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Module 308 > Respiratory Pharmacology > Flashcards

Respiratory Pharmacology Flashcards

1
Q

Drugs used in the respiratory system: Upper airways for…

A

allergy

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2
Q

Drugs used in the respiratory system: Lower airways for…

A

asthma, COPD

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3
Q

Drugs used in the respiratory system: Respiratory infection e.g for …

A

Bronchitis, Pneumonia, Atypical infection

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4
Q

Airway Drugs:

A

Bronchodilators (adrenergic agonists, anticholinergics, methylxanthines)
Anti-inflammatory (Steroids, leukotriene inhibitors)
Mucokinetic agents (Carbocysteine, hypertonic saline, dnase)

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5
Q

Give 2 examples of a beta-2 agonist

A

salbutamol, salmeterol

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6
Q

Name 2 anticholinergic bronchodilators

A

tiotropium, iprtratropium

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7
Q

Name 2 steroids

A

prednisolone, beclomethasone

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8
Q

Name a leukotriene inhibitor

A

monteleukast

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9
Q

Name 3 Mucokinetic agents (Airways)

A

carbocycsteine, hypertonic saline, Dnase

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10
Q

Inhaled Drug Devices

A

Metered dose inhalers (MDIs) = deep exhale/ inhale and puff/ hold breath for slow ten count/ exhale slowly/ wait one minute before second puff - use spacer
Dry-power inhalers - usually one inhalation, not a puff
Nebulisers
Multitude of new devices

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11
Q

Metered dose inhalers (MDIs) - how are they used?

A

deep exhale/ inhale and puff/ hold breath for slow ten count/ exhale slowly/ wait one minute before second puff - use spacer

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12
Q

Dry-power inhalers - how are they used?

A

one inhalation, not a puff

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13
Q

Salbutamol - short or long acting?

A

Short acting - begin immediately, 3-5 hour duration

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14
Q

Routes of Salbutamol

A

Inhaled/IV/Oral

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15
Q

Mechanism of Action of 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

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16
Q

What conditions is salbutamol used in?

A

Asthma and COPD

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17
Q

Salmeterol - short or long acting?

A

Long acting (Begin 2-30 min, 10-12 hour duration)

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18
Q

Routes of Salmeterol

A

Inhaled

19
Q

Mechanism of Action of Salmeterol

A

Long-acting-beta-adrenoceptor agonist

20
Q

What conditions is salmeterol used in?

A

Asthma - in patients requiring long term regular bronchodilator therapy on ICS (not on its own)
NOT PRN
COPD: combination with LAMA or ICS eg. seretide

21
Q

Tiotropium - short or long acting?

A

Long acting (24 hour)

22
Q

Routes of Tiotropium

A

Inhaled (Dry powder Handihaler/Mist resimat)

23
Q

Mechanism of Action of Tiotropium

A

Tiotropium is a long-acting, antimuscarinic agent, which is often referred to as an anticholinergic. 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 bronchodilation

24
Q

Indication for Tiotropium

A

Stable COPD: Symptoms despite SABA (any severity)

Asthma: new indication step 3

25
Q

Ipratropium - short or long acting?

A

Short acting antimuscarinic agent (onset 30 mins, lasts 6 hours)

26
Q

Indication for Ipratropium

A

Nebulised for acute presentations of COPD (and sometimes asthma)

27
Q

Theophylline half life

A

around 5 hours in healthy adults

28
Q

Routes for Theophylline

A

IV/PO

29
Q

Mechanism of action of Theophylline

A

Phosphodiesterase Inhibitor - acts indirectly to stimulate cAMP and bronchial smooth muscle relaxation

30
Q

Indication for Theophylline

A

PO: COPD and asthma - persistent symptoms
IV: COPD and asthma - medical emergencies

31
Q

Adverse Effects of Bronchodilators

A 
Tachycardia
Nervousness, Irritability, Tremor
Inhaled preparations - less common
Oral preparations - more common (tachyarrhythmias/angina)
usually dose related
32
Q

Adverse Effects of Bronchodilators are usually … related

A

dose related

33
Q

Adverse Effects of Bronchodilators - more common in which preparations?

A

oral preparations

34
Q

Glucocorticoids - Systemic (E.g. Prednisolone)

A

IV or oral
Stronger effects
action unaffected by lung restriction
More side effects, esp with long term therapy

35
Q

Glucocorticoids - Inhaled (E.g. beclometasone)

A

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

36
Q

Glucocorticoids are a class of …, which are a class of … hormones.

A

Glucocorticoids are a class of corticosteroids, which are a class of steroid hormones.

37
Q

Airway effects of Glucocorticoids

A

Decrease release of inflammatory mediator
Decrease infiltration and action of WBCs
Decrease airway oedema
Decrease airway mucus production
Increase number and sensitivity of beta-2 receptors

38
Q

Inhaled Steroids - adverse events

A

Oral candidiasis

Dysphonia

39
Q

What is dysphonia?

A

Dysphonia refers to having an abnormal voice. It is also known as hoarseness.

40
Q

General adverse events of steroids

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

41
Q

Medications for Allergic Rhinitis

A

Antihistamines - H1 antagonists, E.g cetirizine, chlorpheniramine
Intranasal Glucocorticoids - e.g. beclometasone (beconase)
Montelukast (Singulair) - inhibit leukotriene receptors, decreased inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils
Sympathomimetics (Decongestants) - Pseudophedrine (alpha agonist) problems with abuse and MAOI

42
Q

Asthma treatment ladder - how many steps?

A

5 steps - move up and down depending on symptoms and success of current drugs

43
Q

Why do we have the asthma treatment ladder?

A

It is as important to move down the ladder as to move up, patients are often left on too much steroids

Module 308 (17 decks)

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