Respiratory Drugs Flashcards
What class of drug is Salmeterol (Serevent)?
Long-acting β2 agonist (LABA)
What class of drug is Salbutamol (Ventolin)?
Short-acting β2 agonist (SABA)
What class of drug is Fluticasone (Flixotide)?
Inhaled corticosteroid
What class of drug is Montelukast (Singulair)?
LT receptor antagonist
What class of drug is Cromoglycate (Intal)?
Mast cell stabiliser
What class of drug is Terbutaline (Bricanyl)?
Short-acting β2 agonist (SABA)
What class of drug is Eformoterol (Symbicort)?
Long-acting β2 agonist (LABA)
What class of drug is Ipratropium (Atrovent)?
Short-acting anticholinergic (antimuscarinic)
What class of drug is Tiotropium (Spiriva)?
Long-acting anticholinergic (antimuscarinic)
What class of drug is Theophylline (Nuelin)?
Phosphodiesterase inhibitor/non-selective adenosine receptor antagonist
What class of drug is Budesonide (Pulmicort)?
Inhaled corticosteroid
What class of drug is Omalizumab?
Recombinant humanised monoclonal antibody (directed against IgE)
What is the mechanism of action of Salmeterol (Serevent)?
Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation
LABAs have a longer half-life than SABAs due to their increased lipophilicity – stay in the lipid membrane and act for longer.
What is the mechanism of action of Salbutamol (Ventolin)?
Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation
What is the mechanism of action of Fluticasone (Flixotide)?
Modulates protein synthesis in the nucleus → inhibition of phospholipase A2 → inhibition of arachidonic acid formation → inhibition of inflammatory mediator formation → reduction of airway inflammation and bronchial hyperreactivity
What is the mechanism of action of Montelukast (Singulair)?
Inhibits the cysteinyl leukotriene receptor; antagonises airway smooth muscle contraction and inflammation caused by leukotrienes.
What is the mechanism of action of Cromoglycate (Intal)?
Acts by inhibiting release of inflammatory mediators from mast cells.
Generally well tolerated as it does not gain access to systemic circulation.
What is the mechanism of action of Terbutaline (Bricanyl)?
Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation
What is the mechanism of action of Eformoterol (Symbicort)?
Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation
LABAs have a longer half-life than SABAs due to their increased lipophilicity – stay in the lipid membrane and act for longer.
What is the mechanism of action of Ipratropium (Atrovent)?
Promote bronchodilation by inhibiting cholinergic bronchomotor tone.
Blocks muscarinic actions of ACh
What is the mechanism of action of Tiotropium (Spiriva)?
Promote bronchodilation by inhibiting cholinergic bronchomotor tone.
Blocks muscarinic actions of ACh
What is the mechanism of action of Theophylline (Nuelin)?
Inhibition of PDE → raised intracellular cAMP → activation of PKA → inhibition of TNF-α and LT-synthesis → reduces inflammation
What is the mechanism of action of Budesonide (Pulmicort)?
Reduces airway inflammation and bronchial hyper-reactivity.
What is the mechanism of action of Omalizumab?
Recombinant humanised monoclonal antibody directed against immunoglobulin E (IgE); reduces the immune system’s response to allergen exposure
What are the side effects of Salmeterol (Serevent)?
Tremor
Palpitation
Headache
Tachycardia
Muscle cramps
Agitation
Insomnia
What are the side effects of Salbutamol (Ventolin)?
Tremor
Palpitation
Headache
Tachycardia
Muscle cramps
Agitation
Insomnia
What are the side effects of Fluticasone (Flixotide)?
Dysphonia
Oropharyngeal candidiasis (esp. if spacer not used)
Bruising
Facial skin irritation following nebulisation
Allergic reaction
What are the side effects of Montelukast (Singulair)?
Headache
Abdominal pain
Diarrhoea
Allergy
What are the side effects of Cromoglycate (Intal)?
Cough
Throat irritation
Bitter taste
Transient bronchospasm
What are the side effects of Terbutaline (Bricanyl)?
Tremor
Palpitation
Headache
Tachycardia
Muscle cramps
Agitation
Insomnia
What are the side effects of Eformoterol (Symbicort)?
Tremor
Palpitation
Headache
Tachycardia
Muscle cramps
Agitation
Insomnia
What are the side effects of Ipratropium (Atrovent)?
Headache
Nausea
Taste disturbance
Dry mouth
Throat irritation
Blurred vision
Dizziness
Urinary retention
What are the side effects of Tiotropium (Spiriva)?
Headache
Nausea
Taste disturbance
Dry mouth
Throat irritation
Blurred vision
Urinary retention
What are the side effects of Theophylline (Nuelin)?
Nausea
Vomiting
Diarrhoea
GORD
Headache
Insomnia
Irritability
Anxiety
Tremor
Palpitations
Theophyllines have a narrow therapeutic range; toxicity is closely related to plasma concentration.
What are the side effects of Budesonide (Pulmicort)?
Dysphonia
Oropharyngeal candidiasis (esp. if spacer not used)
Bruising
Facial skin irritation following nebulisation
Allergic reaction
What are the side effects of Omalizumab?
Common (>1%)
- injection site reactions
- rash
- bleeding (nosebleeds, heavy menstrual bleeding, haematoma)
Infrequent (0.1–1%)
- decrease in platelet count (mild)
Rare (
- anaphylaxis (usually occurs within 2 hours but can be delayed to >24 hours)
- angioedema
- urticaria
- serum sickness-like syndrome
What are the indications for use of Salmeterol (Serevent)?
Administration: puffer, accuhaler
Symptomatic relief of asthma
- Can be used in conjunction with an inhaled corticosteroid (e.g. fluticasone)
Must be combined with inhaled glucocorticoid as monotherapy is associated with increased morbidity/mortality in asthma.
What are the indications for use of Salbutamol (Ventolin)?
Administration: inhaler, nebuliser
- Acute asthma
- Symptom relief during maintenance treatment of asthma and COPD
- Protection against exercise-induced asthma
What are the indications for use of Fluticasone (Flixotide)?
Administration: inhaler, IV for acute severe episodes
- Maintenance treatment of persistent asthma
What are the indications for use of Montelukast (Singulair)?
Administration: oral tablet
- Maintenance treatment in asthma
- Allergic rhinitis
- Prevention of exercise-induced asthma
What are the indications for use of Cromoglycate (Intal)?
Administration: inhaler (MDI/DPI)
- Maintenance treatment in persistent asthma
- Prevention of exercise-induced asthma
Do not use for relief of acute asthma – use short-acting reliever instead.
What are the indications for use of Terbutaline (Bricanyl)?
Administration: inhaler (DPI)
- Acute asthma
- Symptom relief during maintenance treatment of asthma and COPD
- Protection against exercise-induced asthma
SC route may be used in acute severe asthma
What are the indications for use of Eformoterol (Symbicort)?
Administration: inhaler (DPI)
- Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
- Maintenance treatment of COPD
- Symptom relief of asthma in adults already receiving inhaled corticosteroids and regular eformoterol
SC route may be used in acute severe asthma
Must be combined with inhaled glucocorticoid as monotherapy is associated with increased morbidity/mortality in asthma.
What are the indications for use of Ipratropium (Atrovent)?
Administration: inhaler (DPI), nebuliser
- Symptom relief of asthma and COPD
Contraindications: Bladder outlet obstruction
Stop ipratropium if treatment with tiotropium is required for COPD
What are the indications for use of Tiotropium (Spiriva)?
Administration: inhaler (DPI)
- COPD
Contraindications: Bladder outlet obstruction
What are the indications for use of Theophylline (Nuelin)?
Administration: oral tablet, liquid
- Maintenance treatment in severe asthma and COPD
Contraindications: Diabetes (oral liquid contains 50% sugar), GORD, Arrhythmias, Heart failure, pulmonary oedema, severe hypoxia, Thyroid dysfunction, Epilepsy, Acute infection, Treatment with β2 agonists
What are the indications for use of Budesonide (Pulmicort)?
Administration: inhaler (DPI), nebuliser
- Maintenance treatment of persistent asthma
- Croup (nebulised budesonide)
May be used in fixed-dose combination with eformoterol (Symbicort turbuhaler)
What are the indications for use of Omalizumab?
Administration: Injection (IV)
Maintenance treatment of moderate-to-severe allergic asthma in patients treated with inhaled corticosteroids and with raised serum IgE levels
