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OSCE Pharmacology > Respiratory Examination - Asthma, COPD + Corticosteroids > Flashcards

Respiratory Examination - Asthma, COPD + Corticosteroids Flashcards

1
Q

Name 5 drugs commonly used in the treatment of lung conditions

A 
B2 agonist
Muscarinic Receptor Antagonist
Methylxanthines
Leukotriene Receptor Antagonists
Glucocorticoids
Loop diuretics (Pulmonary oedema)
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2
Q

Name some major B2 agonists

A

Short acting - Salbutamol

Long acting - Salmeterol

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3
Q

Mechanism of action of B2 agonists

A

Act on B2 receptors found on bronchial smooth muscle. The receptors are coupled to Gs Proteins, which cause an increase in cAMP and consequent decrease in intracellular [Ca2+]. This reduces the binding of Ca2+ by light myosin, causing smooth muscle dilation.
- Additionally, the decrease in intracellular Ca2+ will also and increase Ca2+ activated K+ currents, thus hyperpolarising muscle cells further and augmenting bronchodilation.

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4
Q

Give two ADRs of b2 agonists

A

Skeletal muscle tremor

Can act on cardiac B1 receptors to induce tachycardia and cardiac dysrhythmia

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5
Q

Give one negative drug-drug interaction of B2 agonists

A

Propanolol (beta blocker) reduces effects

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6
Q

Name a muscarinic receptor antagonist

A

Ipratropium Bromide

Tiotropium bromide

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7
Q

Mechanism of action of muscarinic receptor antagonists?

A
  • Bind to and antagonise M3 cholinergic receptors on bronchial smooth muscle. This blocks the constricting effect of Ach and also inhibits mucus secretions.
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8
Q

Give an ADR of muscarinic receptor antagonist

A

Dry mouth

Systemic effects avoid as not well absorbed

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9
Q

When would you use muscarinic antagonists?

A

COPD and Asthma

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10
Q

Name two methylxanthines

A

Theophylline

Aminophyilline

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11
Q

What is the mechanism of methylxanthines?

A

Competitive antagonist of adenosine

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12
Q

What are two complications of methylxanthine use?

A

Cardiac dysrhymia

Seizure

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13
Q

What are some indications for the use of leukotriene receptor antagonists?

A

Mild asthma

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14
Q

What is the mechanism of action of leukotriene receptor antagonists?

A

Antagonise cysLT1 and prevent early and late responses from inflammatory cells

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15
Q

What are two ADRs of Leukotriene Receptor Antagonists?

A

Headache and gastrointestinal disturbance

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16
Q

Name three corticosteroids

A

Prednisolone
Beclometasone (inhaled)
Hydrocortisone

17
Q

What are three indications for corticosteroids?

A

Immunosuppression
Anti-inflammatory therapy
Replacement of endogenous corticosteroids

18
Q

Give a contra-indication for glucocroticoids

A

Systemic infection

19
Q

What is the mechanism of action of glucocorticoids?

A

Diffuse into cytoplasm and bind receptor. Complex moves to nucleus and binds HRE, causing inducement and inhibition of transcription.

20
Q

Give four of the post-transcriptional effects of glucocorticoids

A
  • Upregulate B2 receptors in lungs
  • Reduce production of acute inflammatory mediator by inhibiting arachadonic acid processing (Upreg lipocortin which inhibits phospholipase A2, no Prost and leukotrienes prod)
  • Reduce number of circulating immunocompetent cells
  • Decreases activity of cells involved in chronic stages of inflammation (macrophages/fibroblast)
21
Q

Give three ADRs of corticosteroids, specifically inhaled

A

Oral candiadiasis
Suppression of HPA acis
Osteoporosis

22
Q

What is the main cortiosteroid used in asthma and COPD?

A

Beclametasone

23
Q

How must you stop corticosteroid therpay?

A

Slowly, to avoid HPA supression

24
Q

Outline the indication for a loop diuretic

A

Pulmonary oedema

25
Q

Name a diuretic used in pulmonary oedema

A

Furosemide

26
Q

What is the mech of action of furosemide?

A

NKCC2 blocker in thick ascending limb of loop of henle

27
Q

Give four ADRs of loop diuretics

A
  • Hypokalaemia, Ototoxicity, hyponatraemia, hyperuricaemia (can precipitate gout)`
28
Q

Give two of the main drug-drug interactions of loop diuretics

A
  • Cardiac glycosides – Hypokalaemia caused by loop diuretic potentiate effects of cardiac glycosides, increasing risk of arrhytmias
  • Aminoglycosides – Can compound ototoxicity
29
Q

Give two common bacterial causes of community acquired pneumonia

A

Strep pneumonia

Haemophilus influenza

30
Q

Give two common causes of hospital acquired pneumonia

A

Staph aureus

Pseudomonas

31
Q

Give two treatments for two community causes pneumonia

A

Step pneumonia -Amoxicillin (b-lactam, inhibit transpeptidase synthesis of cell wall)
Haemophilus - Clarithromycin (macrolide, binds to bacterial ribosome and prevents protein synth)

32
Q

Give two treatments for two hospital acquired pneumonias

A

Staph aureus - Vancomycin (inhibit cell wall synth

Gram -‘ve enterococci - Amino glycoside1

33
Q

How does aminoglycoside work?

A

Inhibit bacterial protein synthetsis

OSCE Pharmacology (10 decks)

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