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Respiratory Medicine > Respiratory Pharmacologuy > Flashcards

Respiratory Pharmacologuy Flashcards

1
Q

Name 3 inhaled corticosteroids (ICS)

A

Beclometasone, budesonide, fluticasone

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2
Q

How to inhaled corticosteroids work?

A
  • Regular preventer of asthma
  • It passes through the plasma membrane and activates cytoplasmic receptors. the activated receptor passes into the nucleus to modify transcription.
  • It reduces mucosal inflammation, widens airways and reduces mucus
  • Reduces mortality
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3
Q

What are some ADR’s of ICS?

A

Candidiasis (rinse out mouth after using to stop), hoarse voice

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4
Q

What is a SABA?

A

A short acting B2 agonist, causes symptomatic relief through reversal of bronchoconstriction. Taken PRN.

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5
Q

What are 2 examples of SABA?

A

Salbutamol and terbutaline

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6
Q

What are two examples of LABA?

A

Formeterol (fast onset), salmeterol (slow onset)

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7
Q

What are some ADR’s of SABA and LABA

A
  • They are adrenergics - tachycardia, palpitations, tremor
  • SVT - Increased SAN activity, causing increased HR and shorter refractory period at AVN
  • Muscle cramps (LABA)
  • Hypokalaemia
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8
Q

What are contraindications of taking a SABA/LABA?

A

Taking a beta blocker

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9
Q

What should a LABA always be prescribed alongside?

A

ICS as increased risk of death when prescribed alone. LABA’s can mask airway inflammation and near fatal asthma attacks.

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10
Q

Name a leukotriene receptor antagonist?

A

Montelukast

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11
Q

How do LTRA’s work?

A

They block the CysLT1 receptor (GPCR). LTC4 binds to the receptor which is released from mast cells and eosinophils, causing bronchoconstriction, increased mucus and oedema.

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12
Q

What are some ADR’s of LTRA’s?

A

Headache, GI disturbance, dry mouth and hyperactivity

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13
Q

Name a LAMA

A

Tiotropium

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14
Q

How do LAMA’s work?

A

They have selective affinity for M3 receptors (smooth muscle and glands). M3 receptor antagonists.

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15
Q

What are some ADR’s of LAMA’s?

A

Anticholinergic - Dry mouth, urinary retention, dry eyes

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16
Q

Name a methylxanthine

A

Theophylline

17
Q

What are 2 problems with theophylline?

A
  1. Narrow therapeutic index, complications include arrythmia in overdose
  2. Interact with CYP450 inhibitors, increasing concentration of theophylline
18
Q

When are oral steroids used?

A

Severe uncontrolled asthma for at least 5 days, and post acute COPD for 5-7 days

19
Q

Name a SAMA

A

Iprotropium bromide - less selective for M3 receptors

20
Q

How do pMDI’s need to be taken?

A

Inhalation by a slow breath in and hold, use a spacer if not using properly

21
Q

How do DPI’s need to be taken?

A

Fast deep inhalation

22
Q

How do methylxanthines work?

A

They are adenosine receptor antagonists. It inhibits phosphodiesterase so less conversion of cAMP -> cGMP. This reduces bronchoconstriction by increasing cAMP levels.

23
Q

If you give IV aminophylline, what has to be monitored?

A

ECG and theophylline levels in the blood after 24hrs

24
Q

What is step one of asthma treatment on the BTS guidelines? When would you move to step two?

A

SABA prn. Consider moving to step two if used more than once daily, or night time symptoms

25
Q

What is step two of asthma treatment on the BTS guidelines? When would you move to step three?

A

Add ICS, titrate as required. Move up if needed.

26
Q

What is step three of asthma treatment on the BTS guidelines?

A

Add LABA. If benefit but still inadequate control, increased dose of ICS. If no benefit, stop LABA and increase ICS.

27
Q

What is step four of asthma treatment on the BTS guidelines?

A

Increase dose of ICS

Add LTRA/theophylline

28
Q

What is step five of asthma treatment on the BTS guidelines?

A

Add oral prednisolone

Refer for specialist care

29
Q

What is step one in the BTS guidelines of COPD management?

A

Give a SABA/LABA

30
Q

What combination therapies can you give in COPD?

A

If FEV1>50% - Give LAMA and LABA
If FEV1<50% - Give LABA and ICS
Give if patient is having exacerbations despite quitting smoking and being on a SABA

31
Q

What is triple combination therapy in COPD?

A

LAMA + ICS + LABA

32
Q

When can LTOT be used in COPD?

A
  1. Clinically stable non smokers with PO2<7.3kPa despite treatment
  2. If PO2 between 7.4-8 and pulmonary hypertension, polycythaemia, peripheral oedema, nocturnal hypoxia
  3. Terminally ill patients
33
Q

How long do you give LTOT for a day for a survival benefit?

A

At least 16hours/day

34
Q

What is pulmonary rehabilitation?

A

Many patients with COPD avoid exercise and physical activity because of breathlessness, which causes a vicious cycle. It is a MDT 6-12 week programme of supervised exercise, home exercise, nutritional advice and disease education.

35
Q

When can chest physiotherapy be used?

A

If a patient has excessive sputum production

Respiratory Medicine (14 decks)

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