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Pharmacology > Respiratory Drugs > Flashcards

Respiratory Drugs Flashcards

1
Q

What is the mechanism of beta2 agonists?

A

Bronchodilation of the airways - allow more air to ventilate the alveoli
Also increase mucus clearance via cilia action

Prevent bronchoconstriction prior to exercise

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2
Q

What are the contraindications of beta-2 agonists?

A

Increase heart rate as they stimulate the SAN, this is particularly a problem in those who suffer from cardiac issues, also decrease refractory period at AVN.

Adrenergic -FOFR
Increased glycogenolysis and renin
Muscle cramps (LABA)

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3
Q

What is the mechanism of action of glucocorticoids in asthma?

A

Reduces chronic inflammation, improving respiration. It is particularly effective at targeting eosinophils

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4
Q

Why might a spacer be given?

A

It aids correct administration of medication, through proper inhalation. Particularly helpful in children and the elderly.

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5
Q

Why is there a difference between asthma and COPD nebulisation?

A

Asthma - O2
COPD- air, since hypercapnia now drives respiration as the choroid plexus detects chronic CO2 and the peripheral chemoreceptors take over. Therefore since the respiratory drive is now due to pO2, this would be lost if nebulized with o2.

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6
Q

What medication is recommended to be taken if glucocorticoids aren’t sufficient enough to manage asthma?

A

Long acting beta agonists

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7
Q

Why do LABAs always need to be prescribed with glucocorticoids?

A

Without them, they increase the likelihood of death

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8
Q

What is the main concern when prescribing glucocorticoids to COPD patients?

A

Increased risk of infection, since glucocorticoids act as immunosuppressants.

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9
Q

Before stepping up or down asthma medication, what key considerations should be made?

A
  • adherence
  • inhaler technique
  • eliminate trigger factors
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10
Q

What is the next step once a regular preventer become insufficient?

A

Inhaled corticosteroids - reduce mucosal inflammation, widen airway, reduce mucus.

Includes beclometasone, budesonide and fluticasone.

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11
Q

What are the ARDs implicated from inhaled corticosteroid use?

A

Pneumonia risk

Local immunosuppressive action- oral candidiasis and hoarse voice

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12
Q

What types of B2 agonists are there?

A

SABA - reversal of bronchoconstriction

LABA- add on therapy

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13
Q

Name a short and fast acting b2 agonist

A

Salbutamol

Terbutaline

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14
Q

Name a long and fast acting b2 agonist

A

Formoterol

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15
Q

Name a long and slow acting b2 agonist

A

Salmeterol

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16
Q

Why might formoterol be prescribed over salmeterol?

A

More potent and efficacious

17
Q

What therapy might be added to an asthmatics medication?

A

Leukotriene receptor antagonists - montelukast

18
Q

What it the mechanism of action of LTRA?

A

LTRA block CysLT1

Prevents LTC4 released by mast cells/eosinophils - which causes bronchoconstriction, mucus and oedema.

19
Q

What is the ADRs of LTRA?

A

Headache
GI disturbance
Dry mouth
Hyperactivity

20
Q

What additional controller therapies might be prescribed?

A

Ipratropium-Long acting muscarinic antagonist - severe asthma and COPD, selective for M3. Anticholinergic effects via inhibition.

Theophylline - a methylxanthine p.o adenosine receptor antagonist.

21
Q

What are the ADRs of tiotropium (LAMA)?

A

Dry mouth
Urinary retention
Dry eyes

22
Q

What are the potential issues with theophylline?

A

Narrow therapeutic index - life-threatening complications including arrhythmia.
Interaction with CYP450 inhibitors - increase concentration

23
Q

What specialist maintenance therapy might be prescribed for asthmatics?

A

Oral steroids- prednisolone
For severe uncontrolled asthma, carry steroid card.

Post acute exacerbation - at least 5 days
Post acute COPD- 5-7 days

24
Q

What are the treatment plans for those with acute severe or life threatening asthma?

A

Oxygen
High dose nebulised B2 agonist
Oral steroids for 7-14 days in addition to ICS
If poor response give nebulised ipratropium bromide (SAMA).
Consider IV aminophylline if life threatening with no success.

25
Q

What are the 5 tasks of management with COPD?

A 
Confirm diagnosis 
Smoking cessation
Pulmonary rehabilitation and lifestyle advice 
Vaccinations 
Consider medication
26
Q

How are acute exacerbations of COPD handled in hospital?

A

Nebulised salbutamol +/- ipratropium . In hypercapnia or acidotic, nebuliser driven by air.

Oral steroids

Antibiotics

Review of chronic treatment and action plan.

27
Q

Why are oral steroids less effective in COPD compared to asthma

A

Asthma is primarily mediated by eosinophils whereas COPD is by neutrophils.

Oral steroids are less effective due to a reduced action on neutrophils.

28
Q

What type of options are there for inhalers?

A

Pressurised metered dose inhalers

Breath- actuated pMDI

Dry powder inhalers

Pharmacology (22 decks)

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