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Y3 DRUGS PROFILES > RESPIRATORY DRUGS > Flashcards

RESPIRATORY DRUGS Flashcards

1
Q

At what concentration is oxygen normally administered and why?

A

60%

if higher can increase risk of hypoventilation and CO2 retention

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2
Q

when is high concentration oxygen administered?

A

critically ill patients

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3
Q

give an example of a beta 2 agonist

A

Short acting: salbutamol, terbutaline

Long acting: salmeterol, formoterol,

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4
Q

give a instances when administration of oxygen should be done with caution/not at all

A

Type 2 respiratory failure (severe COPD) due to the compensation mechanism

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5
Q

how do beta 2 agonists work?

A

stimulate smooth muscle receptors in lungs and activate cAMP which relaxes smooth muscle - reduces airway resistance

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6
Q

Give instances when short and long acting beta 2 agonists are used?

A

Asthma: short acting are used for relieve of breathlessness but long is used as step 3 treatment for chronic asthma
COPD: short is used for relieving breathlessness and long is used in step 2 of treatment
Hperkalaemia: nebulised salbutamol used in addition with insulin, glucose and calcium gluconate

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7
Q

give 4 administration methods for beta 2 agonists

A

oral
inhaled
IV
nebulised

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8
Q

give 3 contraindications for use of beta 2 agonists

A

Hypersensitivity
pre-existing cardiac tachy-arrythmia
pregnancy (cleft palette)

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9
Q

give a cardiac side effect of beta 2 agonists

A

palpitations/tachycardia

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10
Q

give an electrolyte side effect of salbutamol

A

hypokalaemia

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11
Q

give 4 other side effects of beta 2 agonists

A

fine tremor
nervousness
anxiety
Muscle cramps ( caused by long acting)

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12
Q

how do beta 2 agonists interact with beta blockers?

A

Reduce the effect of beta 2 agonists

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13
Q

why should high doses of beta 2 agonists be used cautiously with either diuretics, theophylline or corticosteroids?

A

can potentiate hypokalemia

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14
Q

why should infused beta 2 agonists not be used with methyldopa?

A

Can cause acute hypotension

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15
Q

give an example of an anticholinergic (antimuscarinic)

A

long acting= tiotropium

Short acting= ipratropium

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16
Q

how do antimuscarinic work?

A

It is competitive inhibitor of acetylcholine on the muscarinic receptor. Which blocks the parasympathetic effects (rest and digest) therefore:
Increase heart rate and conduction
Reduce smooth muscle tone in the respiratory tract
Reduced secretion of glands in the respiratory glands and GI tract
Inthe eye they cause relaxation of the pupillary constrictor and ciliary muscles, causing pupillary dilatation and preventing accommodation,
respectively

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17
Q

when are antimuscarinic used?

A

COPD: short acting is used to relieve breathlessness caused by exercise and long acting is used for prophylaxis of exacerbation and breathlessness

Asthma: short acting is used with conjunction with short beta 2 agonist for acute exacerbation while long acting is used in step 4 treatment of chronic asthma with inhaled corticosteroids and long acting beta 2 agonist

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18
Q

how are anticholinergics taken?

A

capsules inside inhalation device

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19
Q

why are anticholinergics contraindicated in narrow angle glaucoma?

A

can worsen symptoms causing pain, blurred vision and corneal oedema by increase intraocular pressure

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20
Q

give a renal side effect of anticholinergics

A

urinary retention

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21
Q

how are anticholinergics metabolised?

A

barely metabolised, 75% in urine

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22
Q

give an example of a corticosteroid

A

prednisolone, hydrocortisone and dexamethasone

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23
Q

what are the effect of corticosteroids?

A

1) Promote of anti inflammatory genes and inhibitor of pro inflammatory genes
2) Metabolic effect causing glucogensis
3) Mineralocorticoid effects of water and sodium retention and potassium excretion via urine

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24
Q

Give 4 examples of when corticosteroids are used

A

1) Treatment of inflammatory disorders and allergic reaction: anaphylaxis and asthma/COPD
2) suppression of autoimmune disease= IBD or inflammatory arthritis
3) Used in chemotherapy or reduce tumour induced inflammation
4) Hormonal replacement in adrenal insufficiency and hypopituitarism

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25
Q

why are corticosteroids contraindicated in chickenpox and shingles?

A

can make diseases more severe

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26
Q

give a contraindication of corticosteroids

A

systemic fungal infection and immunosuppression

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27
Q

Give a GI side effect of corticosteroids

A

peptic ulcer

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28
Q

What is the side effect caused by the mineralocorticoid effects of corticosteroids?

A

hypertension
Oedema
Hypokalaemia

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29
Q

give an electrolyte side effects of corticosteroids

A

hypernatraemia and hypokalaemia

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30
Q

Give a hormonal/endocrine side effects of corticosteroids

A

cushingoid state
growth suppression in children
Adrenal suppression

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31
Q

GIve an oral side effect of corticosteroids

A

oral thrush

32
Q

give a facial side effect of corticosteroids

A

facial oedema + petichiae

33
Q

how are corticosteroids metabolised?

A

broken down by and induce cytochrome p450

34
Q

give an example of a mucolytic

A

carbocysteine and erdosteine

35
Q

how does carbocysteine work?

A

dissolve mucus and lower viscosity - helps with clearance

36
Q

when are mucolytics used?

A

COPD
bronchiectasis
paracetamol overdose

37
Q

give 2 contraindications for use of mucolytics

A

active peptic ulceration

pregnancy in the first trimester

38
Q

give 2 respiratory side effects for mucolytics

A

bronchoconstriction

respiratory tract irritation

39
Q

give a systemic side effect for mucolytics

A

pyrexia

40
Q

give an ENT side effect for mucolytics

A

rhinorrhoea

41
Q

why shouldn’t mucolytics be used with antitussives?

A

cough suppressants + increased mucus production is a bad combo

42
Q

in what 4 ways does theophylline work?

A

phosphodiesterase inhibitor - reduces inflammation and innate immunity
Adenosine receptor antagonist = reduce inflammation
reverse steroid insensitivity
reverse effects of oxidative stress

43
Q

give 2 indications for theophylline

A

COPD

asthma

44
Q

give 4 contraindications for theophylline

A

active peptic ulcer disease
underlying seizure disorders
Hepatic impairment
Pregnancy –> neonatal irritability and apnoea has been reported

45
Q

give a cardiac side effect for theophyllines

A

arrhythmias/tachycardia

46
Q

give 2 other side effects of theophyllines

A

Nausea and vomiting
headache
dizziness
insomnia

47
Q

how is theophylline metabolised?

A

cytochrome p450

48
Q

When is oxygen administrated?

A

To increase oxygen tissue delivery for any condition that causes hypoxemia
To increase reabsorption of pleural gas in pneumothorax
To reduce the half life of carboxyhemoglobin in Carbon monoxide poisoning

49
Q

When is it contradictory to give high flow oxygen?

A

When the patient has chronic type 2 respiratory failure as the patient has adapted to the hypoxia and hypercapenia

50
Q

What should the aim of oxygen levels be for a patient who has type 2 respiratory failure

A

88%-92%

51
Q

By giving high flow oxygen to a person with chronic type 2 respiratory failure what is the result?

A

Disruption to the adaptive state leading to rise in blood co2 levels.
Causing respiratory acidosis, impaired consciousness and worsened tissue hypoxia

52
Q

What should long acting beta 2 agonist be administrated with when used for chronic asthma?

A

Be administrated with inhaled corticosteroids

53
Q

What are the most common side effect of anticholinergics?

A

Dry mouth and throat irritation

54
Q

What are the metabolic side effects of corticosteroids?

A

DM
Osteoporosis
Bone fracture

55
Q

Interaction with what drugs increase risk of peptic ulcers with corticosteroids?

A

NSAIDS and aspirin. Consider giving gastroprotection

56
Q

Interaction of corticosteroids with what drugs can cause hypokalaemia?

A

Beta 2 agonist, thiazides and loop diuretics and theophylline

57
Q

What affect does corticosteroids have on vaccines?

A

Reduce the effect on the immune system

58
Q

What drugs reduce the plasma levels of corticosteroids?

A

Drug that inhibit cytochrome p450 such as phenytoin and rifampicin

59
Q

What affect does corticosteroid treatment have on adrenal cortisol production?

A

It causes the supression of pituitary ACTH secretion switching of stimulus for normal adrenal cortisol production

60
Q

What is the effect of prolong corticosteroid treatment on the adrenal glands?

A

It causes adrenal atropy and prevents endogenous cortisol production

61
Q

What is the risk of sudden withdrawel of long term corticosteroid use?

A

Patient develops acute addisons crisis with potential cardiovascular collapse

62
Q

What is the treatment for step 1: mild, intermittent asthma?

A

Short acting Beta 2 agonist = salbutamol

63
Q

What is the step 2 treatment for asthma?

A

Corticosteroids inhaled such as beclometasone budesonide and fluticasone

64
Q

What is the step 3 treatment for asthma?

A

Inhaled long-acting beta2 agonists such as salmeterol and formoterol
Has to be given with inhaled corticosteroids

65
Q

What improvements does step 3 have to asthma by the indication of long acting beta 2 agonist?

A

Improves lung function and symptoms and decreases asthma attacks in adults and children.

66
Q

What is step 4 treatment for asthma?

Poor control when you are on inhaled steroids and additional treatment

A

Long acting muscranics: tiotropium

67
Q

What is step 5 treatment for asthma?

A

Additional oral steroids such as prednisolone

68
Q

Give examples of 3 inhaled corticosteroids?

A

beclometasone, budesonide, fluticasone

69
Q

What is the use of inhaled corticosteroids for asthma?

A

Step 2 to treat airway inflammation and control symptoms

70
Q

When is inhaled corticosteroids used for COPD?

A

Used to to control symptoms and prevent exacerbations in patients who have severe
airflow obstruction

71
Q

With what drugs is inhaled corticosteroids used in conjuction with for COPD?

A

long-acting

β2-agonist and/or a long-acting antimuscarinic bronchodilator.

72
Q

What is the function of the inhaled corticosteroids?

A

Reduces mucosal inflammation, widens the airways,and reduces mucus secretion.
This improves symptoms and reduces exacerbations in asthma and COPD

73
Q

What are two common side effects of inhaled corticosteroids?

A 
Oral candidasis (oral thrush)
Hoarse voice
74
Q

What side effect can inhaled corticosteroids induce in patients with copd?

A

pneumonia

75
Q

What is the contradictions for high dose inhaled corticosteroids particularly fluticasone?

A

For COPD patients as can cause pneumonia

Children= cause growth suppresison

76
Q

how many puffs can a patient take of salbutamol at any one time?

A

Up to 10 puffs with a minute between each

Y3 DRUGS PROFILES (9 decks)

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