Respiratory drugs Flashcards by Adele Atkins

Name some adrenergic agonist respiratory drugs

Salbutamol

Salmeterol

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Name some anticholinergic respiratory drugs

Tiotropium

Ipatropium

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Name a methyxanthine

Aminophylline

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Name two types of anti=inflammatory drugs used in respiratory illness

Steroids

Leukotreine inhibitors

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Name some mucokinetic agents

Carbocysteine
Hypertonic saline
Dnase

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List some inhaled drug devices

Metered dose inhalers
Dry powder inhalers
Nebulisers

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Describe the metered dose inhaler technique

Deep exhale/inhale and puff/ hold breath for slow 10 count/ exhale slowly/ wait one minute before 2nd puff

Use spacer

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Describe the dry powder inhaler technique

Usually one inhalation, not a puff

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Describe the duration of salbutamol

Short 3-5hr

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List the routes of administration of salbutamol

Inhaled
IV
Oral

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Describe the mechanism of action of salbutamol

Binding to beta 2 adrenoreceptors on the smooth muscle of the bronchioles causes them to relax and leads to bronchodilation

Increased cAMP production by activating adenylate cyclase

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What conditions is salbutamol used in?

Asthma

COPD

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Describe the duration of action of salmeterol

Long acting 10-12hr

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List the routes of salmeterol administration

Inhaled

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Give the mechanism of action of salmeterol

Long acting beta adrenoceptor agonist

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Describe the use of salmeterol

Asthma - in patients requiring long term regular bronchodilator therapy on ICS
COPD persistent symptoms despite therapy

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Describe the duration of tiotropium

24 hrs - long acting

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Give the routes of tiotropium

Inhaled - dry powder handihaler

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Describe the mechanism of action of tiotropium

Lon acting antimuscarinic agent which is often referred to as an anticholinergic
Similar affinity to the subtypes of muscarinic receptors M1-M5
In the airways it inhibits M3 leading to bronchodilation

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Give the indications for tiotropium

Stable COPD despite SABA

Asthma - new indication step 3

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Give the duration of theophylline

Half life 5hrs

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Give the routes of administration of theophylline

IV/PO

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Describe the mechanism of action of theophylline

Phosphodiesterase inhibitor

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What are the indications for theophylline use?

PO - COPD and asthma - persistent symptoms

IV - COPD and asthma medical emergencies

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List the adverse effects of bronchodilators

``` Tachycardia Nervousness Irritability Tremor Inhaled preparations - less common Oral preparations - systemic symptoms - more chance of tachyarrhythmia and angina Dose related ```

Name a systemic steroid

Prednisolone

Describe systemic steroids

IV/PO Stronger effects Action unaffected by lung restriction More side effects especially with long term therapy

Name an inhaled steroid

Beclometasone

Describe inhaled steroids

Localised action Fewer systemic side effects - some absorption occurs Disease may prevent penetration to some areas

Describe the airway effects of steroids

Decrease release of inflammatory mediators Decrease infiltration and action of WBCs Decrease airway oedema Decrease airway mucus production Increase number and sensitivity of beta 2 receptors

List some adverse effects of inhaled steroids

Oral candidasis | Dysphonia

List the general adverse effects of steroids

``` Adrenal suppression Bone loss Slow growth in children Increase risk of cataracts and glaucoma Increased risk of infection Gastric ulceration Hypertension Diabetes Mood disturbance ```

List some medications used in allergic rhinitis

Antihistamines Intranasal glucocorticoids Montelukast Sympathomimetics

Describe the action of a montelukast

Inhibits leukotriene receptors | Decreases inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

Name some antihistamines

Cetirizine | Chlorpheniramine

Describe the asthma treatment ladder

5 Steps Move up and down as required Step 1 - short acting inhaled B2 agonist Step 2 - inhaled steroid (regular preventer therapy) Step 3 - Add inhaled long acting B 2 agonist (LABA) Step 4 - Increase inhaled steroid dose, addition of leukotriene receptor drug Step 5 - Daily steroid tablet

Describe the treatment options in COPD

SABA/SAMA LABA/LAMA/LABA+ICS LAMA + ICS/ LAMA+LABA+ICS

What can occur from over oxygenation?

Type 2 respiratory failure

List some penicillins

Amoxicillin Co-amoxiclav Tazobactum

Describe amoxicillin use in respiratory infection

``` Moderate spectrum Beta lactam Bacteriolytic Routes - IV/Oral Used in CAP/bronchitis/COPD exacerbation Gram positive and negative ```

Describe co-amoxicalv

Amoxicillin plus clavulinic acid - resistant to beta lactamase degredation

What is tazobactum used to treat?

Hospital acquired pneumonia and gram negative bacteria | Extended spectrum beta lactam antibiotic

Describe the mechanism of action of tetracycline antibiotics

Inhibits protein synthesis

Describe the spectrum of tetracycline antibiotics

Broad spectrum action gram negative and positive

What are tetracycline antibiotics useful for treating?

Atypical infections

Describe the route of administation of doxycyline

Oral only

List the side effects of tetracycline antibiotics

``` GI upset Teeth Staining Lupus Allergy Photosensitivity ```

Name some quinolones

Ciprofloxacin | Moxifloxacin

Describe the mechanism of action of quinolones

DNA fragmentation

Describe the spectrum of activity of quinolones

Gram positive and negative and pseudomonas coverage

Describe the route of administration of quinolones

IV/PO/inhaled

Describe the side effects of quinolones

``` GI upset C difficile Tendonitis Liver upset Prologned QTc Arrhythmia ```

Name a macrolide

Clarithromycin

Describe the use of macrolides

Commonly used in respiratory infection

Describe the mechanism of action of macrolides

Protein synthesis inhibitors

Give the routes of administration of macrolides

IV/PO

Describe the spectrum of action of macrolides

Gram positive | Limited gram negative

Give the side effects of macrolides

GI disturbance Allergy Liver abnormality Prolonged QTc

What is the standard TB therapy

``` 2 months (initial phase) - Isoniazid, rifampicin, ethambutol and pyrazinamide 4 months (continuation phase) - Isoniazid and Rifampicin ```

Describe the administration of TB therapy

Direct observed treatment | 1 hr before breakfast on empty stomach

Describe the mechanism of action of isoniazid

Bactericidal and bacteriostatic Inhibits cell wall growth Cytochrome P450 inhibitor

List the side effects of isoniazid

Optic neuritis Peripheral neuropathy Fever

Describe the mechanism of action of rifampicin

Inhibits bacterial DNA dependent RNA synthesis

List the main side effect of rifampicin

Red urine

What does pyrazinamide cause?

Accumulation of pyrazinoic acid

Describe the mechanism of action of ethambutol

Bacteriostatic obstructs synthesis of cell wall

List the side effects of ethambutol

AKI, gout, optic neuropathy, peripheral neuropathy

Name a Cystic fibrosis immunomodulating drug

Ivakaftor