RESPIRATORY PHARMACOLOGY

Question 1

MAIN DISORDERS OF THE RESPIRATORY SYSTEM

Answer 1

• asthma
• COPD
• allergic rhinitis
• cough

Question 2

PATHOPHYSIOLOGY OF ASTHMA

Answer 2

HYPERRESPONSIVENESS TO STIMULI ( allergens, infection, stress, cold air, exercise)→ release of mediators→ inflammation of airway (mucus production) and bronchoconstriction

Question 3

DRUG TREATMENT FOR ASTHMA

Answer 3

• block inflammatory mediators release, omalizumab
• prevent inflammation, leukotriene antagonists
• reduce inflammation, glucocorticoids
• bronchodilators, beta 2 agonists.

Question 4

TYPES OF BRONCHODILATORS

Answer 4

• beta 2 agonists
• anticholinergics
• Xanthine drugs

Question 5

BATA 2 AGONISTS CHARACTERISTICS

Answer 5

• first-line drugs
• moa, beta 2 adrenoreceptors agonists, relax smooth muscle directly, no effect on hyperreactivity or inflammation
• route, aerosol inhalation, PO/IV
• S/E tremor, tachycardia, hypokalaemia
• CAUTIONS/CONTRAINDICATION, hyperthyroidism, CV disease, arrhythmia, hypertension, diabetes
• SEVERAL DRUG INTERACTION
• SHORT ACTING SABA, salbutamol, terbutaline
• LONG ACTING LABA, salmeterol, formoterol

Question 6

ANTICHOLINERGIC CHARACTERISTICS

Answer 6

• ipratropium, tiotropiumum
• muscarinic receptor antagonists
• second-line drugs may be used for COPD
• weak bronchodilators
• route inhalation
• s/e dry mouth, GI upset
• cautions, prostatic hyperplasia, glaucoma
• interaction, reduced absorption of ketoconazole

Question 7

XANTHINE DRUGS CHARACTERISTICS

Answer 7

• theophylline, aminophylline
• moa, inhibit phosphodiesterase, increase level of cAMP, relax directly smooth muscle, no effect on inflammation
• route slow IV, slow-release oral
• narrow TI, rate of elimination can vary, long-acting only
• s/e nausea, anxiety, tachycardia, convulsions
• cautions, cardiac disease, hypertension, epilepsy, elderly
• common drugs interactions

Question 8

LIST OF ANTIINFLAMMATORY MEDS IN ASTHMA TREATMENT

Answer 8

• glucocorticoids
• leukotriene antagonists
• mast cell stabilizers

Question 9

MOA and characteristics of glucocorticoids

Answer 9

• nature, glucocorticoid receptor antagonists, modify gene transcription, increase anti-inflammatory mediators and reduce pro-inflammatory mediators
• treat moderate to severe asthma, beclomethasone, budesonide
• route, inhalation, oral, iv
• s/e generally mild, prolonged use cause suppression of HPA (HYPOTHALAMIC-PITYITARY-ADRENAL AXIS)→ Cushing’s syndrome, loss of bone density
• cautions, pulmonary TB, pregnancy
• interactions, CPY3A4 inhibitor, ketoconazole.

Question 10

LEUKOTRIENE ANTAGONISTS CHARACTERISTICs

Answer 10

• moa, block bronchoconstriction action of leukotriene released from inflammatory cells, reduce hyperreactivity and inflammation
• route, orally, 24h action on asthma release
• s/e minimal headache and GI upset
• caution in pregnancy and breastfeeding, elderly
• interactions, plasma concentration reduced by enzymes inducers and increased by enzymes inhibitors.

Question 11

MAST CELL STABILIZERS CHARACTERISTICS

Answer 11

• cromolyn sodium used prophylactically no acute attack
• MOA, prevents release of mediators from mast cells but mechanism in asthma is unclear
• route, inhalation
• s/e minimal cough, wheeze, transient bronchospasm
• caution may cause allergy

Question 12

SUMMARY OF ASTHMA TREATMENT STRATEGIES

Answer 12

• _long term asthma contro_l: inhaled steroids, leukotriene antagonists, long-acting beta-agonists, combination inhalers, theophylline
• quick relief meds, short-acting beta-agonists, muscarinic antagonists, oral iv steroids
• allergy meds, immunotherapy, omalizumab

Question 13

Question 14

TREATMENT OPTIONS FOR COPD

Answer 14

• BRONCHODILATORS
• INHALED GLUCOCORTICOSTEROIS
• SYSTEMIC GLUCOCORTICOIDS
• OXYGEN

Question 15

LONG TERM CONTROL OF MODERATE COPD

Answer 15

• FEV1, forced expiratory volume in one sec is between 50 and 80%
• treatment requires one or more bronchodilators

Question 16

characteristic of allergic rhinitis and treatment options

Answer 16

• allergen interacts with mast cells inducing histamine release
• ANTI-HISTAMINES ( H1 RECEPTORS BLOCKERS), ALFA RECEPTORS AGONISTS, GLUCOCORTICOIRDS AS NASAL SPRAY

Question 17

CHARACTERISTIC OF DRUGS FOR HIGH FEVER

Answer 17

• ANTIHISTAMINES, the most frequently used drugs, can have a sedative effect
• ALFA ADRENERGIC AGONISTS, nasal decongestant, usually combined with anti-histamines, short term use
• CORTICOSTEROIDS, administered as a nasal spray

Question 18

moderate to severe high fever treatment

Answer 18

review flowchart