega & Ammonia mixture. Irritates bronchial mucoasa causing increased mucosal fluid)

Question 21

Mucolytic examples

Answer 21

Mucolytics break down mucus

• bromhexine (break disulfide bonds between gel-forming mucins & therefore decreases viscosity)
• acetylcysteine (breaks disulfide bonds like bromhexine. Used in cystic fibrosis)

Question 22

Centrally acting cough suppressants

Answer 22

Depress cough centre in medulla (NTS)
Narcotic
- codiene, dihydrocodeine, pholcodine
- activate opioid receptors –> results in less glutamate & NMDA activation (receptor that causes cough)
Non-Narcotic
- dextromethorphan (NMDA receptor antagonist/sigma agonist)
- diphenhydramine - antihistamine/TRPV1 antagonist

Question 23

Peripherally acting cough suppressants

Answer 23

• Local analgesic effect or anti-inflammatory effect
  - camphor, menthol
  - benxydamine (difflam throat spray)
• Enhance drainage of bronchial secretions by reducing viscosity (expectorants)
• relaxation of bronchial smooth muscle (bronchodilators)
• demulcent or soothing effect on irritated throat & airways (honey, syrup, thickener, expectorants)

Question 24

Decongestants

Answer 24

• oxymetazoline (spray)
• xylometaxoline (spray)
• pseudoephedrine (oral)
• phenylephrine (oral)

Question 25

Rhinitis Treatments

Answer 25

1) decongestants
2) antihistamine
3) leukotriene Receptor antagonist
4) Corticosteroids
5) Mast cell stabilisers
6) Intranasal anticholinergics

Question 26

Drugs that can be used to treat asthma during pregnancy & breastfeeding

Answer 26

• bronchodilators - salbutamol, tebutaline
• glucotorticoids - budesonide
• avoid long acting beta 2 agonists during first trimester (unless already on LABA –> don’t stop)

Question 27

When are leukotriene antagonists used? Give an example

Answer 27

3rd line use treatment in asthma

eg. montelukast