Respiratory

Question 1

SABA e.g. salbutamol

Answer 1

^cAMP » SM dilation; increase FEV1; 3-5h (peak 30m)
SEs: tachy, tremor, cramp (hypoK)
uses: asthma (and COPD)

Question 2

LABA e.g. salmeterol

Answer 2

bronchodilation (8-12h); long-term prevention and control; not relieving; add-on (step 3); reduce steroid need and improve function

Question 3

INH CST

Answer 3

decreased inflammatory response: decreased cytokines, PG and increased eosinophil apoptosis » decreased exacerbation
also reduced B2-adrenoceptor down-regulation (associated with BA use)

SEs: local immunosuppression (sore, hoarse) and laryngeal myopathy; systemic (DM etc)

Question 4

LTRA

Answer 4

prevent production of LT » decreased constriction, mucus, and inflammation (eosinophils and vascular permeability)

SEs: GI, headache, hepatic disorders

Question 5

Xanthines (‘phyllines’)

Answer 5

PDE inhibitor » decreased cAMP breakdown » SM dilation
second line (not as effective)
SEs: narrow TI and many interactions; hypoK; headache; N&v, insomnia,  tachy/arrhythmia

Question 6

m3-ACh-R antagonists e.g. ipratropium

Answer 6

Decrease constriction (prevent intracellular Ca increase via M3); COPD > asthma use
SEs: urinary retention,  blurry vision, sedation, dry mouth, constipation,

Question 7

Asthma Management

Answer 7

step up if SABA >3/wk, night Sx >1/w, or exacerbation in last 2y

I: SABA
II: SABA + inh CST
III: SABA + inh CST + LABA/xanth/LTRA
IV: increase CST dose; consider 4th drug
V: add oral steroid

Question 8

COPD management

Answer 8

I: SABA/SAMA
II: SABA + LABA/LAMA (LABA + inh CST if FEV

Question 9

Acute asthma management

Answer 9

oxygen: 40-60%, sats 94-98 (lower if COPD)
neb SABA (higher dose) + oral/IV steroid (pred/hydro)
poor response/LT: neb ipratropium, subcut SABA, IV aminophylline, IV MgSulphate