Respiratory Drugs Flashcards by Charlotte Humphries

What types of bronchodilator drugs are there?

Β-2 agonists - short and long acting = SABA and LABA

Muscarinic antagonists - short and long acting = SAMA and LAMA

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Give examples of
- SABA
- LABA
- SAMA
- LAMA

SABA = Salbutamol (Ventolin), Terbutaline (Bricanyl)
LABA = Formoterol and Salmeterol

SAMA = Ipratropium bromide,
LAMA = Tiotropium, aclidinium bromide

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Give an example of a phosphodiesterase inhibitor

Theophylline, aminophylline

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Given an example of a leukotriene inhibitor

Montelukast

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Which penicillin is used in respiratory problems?

Amoxicillin
Flucloxacillin

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Which B-lactam AB is used for respiratory problems?

Co-Amox

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Which glycopeptide AB is used for respiratory problems?

Vancomycin

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Which cephalosporins are used for respiratory problems?

Cephalexin, Ceftriaxone, Ceftazidime

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Which tetracycline is used for respiratory problems?

Doxycycline

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Which macrolide is used for respiratory problems?

Clarithyromycin, Erythromycin

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Which aminoglycoside AB is used for respiratory problems?

Gentamicin

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Which quinolone is used for respiratory problems?

Ciprofloxacin

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Which nitromidazole AB is used for respiratory problems?

Metronidazole

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Which antifungals are used in respiratory illness?

Amphotericin B
Fluconazole

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Which Anti-TB drugs are used?

Isoniazid
Rifampicin
Ethambutol
Pyrazinamide

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What is the difference between β 2 adrenoreceptors in the airways and muscarinic cholinergic receptors?

Β-2 cause bronchodilator when activated - therefore want to use β 2 agonists - part of the SS (NOR)

Muscarinics cause bronchoconstriction when activated - therefore want to use muscarinic antagonist drugs - part of the PSS (ACh) system

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How can you differentiate asthma and COPD?

Asthma - has variable obstruction - and can be treated as obstruction is reversible. Patients should be well in between exacerbations.

COPD = progressive airflow obstruction that is not fully reversible and does not change much. Ps are symptomatic most of the time.

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What is the advantages and disadvantages of the following methods of drug administration:
- Inhaled
- Oral
- IV

Inhaled = direct deposition into lungs (adv) but very technique dependent

Oral = not technique dependent (adv) but dependant on absorption in gut

IV = systemic effects, not technique dependant (adv) but more side effects.

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How efficient are inhalers?

Not very - only between 8-15% of the drug actually reaches the lung, no matter how good the inhaler technique is

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What factors determine particle deposition in the lungs?

Size of particle (smaller goes further - although too small and they get expired)

Inspiratory flow rate

Distance needed for the particle to travel (determined by method of inhalation)

What is salbutamol given for?

How can it be given?

Relief of symptoms of asthma, BET and COPD - breathlessness, chest tightness and wheeze

Via inhaler or nebuliser

What is salbutamol given with for exacerbations in hospital?

6L of O2 (asthma) and 6L air (COPD)

What is the onset of salbutamol? How long does it last for?

Within 10 mins
Lasts for 3-5 hours

What are the side effects of salbutamol?

Tachycardia
Tremor
Agitation
Due to activation of β receptors in heart and skeletal muscle

If given IV (rare) - get tachyarrythmias, angina - need cardiac monitoring

What is the onset of action and duration of Salmeterol? What is it used in combination with? What is it used for?

Onset = 30 mins Duration = 10-12 hours Used in combo with ICS or LAMA Used for treatment of asthma and COPD

What is the onset of action of formoterol? How long does it last? What is it used in combination with? What is it used for?

Rapid onset - like salbutamol Duration = 10-12 hrs Always used in combo with ICS or LAMA Used for treatment of asthma and COPD

How does Ipratropium bromide work?

Blocks M3 receptors in smooth muscle of airways

What is the onset of action of Ipratropium bromide? How long does it last? When is it used? What does it do?

Onset = 30 minutes Lasts - 6 hours - QDS Used in inhaler for COPD and nebuliser for asthma or COPD exacerbations Reduced mucus production and has weaker bronchodilator effect than SABA

What is the duration of action of tiotropium and aclidinium? What do they do? How are given and what for?

12-24 hours Cause bronchodilation, reduce bronchospasm and decrease mucus production. Given in inhaler - used for COPD and chronic asthma

What are the side effects of SAMA and LAMAs?

Ancholinergic side effects Dry mouth Blurred vision Closed-angle glaucoma Urinary retention Cardiac arrythmias Taste disturbance Dizziness Epistaxis

Which steroids are given for respiratory exacerbations via the following routes: Oral Inhaled (ICS) IV

Oral = prednisolone, dexamethasone ICS = beclomethasone, fluticasone, budesonide IV = methylprednisolone, hydrocortisone

What are some common side effects of inhaled steroids? How can you reduce these?

Oral candidiasis Dysphonia Gargle after use Use spacer (reduces deposition in throat)

Name three types of inhaler devices

Pressurised metered dose inhalers (pMDI) Dry powder inhalers Soft mist inhalers

What is important to remember about methylxanthine medications?

Need monitoring of serum levels - as they have a narrow therapeutic range

How does montelukast work?

Blocks leukotrienes from working - thereby reducing inflammation and causes bronchodilation

When is montelukast prescribed?

On step 3 of the asthma ladder - not optimally controlled by ICS + LABA.. Use for asthma induced by exercise, allergens (high IgE), cold air and aspirin

When are biologics used for asthma?

When P has severe or eosinophilic asthma - in Step 4 or 5 of the asthma ladder.

Name some mucolytic agents that are used for COPD, BET and CF

Carbocisteine N-acetyl cysteine (NAC)

What are the side effects of mucolytic agents?

Gastric ulcers, abdo discomfort and diarrhoea

How is asthma managed?

Avoid allergens and smoking Use inhaled therapy Complete personalised asthma self-management plan Regulare reviews Stepwise approach up and down the asthma ladder

How should you treat an acute asthma exacerbation in hospital?

ABC approach Maintain SpO2 >92% (give O2 6L/min - Hudson mask) ABGs - and monitor. Rising CO2 = indicates deterioration - escalate CXR - exclude pneumothorax, consolidation etc Peak flow - can help decide if admission / discharge needed Can give nebulised salbutamol and ipratropium bromide (work synergistically) - produces greater bronchodilation than one drug alone. Give systemic steroids (IV hydrocortisone or oral prednisolone) - reduces mortality. If v severe - can give IV mag sulphate and IV aminophylline ABs if chest infection IV fluids and K+ if hypokalaemia

How does magnesium sulphate work for asthma?

It is a bronchodilator - it stabilises T-cells and reduces inflammatory markers

What pharmacological management can be given for COPD?

Inhaled therapy LTOT Non-invasive ventilation

What surgical management can be given for COPD?

Lung volume reduction surgery (removes parts that are not ventilating - thereby improving the ventilation of the rest of the lung) Lung transplant

Which drug class is being debated about its use in COPD?

Inhaled corticosteroids

What is the scale for measuring severity of COPD?

mMRC Dyspnoea Scale

What management are patients given in hospital for COPD exacerbations?

CXR - exclude other causes Nebuliser - SABA and LAMA (salbutamol and ipratropium bromide) Oral or IV steroids (prednisolone or hydrocortisone) Controlled O2 - check ABGs and get baseline O2 level IV aminophylline if needed ABs and mucolytics NIV for T2RF LMWH as DVT prophylaxis Nutrition and early physio