Respiratory Drugs

Question 1

Give symptoms for the ff:
Asthma: Esinophilic
Emphysema: Neutrophil
Chronic bronchitis: Neutrophil

Answer 1

A: Coughing with wheezing during breath, and SOB
E: SOB (dyspnea), fatigue
C: SOB (dyspnea) + sputum

Question 2

Give DOCs for the ff: A, E, C

Answer 2

A: Salbutamol, anti- inflammatory Inhaled c.c.st (ICS)
E: DOC bronchodilator Ipra, Tio, salb., salm., formo. (LABA).
Q Inhaled c.c.st are LEAST likely used.
PSO2 <90% oxygen therapy
C: Antibiotics for exacerbations of pneumonia. C.c.st PO for less than <2wks.

Question 3

Drugs that cause bronchodilation

Drugs that cause bronchospasm

Answer 3

-beta2 agonist (sympathomimetics)➡️ Salbutamol, salmeterol, formoterol
mixed alpha & beta
muscarinic antagonists
- Beta blockers

Question 4

MOA of what drug that stimulates this receptor that causes increase CAMP in smooth muscle leading to bronchodilation?

Answer 4

Beta2 Adrenergic Agonist
Beta2 receptor
**Oral beta2 agonist have more SEs, and less bronchodilation effect than inhaled preparations.

Question 5

Relieve broncons., cough, wheezing and chest tight., asth emerg. and exercise ind. asth- Only for rescue as needed, onset and SEs?
• What drug: 1-2 puff tid-QID maximum 8 puffs
• maximum 6 inhalations/day
Regular use can lead to decline in lung function.

Answer 5

Short acting beta2 agonist (SABA): onset 5 min. SEs: Tremors, nervousness, tachycardia, palpitation, weakness, flushing of face or skin, insomnia,
nausea and vomiting.
-Salbutamol (Albuterol)
-Terbutaline

Question 6

Long acting beta2 agonist (LABA) (Maintenance or daily): In asthma LABA combined with ICS. Give drug ex, onset and DOA.
SEs. Same as SABA.

Answer 6

• Inhaled. Formoterol (full B2 agonist), salmeterol (partial agonist)
• Onset:14 min and DOA: up to 24 hours. Reg. BID treatment.
• Therapeutic use. Maintenance therapy and EIA. Used in patients already taking corticosteroids.
Formoterol can be used for acute and maintenance.

Question 7

• Drug type used as bronchodilators.
• This is used as alternative for pts susceptible to tremors or tachy. from B2 agonist.
• Long acting OD, admin. by handihaler.
• Give SEs

Answer 7

• Anticholinergic: Ipratropium bromide
• Tiotropium DPI (Spiriva, Handihaler, and RESPIMAT inhaler) 18 mcg/daily capsule for inhalation.
• SEs. Dry mouth, metallic taste, mydriasis, and glaucoma if released into eye.

Question 8

Brand name and dosing for these anticholinergics:
Ipratropiun (Atrovant)
Tiotropium (Spiriva handilaer, Respimat) Glycopyrronium (Seebri Neohaler)
Aclidinium (Tudorza Pressair)
Umeclidinium (Incruse Ellipta)

Answer 8

Ipra(Atrovant) 2 puffs q6-8h
Tiotro (Spiriva handiler, Respimat) OD
Glyco (Seebri Neohaler) BID
Acli (Tudorza Pressair) BID
Ume (Incruse Ellipta) OD

Question 9

Combinations: ICS + LABA drug examples:

Answer 9

Symbicort = budesonide/formoterol Advair = Fluticasone/salmeterol 
Zenhale = mometasone/formoterol
BREO = FLUTICASONE + VILANTEROL

Question 10

Benefit ↑ lung function, ↓ airway hyper responsiveness, ↓ symptoms of exacerbations.
Give onset.
Fluticasone dosing

Answer 10

Inhaled corticosteroids (ICS)

• Max clinical effects in 2 to 4 wks
• Fluticasone given 2-4 puffs BID

Question 11

ICS SEs
Rinsing mouth and using spacer (aero chamber) can minimize SEs.
High dosages monitor:

Answer 11

Side effects: Sore mouth and sore throat. Oral pharyngeal candidiasis (oral thrush), dysphonea (hoarseness) from vocal cord myopathy and cough
-Check bone densitometry, patient with glaucoma check IOP

Question 12

Oral corticosteroids (Po CST)
Tx and SEs.

Answer 12

• Tx use: Severe asthma with intensive airway inflammation.

* SEs. Hyperglycemia, osteoporosis, hypothyroidism, hypertension, wt gain, ulcers, edema, and susc. to infxs.

Question 13

• have anti-inflammatory action, however not as effective as low dose ICS for improving symptoms or exacerbations. It is considered as ad-on therapy with ICS.
• Therapeutic use:

Answer 13

Leukotriene antagonist: Montelukast and zafirlukast

Tx: Asthma maintenance (steroid sparing agents), and the drug of choice for ASA induced and beta blockers induced asthma

Question 14

Montelukast >2yr age dosing, dos. forms

Zafirlukast >12yr age, dos. forms

Answer 14

M: 10 mg QHS po tabs in children >2 yr age, granules and 4 mg, 5 mg chewable tabs
Z: 20 mg BID po at least 1 h before and 2hr after meals is used in over >12 yr age and only oral available.

Question 15

Advantage of combinations:

Disadvantage:

Answer 15

Adv: More convenient, enhance adherence, less expensive.
Disadv:Loss in dosing flexibility

Question 16

COPD is due to chronic obstruction of airway passage. 2 types:

Answer 16

Emphysema (high altitude sickness)- small air exchange sacs (alveoli) in the lungs perm. enlarged and damaged (alv walls destroyed) dec. O2 abs. = SOB
and chronic bronchitis- inflammof airways in lungs that produces excess mucus (phlegm), assoc. with chronic productive cough. This reduces the flow of air to the lungs.

Question 17

• Chronic bronchitis onset age?

- Risk factors that causes COPD:

Answer 17

• 45 yo

- Factors: Smoking (80-90%), fam hx, occu. exposures to ducts and fumes, air pollution, 2nd hand smoking, asthma

Question 18

Diagnosis: spirometer, peak flow meter, bronchoprovocation test.
alpha1-antitrypsin level: for family history of COPD
Chest X-ray

Answer 18

pulse oximetry+/- arterial blood gas (SpO2): determines the requirement oxygen therapy.
SpO2 >95% = normal
SpO2 91-94% = borderline
SpO2 85-90% = Immediate intervention SpO2 <85% = administer 100% oxygen

Question 19

Treatment sequence for COPD?

Answer 19

SABD –> LABD –> Theophylline –> oral steroids or antibiotics
SABD = salbutamol, ipratropium
LABD = salme, formo, tiotro

Question 20

Drug used for the treatment of COPD:
-It is a muscarinic blocker and acts as bronchodilator
Give others:

Answer 20

-Anticholinergics: Ipratropium (Atrovent) and tiotropium (Spiriva)
• Beta adrenergic agonists
• Corticosteroids
• Theophylline
• Antibiotics. Doxy, azith, and amoxi

Question 21

ASTHMA AND COPD DRUG DOSAGE FORMS:
Salbutamol
Montelukast
Theophylline
Advair (fluticasone/salmeterol) Symbicort (Budosenide/formeterol) Zenhale (mometasone/formeterol)

Answer 21

Salbu-MDI, turbuhaler, nebulizer
Monte- tabs, chew, gran
Theo- tabs, XI tabs
Advair- diskus and turbuhaler
Symbicort- turbuhaler
Zenhale- inhaler

Question 22

Community acquired pneumonia (CAP) without risk factors

Pneumonia in COPD patient is treated by:

Answer 22

amoxicillin, doxycycline, cotrimoxazole, azithromycin, or clarithromycin.

Question 23

COPD with risk factors:

Answer 23

FEV1 <50%, Ischemic heart diseases, use of home O2, chronic use of steroids,
stnd rd antibiotic use <3m, >4 exacerbation/yr. Amoxi/clav, cephalosporin’s (1 , 2 , and 3 ) or
fluroquinolones (levofloxacin and moxifloxacin).

Question 24

Inhalational Drug delivery devices:

Aerosolized medications drug delivery depends on:

Answer 24

Drug form. prop. (part. sz distri., selected the DDS)
Approp. device: with approp. part. sz and lung delivery.
Inh. techq: inspiratory flow rate, inspiratory volume, and breath holding time determines the dose of inhaled drug that deposits in lung

Question 25

READ TIP ANSWERS

Answer 25

page 207

Question 26

A.S.T.H.M.A- management

Answer 26

Adrenergic agonist
Steroids (ICS)
Theophylline, LT
Hydration (IV)
Mask (O2)
Anticholinergic

Question 27

Which of the following asthma device at home helps patient to determine when to go emergence?

Answer 27

Peak flow meter measures peak expiratory flow rate (PEFR)