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103 Theme 4 - Lungs > Respiratory pharmacology > Flashcards

Respiratory pharmacology Flashcards

1
Q

What are the different types of bronchodilators?

A
  • Adrenergic Agonists
  • Beta-2 agonists (Salbutamol, Salmeterol, formoterol)
  • Muscarinic antagonists/Anticholinergics (Tiotropium= long acting anti muscarinic (LAMA),
  • Ipratropium-short acting anti muscarinic (SAMA)
  • Methylxanthines (Aminophylline)
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2
Q

What are the different types of anti-inflammatory drugs for the airways?

A

Steroids (Prednisolone=oral, Beclomethasone= an inhaled corticosteroid ICS)

Leukotriene receptor antagonist

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3
Q

What are the different types of inhaled drug devices?

A

•Pressurised Metered Dose Inhalers (pMDIs)

  • Use spacer/aerochamber
  • HCFC-carbon footprint

•Dry-Powder Inhalers

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4
Q

How do you use pressurised Metered Dose Inhalers (pMDIs)?

A

Deep exhale /Inhale and puff/Hold breath for slow ten count/Exhale slowly/Wait one minute before second puff

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5
Q

How do you use Dry-Powder Inhalers?

A

Usually one inhalation, not a puff

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6
Q

What is the duration of salbutamol?

A

Short acting (begin immediately, 3-5 hour duration)

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7
Q

What are the possible routes of salbutamol?

A
  • Inhaled or nebuliser (higher dose)
  • Intravenous (IV)-very rarely used
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8
Q

What is the mechanism of action for salbutamol?

A
  • Binding to beta(2)-receptors in the lungs results in relaxation of bronchial smooth muscles. It is believed that salbutamol increases cAMP production by activating adenylate cyclase, and the actions of salbutamol are mediated by cAMP
  • Short acting beta agonist (SABA)
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9
Q

What is salbutamol used for?

A

Asthma and COPD

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10
Q

What is the duration of salmeterol?

A

Long acting (begin 2-30 min, 10-12 hour dur)

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11
Q

What is the route of salmeterol?

A

Inhaled

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12
Q

What is the mechanism of action for salmeterol?

A

Long-acting beta-adrenoceptor agonist (LABA)

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13
Q

What is salmeterol used for?

A

Asthma: in patients requiring long-term regular bronchodilator therapy on ICS

NOT PRN (not as needed) and always used with ICS in asthma

COPD: persistent symptoms despite SABA

(either LABA/LAMA combination or

ICS/LABA combination

FEV1 < 50%)

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14
Q

What is the duration of formoterol?

A

Long acting (with short onset similar to salbutamol but with prolonged duration 10-12 hours)

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15
Q

What is the route of formoterol?

A

Inhaled

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16
Q

What is the mechanism of action for formoterol?

A

•Long-acting beta-adrenoceptor agonist

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17
Q

What is formoterol used for?

A
  • Asthma and COPD
  • Combined with ICS (always) for asthma
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18
Q

What is the duration of tiotropium?

A

•Long acting (24 hour). Once daily.

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19
Q

What is the route for tiotropium?

A

Inhaled (Dry powder Handihaler/Mist respimat)

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20
Q

What is the mechanism of action for tiotropium?

A
  • Tiotropium is a long-acting, muscarinic antagonist (LAMA)
  • It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilatation
21
Q

What is tiotropium used for?

A
  • Stable COPD: Symptoms despite SABA (any severity and with LABA)
  • Asthma: in not improving despite ICS/LABA-specialist advice from hospital
22
Q

What is ipatropium?

Mechanism of action

Duration

Route

Use

A
  • Short acting antimuscarinic agent
  • Onset 30 minutes; lasts 6 hours
  • Nebulised
  • Nebulised for acute presentations of COPD and sometimes asthma
23
Q

What is the duration of theophylline?

A

•Duration :Half life around 5 hours healthy adults

24
Q

What is the route of theophylline?

A

•Routes: Oral/Intravenous

25
Q

What is the mechanism of action of theophylline?

A
  • Phosphodiesterase inhibitor
  • Requires monitoring of level (blood test)
26
Q

What is theophylline used for?

A
  • Oral: COPD and asthma –persistent symptoms
  • Intravenous: COPD and asthma-medical emergencies
27
Q

What adverse effects can bronchodilators cause?

A
  • Tachycardia
  • Nervousness, Irritability, Tremor
  • Inhaled preparations: less common
  • Oral preparations (hardly used) and intravenous: More side effects common
  • Tachyarrhythmias/Angina
  • Usually dose related
28
Q

What are the effects of glucocorticoids on the airway?

A
  • Decrease release of inflammatory mediator
  • Decrease infiltration and action of white blood cells
  • Decrease airway oedema
  • Decrease airway mucus production
  • Increase number and sensitivity of beta-2 receptors
29
Q

What are the differences between inhaled and systemic glucocorticoids

A

Systemic -

  • IV or oral
  • Stronger effects as higher doses
  • Action unaffected by inspiratory effort/inhaler technique
  • More side effects, especially with long term therapy

Inhaled -

  • Localized action
  • Fewer side effects: some absorption occurs
  • Disease may prevent penetration of drug to affected areas
30
Q

Name an examples of a systemic glucocorticoid

A

Prenisolone

31
Q

Name 3 examples of inhaled glucocorticoids

A

•e.g. Beclometasone, fluticasone, budesonide

32
Q

What are the adverse effects caused by inhaled glucocorticoids?

A
  • Oral candidiasis-white plaques in mouth
  • Dysphonia

To avoid - gargle and use spacer

33
Q

What are the general adverse effects of glucocorticoids?

A
  • Adrenal suppression
  • Bone loss: exercise, Vit D, calcium
  • Slow growth in children, but not ultimate height
  • Increase risk of cataracts and glaucoma
  • Increased risk of infection
  • Gastric ulceration
  • Hypertension
  • Diabetes

Mood disturbance

34
Q

What are the types of combination inhalers?

A

ICS/LABA

  • Formoterol/Budesonide
  • Formoterol/beclomethasone
  • Salmeterol/fluticasone

LAMA/LABA

•E.g Tiotropium/Olodaterol

35
Q

How does the asthma treatment ladder work?

A

•You move up and down the ladder depending on symptoms and success of current drugs

36
Q

Complete the diagram

A
37
Q

Complete the diagram

A
38
Q

Which medications are used for allergic rhinitis?

A

•Antihistamines

  • H1 antagonists
  • Side effects: Drowsiness, Dry Mouth, Dry Eyes, Confusion
  • Intranasal Glucocorticoids
  • Montelukast (Singulair)
  • •Inhibit leukotriene receptors
  • •↓inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

•Sympathomimetics (Decongestants)

39
Q

Bronchitis and pneumonia are treated differently.

True or false

A

True

Bronchitis ≠ Pneumonia - different treatments!

40
Q

Which penicillins are used to treat respiratory infections?

A

•Amoxicillin

  • •moderate-spectrum, bacteriolytic, B lactam antibiotic
  • •Routes - IV/Oral
  • •Use – CAP (typical)/COPD exacerbations/bronchitis
  • •Active against gram negative and gram positive bacteria

•Co-amoxiclav

  • Amoxicillin is susceptible to degradation by B lactamase -producing bacteria so can be combined with clavulinic acid – a beta lactamase inhibitor
41
Q

What are tetracyclines?

A
  • Tetracycline inhibits protein synthesis
  • Broad spectrum action Gram positive and negative
  • Useful for ‘atypical infections’ e.g. mycoplasma, legionella

Oral route only

Side effects - GI Upset/staining teeth/lupus/allergy/photosensitivity

42
Q

Name a tetracycline

A

Doxycycline

43
Q

What are quinolones?

A
  • Mechanism of action - DNA fragmentation
  • Gram negative and positive coverage (And Pseudomonas)
  • Route - IV/Oral/Inhaled (CF)
  • Side effects – GI upset/ C difficile/ Tendonitis/Liver upset/Prolonged QTc and arrthymia
44
Q

Name 3 quinolones

A

Ciprofloxacin,Levofloxacin, moxifloxacin

45
Q

What are macrolides?

A
  • Commonly used in respiratory infection (including aytpical pneumonia)
  • Mechanism of action - Protein synthesis inhibitors
  • Route- IV/PO
  • Gram positive /limited gram negative cover
  • Side effects- GI/allergy/liver abnormality/prolonged QTc and interactions
46
Q

Name 2 macrolides

A

erythromycin, clarithromycin

47
Q

What is the treatment for interstistial lung disease?

A

Some idiopathic interstitial pneumonias e.g. hypersensitivity pneumonia

•Prednisolone/Azathioprine/MMF

Sarcoid

•prednisolone

Idiopathic pulmonary fibrosis

•Pirfenidone,

Anti inflammatory/ Anti Fibrotic

Reduces fibroblast proliferation, reduces collagen production

48
Q

Which disease is a multi disciplinary meeting important for therapeutic decision making?

A

ILD

103 Theme 4 - Lungs (21 decks)

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