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Pharmacy Exam 2021 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Antihistamine uses

A

Allergies
Uticaria and pruritis
Anaphylaxis in combination with adrenaline

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2
Q

Antihistamine MOA

A

Antagonis H1 receptor, blocking effects of histamine in the inflammatory response

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3
Q

Antihistamine ADRs

A

Sedation (1st gen more than 2nd gen)

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4
Q

Antihistamine ADRs

A

1st Gen: sever liver impairment- may lead to hepatic encephalopathy

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5
Q

Long acting antimuscarinincs

A

Tiotropium, umeclidinium, glycopyrronium, aclidinium

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6
Q

Short acting antimuscarinics

A

Ipratropium

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7
Q

Antimuscarinic indications

A

COPD: SA- breathlessness relief, LA- breathlessness prevention
Asthma: SA breathlessness relief (alongside SABA), LA- breathlessness prevention alongside high dose ICS and LABA

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8
Q

Antimuscarinic MOA

A

bind to muscarinic receptors, competitively inhibiting acetylcholine. They increase HR and conduction, and reduce smooth muscle tone in the respiratory tract and bladder, they also reduce secretions from glands in respiratory tract, GI. They relax pupilary constrictor causing pupil dilation.

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9
Q

Antimuscarinic ADRs

A

Respiratory tract irritation (sinusitis, cough, nasopharyngitis), GI disturbances (dry mouth, constipation), urinary retention, blurred vision, headaches. ADRs more likely with oral/IV use than inhaled.

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10
Q

Antimuscarinics warnings

A

angle-closure glaucoma, arrhythmias, urinary retention. Usually not a problem if inhaled

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11
Q

B agonist indications

A

asthma: SABA- breathlessness, LABA- in addition to ICS for management (always needs to be given in combination to ICS).
COPD: SABA- breathlessness, LABA- second line symptom relief.
Hyperkalemia

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12
Q

B agonist MOA

A

Stimulate B receptor, found in smooth muscle activating cascade leading to smooth muscle relaxation. Stimulate Na/K ATPase pumps on cell surface membranes, causes shift of K into cells from extracellular matrix.

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13
Q

SABAs

A

salbutamol, terbutaline

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14
Q

LABAs

A

salmeterol, formoterol

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15
Q

B agonist ADRs

A

Fight or flight responses (tachycardia, palpitations, anxiety, tremor). Promote glycogenolysis (increasing serum glucose). High dose: raised lactate. LABAs: muscle cramps

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16
Q

B agonist warnings

A

LABA- asthma- must be used with ICS, as monotherapy associated with increased asthma deaths.
Cardiovascular disease- tachycardia may provoke angina/arrhythmias

17
Q

B agonist interactions

A

B blockers- may worsen symptoms

Nebs and theophylline and corticosteroids - hypokalaemia

18
Q

Gas for driving nebulisers

A

Generally speaking oxygen for asthma, medical air for COPD (CO2 retention risk)

19
Q

ICS indications

A

asthma: treat airway inflammation
COPD: control symptoms and exacerbations. Usually with LABA.

20
Q

ICS MOA

A

Activate receptor in cytoplasm, modifying transcription of large number of genes, such as down regulation of pro-inflammatory interleukins, cytokines and chemokines. This reduces mucosal inflammation, widening airways and reduces mucus secretion.

21
Q

ICS ADRs

A

Oral candidiasis, sore throat. COPD: increased risk of pneumonia. little systemic effect (unless high dose, which can cause adrenal suppression, slow growth in children and osteoporosis).

22
Q

ICS warnings

A

COPD- High dose ICS, in particular fluticasone - history of pneumonia, children.

23
Q

ICS interactions

A

No clinically significant interactions

24
Q

ICS counselling points

A

Rinse mouth after use, wash inhaler

25
Q

MDI counselling points

A

Slow and deep breaths

26
Q

DPI counselling points

A

Teach how to use device. Need quick and deep inhalation. If capsule (ie zonda) inhale contents, not take

27
Q

Spacer counselling points

A

Tidal breathing, rinse with water and let air dry, do not towel dry

28
Q

ICS and disease progression

A

Asthma- can prevent progression, prevents remodelling caused by inflammation
COPD: does not prevent progression

29
Q

Montelukast indications

A

Asthma:
Adults- add on if ICS and LABA unsuccessful
Children 5-12 - as alternative to LABA as an add on with ICS being insufficient
Children 5 and under - first line preventative if unable to take ICS

30
Q

Montelukast MOA

A

Block CysLT1 receptor, reducing inflammatory response (Leukotrienes produced by mast cells and eosinophils activate CysLT1, producing inflammatory cascade)

31
Q

Montelukast ADRs

A

Headache and abdo pain common and mild. URTIs.
Uncommon- hyperactivity and loss of focus.
Churg Strauss syndrome (an eosophillic autoimmune disorder, might not be ADR of drug)

32
Q

Montelukast in Pregnancy

A

No evidence of safety, no harmful effects demonstrated. Reasonable to continue if efficacious and alternatives not.

33
Q

Montelukast ADRs

A

None with commonly used drugs.

Pharmacy Exam 2021 (16 decks)

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