Respiratory pharmacology Flashcards
Beta-2 agonists
Salbutamol
Salmeterol
Used as bronchodilators
Salbutamol
A short acting beta-2 agonist (SABA)
Stimulates increased of cAMP in bronchial smooth muscles= bronchodilation
Use: Asthma and COPD
Salmeterol
A long-acting beta-2 agonist
Also known as serevent and found in seretide.
Stimulates increased of cAMP in bronchial smooth muscles= bronchodilation
Begins working between 2-30mins and lasts for 10-12 hrs.
Route of administration”
Inhaled
Antiocholinergics
Tiotropium
Ipratropium
Used as bronchodilators, inhibits M2 receptors.
Increases cAMP by blocking M2.
Tiotropium
Long acting anticholinergic- 24 hrs
Inhibits M3 receptors in bronchus= bronchodilation.
Indications:
Stable COPD- symptoms despite SABA
Asthma- step 3 indication
Use of salmeterol/ serevant
Asthma- when requiring long-term bronchodilator therapy on inhaled corticosteroids
COPD: persistent symptoms despite therapy.
Methylxanthines
Phosphodiesterase inhibitors that raise cAMP and PKA levels in smooth muscles.
Examples:
Aminophylline
Theophyllines
Steriods
Anti-inflammatory drugs
Examples:
Prednisolone
Beclomethasone
Theophylline
Methylxanthine- phosphodiesterase inhibitor
- Prevents inactivation of cAMP. Increases cAMP= bronchial smooth muscle relaxation.
Route of administration:
IV
PO- orally
Indications for theophylline
PO- persistent symptoms for COPD and asthma
IV- medical emergencies for COPD and asthma.
Side effects for bronchodilators
Tachycardia- due to effect on L-type Ca2+ channels in the heart.
Nervousness, irritability and tremor.
More common when taken orally than inhaled:
Tachyarrythmia
Angina
Route of administration for salbuterol
Inhaled
Iv
Orally
Metered dose inhalers (MDIs)
Inhaled drug device
Method:
1. Deep exhale
- Inhale and puff
- Hold breath for slow count of 10.
- Exhaled slowly
- Wait one minute before second puff.
Dry powder inhalers
Inhaled drug device
Method:
One inhalation needed- no puff required.
Nebuliser
Inhaled drug device that administers drug via a mist.
Route of administration for tiotropium
Inhaled:
- Dry powder hand inhaler
- Mist respimat
Systemic glucocorticoids
Steroids.
Administration:
IV
Orally
Not affected by lung restriction
Side effects with long-term therapy.
Example: Prednisolone
Inhaled glucocorticoids
Steroids that have a localised action.
Fewer side effects that systemic glucocorticoids as there is less absorption.
Disease may prevent penetration of drug to affected area
Airway effects of glucocorticoids.
Decreases release of inflammatory mediators.
Decreases airway oedema and mucus production.
Increases number and sensitivity of beta-2 receptors.
Decreases infiltration and action of WBCs.
Prednisolone
Systemic glucocorticoids- reduces inflammation with a stronger effect to beclometasone.
Beclometasone
Inhaled glucocorticoids.
Has a more localised effect- weaker than prednisolone.
Disease may prevent its penetration to affected areas.
Indications:
Airway diseases
Allergic rhinitis
Adverse effects of inhaled/ gargled/ spacer of glucocorticoids
Oral candidiasis
Dysphonia
General adverse effects of steroids used for obstructive airway disease
Adrenal suppression:
Bone loss
Slow growth in children
Increased risk of cataracts and glaucoma
Increased risk of infection
Gastric ulceration
Hypertension
Diabetes
Mood disturbance
Monteleukast
A leukotriene inhibitor
Antihistamines
Histamine-1 antagonist:
used for allergic rhinitis medication.
Examples:
Cetirizine
Chlorpheniramine
Side effects of anti-histamines
Drowsiness
Dry mouth and eyes
Confusion
Cetirzine
An antihistamine
Blocks H1 receptor
Chlorpheniramine
An antihistamine
Blocks H1 receptor
Montelukast
Leukotriene receptor
inhibitor
Reduces: Inflammation Bronchoconstriction Oedema Mucus production Eosinophil recruitment
Amoxicillin
Penicillin used to treat certain respiratory infections- against Gram positive and negative bacteria.
Use:
Community acquired pneumonia
COPD exacerbations
Bronchitis
Co Amoxiclav
Amoxicillin + clavulanic acid
Prevents degradation of beta-lactam ring in amoxicillin by beta-lactamase produced by bacteria.
Uses:
Community acquired pneumonia
COPD exacerbations
Bronchitis
Tazobactam
Used to treat hospital acquired infection and Gram negative bacteria.
Tetracyclines
Antibiotics that inhibits protein synthesis
Targets a broad spectrum of Gram positive and negative bacteria.
Use: atypical infections like mycoplasma.
Administration: oral
Side effects: GI upset, staining of teeth,
lupus, allergy, photosensitivity.
Quinolones
Antibiotics that causes DNA fragmentation.
Bacteria targeted: Positive and negative
Administration: Oral, IV, inhaled.
Side effects: GI upset, C difficile, Tendonitis, Liver upset, Prolonged QT interval, arrhythmias.
Examples:
Ciprofloxacin
Moxifloxacin
Macrolides
Antibiotics that inhibit protein synthesis.
Common used in respiratory infections.
Administration: IV, Orally.
Bacteria targeted: Gram positive, some negative.
Side effect: GI upset, Liver damage, allergy, prolonged QT interval, interactions.
TB standard treatment
Duration: minimum 6 months.
Treatment has to be taken altogether on an empty stomach, 1 hr before breakfast.
Initial phase: 2 months of Isoniazid Rifampicin Pyrazinamide Ethambutol
Continuation phase: 4 months
Isoniazid
Rifampicin
Any noted CNS involve extends the continuation phase to 10 months,
DOT
Directly observed treatment
Used for cases of TB where patient is at risk of not adhering to treatment.
Professional caseworker, DOT observer or family/friend watches patient take TB medication.
CFTR modulating drugs
Ivacaftor: Increases channel opening probability of G551D CFTR
Used for those with Class III mutation.
Lumakaftor: Used for Class III mutation.
Drugs used for some idiopathic interstitial pneumonias
Prednisolone
Azathioprine
MMF (Mycophenolic acid)
Treatment for sarcoidosis
Prednisolone
Treatment for IPF
Prednisolone: anti-inflammatory.
Reduces fibroblast proliferation, thus collagen production.
