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Respiratory > Respiratory pharmacology > Flashcards

Respiratory pharmacology Flashcards

1
Q

What are two categories of cough? Both beginning with ‘U’

A

Useless (persistant, unproductive, dry) and useful (productive)

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2
Q

What are four causes of a useless cough?

A

Asthma, oesophageal reflux, sinusitis, psychogenic

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3
Q

What are the two mechanisms for treatment of dry coughs?

A

Afferent and efferent action

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4
Q

What might cause a useful cough?

A

Chest infection

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5
Q

How would you treat a productive cough? Would you supress it?

A

Do not supress unless exhausting and dangerous. Treat underlying cause e.g. antibiotics

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6
Q

What are 3 common causes of a chronic cough?

A
  1. Upper airway cough syndrome (post nasal drip, rhinitis)
  2. Asthma/COPD
  3. Gastroesophageal reflux disease
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7
Q

How would you treat a cough caused by gastroesophageal reflux?

A

Antacids

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8
Q

What is the chronic lung disease triad?

A

Inflammation, bronchoconstriction, secretions

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9
Q

Does most asthma mortality occur in children or adults?

A

Adults >45yo

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10
Q

What are the 4 types of asthma?

A
  1. Allergy associated
  2. Intrinsic (no identifiable allergen)
  3. Exercise induced
  4. COPD associated
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11
Q

Which type of asthma is the most common?

A

Intrinsic

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12
Q

In asthma treatment mechanisms, what are five possible options?

A
  1. Avoid the antigen
  2. Reduce activity of allergic response
  3. Dilate bronchi
  4. Stabilise mast cells so they don’t produce the mediator
  5. Directly antagonise the mediator
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13
Q

Does cAMP inhibit or stimulate bronchodilation?

A

Stimulate

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14
Q

Does acetylcholone stimulate bronchodilation or bronchoconstriction?

A

Bronchoconstriction

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15
Q

Does adenosine inhibit or stimulate bronchodilation?

A

Inhibit- it stimulates bronchoconstriction.

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16
Q

Is obstruction in COPD reversible?

A

No

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17
Q

What are three afferent action treatments of a dry cough? Do they act above or below the vocal cords?

A
  1. Linctuses (e.g. strepsils) coat airway so isn’t irritated. Above vocal cords.
  2. Steam (initiates mucus production) below vocal cords.
  3. Nebulised local anaesthetics (numbs irritation) below vocal cords.
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18
Q

What are three antitussive (efferent action) treatments of a dry cough?

A

1, Opiods (e.g. codein)

  1. Non- opiods (e.g. dextromethorphan) (16+ yo)
  2. Sedatives (e.g. diphenhydramine) (use in children)
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19
Q

What can opiods cause at a higher than needed dose?

A

Respiratory depression

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20
Q

Why aren’t sedatives used in a productive cough?

A

Could thicken secretions and worsen the cough.

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21
Q

What are the two treatments for a productive cough?

A
  1. Expectorants (e.g. guaiphesin) increase volume of secretion (not used regularly)
  2. Mucolytics (e.g. acetyl cysteine) decreases viscosity of mucus by breaking disulphide bonds. Cystic fibrosis treatment.
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22
Q

What are 5 long term treatments for asthma?

A
  1. Leukotrine pathway inhibitors
  2. Mast cell stabilisers
  3. Corticosteroids
  4. Anti IgE monoclonal antibodies
  5. Ketotifen
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23
Q

What are 5 short term treatments for asthma?

A
  1. Sympathomimetics
  2. Methylxanthines
  3. Anticholinergics
  4. Magnesium
  5. Ketamine
24
Q

What are the two types of leukotriene pathway inhibitors? What are their actions?

A
  • Synthesis inhibitors (inhibits 5-lipoxygenase that synthesises leukotriene from arachidonic acid)
  • Receptor antagonists e.g. montelukast (antagonise the leukotriene recpetor that would = bronchospasm)
25
Q

What are side effects of leukotriene pathway inhibitors?

A

Headache, gastritis, flu

26
Q

Which two types of asthma are treated by leukotriene pathway inhibitors?

A

Allergen or exercise induced

27
Q

What is the route of leukotriene pathway inhibitors?

A

Oral

28
Q

What is the action of mast cell stabilisers?

A

Inhibit release of mast cell mediators

29
Q

What are some side effects of mast cell stabilisers?

A

Throat irritation, cough, dermatitis, myositis, gastroenteritis

30
Q

What is the route of mast cell stabilisers?

A

Inhaled

31
Q

What type of asthma do mast cell stabilisers best treat?

A

Allergic

32
Q

What two routes are possible for corticosteroids?

A

Inhaled (beclomethasone) or oral (prednisone)

33
Q

What is the action of corticosteroids?

A

Reduces bronchial hyperactivity, inhibits inflammatory response, decreases oedema

34
Q

Do corticosteroids relax smooth muscle? Are they of any use acutely?

A

No and no

35
Q

What is cyclesonide?

A

A pro drug corticosteroid with fewer side effects but expensive.

36
Q

What are 4 side effects of corticosteroids?

A
  1. Iatrogenic Cushing’s syndrome
  2. Inhibition of pituitary hypothalamic axis
  3. Oral thrush
  4. Hoarse voice
37
Q

What is the action of anti IgE monoclonal antibodies

A

Inhibit binding of IgE to mast cells

38
Q

What is an example of an anti IgE monoclonal antibody?

A

Omalizumab

39
Q

What are the pros and cons of anti IgE monoclonal antibodies?

A

Pros: lessens asthma severity and reduces requirement for steroids.
Con: very expensive

40
Q

What is the action of Ketotifen? Does it work?

A

Histamine receptor antagonist. Some anti-asthma effect but no proven benefit.

41
Q

What is a side effect of ketotifen?

A

Drowsiness

42
Q

Name 2 examples of short acting sympathomimetics. How long do they last for?

A

Salbutamol, terbatuline. 3-4hrs

43
Q

Name a longer acting sympathomimetic. How long does it last for?

A

Salmetrol. 12hrs

44
Q

What are some side effects of sympathomimetics?

A

Palpitation, tachycardia, cardiac arrhythmia, tremor, restlessness, nervousness, hypokalaemia.

45
Q

What routes can sympathomimetics be given via?

A

IV, nebuliser, inhaler

46
Q

Name an oral and an IV methylxanthine

A

Oral - theophylline

IV- aminophyline

47
Q

What is the action of methylxanthine?

A

Bronchodilator- inhibits phosphodiesterase which breaks down cAMP (so like a reuptake inhibitor) and inhibits adenosine which causes bronchoconstriction.

48
Q

What are some side effects of methylxanthine?

A

Palpitation, cardiac arrythmia, hypotension, GI irritation, diuresis, hypokalaemia, anxiety, headache, seizure

49
Q

What are the two routes methylxanthine can be given via?

A

Oral and IV

50
Q

Wht must patients on methylxanthine have their plasma concentration checked frequently?

A

It has a very narrow therapeutic window.

51
Q

Name an anticholinergic

A

Ipratropium

52
Q

What is the action of anticholinergics?

A

Bronchodiolator- inhibits muscarinic receptors (e.g. receptor for acetylcholine which stimulates bronchoconstriction). Inhibits effects of vagus nerve stimulation.

53
Q

What are some side effects of anticholinergics?

A

Airway irritation, anticholinergic effects, GI upset, urinary retention, mouth dryness

54
Q

What route are anticholinergics taken via?

A

Inhaled

55
Q

When is magnesium used in asthma treatment?

A

Acute IV for patients who fail to respond to inhaled bronchodilators

56
Q

What is the action of ketamine in asthma treatment?

A

Anaesthetic agent with bronchodilator properties

57
Q

When is ketamine used in asthma treatment?

A

Not in routine management. For life threatening or near fatal asthma.

Respiratory (12 decks)

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