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308: Clinical pharmacology and therapeutics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Salbutamol

  • Brand names
  • Mechanism, duration
  • Indications
  • Side effects
A

Ventolin

Short acting beta-2 agonist
- Relaxation of smooth muscle = bronchodilation

Duration= 3-5 hours.

Indications

  • Symptomatic asthma, COPD
  • Hyperkalaemia

Side effects

  • Sinus Tachycardia, palpatations (beta-2 agonist on heart)
  • Tremors
  • Hypokalaemia
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2
Q

Marketed name for salbutamol is…

A

Ventolin

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3
Q

Types of inhaled drug devices

A

Metered dose inhalers (MDIs)
- can be used with space to increase time of use

Dry powder inhaler
- Not puffs, one inhalation

Nebuliser
- delivers drug in form of mist

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4
Q

Instructions on how to used meter ed dose inhaler

A
  1. Exhale fully
  2. Inhale and puff
  3. Hold breath, slow count to ten
  4. Exhale slowly
  5. wait 1 min before second puff
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5
Q

Salmeterol

  • Brand names
  • Mechanism, duration
  • Indications
  • Side effects
A

Long actin beta-2 agonist
- Smooth muscle relaxation in bronchi= bronchodilation

Onset and duration

  • Onset: 2-30 mins
  • Acts: 10-12 hrs

Indications

  • Asthma (in those on ICS)
  • COPD (persistent symptoms despite therapy

Side effects

  • Tremors
  • palpitations
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6
Q

Brand name for salmeterol is…

A

Serevent

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7
Q

Salmeterol

  • Administration
  • Indication
A

Only inhaled.

In asthma

  • In those with ICS
  • After SABA alone is not effective

In COPD
- When symptoms persist

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8
Q

LABA

A

Long acting beta-2 agonist

Acts on smooth muscle in bronchi to relax= bronchodilation

Duration= 10-12 hrs
onset= 15-45 mins

Examples

  • Salmeterol (serevent)
  • Formoterol (Oxeze) (faster onset)
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9
Q

Tiotropium

  • Brand names
  • Mechanism, duration
  • Indications
  • Side effects
A

Spiriva

Mechanism

  • LAMA/ anticholinergic
  • Ats on M1-5
  • In airways, acts on M3= inhibits contraction= bronchodilation.

Indication

  • Stable COPD, symptoms with SABA
  • Asthma: step 3.
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10
Q

Ipratropium

  • Brand name
  • Onset
  • Duration
  • Administration
  • Indication
A

Short acting antimuscarinic
- Atrovent

Onset= 30 mins
- Lasts 6 hours

administration

  • MDI
  • Nebs

Acute COPD/ asthma

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11
Q

Theophylline

  • Mechanism
  • Routes
  • Indications
A

Phosphodiesterase inhibitor
- Relaxant of smooth muscle= bronchodilation

Routes

  • PO
  • IV

Indications
- IV: Acute asthma exacerbation

  • PO: Persistent symptoms in asthma/ COPD
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12
Q

Theophylline

  • Metabolism
  • Side effects
A

Narrow therapeutic index

  • Metabolised by cytochrome p450
  • Clearance declines with age/ comorbidities.

Level= 10-20mg/L

stop infusion 20 mins before taking level

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13
Q

Drugs that increase levels of theophylline/ aminophylline

A

Drugs that inhibit cytochrome P450

  • Ciprofloxacin
  • Erythromycin
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14
Q

Drugs that decrease levels of theophylline/ aminophylline

A

Inducers of cytochrome P450

  • Rifampicin
  • Ritonavir

Smoking induces metabolism of theophylline

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15
Q

Side effects of methylxanthines

A

Headache, nausea

Insomnia

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16
Q

Toxicity signs of theophylline

A

Vomiting, tachycardia

Ventricular arrhythmia

Convulsions

17
Q

Aclidinium

A

LAMA

18
Q

Corticosteroid mechanism in asthma

A

Decreases cytokines that activate eosinophils
- Reduced IgE expression and production

Inhibits COX2 induction= anti-inflammatory

Inhibits leukotrienes
- Smooth muscle relaxation, anti-inflammatory

19
Q

ICS

  • examples
  • side effects
A
  • Beclamethasone
  • Budesonide
  • Fluticasone
  • Memetasone

Oral candidiasis
Hoarse voice
- Can be avoided by rinsing mouth, gargling with water after inhaler/ using spacer.
- Or treat with nystatin

20
Q

Treatment of COPD patients with asthmatic features.

A
  1. LABA + ICS
  2. If symptoms persist, add LAMA.
    - Symptoms interfering with ADLs (trial triple therapy for 3 months)
    - Severe exacerbation requiring hospitalisation
    - 2 moderate exacerbation in a year

If symptoms do not improve after triple therapy for LAMA+LABA group, revert back.

21
Q

SMART therapy

  • Description
  • Indications
A

Single maintenance and reliever therapy
- Single inhaler that contains combination of drugs

Indications
- Poorly Step 3 asthmatic patients

22
Q

SMART therapy

- Examples

A

Symbicort
- Budesonide+ formorterol

Fostair
- Beclamethasone + formeterol

DuoResp
- Formeterol + budesonide

23
Q

Use of oral corticosteroids

A

On in severe asthma/COPD

Administration
- Short course, High dose prednisolone for acute attacks

24
Q

Oral prophylactic antibiotic therapy for COPD

- Indications

A
  • Frequent (4+ a year) exacerbations with sputum
  • Prolonged exacerbations with sputum
  • Exacerbations requiring hospitalisation
25
Q

Oral prophylactic antibiotic therapy for COPD

- Medication

A

Azithromycin

  • 250mg OD
  • 3x a week
26
Q

Montelukast

  • Brand name
  • Mechanism
  • Indications
  • Side effects
A

Singulair

Leukotriene receptor inhibitor

  • Bronchodilation
  • Reduces inflammation

Indications
- Asthma step 3+

Side effects

  • Headaches
  • GI discomfort
  • Psychiatric disturbance

308: Clinical pharmacology and therapeutics (13 decks)

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