Respiratory pharmacology

Question 1

List four main causes of respiratory pathology

Answer 1

Trauma

Infection

Allergy

Toxin

Question 2

List the three main aims of respiratory therapeutics

Answer 2

1. to control aetiology
2. to control inflammation
3. to provide relief of symptoms

Question 3

Name two classes of drugs that might be important in controlling respiratory aetiology

Answer 3

Chemotherapeutics

Diuretics

Question 4

Name three drug classes that might be useful in controlling respiratory inflammation

Answer 4

Glucocorticosteroids

Antihistamines

Leukotriene antagonists

Question 5

Name six classes of drugs that might provide relief of respiratory symptoms

Answer 5

Bronchodilators

Mucolytics

Antitussives

Expectorants

Surfactants

Decongestants

Question 6

Which system stimulates the production of mucus from the respiratory system

Answer 6

Cholinergic innervation

Question 7

Which cells produce mucous in the respiratory system?

Answer 7

Submucosal glands and goblet cells

Question 8

Briefly describe the structure of mucous in the respiratory systems

Answer 8

Mucoproteins, DNA

Question 9

What is the normal function of mucous in the respiratory system?

Answer 9

Protective coating from nasal cavity to large bronchioles

Humidifies air, protects from irritants and infection

Question 10

What is the function of mucolytics?

Answer 10

Break up mucous

Question 11

Name two mucolytics

Answer 11

Acetylcysteine (nebulisation)

Bromhexine

Question 12

Describe the mechanism of action of acetylcysteine as a mucolytic

Answer 12

Breaks disulfide linkes in mucoproteins

Question 13

Describe the mechanism of action of bromhexine as a mucolytic

Answer 13

Increased lysosome activity

Question 14

What else can acetylcystein be used for besides being a mucolytic?

Answer 14

Paracetamol toxicity

Question 15

Name an expectorant

Answer 15

Guaifenisin (glycerol guiacolate)

Question 16

What is the aim of using an expectorant?

Answer 16

Designed to increase respiratory secretions and help clear airways

No real data to suggest effectiveness in dogs and cats

Question 17

Which class of drugs can be used as a decongestant?

Answer 17

Selective alpha 1 agonists

Question 18

Name 2 alpha1 agonists that might be used as decongestants

Answer 18

Pseudoephidrine, phenylephrine

Question 19

What is the purpose of antitussives?

Answer 19

Reduce cough reflex through a reduction in sensitivity of irritant receptors

Question 20

Name two classes of antitussive

Answer 20

Opioids

Non-opioid antitussives

Question 21

Name three opioids that might be useful as antitussives

Answer 21

Hydrocodone, codiene, butorphanol

Question 22

Name a non-opioid antitussive

Answer 22

Dextromethorphan hydrobromide

Question 23

When would you consider using a respiratory stimulant?

Answer 23

Caesarian puppies/kittens

Anaesthetic induced apnoea

Question 24

Name a respiratory stimulant

Answer 24

Doxapram

Question 25

What are contraindications for doxapram?

Answer 25

epilepsy, head trauma

Question 26

Which receptors are present on bronchial smooth muscle?

Answer 26

M1, M2, **M3** Beta2 Histamine 1 Serotonin (cats) NO (some species)

Question 27

What is the effect of M3 receptor agonists on bronchial smooth muscle

Answer 27

Bronchoconstriction and mucous secretion

Question 28

Which drugs might be useful in antagonising muscarinc receptors?

Answer 28

Atropine Ipratropium bromide (doesn't stop mucociliary clearance - advantage over atropine)

Question 29

List four pathophysiologic effects of asthma

Answer 29

Thicking of epithelium Hypertrophy of goblet cells and submucosal glands Bronchial smooth muscle spasms and hypertrophy Cellular infiltration and oedema of mucosa and submucosa

Question 30

What three processes occur in the immediate phase of asthma?

Answer 30

Mast cell release Bronchoconstriction Chemotaxis

Question 31

What process occurs in the late phase of asthma?

Answer 31

Continuation of inflammation

Question 32

Name three anatomical/physiological differences between the airways of dogs and cats

Answer 32

Cats with greater broncho-motor tone at rest Cats with smaller airway radius Cats with additional receptor types

Question 33

Name four major categories of feline bronchial disease

Answer 33

Bronchial asthma Acute bronchitis Chronic bronchitis Emphysema

Question 34

List some key features of bronchial asthma

Answer 34

Allergic component Airway eosinophilia Chronic inflammation even without clinical signs Serotonin main mediator in cats

Question 35

List some key features of acute bronchitis

Answer 35

Short duration airway obstruction neutrophilia and macrocytosis

Question 36

List some key features of chronic bronchitis

Answer 36

mixed cellular inflammation or mycoplasma infection

Question 37

List some key features of emphysema

Answer 37

destruction of bronchiolar and alveolar walls

Question 38

What are the clinical signs of feline bronchial disease?

Answer 38

Episodic, sub-acute or chronic: Cough, wheeze, expiratory dyspnoea, tachypnoea

Question 39

What are some important diagnostic features of bronchial disease?

Answer 39

History: especially environmental Physical exam/CSx Thoracic radiographs (bronchial pattern) Bronchalveolar lavage/tracheal ash

Question 40

List some anti-inflammatory actions of glucocorticosteroids

Answer 40

Inhibit formation of prostaglandins (stabilise cell walls) Down-regulate fibroblast proliferation and collagen formation reduce endothelial cell permeability

Question 41

List some immunomodulatory functions of glucocorticoids

Answer 41

Immunosuppression Cytotoxic to T lymphocytes at high concentrations Reduction in neutrophil movements Reduction in dendritic cells (APC, link innate and adaptive immunity)

Question 42

List some first line drug classes in feline asthma?

Answer 42

Glucocorticosteroids Bronchodilators

Question 43

List four glucocorticoids that might be useful in feline asthma

Answer 43

Prednisolone (oral: cheap but systemic effects) Hydrocortisone or dexamethasone injection Fluticasone (inhalation: $$ but no systemic effects)

Question 44

Name two classes of bronchodilators

Answer 44

B2 agonists Methylxanthines

Question 45

List some B2 agonists and routes of administration that might be used as bronchodilators in feline asthma

Answer 45

Terbutaline (oral, IM, SC) Salmeterol (inhalation) Salbutamol (inhalation, IV) Cluenbuterol

Question 46

List two methylxanthines

Answer 46

Aminophylline Theophylline

Question 47

Name some naturally occuring xanthines

Answer 47

theophylline theobromine caffeine

Question 48

Name some effects of methylxanthines

Answer 48

anti-asthmatic:bronchodilators CNS stimulant positive chronotrope and inotrope diuretic

Question 49

List the effects of theophylline (in people)

Answer 49

treating underlying inflammation synergistic antiinflammatory effects with glucocorticosteroids improve mucociliary clearance decrease fatigue of respiratory muscles inhibit release of mast cells

Question 50

Name an antileukotriene

Answer 50

Zafirlukast

Question 51

List two muscarinic antagonists

Answer 51

Ipratropium atropine

Question 52

List a class of drugs that might be useful in allergic rhinitis

Answer 52

antihistamines

Question 53

Are antibiotics important in the treatment of respiratory disease?

Answer 53

Depends on cause: primary therapy for many respiratory diseases of cattle and poultry Not effective in feline bronchial disease unless caused by mycoplasma