Respiratory drugs Flashcards
Mechanism of action of Salbutamol (Ventolin)?
SHORT-acting Beta-2 agonist. Block Beta-2 adrenoreceptors in the smooth muscles of the airways from the trachea to the terminal bronchioles. (Causes bronchodilation)
Mechanism of action of Formoterol and Salmeterol?
LONG-acting Beta-2 agonists block Beta-2 adrenoreceptors in the smooth muscles of the airways from the trachea to the terminal bronchioles. (Causes bronchodilation)
Mechanism of action of aclidinium bromide, ipratropium bromide, and Tiotropium?
Muscarinic antagonist. Results in bronchodilation by blocking the muscarinic cholinergic receptors in the smooth muscle of the airways, which opposes parasympathetic action
Mechanism of action of Montelukast?
Leukotriene inhibitor. Blocks leukotrienes from working, reduces inflammation in asthma.
Examples of Beta-lactam antibiotics?
Penicillins such as Amoxicillin and Flucloxacillin
Mechansim of action of Co-Amoxiclav?
Beta-lactam antibiotic + Beta-lactamase inhibitor
Glycopeptide antibiotic?
Vancomycin
Doxycycline belongs to what class of antibiotics?
Tetracyclines
Drug class of Clarithromycin, Erythromycin?
Macrolides
Gentamicin belongs to which drug class?
Aminoglycoside
Drug class of Ciprofloxacin?
Quinolones
Drug class of Metronidazole?
Nitroimidazole
Isoniazid, Rifampicin, Ethmbutol, and Pyrazinamide are used to treat what condition?
Tuberculosis
Method of delivery of Fluticasone, Budesonide, and Beclomethasone?
Inhaled cortocosteroids
And FEV1/FVC ratio of less than ______ indicates obstructive airway disease
70%
A lung condition characterised by progressive airflow obstruction which is not fully reversible and does not change markedly over several months. Largest contributing factor is history of smoking
COPD
Goal of treatment for asthma and COPD therapy is to improve pulmonary function towards and FEV1 or PEF > ____, and prevent exacerbations
80%
What percentage of inhaled drugs reach the intended target in the lungs?
8-15% of the drug
Factors that favor distal particle sedimentation (deposition in the alveoli) include
small particle size and slow flow rate
Inhaled drugs with large particle size (>6 mincrometers) are more likely to be deposited __________, whereas particules that are 2-3 micrometers are more likely to be deposited in _______.
centrally, alveoli
Adrenergic agonists act on which receptors in the smooth muscle of the bronchial mucosa?
Beta-2 receptors
Which drug is commonly prescribed for symptom relief in asthma, COPD, and bronchiectasis?
Salbutamol (Ventalin) inhalers
Salbutamol is given via nebuliser for an exacerbation of asthma and COPD. Administer with __ L of oxygen for asthma, or ___L of AIR for COPD patients
6, 6
Name the important side effects of Salbutamol (Ventolin)
Tachycardia (Beta receptors in the heart)
Tremor (Beta receptors in skeletal muscle)
Agitation
Hypokalaemia
Also know that IV use, such as in acute asthma attacks, causes more serious side effects such as tachyarrhythmias and angina. Cardiac monitoring is recommended.
Long-acting Beta-2 agonists such as Salmeterol and Formoterol are not prescribed on their own. They are always used in combination with inhaled corticosteroids and/or _____
Long acting muscarinic antagonists
Drug class of Iprotropium bromide (Atrovent)?
Short acting muscarinic antagonist
Mechanism of action of Ipratropium bromide (Atrovent?)
Short-acting muscarinic antagonist (SAMA). Blocks M3 receptors in smooth muscle of airways. Has a weaker bronchodilator effect compared so SABAs
Indication/use for Ipratropium bromide (Atrovent?)
Can be used via inhaler for daily use in COPD - 20-40 micrograms qds. Helps to reduce mucous production.
Ipratropium bromide can also be nebulised for acute exacerbations of COPD or asthma
Therapeutic actions of Tiotropium and Aclidinium (LAMAs)?
Cause bronchodilation
Reduce bronchospasm
Decreases mucous production
Mechanism of action of Tiotropium?
Long-acting muscarinic antagonist. Inhibits M3 receptors in the smooth muscle of airways.
Route of administration for Tiotropium?
Given once per day as an inhaler (DPI Handihaler or as a mist- Respimat)
Indications for Tiotropium
Stable COPD- continued symptoms despite SABAs
Chronic asthma- not improving despite inhaled corticosteroids/LABA.
** Side effects of SAMAs- Ipratropium bromide- and LAMAs- Tiotropium & Aclidinium?
Anticholinergic effects:
Dry mouth
Blurred vision
Closed-angle glaucoma
Urinary retention
Cardiac arrhythmias
Taste disturbance
Dizziness
Epistaxis
(Systemic s/e are rare because little systemic absorption occurs with inhaled use)
Inhaled corticosteroids such as Beclomethasone, Fluticasone, and Budesonide are almost always given in combination with which type of respiratory drugs?
Either LABAs (Salmeterol or Formoterol) and/or LAMAs (Tiotropium or Aclidinium)
Which corticosteroids can be used intravenously for acute/emergency respiratory concerns?
Methylprednisolone or hydrocortisone
Common side effects of inhaled steroids?
Oral candidiasis, dysphonia
Side effects of oral steroids?
Indigestion, skin bruising, insomnia (rarely- psychosis), gastric ulcers, weight gain (d/t stimulation of appetite)
Long term use: Post-capsular cataracts, osteoporosis, weight gain, Cushingoid appearance, adrenal suppression, HTN, diabetes, avascular necrosis, growth retardation in children
How long should someone wait between doses of a pressurised metered dose inhaler? (pMDI)
One minute
Which type of inhaler devices have the least amount of user error?
Dry powdered inhalers and pressurised metered dose inhalers when used WITH a spacer
Which two drugs are commonly nebulised to treat patients with exacerbations of asthma or COPD?
Short-acting beta-2 agonists (such as Salbutamol) and anticholinergic medications (SAMA) such as Iprotropium bromide.
Mechanism of action of methylxanthine?
Non-selective phosphodiesterase inhibitor. (weak bronchodilator)
Indication for theophylline?
Oral methylxanthine given for acute exacerbation of asthma and COPD
Which of the methyxanthines can be given intravenously for acute exacerbation of asthma and COPD?
Aminophylline
What is important to remember about prescribing methylxanthines?
The have a NARROW THERAPEUTIC RANGE and require monitoring of blood levels. Due to their metabolism by the CYP450 system, they also interact with many different drugs
Which respiratory drug is indicated for asthma induced by exercise, high IgE allergens, cold air and aspirin?
Montelukast (Leukotriene inhibitor)
- Step 3 of asthma ladder, so only used when patient is unable to tolerate ICS or their asthma is not optimally controlled on ICS+LABA
These drugs are used in Step 4 or 5 of the “Asthma ladder.” Reserved for patients who have severe allergic or eosinophilic asthma, or for patients who are unable to come off oral prednisolone (as “steroid sparing” agent).
Monocolonal Abs aka “Biologics”
Name two common mucolytic agents used for patients with COPD, bronchiectasis, and cystic fibrosis
Carbocisteine and N-acetyl cysteine
Side effects of Carbocystine and NAC?
Gastric ulcers, abdominal discomfort and diarrhoea
How many patients die every day in the UK from an asthma attack?
Three
Vomiting, headaches, tachycardia, ventricular arrhythmia, and convulsions are signs of toxicity of which asthma drug class?
Methylxanthines (e.g. Theophylline)
What type of mask should you use when administering controlled oxygen to a patient with COPD?
Venturi mask. Start at 24% (blue) or 28% (white) until O2 sats of 88-92% are achieved.
What type of masks deliver high concentrations of oxygen at 60-90% at 10-15L/minute? Commonly used in emergencies
Non-rebreathing mask
Important adverse effects include HA, abdominal pain, GI upset, and increased risk of upper respiratory tract infections
Montelukast (leukotriene receptor antagonist)
