Respiratory

Question 1

Antihistamine uses

Answer 1

Allergies
Uticaria and pruritis
Anaphylaxis in combination with adrenaline

Question 2

Antihistamine MOA

Answer 2

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

Question 3

Antihistamine ADRs

Answer 3

Sedation (1st gen more than 2nd gen)

Question 4

Antihistamine ADRs

Answer 4

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

Question 5

Long acting antimuscarinincs

Answer 5

Tiotropium, umeclidinium, glycopyrronium, aclidinium

Question 6

Short acting antimuscarinics

Answer 6

Ipratropium

Question 7

Antimuscarinic indications

Answer 7

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

Question 8

Antimuscarinic MOA

Answer 8

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.

Question 9

Antimuscarinic ADRs

Answer 9

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.

Question 10

Antimuscarinics warnings

Answer 10

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

Question 11

B agonist indications

Answer 11

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

Question 12

B agonist MOA

Answer 12

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.

Question 13

SABAs

Answer 13

salbutamol, terbutaline

Question 14

LABAs

Answer 14

salmeterol, formoterol

Question 15

B agonist ADRs

Answer 15

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

Question 16

B agonist warnings

Answer 16

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

Question 17

B agonist interactions

Answer 17

B blockers- may worsen symptoms

Nebs and theophylline and corticosteroids - hypokalaemia

Question 18

Gas for driving nebulisers

Answer 18

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

Question 19

ICS indications

Answer 19

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

Question 20

ICS MOA

Answer 20

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.

Question 21

ICS ADRs

Answer 21

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).

Question 22

ICS warnings

Answer 22

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

Question 23

ICS interactions

Answer 23

No clinically significant interactions

Question 24

ICS counselling points

Answer 24

Rinse mouth after use, wash inhaler

Question 25

MDI counselling points

Answer 25

Slow and deep breaths

Question 26

DPI counselling points

Answer 26

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

Question 27

Spacer counselling points

Answer 27

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

Question 28

ICS and disease progression

Answer 28

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

Question 29

Montelukast indications

Answer 29

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

Question 30

Montelukast MOA

Answer 30

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

Question 31

Montelukast ADRs

Answer 31

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)

Question 32

Montelukast in Pregnancy

Answer 32

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

Question 33

Montelukast ADRs

Answer 33

None with commonly used drugs.