Respiratory drugs

Question 1

SABA examples

Answer 1

salbutamol, terbutaline, albuterol

Question 2

SABA main indications

Answer 2

first line treatment for mild intermittent asthma, COPD

Question 3

mechanism of action of SABA

Answer 3

agonists of beta 2 adrenoceptors. causes bronchodilation and decreases mucous secretion

Question 4

contraindications of SABA

Answer 4

use in caution with patients with arrhythmias, CVD, diabetes, hypertension, hyperthyroidism, hypokalaemia, and susceptibility to QT interval prolongation

Question 5

adverse effects of SABA

Answer 5

tremor most common can also affect heart rhythm , oral thrush

Question 6

LABA main indications

Answer 6

nocturnal asthma, COPD

Question 7

LABA mechanism of action

Answer 7

agonists of beta2 adrenoceptor, always administered with an ICS

Question 8

Contraindications of LABA

Answer 8

use with caution in patients with arrhythmias, CVD, hyperthyroidism, hypokalaemia, susceptibility to QT interval

Question 9

adverse effects of LABA

Answer 9

beta 2 down regulation and tachyphylaxis with chronic use, may worsen asthma when used alone should always be given with ICS

Question 10

Inhaled corticosteroids main indication

Answer 10

second line in asthma, consider for COPD where patient is a frequent exacerbator (2+ hopsital admissions a year) AND is eosinophilic (less than 300 cells/microlitre)

Question 11

mechanism of action of ICS

Answer 11

synthetic derivatives of cortisol, anti inflammatory effect

Question 12

Adverse effects of ICS

Answer 12

dysphonia and oropharyngeal candidiasis, pneumonia in COPD due to local immune suppression and impaired mucociliary clearance

Question 13

Leukotriene receptor anatagonists main indication

Answer 13

add on in uncontrolled asthma (oral)

Question 14

leukotriene receptor antagonist mechanism of action

Answer 14

prevent CysLTs from causing bronchoconstriction, mucus secretion, oedema

Question 15

adverse effects of leukotriene receptor antagonists

Answer 15

generally well tolerated, headache, GI upset

Question 16

Xanthines main indication

Answer 16

add on in uncontrolled asthma (theophylline oral), used in acute severe asthma attack (Iv aminophylline)

Question 17

xanthines mechanism of action

Answer 17

inhibit mediator release of mast cells, increase mucus clearance, increase diaphragmatic contractility and reduce fatigue. prevent inactivation of cAMP and cGMP (they relax smooth muscle and are antiinflammatory)

Question 18

xanthines contraindications

Answer 18

drug interactions involving CYP450s

Question 19

adverse effects of xanthines

Answer 19

very narrow therapeutic index- adverse effects at supratherapeutic concentrations include dysrthmia, seizures and hypotension. at therapeutic conc can cause nausea, vomiting, headache

Question 20

omalizumab

Answer 20

very expensive specialist treatment. injection every 2 -4 weeks. for asthma. anti IgE

Question 21

mepolizumab/ benralizumab

Answer 21

very expensive specialist treatment. injection every 4-8 weeks. for asthma. targets cytokine that activates eosinophils. - IL5

Question 22

dupilumab

Answer 22

very expensive specialist treatment. injection every 2 weeks. for asthma. blocks cytokines responsible for eosinophilic inflammation, IgE, airway hyper reactivity and mucin production

Question 23

SAMA example

Answer 23

ipratropium

Question 24

mechanism of action of SAMA

Answer 24

non selective m3 receptor antagonist- stops bronchoconstriction caused by M receptor activation in response to ACh. also reduces mucous secretion

Question 25

main indication of SAMA

Answer 25

highly nebulised dose used in acute COPD

Question 26

mucolytics main indication

Answer 26

COPD, cystic fibrosis

Question 27

adverse effects of mucolytics

Answer 27

diarrhoea, nausea, GI disturbance

Question 28

LAMA main indication

Answer 28

palliative effect for long term management of COPD

Question 29

LAMA mechanism of action

Answer 29

pharmacological antagonist of bronchoconstriction caused by M3 receptor activation in response to ACh