Respiratory Drugs

Question 1

Which classes of drugs cause low potassium?

Answer 1

Corticosteroids, beta 2 agonists, methylxanthines (aminophylline)

Question 2

Which drugs cause tachycardia?

Answer 2

Beta 2 agonist, methylxanthines (theophylline)- come from caffeine

Question 3

Which classes cause hyperglycaemia in a diabetic patient?

Answer 3

Corticosteroids, beta 2 agonists

Question 4

Which drugs cause psychiatric side effects?

Answer 4

Corticosteroids, leukotriene receptor antagonist

Question 5

Which class causes osteoporosis?

Answer 5

Corticosteroids

Question 6

How do selective beta2 agonists work?

Answer 6

Stimulate b2 adrenoreceptors and cause adenyl cyclase to convert ATP to cAMP which activate a protein kinase
This inhibits myosin light chain kinase inhibits smooth muscle contraction resulting in bronchial smooth muscle relaxation

Question 7

What is different in dosing of inhaled and nebuliser?

Answer 7

Inhaled 100mcg, nebuliser 2.5mg

Question 8

How does aminophylline work?

Answer 8

Inhibits phosphodiesterase which breaks down CAMP into AMP, therefore more protein kinase A

Question 9

What are side effects of SABA?

Answer 9

Fine tremor, resting sinus tachycardia, hypokalaemia

Question 10

SABA onset and duration?

Answer 10

5 minutes, last 4-6 hours

Question 11

Onset of action of LABA?

Answer 11

15-45 mins, Formoterol

Question 12

How do antimuscarinics work?

Answer 12

Bind to muscarinic receptors in bronchial smooth muscle (mainly M2/M3), cause bronchodilator
Tiotropium - selective to m3 due to slow dissociation

Question 13

What should not be prescribed concurrently?

Answer 13

LAMA inhaler, and SAMA-

Question 14

SAMA onset and duration?

Answer 14

Onset 30 mins, 3-5 hours

Question 15

Dose of SAMA?

Answer 15

Nebuliser 500mcg QDS, inhaler 20mcg QDS

Question 16

When using a nebuliser ipratropium what should you be cautious of?

Answer 16

Narrow angle glaucoma due to increased risk of intraocular pressure

Question 17

Side effects of antimuscarinics?

Answer 17

Dry mouth, dry eyes, headache constipation

Question 18

First line for COPD?

Answer 18

LABA/LAMA

Question 19

Asthma treatment with?

Answer 19

LAMA + ICS/LABA

Question 20

Tiotropium onset duration?

Answer 20

2 hours onset, lasts 24 hours

Question 21

Which is the only LAMA licensed for COPD and asthma?

Answer 21

Respiratory 2.5mcg inhale 2 puffs in the morning

Question 22

How do corticosteroids work in asthma?

Answer 22

Decrease formation of stroking skin which activate eosinophils and are responsible for promoting production of IgE
Inhibit COX2 induction- antinflammatory
Inhibit leukotrienes, which would trigger contraction in smooth muscles

Question 23

Side effects of corticosteroids?

Answer 23

Oral candidiasis, hoarse voice,

Question 24

LAMA/LABA and ICS are for?

Answer 24

COPD patients with asthmatic features suggesting steroid responsiveness who remain breathless or have exacerbation on LABA/LAMA

Question 25

MDI vs DPI?

Answer 25

MDI- slow/ steady DPI- quick and deep

Question 26

Acute attack of asthma/COPD?

Answer 26

Asthma- pred 40- 5 days COPD- Pred 30 for 5-7 days

Question 27

Theophylline is metabolised by?

Answer 27

Cytochrome P450, clearance declines with age/comorbidities

Question 28

Smoking cessation …?

Answer 28

Increases serum theophylline

Question 29

Theophylline level and monitoring?

Answer 29

10-20mg/l Oral: 4-6 hours after dose then 5 days later IV: take 6 hours after infusion, then once daily

Question 30

Drug interactions with theophylline?

Answer 30

Metabolised by CYP1A2 So enzyme inhibitors such as macrolides, ciprofloxacin will increase levels Enzyme inducers such as rifampicin/ ritonavir will decrease levels

Question 31

Side effects of theophylline?

Answer 31

Headache, insomnia, nausea, hypokalaemia, Toxicity: vomiting nausea, tachycardia, ventricular arrhythmia and convulsions HINT hypokalamia

Question 32

Mucolytics are used in?

Answer 32

COPD, severe pneumonia, Cystic Fibrosis, bronchiectasis carbociterine, acetylcysteine, may report itching

Question 33

How do leukotrienes work?

Answer 33

Released from mast cells and eosinophils and cause bronchoconstriction and inflammation

Question 34

LTRA work by?

Answer 34

Binding to LT receptors, and airway macrophages and eosinophils blocking bronchoconstriction and mucous secretion

Question 35

Side effects of LTRA?

Answer 35

Neuropsychiatric side effects, headaches, GI

Question 36

If hospital stays within 2 weeks treat as?

Answer 36

HAP

Question 37

Nicotine withdrawal can cause?

Answer 37

Insomnia, irritability, anxiety craving

Question 38

Craving satisfaction?

Answer 38

Dual NRT- long acting OD patch plus 1 short acting PRN

Question 39

Nicotine partial agonist, drug to help smoking?

Answer 39

Varenicline

Question 40

Asthma guideline?

Answer 40

1. SABA + ICS 2. ICS + LABA 3. increase ICS to moderate or add LTRA Refer to specialist

Question 41

When to consider stepping up treatment?

Answer 41

Increased frequency attacks x3 or more inhaled b2 agonist Symptomatic x3 or more Waking one night a week

Question 42

Asthmatic specialist treatment?

Answer 42

Tiotropium respimat Long term PO corticosteroids MAB= mepolizumab- eosinophilia asthma Omalizumab- severe allergic asthma

Question 43

Specialist COPD drug roflumilast?

Answer 43

Phosphodiesterase 4 inhibitor