Respiratory Pharmacology

Question 1

Drugs used in the respiratory system: Upper airways for…

Answer 1

allergy

Question 2

Drugs used in the respiratory system: Lower airways for…

Answer 2

asthma, COPD

Question 3

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

Answer 3

Bronchitis, Pneumonia, Atypical infection

Question 4

Airway Drugs:

Answer 4

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

Question 5

Give 2 examples of a beta-2 agonist

Answer 5

salbutamol, salmeterol

Question 6

Name 2 anticholinergic bronchodilators

Answer 6

tiotropium, iprtratropium

Question 7

Name 2 steroids

Answer 7

prednisolone, beclomethasone

Question 8

Name a leukotriene inhibitor

Answer 8

monteleukast

Question 9

Name 3 Mucokinetic agents (Airways)

Answer 9

carbocycsteine, hypertonic saline, Dnase

Question 10

Inhaled Drug Devices

Answer 10

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

Question 11

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

Answer 11

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

Question 12

Dry-power inhalers - how are they used?

Answer 12

one inhalation, not a puff

Question 13

Salbutamol - short or long acting?

Answer 13

Short acting - begin immediately, 3-5 hour duration

Question 14

Routes of Salbutamol

Answer 14

Inhaled/IV/Oral

Question 15

Mechanism of Action of Salbutamol

Answer 15

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

Question 16

What conditions is salbutamol used in?

Answer 16

Asthma and COPD

Question 17

Salmeterol - short or long acting?

Answer 17

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

Question 18

Routes of Salmeterol

Answer 18

Inhaled

Question 19

Mechanism of Action of Salmeterol

Answer 19

Long-acting-beta-adrenoceptor agonist

Question 20

What conditions is salmeterol used in?

Answer 20

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

Question 21

Tiotropium - short or long acting?

Answer 21

Long acting (24 hour)

Question 22

Routes of Tiotropium

Answer 22

Inhaled (Dry powder Handihaler/Mist resimat)

Question 23

Mechanism of Action of Tiotropium

Answer 23

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

Question 24

Indication for Tiotropium

Answer 24

Stable COPD: Symptoms despite SABA (any severity)

Asthma: new indication step 3

Question 25

Ipratropium - short or long acting?

Answer 25

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

Question 26

Indication for Ipratropium

Answer 26

Nebulised for acute presentations of COPD (and sometimes asthma)

Question 27

Theophylline half life

Answer 27

around 5 hours in healthy adults

Question 28

Routes for Theophylline

Answer 28

IV/PO

Question 29

Mechanism of action of Theophylline

Answer 29

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

Question 30

Indication for Theophylline

Answer 30

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

Question 31

Adverse Effects of Bronchodilators

Answer 31

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

Question 32

Adverse Effects of Bronchodilators are usually ... related

Answer 32

dose related

Question 33

Adverse Effects of Bronchodilators - more common in which preparations?

Answer 33

oral preparations

Question 34

Glucocorticoids - Systemic (E.g. Prednisolone)

Answer 34

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

Question 35

Glucocorticoids - Inhaled (E.g. beclometasone)

Answer 35

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

Question 36

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

Answer 36

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

Question 37

Airway effects of Glucocorticoids

Answer 37

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

Question 38

Inhaled Steroids - adverse events

Answer 38

Oral candidiasis | Dysphonia

Question 39

What is dysphonia?

Answer 39

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

Question 40

General adverse events of steroids

Answer 40

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

Question 41

Medications for Allergic Rhinitis

Answer 41

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

Question 42

Asthma treatment ladder - how many steps?

Answer 42

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

Question 43

Why do we have the asthma treatment ladder?

Answer 43

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