Respiratory Drugs

Question 1

List the ways that respiratory drugs can be administered.

Answer 1

Inhalation
Oral
IV

Question 2

Describe how inhaled respiratory drugs work.

Answer 2

Inhaled drugs are topical drugs.

The power falls and settles on airway linings as the speed of the air slows.

Question 3

What drugs impair ventilation?

Answer 3

Beta blockers

Respiratory depressants;
Benzodiazepines (cause drowsiness)
Opioids (have an effect on the area of the brain which regulates respiratory rate)

Question 4

What are the 2 main actions of respiratory drugs?

Answer 4

Improving ventilation

Improving gas exchange

Question 5

How do respiratory drugs improve ventilation?

Answer 5

Improve ventilation via;

Increasing the airway diameter
Preventing mast cell degranulation

Question 6

What drugs increase airway diameter and improve ventilation?

Answer 6

Bronchodilators - Beta2 agonists and anticholinergics

Anti-inflammatory drugs - corticosteroids.

Question 7

What drugs improve ventilation by preventing mast cell degranulation?

Answer 7

Leukotriene receptor antagonists

Question 8

What drugs improve gas exchange?

Answer 8

Theophyllines

Oxygen

Question 9

Name the types of inhalers.

Answer 9

Meter dose inhaler (puffer)

Breath activated device (spinhaler and turbohaler)

Question 10

How can we aid the delivery of respiratory drugs?

Answer 10

Nebuliser - Bubbles contain high concentrations of the drug.

Spacers - Increases the concentration of drug reaching the airways and reduced the effects of steroids in the oral cavity. = thrush

Question 11

Name short acting b2 agonists that improve airway diameter (and therefore ventilation)

Answer 11

Salbutamol (blue)

Terbutaline (blue)

Question 12

What is the onset of short acting b2 agonists?

Answer 12

2 - 3 mins

Question 13

How long do the effects if short acting b2 agonists last?

Answer 13

4 - 6 hours

Question 14

What do short acting b2 agonists treat?

Answer 14

Treat constriction of the airways in an acute attack.

Question 15

Name a long acting b2 agonist used to improve airway diameter (and therefore ventilation)

Answer 15

Salmeterol (green)

Question 16

What is the onset of long acting b2 agonists?

Answer 16

onset 1-2 hours

Question 17

How long do long acting b2 agonists last?

Answer 17

12 -15 hours

Question 18

What are long acting b2 agonists used for?

Answer 18

Used as a preventative measure - not used to treat an acute attack.

MUST BE USED ALONGSIDE INHALED STEROIDS.

Question 19

Name an anticholinergic drug that improves airway diameter (and therefore ventilation)

Answer 19

Ipratropium (grey)

Question 20

What are the actions of ipratropium?

(Anticholinergic drug that is used for bronchodilation and improving ventilation)

Answer 20

Inhibits muscarinic nerve transmission

Reduces mucus secretion

Question 21

Name corticosteroids that improve airway diameter (and therefore ventilation)

Answer 21

Beclomethasone (brown)
Fluticasone (orange)
Mometasone (pink)

Question 22

What are the actions of corticosteroids?

(Used for bronchodilation and improving ventilation)

Answer 22

Target all 3 mechanisms of asthma;

Reduce inflammation of the bronchial wall
Reduce contraction of smooth muscle
Reduce mucous secretion

Question 23

What medication is the most effective way to treat asthma?

Answer 23

Corticosteroids

Question 24

When would inhaled corticosteroids be used?

Answer 24

Used if short acting b2 agonists have to be taken > 3 times per week.
(used alongside long acting b2 agonists)

Not used to TREAT an acute attack however is taken as a preventative measure for latent attacks.

Question 25

When would oral steroids be given to an asthmatic patient?

Answer 25

In a very severe asthma attack.

Question 26

Describe the progression of treatment for asthma.

Answer 26

Starting point - salbutamol : inhaled short acting b2 agonist.
If this has to be taken > 3 x per week patient moves on to;

Beclamethasone : inhaled corticosteroid.
This is usually taken alongside a long acting b2 agonist - Salmeterol.

Leukotriene agonists - prevent mast cell degranulation.

In very severe asthma/asthma attacks patients have to take oral steroids and are regularly hospitalised.

Question 27

What do b2 agonists (used in an acute attack) not have an effect on?

Answer 27

Oedema of the airways

Excessive mucous secretion

Question 28

What are the side effects of steroid inhalers?

Answer 28

Commonly;
Oral candidiasis = fungal infection of the mouth.

When dosages are > 1500 ug
= Osteoporosis
= adrenal suppression.

Question 29

What medications are taken to treat oral candidiasis?

Answer 29

Nystatin

Fluconazole