Respiratory Pharmacology

Question 1

What things should you check before stepping up or down asthma treatment?

Answer 1

1. Adherence to treatment
2. Inhaler Technique
3. Eliminate trigger factors

Question 2

Asthma treatment stages?

Answer 2

1. SABA as needed
2. Regular low dose ICS
3. LABA + ICS
4. LABA + ICS + LTRA
5. LABA + ICS + LTRA + oral steriod

(SABA as required for 2-5)

Question 3

SABA - ADR?

Answer 3

Salbutamol, Terbutaline

B2 agonist - bronchodilation

Tachycardia / palpitations / anxiety (fight or flight)

Question 4

LAMA - when is it most effective and it’s ADR?

Answer 4

Long Acting Muscarinic Antagonist

Tiotropium bromide

M3 receptor antagonist on bronchiole smooth muscle

More effective at night - ^parasympathetics

Anti-cholinergic ADR - dry mouth, dry eyes

Question 5

LABA - when to take it?

Answer 5

Salmeterol, Formoterol

B2 agonist - bronchodilation

LABA HAS TO BE GIVEN WITH ICS
(LABA will mask airway inflammation/asthma attacks)

Question 6

LTRA

Answer 6

Leukotriene Receptor Antagonist

Montelukast - p.o.

Blocks CysLT1 receptor - reduced bronchoconstriction / mucus secretion

Question 7

Methylxanthines - main ADR?

Answer 7

Theophylline - p.o.
Aminophylline - i.v.

Adenosine receptor antagonist to reduce bronchoconstriction

Arrhythmia - narrow TI

Question 8

Asthma attack/exacerbation treatment?

Answer 8

1. Give O2
2. Nebulised salbutamol
3. Prednisolone (oral)
4. Nebulised Ipatromium bromide (SAMA - Short)
5. Aminophylline i.v.

Question 9

COPD treatment?

Answer 9

1. Cessation of smoking
2. Pulmonary rehabilitation
3. Flu/pneumococcal vaccine

Question 10

ICS

Answer 10

Inhaled Corticosteroids

Beclometasone, Budenoside, Fluticasone

Activation of B2 receptors
Inactivation of inflammatory mediators