Respiratory Flashcards
name 2 short acting and 2 long acting Beta 2 agonsists
short: salbutamol, terbutaline
long: salmeterol, formoterol
how do B2 agonists work?
Stimulates beta-2 receptors causing smooth muscles of airways (and other) to relax
can also shift K+ intracellularly to treat hyperkalaemia
what are the indications to take B2 agonsists?
Asthma
COPD
uncomplicated premature labour
(hyperkalaemia rarely)
what are the contraindications of taking B2 agonists?
only use long acting alongside inhaled corticosteroids
CV disease - tachycardia leading to angina or arrhythmia
what are the side effects of B2 agonists?
tachycardia, palpitations, arrhythmia, anxiety, fine tremor, muscle craps, hyperglycaemia, headache, hypotension
what are the interactions with B2 agonists?
Beta blockers reduce efficacy of B2 agonists
theophylline and corticosteroids - can lead to hypokalaemia
Name 2 long acting and one short acting anticholinergic drugs
Long: Tiotrpium, Glycopyrronium
short: ipratropium
how do anticholinergic/antimuscarinic drugs work?
bind to muscarinic receptors and competitively inhibit Ach. this acts as a bronchodilator and also increases HR
what are the indications to take Anticholinergics?
- COPD - short acting relieve exacerbation. long acting help prevent breathlessness
- Asthma - same as above
what are the contraindications to taking anticholinergics?
angle closure glaucoma - causes raised IOP
arrhythmia or MI
what are the side-effects of anticholinergics?
dry mouth, cough, headache
GI motility disorder
what are the interactions with anticholinergics?
very few important ones
possibly DOPA drugs (possibly reduce absorption); tricyclic antidepressants, antihistamines, clozapine, codeine, disopyramide, MAOIs, nefopam (increased anti-muscarinic side effects)
Name 3 inhaled corticosteroids.
Beclometasone, budesonide, fluticasone
how do inhaled corticosteroids work?
down regulate inflammatory cytokines eg ILs and up regulate anti inflammatory production. This helps reduce mucosal inflammation, widen airways and reduce secretions
what are the indications for inhaled corticosteroids?
Asthma - only if not contolled by B2 agonists
COPD - only used in severe cases
what are the contraindications of inhaled corticosteroids?
history of pneumonia
children
what are the side effects of inhaled corticosteroids?
local immunosuppressive effects - can lead to thrush and increase chance of pneumonia
hoarse voice
what are the interactions of inhaled corticosteroids?
very few - no systemic absorption
which responds better to inhaled corticosteroids asthma or COPD?
Asthma
does not stop progression of disease in COPD
name 3 oral corticosteroids.
prednisolone, hydrocortisone, dexamethasone
how do corticosteroids work?
down regulate inflammatory cytokines eg ILs and up regulate anti inflammatory production. This helps reduce mucosal inflammation, widen airways and reduce secretions
what are the indications to take corticosteroids?
allergic or inflammatory diseases eg asthma
what are the side effects of corticosteroids?
immunosuppression (more common infections) Adrenal suppression, withdrawal, psychiatric reactions ( insomnia, confi=usion, psychosis), diabetes, osteoporosis
what are the contraindications to taking corticosteroids?
infection
children - suppress growth
what are the interactions with corticosteroids?
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
what class of drug is carbocysteine?
mucolytic
how does carbocysteine work?
dissolves chemical bonds in mucous to reduce the viscosity making it easier to cough up
what are the indications to take carbocysteine?
cough associated with thick bronchial secretions eg bronchitis, bronchiectasis, CF and emphysema
what are the contraindications to taking carbocysteine?
active peptic ulceration (disrupts gastric mucosal barrier)
what are the side effects of carbocysteine?
bronchospasm - a bronchodilator should be given immediately before
what are the interactions with carbocysteine?
very few important ones
potentially increase adverse effects of some drugs inc chloramphenicol, gliclazide
How does Theophylline work?
competitive PDE inhibitor - reduced inflammation and lower innate immunity
adenosine antagonist - increase HR, bronchodilates and relaxes smooth muscle
what are the indications to take theophylline?
Reversible airways obstruction, severe acute asthma
what are the contraindications to taking theophylline?
Cardiac arrhythmias/cardiac disease, hypertensions, hyperthyroidism, peptic ulcer, epilepsy, elderly, fever
what are the side effects of theophylline?
Nausea, vomiting, gastric irritation, diarrhoea, palpitation, tachycardia, arrhythmias, headache, CNS stimulation, insomnia, convulsions
what are the interactions with theophylline?
corticosteroids - increases hypokalaemia
B2 agonists - increases hypokalaemia
adenosine - competitive inhibition
quinolones - increase toxicity
how does oxygen work?
Increases oxygen levels in blood, also decreases resistance to blood flow in many types of diseased lungs
what are the indications for oxygen?
(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
what are the contraindications for oxygen?
type 2 respiratory failure - reduces hypercapnic drive
smoking - risk of explosion
what are the side effects of oxygen?
uncomfortable mask
dry mouth
