Respiratory Pharmacologuy Flashcards
Name 3 inhaled corticosteroids (ICS)
Beclometasone, budesonide, fluticasone
How to inhaled corticosteroids work?
- 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
What are some ADR’s of ICS?
Candidiasis (rinse out mouth after using to stop), hoarse voice
What is a SABA?
A short acting B2 agonist, causes symptomatic relief through reversal of bronchoconstriction. Taken PRN.
What are 2 examples of SABA?
Salbutamol and terbutaline
What are two examples of LABA?
Formeterol (fast onset), salmeterol (slow onset)
What are some ADR’s of SABA and LABA
- They are adrenergics - tachycardia, palpitations, tremor
- SVT - Increased SAN activity, causing increased HR and shorter refractory period at AVN
- Muscle cramps (LABA)
- Hypokalaemia
What are contraindications of taking a SABA/LABA?
Taking a beta blocker
What should a LABA always be prescribed alongside?
ICS as increased risk of death when prescribed alone. LABA’s can mask airway inflammation and near fatal asthma attacks.
Name a leukotriene receptor antagonist?
Montelukast
How do LTRA’s work?
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.
What are some ADR’s of LTRA’s?
Headache, GI disturbance, dry mouth and hyperactivity
Name a LAMA
Tiotropium
How do LAMA’s work?
They have selective affinity for M3 receptors (smooth muscle and glands). M3 receptor antagonists.
What are some ADR’s of LAMA’s?
Anticholinergic - Dry mouth, urinary retention, dry eyes
Name a methylxanthine
Theophylline
What are 2 problems with theophylline?
- Narrow therapeutic index, complications include arrythmia in overdose
- Interact with CYP450 inhibitors, increasing concentration of theophylline
When are oral steroids used?
Severe uncontrolled asthma for at least 5 days, and post acute COPD for 5-7 days
Name a SAMA
Iprotropium bromide - less selective for M3 receptors
How do pMDI’s need to be taken?
Inhalation by a slow breath in and hold, use a spacer if not using properly
How do DPI’s need to be taken?
Fast deep inhalation
How do methylxanthines work?
They are adenosine receptor antagonists. It inhibits phosphodiesterase so less conversion of cAMP -> cGMP. This reduces bronchoconstriction by increasing cAMP levels.
If you give IV aminophylline, what has to be monitored?
ECG and theophylline levels in the blood after 24hrs
What is step one of asthma treatment on the BTS guidelines? When would you move to step two?
SABA prn. Consider moving to step two if used more than once daily, or night time symptoms
What is step two of asthma treatment on the BTS guidelines? When would you move to step three?
Add ICS, titrate as required. Move up if needed.
What is step three of asthma treatment on the BTS guidelines?
Add LABA. If benefit but still inadequate control, increased dose of ICS. If no benefit, stop LABA and increase ICS.
What is step four of asthma treatment on the BTS guidelines?
Increase dose of ICS
Add LTRA/theophylline
What is step five of asthma treatment on the BTS guidelines?
Add oral prednisolone
Refer for specialist care
What is step one in the BTS guidelines of COPD management?
Give a SABA/LABA
What combination therapies can you give in COPD?
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
What is triple combination therapy in COPD?
LAMA + ICS + LABA
When can LTOT be used in COPD?
- Clinically stable non smokers with PO2<7.3kPa despite treatment
- If PO2 between 7.4-8 and pulmonary hypertension, polycythaemia, peripheral oedema, nocturnal hypoxia
- Terminally ill patients
How long do you give LTOT for a day for a survival benefit?
At least 16hours/day
What is pulmonary rehabilitation?
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.
When can chest physiotherapy be used?
If a patient has excessive sputum production
