Respiratory

Question 1

name 2 short acting and 2 long acting Beta 2 agonsists

Answer 1

short: salbutamol, terbutaline
long: salmeterol, formoterol

Question 2

how do B2 agonists work?

Answer 2

Stimulates beta-2 receptors causing smooth muscles of airways (and other) to relax
can also shift K+ intracellularly to treat hyperkalaemia

Question 3

what are the indications to take B2 agonsists?

Answer 3

Asthma
COPD
uncomplicated premature labour
(hyperkalaemia rarely)

Question 4

what are the contraindications of taking B2 agonists?

Answer 4

only use long acting alongside inhaled corticosteroids

CV disease - tachycardia leading to angina or arrhythmia

Question 5

what are the side effects of B2 agonists?

Answer 5

tachycardia, palpitations, arrhythmia, anxiety, fine tremor, muscle craps, hyperglycaemia, headache, hypotension

Question 6

what are the interactions with B2 agonists?

Answer 6

Beta blockers reduce efficacy of B2 agonists

theophylline and corticosteroids - can lead to hypokalaemia

Question 7

Name 2 long acting and one short acting anticholinergic drugs

Answer 7

Long: Tiotrpium, Glycopyrronium
short: ipratropium

Question 8

how do anticholinergic/antimuscarinic drugs work?

Answer 8

bind to muscarinic receptors and competitively inhibit Ach. this acts as a bronchodilator and also increases HR

Question 9

what are the indications to take Anticholinergics?

Answer 9

1. COPD - short acting relieve exacerbation. long acting help prevent breathlessness
2. Asthma - same as above

Question 10

what are the contraindications to taking anticholinergics?

Answer 10

angle closure glaucoma - causes raised IOP

arrhythmia or MI

Question 11

what are the side-effects of anticholinergics?

Answer 11

dry mouth, cough, headache

GI motility disorder

Question 12

what are the interactions with anticholinergics?

Answer 12

very few important ones

possibly DOPA drugs (possibly reduce absorption); tricyclic antidepressants, antihistamines, clozapine, codeine, disopyramide, MAOIs, nefopam (increased anti-muscarinic side effects)

Question 13

Name 3 inhaled corticosteroids.

Answer 13

Beclometasone, budesonide, fluticasone

Question 14

how do inhaled corticosteroids work?

Answer 14

down regulate inflammatory cytokines eg ILs and up regulate anti inflammatory production. This helps reduce mucosal inflammation, widen airways and reduce secretions

Question 15

what are the indications for inhaled corticosteroids?

Answer 15

Asthma - only if not contolled by B2 agonists

COPD - only used in severe cases

Question 16

what are the contraindications of inhaled corticosteroids?

Answer 16

history of pneumonia

children

Question 17

what are the side effects of inhaled corticosteroids?

Answer 17

local immunosuppressive effects - can lead to thrush and increase chance of pneumonia

hoarse voice

Question 18

what are the interactions of inhaled corticosteroids?

Answer 18

very few - no systemic absorption

Question 19

which responds better to inhaled corticosteroids asthma or COPD?

Answer 19

Asthma

does not stop progression of disease in COPD

Question 20

name 3 oral corticosteroids.

Answer 20

prednisolone, hydrocortisone, dexamethasone

Question 21

how do corticosteroids work?

Answer 21

down regulate inflammatory cytokines eg ILs and up regulate anti inflammatory production. This helps reduce mucosal inflammation, widen airways and reduce secretions

Question 22

what are the indications to take corticosteroids?

Answer 22

allergic or inflammatory diseases eg asthma

Question 23

what are the side effects of corticosteroids?

Answer 23

immunosuppression (more common infections) Adrenal suppression, withdrawal, psychiatric reactions ( insomnia, confi=usion, psychosis), diabetes, osteoporosis

Question 24

what are the contraindications to taking corticosteroids?

Answer 24

infection

children - suppress growth

Question 25

what are the interactions with corticosteroids?

Answer 25

NSAIDs - increase risk of ulceration enhance hypokalaemia in B2 agonists, theophylline, loop/thiazide diuretics efficacy reduced with P450 inducers eg phenytoin, carbamazapine reduce response to vaccines

Question 26

what class of drug is carbocysteine?

Answer 26

mucolytic

Question 27

how does carbocysteine work?

Answer 27

dissolves chemical bonds in mucous to reduce the viscosity making it easier to cough up

Question 28

what are the indications to take carbocysteine?

Answer 28

cough associated with thick bronchial secretions eg bronchitis, bronchiectasis, CF and emphysema

Question 29

what are the contraindications to taking carbocysteine?

Answer 29

active peptic ulceration (disrupts gastric mucosal barrier)

Question 30

what are the side effects of carbocysteine?

Answer 30

bronchospasm - a bronchodilator should be given immediately before

Question 31

what are the interactions with carbocysteine?

Answer 31

very few important ones potentially increase adverse effects of some drugs inc chloramphenicol, gliclazide

Question 32

How does Theophylline work?

Answer 32

competitive PDE inhibitor - reduced inflammation and lower innate immunity adenosine antagonist - increase HR, bronchodilates and relaxes smooth muscle

Question 33

what are the indications to take theophylline?

Answer 33

Reversible airways obstruction, severe acute asthma

Question 34

what are the contraindications to taking theophylline?

Answer 34

Cardiac arrhythmias/cardiac disease, hypertensions, hyperthyroidism, peptic ulcer, epilepsy, elderly, fever

Question 35

what are the side effects of theophylline?

Answer 35

Nausea, vomiting, gastric irritation, diarrhoea, palpitation, tachycardia, arrhythmias, headache, CNS stimulation, insomnia, convulsions

Question 36

what are the interactions with theophylline?

Answer 36

corticosteroids - increases hypokalaemia B2 agonists - increases hypokalaemia adenosine - competitive inhibition quinolones - increase toxicity

Question 37

how does oxygen work?

Answer 37

Increases oxygen levels in blood, also decreases resistance to blood flow in many types of diseased lungs

Question 38

what are the indications for oxygen?

Answer 38

(high conc): pneumonia, PE, pulmonary fibrosis, shock, severe trauma, sepsis, anaphylaxis (in uncomplicated cases) (low conc for risk of hypercapnic resp failure): COPD, advanced CF, severe bronchiectasis, severe ankylosing spondylitis, severe lung scarring from TB, opioid overdose

Question 39

what are the contraindications for oxygen?

Answer 39

type 2 respiratory failure - reduces hypercapnic drive | smoking - risk of explosion

Question 40

what are the side effects of oxygen?

Answer 40

uncomfortable mask | dry mouth