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Respiratory drugs > Respiratory drugs > Flashcards

Respiratory drugs Flashcards

1
Q

Drugs that cause bronchospasm

A
  1. Non-selective beta blockers
  2. Histamine releasing drugs
  3. Cholinomimetics
  4. Morphine (histamine release + vagal tone)
  5. Prostaglandin F2 alpha (constriction of uterus, blood vessels and bronchi)
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2
Q

Treatment of atopic/extrinsic/allergic asthma

A

Omalizumab - binds to IgE prevents binding to IgE receptor and mast cell degranulation

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3
Q

Bronchodilators

A

Big Mike Makes The Coffee
B2 adrenoreceptors
Muscarinic 3 blockers
Methylxanthine Theophylline
Cysteinyl leukotrienes

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4
Q

B2 receptor agonists

A

Selective
1. SABA. salbutamol + terbutaline
2. LABA - salmetorol + formeterol

Non-selective
Aie
1. Adrenaline
2. Isoprenaline
3. Ephedrine

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5
Q

Adverse effects of B2 adrenoreceptor agonists

A

TTTH
1. Tachycardia and arrhythmia (direct acts on b1 and indirect vasodilation of skeletal muscles decreases BP)
2. Tremor
3. Tolerance
4. Hypokalemia (potassium shift)

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6
Q

Why are B2 agonists not used for children?

A

B2 receptors are not fully developed

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7
Q

Muscarinic blockers

A
  1. Atropine
  2. Ipratropium

Passive weak bronchodilation
Must be used with B2 agonist

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8
Q

Why is atrophine not used for asthma treatment?

A
  1. Nonselective
    زغلوله الناشفه حبست جوزها ابو سريعه
  2. Tertiary amide - can cross BBB
    SAD HC
    Sedation
    Amnesia
    Delirium
    Hallucination
    Coma
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9
Q

What is used as a substitute for atropine?

A

Ipratropium for COPD
1. More selective
2. Quaternary amide
3. Does not cause excessive dryness

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10
Q

Methylxanthines

A

Natural
1. Theophylline
2. Caffeine
3. Theobromine

Semi-synthetic
1. Aminophylline injectable

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11
Q

Mechanism of action of methylxanthines

A
  1. Block adenosine 1 receptors (bronchodilation, decreased mucus secretion, CNS stimulation, block histamine release and tachycardia increase AV conduction)
  2. Inhibit PDE 3 and 4
    PDE 5 inhibitor - sildenafil Viagra
    ↑ cAMP - bronchodilation and vasodilation (relaxation of smooth muscle) and ↑ cardiac muscle contractility (+ve inotropic)
    ↑ CGMP - NO release vasodilation EXCEPT brain vasoconstriction
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12
Q

Effects of methylxanthine

A
  1. Smooth muscle relaxation (bronchodilation and vasodilation)
  2. Cardiac muscle contraction (+ve inotropic)
  3. Vasoconstriction of cerebral blood vessels - migraine
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13
Q

Uses of methylxanthine

A

Respiratory
1. Acute - slow infusion aminophylline AA
2. Chronic - SR theophylline or aminophylline rectal suppository

CNS
1. Hypnotic overdose (CNS stimulant)
2. Delay physical and mental fatigue
3. Migraine - methylxanthine + ergotamine (alpha 1 agonist) + sumatriptan
↑ ergotamine absorption + synergism
4. Neonatal apnea syndrome (caffeine sulphate)

CVS
Pulmonary edema due to acute left sided HF

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14
Q

Adverse effect of methylxanthine

A

CNS - insomnia, nervousness, tremors, headache, seizures

CVS - tachycardia
Rapid IV injection - syncope, hypotension and cardiac arrest

GIT - ↑ HCL secretion

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15
Q

Methylxanthine contraindications

A
  1. Peptic ulcers - increases HCL
  2. Arrythmia - tachycardia
  3. Renal, hepatic or pulmonary disorders
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16
Q

Methylxanthine drug interactions

A

Microsomal enzyme inhibitors
1. Cimetidine - peptic ulcer
2. Erythromycin
3. Zileuton - 5LOX inhibitor

Microsomal enzyme inducers
1. Smoking
2. Rifampin
Unless stop for duration of treatment or increase dosage

17
Q

Anti-inflammatory drugs

A

Chronic
1. Oral prednisolone 20 mg
2. Oral dexamethasone 4-8 mg
3. Beclomethasone inhalation

Acute
1. Hydrocortisone IV 200mg every 4hrs if necessary
2. Dexamethasone (beclomethasone)

18
Q

Adverse effects of anti inflammatory drugs

A

Oropharyngeal candidiasis
Take with anti fungal drugs amphotericin + nystatin AND mouthwash

19
Q

Anti-inflammatory pre-cations

A
  1. Gradual withdrawal to avoid acute adrenal crisis
  2. Diet rich in K+ and protein and low in NaCL and carbs
  3. Diuretics - edema and weigh gain
  4. Immunosuppressant therefore treat infections with antibiotic and reduce steroid dose
20
Q

Prophylactic treatment

A
  1. Leukotriene inhibitors
    - Montelukast x1 management of asthma in children
    - Zafirulokast x2
    LTD4 receptor blockers
    - Zileuton (5 LOX inhibitor + microsomal enzyme inhibitor contraindicated in methylxanthine)
  2. Mast cell stabilizers via chloride channels
    - Nedocromil
    - Cromolyn - sodium cromoglycate (not absorbed from diet)
  3. Ketofien - 2nd gen antihistamine + mast cell stabilizer
21
Q

Other drugs

A
  1. Expectorants and mucolytics
  2. Heliox
  3. Omalizumab
22
Q

Management of cough

A
  1. Specific - underlying cause
  2. Non-specific - symptomatic
    - Dry cough antitussive
    - Wet cough mucolytic and expectorant
23
Q

Antitussives

A

Peripheral
1. Water vapor with methanol or benzoin tincture
2. Benzonatate - glycerol dervivative of procaine local anesthetic effect

Central
1. Opioids codeine and hydrocodone - lower dose than that that causes analgesic effect
2. Synthetic opioid L isomers dextromethorphan

24
Q

Mucolytics

A
  1. Bromhexine - formation of mucus breaks mucopolyschharide fibers
  2. Ambroxol - increases surfactant production
  3. N-acetylcysteine and carbocyseine - add H+ to disulfide bonds between glycoproteins breaking them apart
25
Q

Expectorants

A
  1. Potassium iodide - increases proteolytic enzyme effect
  2. Guaifenesin
  3. Others
    - Ammonium chloride
    - Tincture ipecacuanha
    - Herbal remedies
26
Q

In emergency department the preferred first line of asthma therapy is

A

B2 agonist

Respiratory drugs (1 decks)

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