Respiratory Drugs Flashcards
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
Give examples of
- SABA
- LABA
- SAMA
- LAMA
SABA = Salbutamol (Ventolin), Terbutaline (Bricanyl)
LABA = Formoterol and Salmeterol
SAMA = Ipratropium bromide,
LAMA = Tiotropium, aclidinium bromide
Give an example of a phosphodiesterase inhibitor
Theophylline, aminophylline
Given an example of a leukotriene inhibitor
Montelukast
Which penicillin is used in respiratory problems?
Amoxicillin
Flucloxacillin
Which B-lactam AB is used for respiratory problems?
Co-Amox
Which glycopeptide AB is used for respiratory problems?
Vancomycin
Which cephalosporins are used for respiratory problems?
Cephalexin, Ceftriaxone, Ceftazidime
Which tetracycline is used for respiratory problems?
Doxycycline
Which macrolide is used for respiratory problems?
Clarithyromycin, Erythromycin
Which aminoglycoside AB is used for respiratory problems?
Gentamicin
Which quinolone is used for respiratory problems?
Ciprofloxacin
Which nitromidazole AB is used for respiratory problems?
Metronidazole
Which antifungals are used in respiratory illness?
Amphotericin B
Fluconazole
Which Anti-TB drugs are used?
Isoniazid
Rifampicin
Ethambutol
Pyrazinamide
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
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.
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.
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
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
