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Drugs > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What class of drugs does carbocysteine belong to?

A

Mucolytics

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2
Q

What is the mechanisms by which carbocysteine works?

A
  • Alters the metabolism of mucus secreting cells

- Reduces mucus viscosity, reduces bronchial inflammation and reduces bronchospasm

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3
Q

What are the indications for carbocysteine/mucolytics?

A

COPD
Bronchiectasis
Chronic bronchitis

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4
Q

What are the CI for using mucolytics

A

Peptic ulcers - removes protective muscus barrier

1st trimester of pregnancy (avoid)

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5
Q

What are the SEs of using mucolytics?

A

GI bleeding

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6
Q

How are mucolytics excreted?

A

Renally

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7
Q

Name 2 short acting B2 agonists and 2 long acting B2 agonists

A

SA: salbutamol, Terbutaline
LA: Salmeterol, Formeterol

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8
Q

What is the mechanism for B2 agonists?

A

B2 receptors found in smooth muscle of bronchi, GI tract, uterus and blood vessels

Activation causes smooth muscle relaxation - dilates airways and inmproves airflow

Also acts on NaK-ATPase pumps on cell surface membranes. Shifts K intracellularly. Treatment for hyperK+

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9
Q

What are the indications for B2 agonists?

A

Asthma: SA - relieve SOB. LA: 3rd stage of treatment for chronic asthma. MUST be used in combo with a corticosteroid

COPD. SA: relieve SOB. LA: 2nd line treatment for COPD

HyperK+: nebulised salbutamol (in combo with insulin, glucose and calcium gluconate)

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10
Q

What are the CIs for Beta2 agonists?

A

CV disease - can precipitate arrhythmias/angina

LA - must be used in combo with corticosteroid. Without = associated with asthma related deaths

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11
Q

What are the SE for Beta2 agonists?

A
  • Palpitations
  • Tachycardia
  • Tremor
  • Anxiety
  • Hyperglycaemia
  • Muscle cramps
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12
Q

What are the interactions B2 agonists?

A
  • reduce effectiveness of Beta blockers

- Hypo k+ in combo with K+ reducing drugs (e.g. diuretics e.g. loop/thiazie, corticosteroids and theophylline)

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13
Q

Name two long acting anticholinergics and one short acting

A

LA: tritropium, glycopyrronium
SA: Ipratropium

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14
Q

What is the mechanism by which anticholinergics exert their action?

A

Competitive inhibitor of acetylcholine - blocks cholinergic receptors

Reduced parasympathetic tone which reduces smooth muscle contraction, reduces secretion and increases HR/conduction

Also reduces pupillary constrictor and muscles, causing dilatation and loss of accomodation

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15
Q

What are the indications for anticholinergics?

A
  1. COPD: SA: reduce SOB. LA; prevent exacerbation and SOB
  2. Asthma: adjuvant therapy for relief of SOB during acute exacerbations (added to long term B2 agonist. LAMAs to high dose inhaled corticosteroids and long term B2 agonists for chronic asthma
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16
Q

What are the CI for anticholinergics?

A

Patients with arrythmias

Patients with angle closure glaucoma - could increase intra-occular pressure

17
Q

What are the SEs of anticholinergics?

A

Not systemically absorbed so not many SEs!

Dry mouth

18
Q

What are the interactions of anti-cholinergics?

A

Not generally problem due to non-systemic absorption

19
Q

Name 3 inhaled corticosteroids

A

Beclometasone
Budesonide
Fluticasone

20
Q

Name 3 oral corticosteroids

A

Prednisone
Hydrocortisone
Dexamethasone

21
Q

How do corticosteroids exert their action?

A

Bind to glucocorticoid receptors > translocate into nucleus - bind to glucocorticoid > response elements > gene expression regulation

Down regulate inflammatory gene s and up regulate anti-inflammatory genes

  • reduce monocytes and eosinophils
  • Reduces infiltration of leukocytes
  • reduces production of leukotrienes and prostaglandins
  • reduces leakiness and vasodilation of capillaries
  • Increased gluconeogeneis - increases catabolism of muscle and fat
  • Increases Na and H2O retention and K+ excretion
22
Q

What are the indications for corticosteroids?

A

Allergic or inflammatory disorders e.g. anaphylaxis, asthma

Suppression of auto immune diseases e.g. SLE, RA, IBD

Tx of some cancers - reduces tumour associated swelling

Hypo-pituitaraism or adrenal insufficiency

23
Q

What are the CIs for corticosteroids?

A

Children (growth suppression)

Active infection (e.g. pneumonia)

24
Q

What are the SEs of corticosteroids?

A
  • Immunosuppression
  • Metabolic - diabetes, osteoperosis
  • Psych - insomnia, anxiety, psychosis, suicidal ideas
  • Increased catabolism - muscle weakness, skin thinning, easy bruising, gastritis
  • Hypertension hypoklaemia, oedema
  • Suppression of pituritary ACTH secretion - adrenal atrophy.
    If suddenly withdrawn, ADDISONIAN CRISIS!
25
Q

What are the interactions of corticosteroids?

A

HypoK+ if combined with diuretics, beta agonists and theophylinnes

NSAIDs - increased risk of peptic ulcers/GI bleeding

Efficacy reduced with cytochrome P450 inducers

Reduce immune response to vaccines

26
Q

What time of the day should you take corticosteroids?

A

One in the day to mimic normal circadian rhythm

27
Q

What are the mechanisms for theophyllines?

A

Blocks type III/IV phosphodiesterase - reduces breakdown of smooth muscle cAMP and increases bronchodlation

Blocks adenosine AIIB receptors - prevents adenosine mediated bronchoconstriction. Also increases HR

Activates histone deacetylase - prevents transcription of pro-inflammatory genes

28
Q

What are the indications for theophyllines?

A
  • COPD - but not acute exaccerbations
  • Empysema
  • Acute/chronic asthma
29
Q

What are the CIs for theophyllines?

A

Low therapeutic index

  • Arrthymias
  • HTN
  • Hyperthyroidism
  • Peptic ulcer
  • Epilepsy
  • Elderly
  • fever
  • Hypo-K+
30
Q

What are the SEs of theophyllines?

A 
Palpitations
Tachycardia
Arrythmias
GI distrubance
CNS stimulation
Convulsion
Headache
31
Q

What are the indications for Oxygen?

A
  • increase tissue oxygen delivery in state of hypoxaemia
  • Accelerate reabsorption of pleural gas (nitrogen) in pneumothorax
  • Reduces half-life of carboxy-haemoglobin in carbon monoxide poisoning
32
Q

What are the CI of oxygen?

A

Type II respiratory failure (e.g. COPD) - increase oxygen reduces respiratory drive, increasing PaCO2 > resp acidosis > loss of conciousnessness and worsened hypoxaemia

  • near a fire source!! (ie. dont smoke)

Drugs (9 decks)

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