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Theme 4 > Respiratory Pharmacology > Flashcards

Respiratory Pharmacology Flashcards

1
Q

Drug groups in respiratory system

A

Upper airways
- Allergy

Lower Airways

  • Asthma
  • COPD

Respiratory infection

  • Bronchitis
  • Pneumonia
  • Atypical infection

Interstitial lung disease
Novel CF gene drugs
Ventilatory failure

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2
Q

Airway drugs

A

Bronchodilators

  • Adrenergic Agonists
  • Beta-2 agonists (Salbutamol, Salmeterol)
  • Anticholinergics (Tiotropium Iptratropium)
  • Methylxanthines (Aminophylline)

Anti-inflammatory

  • Steroids (Prednisolone, Beclomethasone)
  • Leukotriene Inhibitors (Monteleukast)

Mucokinetic agents

  • Carbocysteine
  • Hypertonic saline
  • Dnase
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3
Q

Inhaled Drug Devices

A

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-Powder Inhalers
- Usually one inhalation, not a puff

Nebulisers
Multitude of new devices

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4
Q

Salbutamol

A

Duration - Short acting (begin immediately, 3-5 hour duration)

Routes - Inhaled/IV/Oral

Mechanism of action
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

Use - Asthma and COPD

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5
Q

Serevent - Salmeterol

A

Duration - Long acting (begin 2-30 min, 10-12 hour dur)
Routes - Inhaled

Mechanism of action - Long-acting beta-adrenoceptor agonist

Use
- Asthma: in patients requiring long-term regular bronchodilator therapy on ICS
- NOT PRN
- COPD: persistent symptoms despite therapy
(ICS/LABA combination FEV1 < 50%)
eg seretide

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6
Q

Tiotropium

A

Duration - Long acting (24 hour)
Routes - Inhaled (Dry powder Handihaler/Mist resimat)

Mechanism of action
Tiotropium is a long-acting, antimuscarinic agent, which is often referred to as an anticholinergic. It has 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

Indication:

  • Stable COPD: Symptoms despite SABA (any severity)
  • Asthma: new indication step 3
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7
Q

Ipratropium

A

Short acting antimuscarinic agent
Onset 30 minutes; lasts 6 hours
MDI, Nebulised
Nebulised for acute presentations of COPD (and sometimes asthma

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8
Q

Theophylline

A

Duration: Half life around 5 hours healthy adults

Routes: IV/PO

Mechanism of action - Phosphodiesterase inhibitor

Indication:

  • PO: COPD and asthma –persistent symptoms
  • IV COPD and asthma medical emergencies
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9
Q

Adverse Events - Bronchodilators

A 
Tachycardia
Nervousness, Irritability, Tremor
Inhaled preparations: less common
Oral preparations: More common
Tachyarrhythmias/Angina
Usually dose related
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10
Q

Glucocorticoids - systemic

A

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

Eg Prednisolone

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11
Q

Glucocorticoids - inhaled

A

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

Eg Beclometasone

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12
Q

Glucocorticoids - airway effects

A

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

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13
Q

Adverse events

A

Inhaled: gargle and use spacer

  • Oral candidiasis
  • Dysphonia

General

  • 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
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14
Q

Allergic Rhinitis Medications

A

Antihistamines
Intranasal Glucocorticoids
Montelukast (Singulair)
Sympathomimetics (Decongestants)

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15
Q

Antihistamines

A

Cetirizine, Chlorpheniramine
H1 antagonists
Side effects: Drowsiness, Dry Mouth, Dry Eyes, Confusion

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16
Q

Intranasal Glucocorticoids

A

Beclometasone (Beconase)

17
Q

Montelukast (Singulair)

A

Inhibit leukotriene receptors

↓inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

18
Q

Sympathomimetics (Decongestants)

A

Pseudoephedrine (alpha agonist) Problems with abuse and MAOI

19
Q

Asthma treatment ladder

A

There is an asthma treatment ladder - 5 steps
You move up and down the ladder depending on symptoms and success of current drugs

Side effects
It is as important to move down the ladder as to move up
Patients are left often on too much steroids

20
Q

Oxygen

A

Indications
Oxygen is a drug –must be prescribed (target sats)

SIDE EFFECTS ARE LIFE THREATENING
(over oxygenation in type 2 respiratory failure)

Oxygen delivery
Nasal 
Hudson mask
Venturi
Reservoir
21
Q

Respiratory infection

A

Bronchitis- (COPD and asthma)
Community acquired pneumonia (CAP) - Severity scoring
Hospital acquired pneumonia HAP (early and late)
Ventilator acquired pneumonia (VAP)
Aspiration
Bronchitis ≠ Pneumonia
Different treatments!

22
Q

Antibiotics used to cover respiratory infection

A

Penicillins

Amoxicillin

  • Moderate-spectrum, bacteriolytic, B lactam antibiotic
  • Routes - IV/Oral
  • Use – CAP/COPD exabaerbations/bronchitis
  • Active against gram negative and gram positive bacteria

Comamoxiclav
Amoxicillin is susceptible to degradation by B lactamase -producing bacteria so can be combined with clavulinic acid – a b lactamase inhibitor

Tazobactum – hospital acquired infections & gram neg bacteria
extended spectrum b lactam antibiotic

23
Q

Tetracyclines (Doxycycline)

A

Tetracycline inhibits protein synthesis
Broad spectrum action Gram positive and negative
Useful for ‘atypical infections’ eg mycoplasma

Oral route only
Side effects - GI Upset/staining teeth/lupus/allergy/photosensitivity

24
Q

Quinolones

A

Eg Ciprofloxacin/moxifloxacin

Mechanism of action - DNA fragmentation
Gram negative and positive coverage (And Pseudomonas)
Route - IV/Oral/Inhaled (CF)
Side effects – GI upset/ C difficile/ Tendonitis/Liver upset/Prolonged QTc and arrthymia

25
Q

Marcolides

A

Eg clarithromycin

Commonly used in respiratory infection
Mechanism of action - Protein synthesis inhibitors
Route- IV/PO
Gram positive /limited gram negative cover
Side effects- GI/allergy/liver abnormality/prolonged QTc and interactions

26
Q

TB therapy

A

Standard treatment for TB is a minimum of 6 months:
- 2 months (initial phase) of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Known as standard quadruple therapy.

Followed by:
- 4 months (continuation phase) of Isoniazid and Rifampicin. Known as standard dual therapy

N.B. If there is central nervous system involvement the continuation phase of treatment is extended to 10 months making a 12 month full treatment plan.

TB treatment is taken all together on an empty stomach 1 hour before breakfast; compliance is essential for cure.

27
Q

DOT

A

Directly observed treatment is known as DOT.
Each DOT case is assessed by the TB specialist team regarding the patient’s ability to adhere to the six-month treatment regimen.
DOT is initiated for those at risk of being unable to adhere to treatment.
A professional case worker, person trained to be a DOT observer, or a trusted family member or friend will watch the patient take their TB treatment.
Primary care providers, such as GP practices
or pharmacists, may be asked to provide DOT

28
Q

TB therapy

A

Isoniazid (H/I)
Rifampicin (R)
Pyrazinamide (Z/P)
Ethambutol (E)

General side effects: Hepatotoxcity, nausea and skin rashes, Allergy

29
Q

Isoniazid (H/I)

A

Bactericidal and bacteriostatic – inhibits cell wall growth
Cytochrome P450 inhibitor – interactions!!
fever, peripheral neuropathy and optic neuritis

30
Q

Rifampicin (R)

A

inhibits bacterial DNA-dependent RNA synthesis
Cytochrome P450 inducer – interactions!!
reddish colour to the urine

31
Q

Pyrazinamide (Z/P)

A

Causes accumulation pf pyrazinoic acid

use with caution in patients with gout

32
Q

Ethambutol (E)

A

Bacteriostatic obstructs development of cell wall

Peripheral neuropathy, optic neuropathy , gout, AKI

33
Q

CF Novel therapies

A

Most common lethal inherited disorder of Caucasian people
70,000 cases worldwide

Gene codes for the cystic fibrosis transmembrane conductance regulator (CFTR)

About 2000 mutations have been identified in the CFTR gene since its discovery in 1989

  • 242 different disease causing mutations
  • CFTR2 project
34
Q

Pulmonary Fibrosis

A

ILD MDT important for therapeutic decision making

Some idiopathic interstitial pneumonias -Prednisolone/Azathiprine/MMF

Sarcoid - prednisolone

Idiopathic pulmonary fibrosis
Perfenidone
Anti inflammatory/ Anti Fibrotic
Reduces fibroblast proliferation, reduces collagen production

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